Abstract
There is an ongoing debate as to whether singing helps left-hemispheric stroke patients recover from non-fluent aphasia through stimulation of the right hemisphere. According to recent work, it may not be singing itself that aids speech production in non-fluent aphasic patients, but rhythm and lyric type. However, the long-term effects of melody and rhythm on speech recovery are largely unknown. In the current experiment, we tested 15 patients with chronic non-fluent aphasia who underwent either singing therapy, rhythmic therapy, or standard speech therapy. The experiment controlled for phonatory quality, vocal frequency variability, pitch accuracy, syllable duration, phonetic complexity and other influences, such as the acoustic setting and learning effects induced by the testing itself. The results provide the first evidence that singing and rhythmic speech may be similarly effective in the treatment of non-fluent aphasia. This finding may challenge the view that singing causes a transfer of language function from the left to the right hemisphere. Instead, both singing and rhythmic therapy patients made good progress in the production of common, formulaic phrases—known to be supported by right corticostriatal brain areas. This progress occurred at an early stage of both therapies and was stable over time. Conversely, patients receiving standard therapy made less progress in the production of formulaic phrases. They did, however, improve their production of non-formulaic speech, in contrast to singing and rhythmic therapy patients, who did not. In light of these results, it may be worth considering the combined use of standard therapy and the training of formulaic phrases, whether sung or rhythmically spoken. Standard therapy may engage, in particular, left perilesional brain regions, while training of formulaic phrases may open new ways of tapping into right-hemisphere language resources—even without singing.
Highlights
Left-hemispheric stroke patients often suffer a profound loss of spontaneous speech, known as non-fluent aphasia
Comparing the means before and after each treatment, strong increases in the production of formulaic lyrics were found for www.frontiersin.org patients undergoing singing therapy, and rhythmic therapy (M = 50.40, 95% CI [42.17, 58.63]). These effects proved to be stable over a period of 3 months after the end of singing and rhythmic therapy (M = −0.74, 95% CI [−3.84, 2.35]; M = 2.76, 95% CI [−2.82, 8.34])
The experiment controlled for phonatory quality, vocal frequency variability, pitch accuracy, syllable duration, phonetic complexity and other influences, such as the acoustic setting and learning effects induced by the testing itself
Summary
Left-hemispheric stroke patients often suffer a profound loss of spontaneous speech, known as non-fluent aphasia. Attention has been mainly focused on two research questions: from a cross-sectional view, one may ask whether it is singing itself that enables aphasic patients to produce text; from a longitudinal view, one may ask whether one could use singing to aid speech recovery. These questions have inspired a growing scientific debate and a number of singing therapies (Keith and Aronson, 1975; Van Eeckhout et al, 1997; Jungblut, 2009), among them a rehabilitation program known as melodic intonation therapy (Albert et al, 1973; Sparks et al, 1974; Helm-Estabrooks et al, 1989). According to the inventors of the therapy, singing is supposed to stimulate the intact right hemisphere, which assumes the function of damaged left-hemisphere speech areas
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