One of the few accepted treatments for severe non-fluent aphasia is Melodic Intonation Therapy (MIT). Inspired by the common clinical observation that patients can actually sing the lyrics of a song better than they can speak the same words, MIT emphasizes the prosody of speech through the use of slow, pitched vocalization (singing), and has been shown to lead to significant improvements in propositional speech beyond the actual treatment period. It has been hypothesized that this effect is due to the gradual recruitment of right- hemispheric language regions for normal speech production, and this is further supported by our own functional magnetic resonance imaging (fMRI) pilot data. Although the MIT-induced treatment effect has been shown in several small case series, it is not clear whether the effect is due to the intensity of the treatment or to the unique, components of MIT that are not found in other, non-intonation-based interventions. Thus, our overall aim is to test our hypothesis that MIT's rehabilitative effect is achieved by using its melodic and rhythmic elements to engage and/or unmask the predominantly right-hemispheric brain regions capable of supporting expressive language function. In order to test this hypothesis, we have developed an experimental design that includes the randomization of chronic stroke patients with persistent, moderate to severe non-fluent aphasia into three parallel groups receiving 1) 75 sessions of Melodic Intonation Therapy (approximately 8 weeks), 2) 75 sessions of an equally intensive, alternative verbal treatment method developed for this study (Speech Repetition Therapy), or 3) an equal period of No Therapy. All patients will undergo two pre-therapy and two post-therapy behavioral assessments in addition to the pre- and post-therapy fMRI studies examining the neural correlates of overtly spoken and sung words and phrases. This design allows us to 1) examine the efficacy of MIT over No Therapy, 2) examine the effects of elements specific to MIT (e.g., melodic intonation and rhythmic tapping) by comparing it to a control intervention (SRT) that is similar in structure and intensity of treatment, 3) compare post-therapy effects with pre-therapy baseline variations, and 4) examine post-treatment maintenance effects. Our primary speech outcome measure will be the number of Correct Information Units (CIU)/min produced during spontaneous speech. Secondary outcome measures include correctly named items on standard picture naming tests, timed automatic speech, and linguistically-based measures of phrase and sentence analysis.

Public Health Relevance

Aphasia is a common and devastating complication of stroke or other brain injury that causes severe communication difficulties for tens of thousands of adults each year, yet surprisingly the neural processes that underlie language recovery from stroke or traumatic brain injury remain largely unknown and therefore, have not been specifically targeted by aphasia therapies. One of the few accepted treatments for severe non-fluent aphasic patients is Melodic Intonation Therapy (MIT) with melodic intonation of words/phrases and rhythmic hand tapping as specific elements. In a randomized clinical trial, we will test the efficacy of MIT over no treatment and an alternative intervention that controls for the intensity of the therapy and therapist-patient interaction, but does not have any of the specific elements of MIT.

Agency
National Institute of Health (NIH)
Institute
National Institute on Deafness and Other Communication Disorders (NIDCD)
Type
Research Project (R01)
Project #
5R01DC008796-03
Application #
7749033
Study Section
Language and Communication Study Section (LCOM)
Program Officer
Cooper, Judith
Project Start
2008-01-01
Project End
2012-12-31
Budget Start
2010-01-01
Budget End
2010-12-31
Support Year
3
Fiscal Year
2010
Total Cost
$357,638
Indirect Cost
Name
Beth Israel Deaconess Medical Center
Department
Type
DUNS #
071723621
City
Boston
State
MA
Country
United States
Zip Code
02215
Pani, Ethan; Zheng, Xin; Wang, Jasmine et al. (2016) Right hemisphere structures predict poststroke speech fluency. Neurology 86:1574-81
Doughty, Christopher; Wang, Jasmine; Feng, Wuwei et al. (2016) Detection and Predictive Value of Fractional Anisotropy Changes of the Corticospinal Tract in the Acute Phase of a Stroke. Stroke 47:1520-6
Chen, Joyce L; Schlaug, Gottfried (2016) Increased resting state connectivity between ipsilesional motor cortex and contralesional premotor cortex after transcranial direct current stimulation with physical therapy. Sci Rep 6:23271
Chen, Joyce L; Fujii, Shinya; Schlaug, Gottfried (2016) The use of augmented auditory feedback to improve arm reaching in stroke: a case series. Disabil Rehabil 38:1115-1124
Altenmüller, Eckart; Schlaug, Gottfried (2015) Apollo's gift: new aspects of neurologic music therapy. Prog Brain Res 217:237-52
Rüber, Theodor; Lindenberg, Robert; Schlaug, Gottfried (2015) Differential adaptation of descending motor tracts in musicians. Cereb Cortex 25:1490-8
Feng, Wuwei; Wang, Jasmine; Chhatbar, Pratik Y et al. (2015) Corticospinal tract lesion load: An imaging biomarker for stroke motor outcomes. Ann Neurol 78:860-70
Schlaug, Gottfried (2015) Musicians and music making as a model for the study of brain plasticity. Prog Brain Res 217:37-55
Wan, Catherine Y; Zheng, Xin; Marchina, Sarah et al. (2014) Intensive therapy induces contralateral white matter changes in chronic stroke patients with Broca's aphasia. Brain Lang 136:1-7
Ellis, Robert J; Bruijn, Bente; Norton, Andrea C et al. (2013) Training-mediated leftward asymmetries during music processing: a cross-sectional and longitudinal fMRI analysis. Neuroimage 75:97-107

Showing the most recent 10 out of 49 publications