Melodic intonation therapy paired with video feedback: A potential method for bolstering production?

Aphasia is a linguistic problem that occurs after brain damage. It's a broad term that encompasses everything from modest word retrieval challenges to a complete inability to produce and interpret language. Fluent and non-fluent aphasia are two types of aphasia. Non-fluent aphasia is characterized by sluggish, effortful speaking and is caused by a stroke in the left frontotemporal areas. These patients' language production is mainly limited to one- or two-word utterances. Non-fluent aphasic patients can sing fluently despite their significant language production handicap, which has led to the use of singing and music in aphasia rehabilitation. Objective: To examine the effectiveness of Melodic Intonation Therapy (MIT) in patients with chronic Broca's aphasia. Methods: A descriptive study was conducted from March 1 to September 30, 2021, at NUR International University to investigate the efficacy of MIT in patients with persistent Broca's aphasia. For this purpose data was collected from almost 50 speech therapists working with chronic Broca's aphasic patients through a self-designed questionnaire. The questionnaire was used as a data collecting instrument that was designed by expert opinion and literature review. Results: Results indicated that MIT is effective in patients with chronic Broca's aphasia. On asking the respondent about the efficacy of MIT almost 88% responded that MIT is effective, 8% were not sure about the efficacy of MIT and 4% responded MIT is not effective in chronic aphasic patients. On asking the respondent about the development of expressive language 64 % responded that expressive Language is improved while 36 % were not sure about the development of expressive language development. On asking the respondent whether MIT reduces psychological stress on individuals regarding the necessity to speak correctly, 88 % responded with yes while 12 % responded with No that MIT reduces psychological stress. Conclusions: It is concluded from this study that MIT is effective in patients with chronic Broca’s aphasia.

Background: Melodic Intonation Therapy (MIT) is a therapeutic approach used to increase verbal output in adults with aphasia through combination of melodic intoning and rhythmic tapping with simple phrase production. Although MIT was developed in the 1970s, few studies have been conducted relative to determining the programme's overall effectiveness as well as examining ability to generalise skills to other communicative contexts. Aims: The purpose of the current investigation was to examine the effectiveness of MIT as a means of increasing verbal output in a gentleman with chronic Broca's aphasia. Methods & Procedures: A modified version of MIT without the tapping component was implemented with BR, 69-year-old male with chronic Broca's aphasia of 4 years' duration. BR had tried MIT previously with little success: he had difficulty with the tapping element and the packaged phrases lacked functionality, adversely affecting his motivation. A set of automatic and self-generated phrases were developed and implemented with a multiple baseline design across phrase type with an established criterion of 75% accuracy over two consecutive sessions for both stimulus sets. Generalisation stimuli were presented at the last weekly session. BR attended three hour-long weekly sessions, for 8 weeks. Follow-up probing with all stimuli occurred at 2 and 4 weeks post-treatment. A set of standardised tests and social validation measures were administered pre- and post-treatment. Outcomes & Results: BR reached 75% accuracy on automatic phrases at 4 weeks into the treatment programme, which was retained throughout the maintenance phase and both follow-up sessions. Performance on self-generated phrases was 55% at 8 weeks -post-treatment, which was maintained at both follow-up sessions. Separate Welch two s-ample t-tests used to analyse the automatic and self-generated phrase data, yielded highly significant treatment effects for both data sets, with non-significant findings for autocorrelation. Improved performance on standardised tests was observed most no-tably for auditory comprehension and reading and writing skills, with some improvement in spontaneous speech and naming. Increased perception of communicative effectiveness was reported independently by both BR and his spouse. Conclusions: Overall, BR significantly increased his ability to produce short phrases using MIT without tapping. Thus MIT appears to be a viable option for enhancing verbal output for some individuals with non-fluent aphasia, regardless of time post-stroke. Additional investigations are needed to examine generalisation effects to other linguistic contexts. Efficiency issues (treatment length, intensity) require further exploration relative to MIT efficacy and effectiveness and its variations.

Background : Melodic intonation therapy (MIT) is a well-known method of aphasia rehabilitation using prosodically based melodic phrases. The literature includes MIT adapted to many languages and efficiently applied to certain groups of non-fluent aphasic patients. However, there has been no report on the efficacy of the method for Persian-speaking patients. Aims : The objective of this study was primarily to investigate the effects of 15 sessions of MIT treatment (adapted to the Persian language) in selected patients with non-fluent aphasia; primarily on expository speech (phrase length and number of correct content units) and oral expression skills (repetition, responsive naming, and confrontational naming), and secondarily, on auditory comprehension abilities (word discrimination, commands). Methods and Procedures : Participants in the study included seven right-handed Persian-speaking patients afflicted with chronic (>14 months post-onset) non-fluent aphasia. Based on the rules of Persian prosody, MIT was adapted to the Persian language. Using a pre, post treatment design, each outcome measure was tested twice before and twice after MIT treatment. Changes in the variables not treated were also measured as baselines controlling treatment effects. Outcomes and Results : Using the Wilcoxon signed-rank test, improvements in the selected variables were shown to be statistically significant after the treatment phase and not during the treatment-free phases. Non-target variables remained unchanged after the treatment and throughout the non-treatment phases. Conclusions : Our study showed that MIT can be adapted for Persian aphasic patients and administered with measurable positive results after 15 sessions of treatment. MIT improved primarily spontaneous speech production, and as minor effects, selected oral expression and auditory comprehension subtests. Therefore MIT might be considered as a method for the rehabilitation of selected non-fluent Persian aphasic patients. More long-term follow-up studies with randomised controlled clinical trials are needed for stronger conclusions.

Melodic Intonation Therapy (MIT) is a language production therapy for severely non-fluent aphasic patients using melodic intoning and rhythm to restore language. Although many studies have reported its beneficial effects on language production, randomized controlled trials (RCT) examining the efficacy of MIT are rare. In an earlier publication, we presented the results of an RCT on MIT in subacute aphasia and found that MIT was effective on trained and untrained items. Further, we observed a clear trend in improved functional language use after MIT: subacute aphasic patients receiving MIT improved considerably on language tasks measuring connected speech and daily life verbal communication. Here, we present the results of a pilot RCT on MIT in chronic aphasia and compare these to the results observed in subacute aphasia. We used a multicenter waiting-list RCT design. Patients with chronic (>1 year) post-stroke aphasia were randomly allocated to the experimental group (6 weeks MIT) or to the control group (6 weeks no intervention followed by 6 weeks MIT). Assessments were done at baseline (T1), after 6 weeks (T2), and 6 weeks later (T3). Efficacy was evaluated at T2 using univariable linear regression analyses. Outcome measures were chosen to examine several levels of therapy success: improvement on trained items, generalization to untrained items, and generalization to verbal communication. Of 17 included patients, 10 were allocated to the experimental condition and 7 to the control condition. MIT significantly improved repetition of trained items (β = 13.32, p = 0.02). This effect did not remain stable at follow-up assessment. In contrast to earlier studies, we found only a limited and temporary effect of MIT, without generalization to untrained material or to functional communication. The results further suggest that the effect of MIT in chronic aphasia is more restricted than its effect in earlier stages post stroke. This is in line with studies showing larger effects of aphasia therapy in earlier compared to later stages post stroke. The study was designed as an RCT, but was underpowered. The results therefore have to be interpreted cautiously and future larger studies are needed.Clinical Trial Registration: www.ClinicalTrials.gov, identifier NTR 1961.

Background: Many studies have reported positive results regarding the benefits of melodic intonation therapy (MIT) in patients with non-fluent aphasia. Currently, there is no specific inclusion of speech therapists (STs) in MIT research. Investigating effective speech therapy (ST) techniques to address the language functions hindered by non-fluent aphasia could yield evidence for aphasia rehabilitation research. Objective: This systematic review (SR) examines the effectiveness of the traditional MIT protocol used by STs on speech recovery for patients with non-fluent aphasia after stroke. It also discusses other characteristics of the traditional MIT, such as the participants, the MIT protocol applied, the therapy intensity, and the role of STs. Materials and methods: This SR followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) 2020 statement. The four computerized databases (PubMed, Embase, ICTRP, and Google Scholar) were searched in February 2024 to review all empirical findings. We also conducted a hand search in relevant journals. The search yielded 538 studies, of which 2 met the criteria and underwent review. The methodological quality of the included studies was evaluated using the Cochrane Collaboration’s tool for assessing the risk of bias. Furthermore, the protocol was registered in PROSPERO under the reference CRD42024508733. Results: This review included 2 randomized controlled trials (RCTs) involving 44 patients. We found evidence that MIT significantly improved speech recovery, precise language repetition, and functional communication in patients with non-fluent aphasia. STs were interventionists in MIT research and used MIT following the American manual, and they had previously received MIT training. Conclusion: Our review provides some evidence of the effectiveness of MIT on speech recovery in patients with non-fluent aphasia after stroke. MIT may be a practical alternative to standard ST. There is some indication that MIT requires music therapy (MT) skills and training; therefore, STs must also have these abilities.

What Can Neuroimaging Tell Us About Aphasia?

For decades Melodic Intonation Therapy (MIT) has shown good potential within the aphasia population, yet has seldom been used as a frontline treatment, rather placed within a myriad of treatment techniques utilized during aphasia therapy. Debate continues regarding the mechanisms of change from MIT, both therapeutically and neurologically. Modified Melodic Intonation Therapy (MMIT) has developed through the work of Music Therapists and, as the main focus of treatment for non-fluent aphasia, can be an effective means of language re-acquisition for improved speech production. Clinical results from 7 clients with chronic non-fluent aphasia who received MMIT are discussed.

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Melodic intonation therapy (MIT) is one of the most well-known treatment methods which is based on pitch and rhythm and was developed to increase verbal output in adults with non-fluent aphasia. Although MIT has been adapted to several languages, in Greece it is almost unknown. The aim of the proposed study is twofold: (1) to translate and adapt the MIT to the Greek language, and (2) to conduct an experimental study in order to examine the effect of MIT on Greek patients with Broca’s aphasia. To this aim, a 64-year-old, right-handed male who had a 6-year primary school education level, no musical abilities and poor performance on the recognition of prosody attended the MIT intervention program almost two and a half years after the event of suffering an ischemic stroke. The MIT intervention was administered three times per week for a 12-week period, in which each session lasted from 30 to 40 min. The patient underwent three assessments all using both the Boston Diagnostic Aphasia Examination–Short Form (BDAE-SF) and brain perfusion single-photon emission computed tomography (SPECT); (1) before the MIT, (2) immediately after, and (3) 3 months after the completion of MIT. The results from the BDAE-SF revealed an impressive improvement on both trained and prepositional speech production, immediately after the completion of the MIT, and a stable improved performance 3 months after MIT. The SPECT scan revealed reactivation of the perilesional areas of the left hemisphere, and considerably improved perfusion of the frontal lobe, the anterior temporal lobe, and the upper part of the parietal lobe of the right hemisphere. The improvement persisted and even expanded 3 months after MIT. Therefore, MIT is a promising intervention program and its positive effects last for at least 3 months after the completion of the intervention.

Melodic intonation therapy (MIT) is a structured protocol for language rehabilitation in people with Broca’s aphasia. The main particularity of MIT is the use of intoned speech, a technique in which the clinician stylizes the prosody of short sentences using simple pitch and rhythm patterns. In the original MIT protocol, patients must repeat diverse sentences in order to espouse this way of speaking, with the goal of improving their natural, connected speech. MIT has long been regarded as a promising treatment but its mechanisms are still debated. Recent work showed that rhythm plays a key role in variations of MIT, leading to consider the use of pitch as relatively unnecessary in MIT. Our study primarily aimed to assess the relative contribution of rhythm and pitch in MIT’s generalization effect to non-trained stimuli and to connected speech. We compared a melodic therapy (with pitch and rhythm) to a rhythmic therapy (with rhythm only) and to a normally spoken therapy (without melodic elements). Three participants with chronic post-stroke Broca’s aphasia underwent the treatments in hourly sessions, 3 days per week for 6 weeks, in a cross-over design. The informativeness of connected speech, speech accuracy of trained and non-trained sentences, motor-speech agility, and mood was assessed before and after the treatments. The results show that the three treatments improved speech accuracy in trained sentences, but that the combination of rhythm and pitch elicited the strongest generalization effect both to non-trained stimuli and connected speech. No significant change was measured in motor-speech agility or mood measures with either treatment. The results emphasize the beneficial effect of both rhythm and pitch in the efficacy of original MIT on connected speech, an outcome of primary clinical importance in aphasia therapy.

Background. Little is known about the efficacy of language production treatment in subacute severe nonfluent aphasia. Although Melodic Intonation Therapy (MIT) is a language production treatment for this disorder, until now MIT effect studies have focused on chronic aphasia. Purpose. This study examines whether language production treatment with MIT is effective in subacute severe nonfluent aphasia. Methods. A multicenter, randomized controlled trial was conducted in a waiting-list control design: patients were randomly allocated to the experimental group (MIT) or the control group (control intervention followed by delayed MIT). In both groups, therapy started at 2 to 3 months poststroke and was given intensively (5 h/wk) during 6 weeks. In a second therapy period, the control group received 6 weeks of intensive MIT. The experimental group resumed their regular treatment. Assessment was done at baseline (T1), after the first intervention period (T2), and after the second intervention period (T3). Efficacy was evaluated at T2. The impact of delaying MIT on therapy outcome was also examined. Results. A total of 27 participants were included: n = 16 in the experimental group and n = 11 in the control group. A significant effect in favor of MIT on language repetition was observed for trained items, with mixed results for untrained items. After MIT there was a significant improvement in verbal communication but not after the control intervention. Finally, delaying MIT was related to less improvement in the repetition of trained material. Conclusions. In these patients with subacute severe nonfluent aphasia, language production treatment with MIT was effective. Earlier treatment may lead to greater improvement.

Patients with large left-hemisphere lesions and post-stroke aphasia often remain nonfluent. Melodic intonation therapy (MIT) may be an effective alternative to traditional speech therapy for facilitating recovery of fluency in those patients. In an open-label, proof-of-concept study, 14 subjects with nonfluent aphasia with large left-hemisphere lesions (171 ± 76 cc) underwent two speech/language assessments before, one at the midpoint, and two after the end of 75 sessions (1.5h/session) of MIT. Functional MR imaging was done before and after therapy asking subjects to vocalize the same set of 10 bi-syllabic words. We found significant improvements in speech output after a period of intensive MIT (75 sessions for a total of 112.5h) compared to two pre-therapy assessments. Therapy-induced gains were maintained 4 weeks post-treatment. Imaging changes were seen in a right-hemisphere network that included the posterior superior temporal and inferior frontal gyri, inferior pre- and postcentral gyri, pre-supplementary motor area, and supramarginal gyrus. Functional changes in the posterior right inferior frontal gyri significantly correlated with changes in a measure of fluency. Intense training of intonation-supported auditory-motor coupling and engaging feedforward/feedback control regions in the unaffected hemisphere improves speech-motor functions in subjects with nonfluent aphasia and large left-hemisphere lesions.

Background: Melodic intonation therapy (MIT) is a treatment approach used to facilitate verbal production in adults with aphasia by combining melodic intoning and rhythmic tapping. Although MIT was developed in the early 1970s, there is limited empirical evidence documenting specific behavioural outcomes.Aims: Two individuals with chronic Broca’s aphasia and acquired apraxia of speech received MIT applied to wh-questions in the context of multiple baseline designs. Methods & Procedures: Linguistic principles were applied to the selection of items used for treatment and measurement of generalisation effects. The dependent variables were (a) production of wh-questions and (b) articulatory accuracy via percentage of consonants correct in the production of wh-questions.Results: For Participant 1, there was an increase in the production of wh-questions for only one wh-morpheme which was maintained at 6 weeks post-treatment. For Participant 2, there was an increase in production of wh-questions for two wh-morphemes; however, performance was variable and declined by 6 weeks post-treatment. For both participants, there were modest gains in percentage of consonants correct for treated and generalisation items at 6 weeks post-treatment.Conclusions: There were limited gains in the production of wh-questions for both participants with the application of MIT. However, there were modest gains in percentage of consonants correct. MIT as applied in this investigation to wh-questions utilising linguistic principles did not result in improvement in the formulation and production of wh-questions, but treatment did have positive effects on articulatory accuracy for treatment and generalisation items. Additional research is needed to further examine the efficacy of MIT for outcomes involving both language and speech production.

Melodic intonation therapy (MIT) is a melodic musical training method that could be combined with language rehabilitation. However, some of the existing literature focuses on theoretical mechanism research, while others only focus on clinical behavioral evidence. Few clinical experimental studies can combine the two for behavioral and mechanism analysis. This review aimed at systematizing recent results from studies that have delved explicitly into the MIT effect on non-fluent aphasia by their study design properties, summarizing the findings, and identifying knowledge gaps for future work. MIT clinical trials and case studies were retrieved and teased out the results to explore the validity and relevance of these results. These studies focused on MIT intervention for patients with non-fluent aphasia in stroke recovery period. After retrieving 128 MIT-related articles, 39 valid RCT studies and case reports were provided for analysis. Our summary shows that behavioral measurements at MIT are excessive and provide insufficient evidence of MRI imaging structure. This proves that MIT still needs many MRI studies to determine its clinical evidence and intervention targets. The strengthening of large-scale clinical evidence of imaging observations will result in the clear neural circuit prompts and prediction models proposed for the MIT treatment and its prognosis.

Palilalia is a rarely documented speech disorder associated with Parkinson’s disease, stroke, epilepsy, etc. Palilalia is characterized by an increased rate of speech along with repetitions of words, phrases, or sentences. Only one published article has discussed treatment of Palilalia. Helm (1979) utilized a pacing board to help his 54-year-old client speak slower and reduce his repetitions. The participant touched the divided board with his fingers as he produced each syllable. This board reportedly slowed the patient’s speech. Melodic intonation therapy (MIT) was designed to help individuals with aphasia communicate more effectively (Sparks & Holland, 1976). MIT involves intoning propositional phrases and sentences using a limited range of musical notes to produce utterances along with tapping to keep the rhythm. Speech productions with MIT resulted in slower, more lyrical productions in comparison to spontaneous speech (Sparks & Holland). MIT incorporates aspects of pacing and rhythm that could be effective in slowing speech rate. This study utilized a single-subject design involving a 42-year-old male who experienced an anoxic brain injury. Speech samples from therapeutic sessions were collected and analyzed. The results indicated significant differences in terms of rate and fundamental frequency between spontaneous utterances and those produced using MIT strategies.