Abstract
Singing has been used in language rehabilitation for decades, yet controversy remains over its effectiveness and mechanisms of action. Melodic Intonation Therapy (MIT) is the most well-known singing-based therapy; however, speculation surrounds when and how it might improve outcomes in aphasia and other language disorders. While positive treatment effects have been variously attributed to different MIT components, including melody, rhythm, hand-tapping, and the choral nature of the singing, there is uncertainty about the components that are truly necessary and beneficial. Moreover, the mechanisms by which the components operate are not well understood. Within the literature to date, proposed mechanisms can be broadly grouped into four categories: (1) neuroplastic reorganization of language function, (2) activation of the mirror neuron system and multimodal integration, (3) utilization of shared or specific features of music and language, and (4) motivation and mood. In this paper, we review available evidence for each mechanism and propose that these mechanisms are not mutually exclusive, but rather represent different levels of explanation, reflecting the neurobiological, cognitive, and emotional effects of MIT. Thus, instead of competing, each of these mechanisms may contribute to language rehabilitation, with a better understanding of their relative roles and interactions allowing the design of protocols that maximize the effectiveness of singing therapy for aphasia.
Highlights
The relationship between singing and language impairment has been discussed in case studies and in the research literature for hundreds of years
Reports of many other individuals who were able to sing accurately and fluently with lyrics despite expressive language impairments prompted a study by Yamadori et al (1977) to investigate singing ability in those with non-fluent (Broca’s) aphasia following stroke or head trauma in frontal regions of the left hemisphere
Clinicians reported the successful use of singing to assist aphasia rehabilitation, and this eventually led to the first formalized singing treatment for aphasia – Melodic Intonation Therapy (MIT)
Summary
The relationship between singing and language impairment has been discussed in case studies and in the research literature for hundreds of years. Reports of many other individuals who were able to sing accurately and fluently with lyrics despite expressive language impairments prompted a study by Yamadori et al (1977) to investigate singing ability in those with non-fluent (Broca’s) aphasia following stroke or head trauma in frontal regions of the left hemisphere. They found that most of their participants could sing the melody correctly, while about 50% of participants, including some with severe Broca’s aphasia, could sing the lyrics fluently and without errors. The aim of the current review is to examine these putative mechanisms in detail, synthesize the existing evidence, and suggest directions for future basic and clinical research
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