Melodic Intonation Therapy
For Patients Suffering from
Broca’s Aphasia
Melodic Intonation Therapy
(MIT) uses melody and
rhythm to assist recovery
of speech in patients who have been diagnosed with aphasia. It uses natural prosody to stimulate verbal expression. MIT was
first introduced in 1973 by Albert, Sparks and Helm, yet it is considered a new and experimental
therapy technique. Researchers from the University
of Texas discovered that music stimulates several different areas of the
brain instead of just one area. They also discovered that there is a strong correlation between the right side of the brain
that comprehends music and the left side of the brain that comprehends language. It is suspected that by stimulating the right
side of the brain, the left side of the brain will begin to make connections too. Studies using PET scans have shown that
Broca’s area is activated by the use of sung words.
MIT is most likely to be
successful with patients who have non-bilateral brain damage, good auditory skills, non-fluent verbal communication and poor
word repetition. It is recommended that a full knowledge of the affected parts of the brain are understood.
This approach uses a limited
range of notes, similar to a chant, and bases the intoned patterns on one of several speech prosody patterns that make sense
to the meaning of a sentence. It is slower than speech with more precise rhythm and accented points of stress.
There are 4 steps in MIT.
Step 1: The SLP hums short phrases in a rhythmic, singsong tone. The patient tries to tap out the rhythm and stress
patterns.
Step 2: The patient repeats the
hummed phrases with help from the SLP. The patient and the SLP hum in unison.
Step 3: The SLP intones a sentence. The patient repeats the sentence. The therapist’s participation is minimized
and the patient begins to respond to questions using the rhythmic speech patterns learned previously. The SLP asks, “What
did you say?” and the patient repeats the answer.
Step 4: The patient transitions
the constant melodic pitch used to a variable pitch that is used in normal conversation. More complex phrases and longer sentences
are introduced. Normal stress patterns, tempos and rhythms of speech are practiced.
An expected outcome after
this sequence is completed is that the patient will increase his communication by the production of intelligible words and
word groups. Patients are typically able to form sentences with 3-5 words. Depending on the initial cause of the speech impairment,
more complex communication is possible. If proper breathing techniques are disturbed, new patterns can be developed during
all stages to make speech natural.
Case Study
Mr. E was a 61 year old
male who had a left hemisphere stroke. He had been in therapy for 19 months before he began MIT therapy. He was seen 3 times
weekly for a year. Baseline data obtained from the Porch Index of Communicative Ability indicated that he had adequate comprehension
skills but depressed verbal skills with an overall performance level in the 59th percentile. His expressive speech
was performed by pantomiming and verbs were communicated by gesture. Word combinations were rarely used.
Therapy was begun with hand
tapping to introduce the patient to the MIT procedure. The introductory phase began where the melody was hummed and the rhythm
was tapped out. This phase was an easy phase for Mr. E. The second phase involved connecting words to the melody tapped out.
The rhythm seemed to be of help so he began tapping out phrases by first paying attention to the number of syllables in the
words, and then progressed to phrases. After the rhythm was established, the verbal production followed-from intoning to song
to normal speech prosody. Two observations were made during this final phase that were
interesting. One was the fact that Mr. E would first tap out the structure of his response before he would produce it verbally.
Then he would give the verbal response accompanied by handtapping. The second
observation was that Mr. E would use gestures to help retrieve the word and then tapped out the rhythm before he expressed
his sentence.
After about 5 months, Mr.
E began to use four to five word utterances in response to questions or a pictured stimulus.
Mrs. E said they sang their conversations at home and as they had success with communication and became more confident,
Mr. E began making more involved utterances at home.
Case 2
Dr. L was a 53 year old
male who began MIT therapy seven months after he suffered a left hemisphere stroke. Dr. L could only make one vocalization
and that occurred when he coughed. He could not blend individual phonemes to form syllables or words. Since MIT is recommended
for persons who have some verbal ability, some modifications needed to be made. Therefore, intervention began with intoning
the /a/ phoneme. It was intoned with a steady rhythm and stress.
The idea of melody was established,
intonation and melody were introduced and Dr. L began to laugh with the music melody. Single phonemes were intoned until the
glide between them was accomplished easily for him. Gradually he moved to phrases,
and then short sentences. If he had difficulty with a word, he used gliding to bring the phonemes together. Written words
greatly enhanced his progress during therapy. Dr. L had become dependent on the
spelling of words. He had a 33 word vocabulary which he can use to ask and answer questions and can imitate words when the
visual stimulus is present.
Dr. L was presented with
a communication board where the red words were words he was able to say easily and the black words were ones he had not mastered
yet. He was able to practice the glides from the phonemes and eventually learn how to say the word through his practice with
MIT.
These two case studies support
the benefits of MIT. In both cases, the therapy progression was changed somewhat to address the individual’s needs.
But, the main principles were used and the patient progressed expressively. MIT is certainly a treatment plan that could have
beneficial results for a patient who suffers from Broca’s aphasia.
MIT
therapy was first introduced in the 1970’s. Few research studies have been
performed to analyze the effectiveness of this treatment. However, some SLP’s use the method for adults with aphasia
and children with apraxia with good results. (Roper). Music touches a spot of creativity within us. It can serve as a link
to achieve communication with a person who has been unreachable by other therapy methods. (Zoller). According to Belin, et
al, repeating words using MIT reactivates Broca’s area and the left prefrontal cortex while deactivating the counterpart
of Wernicke’s area in the right hemisphere. They feel that the recovery process induced by MIT coincides with the reactivation
of the left prefrontal structures.
MIT is most likely to
be successful for patients who meet certain criteria. Those individuals who have good auditory skills, non-fluent verbal communication
and poor word repetition would be good candidates. The SLP may need to gather information on the technique and try it with
the patient for a while to see if any progress is being made. Patience and perseverance on the part of the SLP and patient
are key elements. Family involvement encourages carryover and is a powerful component to the patients’ recovery. Since
SLP’s need to be creative in order to meet the needs of their patients, when other more traditional methods haven’t
brought progress, MIT may be an important consideration.
