Abstract
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.
Highlights
Aphasia is an acquired loss or impairment of the ability to communicate by language following brain damage and is present in more than one-third of stroke survivors (Wade et al, 1986; Dickey et al, 2010)
FL and JPL had a moderate degree of aphasia whereas FS had a more severe clinical profile, especially because he experienced more severe apraxia of speech than the other participants in connected speech
In JPL, significant change was only found from T2 to T3, with melodic therapy (MT) again (Z = −2.329, p = 0.024)
Summary
Aphasia is an acquired loss or impairment of the ability to communicate by language following brain damage (usually in the left hemisphere) and is present in more than one-third of stroke survivors (Wade et al, 1986; Dickey et al, 2010). In its original form, Melodic Intonation Therapy (MIT, Albert et al, 1973; Sparks et al, 1974) is a formalized impairment-based approach of language rehabilitation in people with Broca’s aphasia (AAN, 1994) (see Zumbansen et al, 2014 for a synthesis of MIT variations). The particularity of MIT in comparison to other therapies for aphasia is that it trains patients to produce speech using a form of singing to facilitate their speech output. Patients first learn to intone speech through a structured, intensive therapeutic protocol where they are asked to produce numerous and varied short sentences, with the help of additional facilitation techniques, such as unison production, lip-reading, hand-tapping of the rhythm, and use of formulaic phrases that are often better produced in Broca’s aphasia.
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