Melodic Intonation Therapy Research Articles

Music-based interventions (MBIs) offer promising strategies for addressing speech-language impairments in individuals with nonfluent aphasia. This systematic review summarizes the current literature of MBIs for nonfluent aphasia recovery by types of MBIs to determine the efficacy of MBIs and assesses the risk of bias to identify common methodological limitations. A systematic search was conducted of MEDLINE, PubMed, and APA PsycInfo for the 20 years preceding July 2024. Risk of bias assessment was performed using the revised Joanna Briggs Institute critical appraisal tool for randomized controlled trials (RCTs). Ten RCTs met the inclusion criteria, featuring MBIs such as Melodic Intonation Therapy, Modified Melodic Intonation Therapy, and singing-based approaches. The results highlighted the potential of MBIs in various domains, particularly in enhancing repetition and naming abilities, even when compared to speech therapy. The reviewed studies exhibited a moderate to high risk of bias. Outcome measures varied widely, and functional communication, a critical rehabilitation goal, was examined in just two RCTs. Furthermore, heterogeneous control conditions and statistical methods hindered meaningful comparisons across studies. Future research should prioritize functional communication outcomes and refine intervention protocols to strengthen the evidence base. Addressing these gaps is essential for advancing the potential benefits of these clinical tools for nonfluent aphasia recovery.

Research trends and hotspots in post-stroke speech rehabilitation: A bibliometric analysis.

ABSTRACT Background Over the past decade, the field of music neuroscience has surged in its examination of the efficacy of music rehabilitation. A growing area of interest within this surge has been research on music interventions for post-stroke aphasia. Brain activation during music processing and perception may overlap with activity during speech and language processing. This overlap suggests possible improvement of speech and language through activation of the multimodal music system. However, the role of music has not been investigated from the perspective of existing literature on skilled language treatment to identify gaps in evidence and outcomes. Aims We surveyed the current literature regarding the use of music-based methods for skilled aphasia rehabilitation to answer the question, “What research has been conducted on music-based, speech-language interventions for post-stroke aphasia?” Methods & procedures We conducted a systematic database search of PubMed, EBSCO Discovery Search, CINAHL Complete, CINAHL Plus with Full Text, MEDLINE Complete, MEDLINE, APA PsycArticles, and APA PsycInfo using the following search terms: (music) AND (aphasia) AND (treatment OR rehabilitation OR intervention OR therapy OR management OR approach) AND (music OR choir OR choral OR melodic OR melody OR sing OR singing OR song) AND (aphasia OR language OR dysphagia OR cognitive-communication). Outcome & results Twenty-seven studies met our inclusion criteria after full-text review. The primary use of music in skilled rehabilitative aphasia therapy and focus of music neurorehabilitation research for aphasia is melodic intonation therapy (MIT), and most studies that fell within the search parameters discussed the use, mechanisms, and adaptation of MIT within the aphasia rehabilitation space. Our review highlighted considerable inconsistency in both the administration of MIT and the reporting of characteristics of MIT used in each study. Sample sizes of included studies ranged from one to ten participants, and most studies were published from 2010 to the present. Conclusions The rise in music neurorehabilitation literature occurred without foundational research of music as an aphasia intervention to provide uniformity or example. Lack of standardization, variability of results, and inconsistency of reporting lessened the quality of evidence found in the included studies. There is a need in this field for standardization of practice and reporting, even in the exploration of new clinical applications of music interventions.

This article provides a systematic review of music therapy research progress and clinical applications in stroke rehabilitation. Music therapy, through techniques such as Melodic Intonation Therapy (MIT) and Rhythmic Auditory Stimulation (RAS), offers distinct advantages by activating alternative neural pathways and promoting neuroplasticity, which significantly improves emotional regulation, cognitive function, language expression, and motor function in stroke patients. According to clinical evidence, music therapy notably decreases depression and anxiety; promotes neuroplasticity; activates brain regions associated with language and motor function; and improves gait stability and limb coordination. However, current research faces challenges such as insufficient sample sizes, unclear long-term effects, and a lack of standardized protocols. Future studies should incorporate technologies such as artificial intelligence and virtual reality to explore personalized music therapy interventions and establish multi-center collaborative clinical research systems, thereby promoting standardized application of music therapy in stroke rehabilitation.

Introduction: This research aims to see the effect of modifying Melodic Intonation Therapy (MIT) and Dhikr Asmaul Husna in audio form on the speaking ability of stroke patients. Aphasia is a disability problem experienced by stroke patients and can become persistent, reducing their quality of life. Efforts are needed to improve speaking ability so patients can continuously and independently carry out post-stroke speech exercises at home. The results showed that MIT gave better results in improving the speech ability of stroke patients. In the MIT method, patients repeat words spoken by nurses or family members using musical elements while speaking. Methods: This type of research is quantitative with a quasi-experimental design pre and post-test. Researchers carry out interventions using media in the form of Melodic Intonation Therapy Audio (MIT-A), which results from research development. This study's population is stroke patients treated at Dr. Soekardjo Tasikmalaya Hospital, Prasetya Bunda Hospital, and Banjar City Hospital. The sample consisted of 33 respondents from three Tasikmalaya and Banjar City hospitals. Exercises start when the patient is treated and continue to be done at home. Speech ability was evaluated using the TADIR method (Aphasia Test for Diagnostics and Rehabilitation), assessed before the intervention and at the first control visit. The intervention was carried out for one month. The hypothesis in this study is that there is a difference in the average score of speech ability before and after the intervention. The t-dependent test tests the difference in TADIR scores before and after training. Results: The study showed a difference in the average TADIR score before and after training (p-value 0.000). This indicates that speech training using MIT-Audio has a significant effect on the speaking ability of stroke patients. Conclusion: The results of this study conclude that speech training through modified MIT in audio form improves the speaking ability of stroke patients who experience aphasia. The researcher recommends that future researchers apply this speech training media by differentiating the type of aphasia experienced by the patient.

Introduction: Aphasia, occurring in 20–40% of stroke patients, highlights the prevalence of language impairment in this population. Behavioral speech and language therapy is the mainstay of treatment, although other interventions have been introduced to improve speech and behavioral therapy effects. This research aimed to develop a modified MIT model to enhance the speaking ability of stroke patients with aphasia. Materials and methods: The research utilized a research and development (R&D) approach to create and validate an MIT modified with Dhikr spiritual therapy for stroke patients with aphasia. A limited trial was conducted with consecutive sampling at Dr. Soekardjo Hospital of Tasikmlaya, focusing on specific inclusion and exclusion criteria. Feasibility testing involved 10 stroke patients, utilizing quantitative and qualitative instruments such as questionnaires, interviews, and Focus Group Discussion (FGD), leading to iterative improvements based on expert input and assessments. Results: Validation by three experts yielded an average score of 86.11% in Phase I and 94.04% in Phase II. MIT demonstrated positive feasibility outcomes with an average score of 91.66%. Furthermore, the speaking ability was significantly improved, evidenced by TADIR scores, with a p-value < 0.001. Conclusion: The developed MIT-A enhances speech abilities for stroke patients with aphasia, as demonstrated by positive outcomes in the limited trial. MIT-A holds promise as a feasible and impactful tool, offering a novel approach to aphasia rehabilitation.

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.

A growing body of research indicatesthat music-based interventions show promising results for adults with a wide range of speech, language and communication disorders. The purpose of this scoping review is to summarize the evidence on how speech-language therapists (SLTs) use music and music-related elements in therapeutic interventions for adults with acquired neurogenic communication impairments. This scoping review was completed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines. A systematic search of three databases (Allied and Complementary Medicine Database, Cumulative Index to Nursing and Allied Health Literature and OVID Medline) was conducted and articles were included if they (1) incorporated adult human participants; (2) received an assessment or intervention facilitated by an SLT; (3) incorporated techniques and interventions which included music-related elements (e.g., rhythm, melody, harmony and dynamics); (4) were written in the English language; and (5) were peer-reviewed full-text articles. Data were extracted using the Rehabilitation Treatment Specification System framework. A total of 25 studies met the inclusion criteria. The studies included participants with neurogenic communication impairments secondary to stroke, Parkinson's disease, dementia and traumatic brain injury. Musical interventions identified in the studies were Melodic Intonation Therapy, Modified Melodic Intonation Therapy, choral singing, singing therapy and songwriting. The majority of the studies reported interprofessional collaboration between SLTs and at least one other healthcare clinician and/or musician. Many studies also included music-based interventions lead and facilitated by musically trained SLTs. The results of the studies included in this review indicate that SLTs are using music-based interventions to target therapeutic goals to improve speech, language, voice and quality of life in collaboration with other clinicians and professional musicians. What is already known on this subject A growing body of research indicates that interventions using music (i.e., choirs and songwriting) and musical elements (i.e., rhythm and dynamics) show promising results for adults with neurogenic communication impairments. Currently, however, there is no clear indication of how speech-language therapists (SLTs) are using music in their clinical practice. What this study adds This scoping review collates the current evidence on how SLTs use music and musical elements in their clinical practice. SLTs are using music and musical elements for individuals with neurogenic communication impairments in populations such as Parkinson's disease, dementia and traumatic brain injury. Common interventions described in the literature include Melodic Intonation Therapy, choral singing, singing therapy and songwriting. What are the clinical implications of this work? Many SLTs collaborate when delivering music-based interventions, particularly with music therapists (MTs). This scoping review suggests that SLTs should continue to explore music-based interventions in collaboration with MTs and professional musicians to target therapeutic goals to improve speech, language, voice and quality of life.

The Irreversible brain disorders that cause sequelae in the form of motor aphasia or speech disorders which are mostly clinical manifestations in post-stroke patients cause inability to move, speech problems, perspective, because there are problems with brain function. Melodic Intonation Therapy (MIT) is the development of music as a therapeutic medium to improve language skills that use musical elements (intonation and beats) as therapy to improve language skills for people with aphasia. The purpose of this study is to analyze Melodic Intonation Therapy (MIT) on Speech Ability in Stroke Patients With Aphasia with the research stage based on field research in the Srondol community who experienced Stroke with speech difficulties/Aphasia. This research method uses an experimental quasy with a pre-post test with control group design with a sample of 30 respondents with the results of speech development of aphasia patients, international publications, and guidelines for the management of Melodic Intonation Therapy (MIT) in Stroke Patients with Aphasia. Based on the results of the study, it was found that patients who experienced stroke of the families of stroke patients supported him because family support was very important to maintain and maximize physical and cognitive recovery.

Abstract This literature review explores the impact of music on tonal language learning, with a focus on Mandarin Chinese. Utilising searches across major databases such as ERIC (EBSCO), ProQuest Central, Google Scholar, and Web of Science from 2005 to 2024, we selected relevant peer‐reviewed English‐language articles examining music's role in aiding tone acquisition and related cognitive processes. From 30 publications, findings are categorised into theoretical relationships, cognitive effects, melodic intonation therapy (MIT) applications and digital music applications. Theoretical frameworks emphasise the correlation between musicality and language proficiency, highlighting musicians' enhanced tonal perception and production skills. Cognitive effects include music's influence on pronunciation, memory and cultural understanding. MIT's effectiveness in tonal language learning is then discussed, emphasising its potential to improve cortical representations of tone categories. Finally, digital music applications are examined, focusing on language learning apps incorporating music for personalised and engaging learning experiences. The review finds significant literature reporting that music‐based methodologies, aligned with experiential learning paradigms, hold significant potential in Mandarin Chinese acquisition. They enhance listening comprehension, spoken language production, and understanding of grammar and syntax. Similar to MIT principles, music‐assisted tonal language learning utilises exaggerated melody and rhythm to improve language production, especially with complex words. This review is motivated by the recognition of music's potential benefits in language education, especially for tonal languages. It aims to provide educators and researchers with insights into effective methods and applications, guiding instructional practices and stimulating further empirical investigations in this interdisciplinary field. Ultimately, it contributes to the ongoing discourse on optimising tonal language learning methodologies.

Aims: This Evidance Based Nursing Practice (EBNP) is to increase language production in patients with non-fluent aphasia post stroke. Methods: This EBNP method uses pre and post to see an increase in language production by assessing token test scores. By calculating the number of samples G-Power version 3.1.9.7 as many as 7 respondents. Data processing using Jamovi. Results: The analysis obtained using the t-test showed that the token test score experienced a significant change before and after the administration of intonation melody therapy (pValue <0.001), while the outcome of an increase in language production showed a significant change after administration of intonation melody therapy (pValue 0.896) with an average mean change mean 11.4 (95% CI: 6.28 -16.6) and moderate effect size (Cohen's d: 0.205). Conclusion: provision of melodic intonation therapy is proven effective in increasing language production in patients with post stroke non fluent aphasia.

Neurologic music therapy (NMT) has proven instrumental in aiding recovery from complications in patients with a diverse range of neurologic diseases. Integrating music and virtual reality with standard rehabilitation therapies enhances patient compliance and makes therapy more enjoyable. The act of listening to music not only reduces epileptiform discharges but also amplifies brain plasticity. Moreover, music induces discernible variations in brain anatomy between musicians and non-musicians. As a cost-effective intervention, music therapy significantly contributes to the accelerated and efficient recovery of post-stroke patients, particularly when applied promptly after the event. Substantial evidence supports the integration of music into rehabilitation programs, facilitating the recovery of hand function, dexterity, spatial movement, cognitive function, mood, coordination, stride length, and memory. Techniques such as learning words as lyrics, melodic intonation therapy, and singing play crucial roles in expediting recovery for aphasic patients. Recognized by the World Rehabilitation Federation, NMT therapists are valuable members of the rehabilitation team. The approval of NMT as an effective, evidence-based treatment method underscores its significance in enhancing patient outcomes.

ABSTRACT Introduction Music therapy (MT) has been adapted to post-stroke rehabilitation for years and there were several theories of treatment methods. Our music therapist utilized neurological MT to design a treatment program for stroke survivors. We aimed to compare the effects of a low-dose neurological MT with no MT on outcomes measuring depression, activity of daily living and cognitive function amongst stroke survivors. Method A single masked, randomized controlled study was designed and patients with subacute stroke were recruited. The patients were assigned to a MT group or a conventional therapy (CT) group. Both groups received CT including physical therapy and occupational therapy. Patients with aphasia also received speech therapy. The MT group underwent an additional hour of neurological MT per week for a total duration of 4 weeks. Our MT method comprised therapeutic singing, therapeutic instrument music playing, melodic intonation therapy, and rhythmic speech cueing. The primary outcome measure was the Beck Depression Inventory-II (BDI-II). Secondary outcomes were the Mini-Mental State Examination (MMSE), modified Rankin Scale (MRS) and Barthel Index (BI). Result Eighty-two patients were recruited. No significant differences were found at baseline. There was significant post-treatment effect among both groups for the BI (p < 0.001, Mdiff = 13.96, 95%CI = (11.64,16.29)), MMSE (p < 0.001, Mdiff = 1.04, 95%CI = (0.51,1.57)) and MRS (p < 0.001, Mdiff = −0.45, 95%CI = (−0.57,−0.34)). Additionally, a significant difference was observed between the groups for the MRS (p = 0.033, Mdiff = −0.24, 95%CI = (−0.03,0.52)). No significant between-group effect was found regarding the BI and MMSE. Discussion This study highlights the added value of MT in improving MRS, while requiring relatively less therapeutic time.

ABSTRACT Background Cognitive-linguistic interventions for aphasia are behavioural-based approaches to therapy that aim to treat language impairment skills post-acquired brain injury. The purpose of cognitive-linguistic intervention is to restore and rehabilitate language impairment skills through targeting phonologic, semantic and syntactic systems, which may support goals to improve everyday communication. Aims The aim of this systematic review was to investigate the effects of cognitive-linguistic interventions on language processing for aphasia in the first 90 days post-stroke. Secondary aims include the investigation of the effects of these interventions on functional communication and quality of life. Methods A systematic search was conducted across six databases. Twenty-one studies met the predefined eligibility criteria and were included in the review. Studies were rated for methodological quality and data extracted. A narrative synthesis was completed and conducted for all included studies. Four studies were suitable for meta-analysis. Main Contribution Evidence for the effects of cognitive-linguistic intervention for aphasia in the first 90 days post-stroke is inconclusive. Intervention approaches included constraint-induced intervention, melodic intonation therapy and study specific cognitive-linguistic intervention. Multiple studies investigated the use of computers as a mode of intervention delivery or to increase the frequency of intervention or session duration. Improvement on language outcomes was associated with positive effects on functional communication, regardless of the specific intervention. There were mixed results for quality-of-life outcomes. Conclusions Further research is required to guide aphasia intervention the first 90 days post stroke, a time critical period for recovery and rehabilitation. Research reports should include adequate description of participant characteristics and consistent use of intervention protocols and outcome measures. Providing a clear description of theoretical underpinnings and detailed information regarding the components of intervention will also facilitate future research synthesis.

Melodic intonation therapy for non-fluent aphasia after stroke: A clinical pilot study on behavioral and DTI findings

The study investigated the effect of cognitive behavioural therapy (CBT) and melodic intonation therapy (MIT) on the verbal communication skills of persons with apraxia. A pre-test, post-test, and control group quasi-experimental research design was used with a sample of persons with post-stroke apraxia receiving speech and language therapeutic services in Ibadan Metropolis. University College Hospital was selected as the treatment center for the study. Thirty persons with apraxia were purposively selected and assigned to one of three groups: CBT, melodic intonation therapy, or control (N = 30, male = 16, female = 14, mean age = 63.1 years). Twenty-four sessions of CBT and melodic intonation therapy classes were held with the experimental group only. The control group was exposed to placebo treatment over the same period. An apraxia of speech rating scale (ASRS) was administered to assess the verbal communication skills of the prospective participants. Those who met the inclusion criteria were selected for the study. The instruments used were the ASRS, the English proficiency test of oral communication skill rating scale, and two self-developed therapeutic plans. Data were analysed using analyses of covariance and Scheffe’s post-hoc test at a 0.05 level of significance. There was a significant main effect of treatment (CBT and MIT) on the verbal communication skills of the participants (F (2,11) = 200.84, P &lt; 0.05, X = 0.56). Participants in the MIT group had the highest mean score (56.20), followed by those in CBT (37.90), while those in the control group had the lowest mean score (23.80). CBT and MIT were effective in enhancing the verbal communication skills of persons with apraxia. However, MIT showed better outcomes than CBT. Therefore, it is appropriate for speech therapists, pathologists, and other relevant practitioners to adopt these strategies to improve the verbal communication skills of those with apraxia.

Globally, more than 10 million new stroke cases occur annually, of which aphasia accounts for about one-third. Aphasia has become an independent predictor of functional dependence and death for the stroke population. The closed-loop rehabilitation of combining behavioral therapy with central nerve stimulation seems to be the research trend of post-stroke aphasia (PSA) due to its advantages in improving linguistic deficits. To verify the clinical efficacy of a closed-loop rehabilitation program combining melodic intonation therapy (MIT) with transcranial direct current stimulation (tDCS) for PSA. This was a single-center, assessor-blinded, randomized controlled clinical trial, which screened 179 patients and included 39 PSA subjects, with the registration number ChiCTR2200056393 in China. Demographic and clinical data were documented. The primary outcome was the Western Aphasia Battery (WAB) used to assess language function, and the secondary outcomes included Montreal Cognitive Assessment (MoCA), Fugl-Meyer Assessment (FMA), and Barthel Index (BI) for evaluating cognition, motor, and activities of daily living, respectively. With the computer-generated randomization sequence, subjects were randomly divided into the conventional group (CG), MIT combined with sham stimulation group (SG), and MIT combined with tDCS group (TG). After the three-week intervention, the functional changes in each group were analyzed by the paired sample T-test, and the functional difference between the three groups was analyzed by ANOVA. There was no statistical difference on the baseline. After the intervention, the WAB's aphasia quotient (WAB-AQ), MoCA, FMA, and BI were statistically different in SG and TG, including all the sub-items in WAB and FMA, while only listening comprehension, FMA, and BI were statistically different in CG. The differences of WAB-AQ, MoCA, and FMA were statistically different among the three groups, but BI was not. The post hoc test results revealed that the changes of WAB-AQ and MoCA in TG were more significant than the others. MIT combined with tDCS can augment the positive effect on language and cognitive recovery in PSA.

Current Situation of Melodic Intonation Therapy in Japan : The National Investigation of MIT

The ability to produce words through singing can be preserved in severe aphasia, but the benefits of group-based singing rehabilitation in aphasia are largely unknown. Our aim was to determine the efficacy of a multicomponent singing intervention on communication and speech production, emotional-social functioning and caregiver well-being in aphasia. Fifty-four patients with acquired brain injury and chronic aphasia and their family caregivers (n = 43) were recruited. Using a crossover randomized controlled trial design, participants were randomized to two groups who received a 4-month singing intervention either during the first or second half of the study in addition to standard care. The intervention comprised weekly group-based training (including choir singing and group-level melodic intonation therapy) and tablet-assisted singing training at home. At baseline, 5- and 9-month stages, patients were assessed with tests and questionnaires on communication and speech production, mood, social functioning, and quality of life and family caregivers with questionnaires on caregiver burden. All participants who participated in the baseline measurement (n = 50) were included in linear mixed model analyses. Compared with standard care, the singing intervention improved everyday communication and responsive speech production from baseline to 5-month stage, and these changes were sustained also longitudinally (baseline to 9-month stage). Additionally, the intervention enhanced patients’ social participation and reduced caregiver burden. This study provides novel evidence that group-based multicomponent singing training can enhance communication and spoken language production in chronic aphasia as well as improve psychosocial wellbeing in patients and caregivers.https://www.clinicaltrials.gov, Unique identifier: NCT03501797.

Background: Since the 1970s, publications evaluating the effect of musical or singing tools to support aphasia remediation have flourished. Aims: This systematic literature review examines the hypothesis that music- and singing-based therapies promote the recovery of language, communication, and cognitive-linguistic functions in patients with aphasia. Methods: To do so, the selection, reading and analysis of 51 studies were conducted. Results: Analyzed publications show high levels of efficacy of musical and singing-based interventions (89% of significant effects in the linguistic domain, 100% in the communication domain, and 100% for cognitivo-linguistic tests), covering a large range of criteria, from articulation to the decrease of stereotypies in speech. This systematic review distinguishes the efficacy of three types of musical intervention: the Melodic Intonation Therapy and its variants, singing-based interventions, and musical listening. In addition, it collects data on the generalization of acquired skills and the effects according to aphasia severity, stage and patient musical background. This work allows to identify factors that may influence intervention outcomes and suggests research perspectives. Conclusions: This review will provide precious data for therapists who are willing to build an evidence-based practice using music and singing.