Da Musically Inclined Bomb

DePauw University's First Year Seminar on Writing about Music

Sunday, December 03, 2006

Preserved Singing in Aphasia:A Case Study of the Efficacy of Melodic Intonation Therapy

This study demonstrates the efficacy of Melodic Intonation Therapy (MIT) in a neurologically stable amateur male musician with severe expressive aphasia using a pre- versus post-treatment design.
Aphasia is the loss or impairment of the ability to use of comprehend words resulting from brain damage. In this study the patient, referred to as KL, had difficulties with language dealing with expression and comprehension, but has verbal apraxia, or the ability to repeat words by copying someone's mouth movements. The purpose of this study was to help KL regain some of his ability to produce words and phrases using MIT sessions.
The study involved three tasks. In Task 1, pairs of sentences were presented both visually on printed cards and verbally. KL was required to identify the grammatically correct sentence within each pair; he was able to get 16/18 correct. Task 2 involved KL constructing grammatically correct sentences from printed word cards presented in a random order. He was unable to produce 8/9 sentence anagrams, thus showing he understands the structure but cannot produce his own. In Task 3, 20 phrases of three words were generated and randomly put into one of three groups on ten. Each word was printed beneath a line drawing of the last word, with each group having a simliar number of phrases with one-, two-, three- or four- syllable words. Group 1 had tunes composed for each phrase with the rhythm and pitch contour similar to that of conversation; these were the MIT phrases. Group 2 phrases were given a slightly exaggerated rhythm that approximated the rhythms of Group 1 without stepping away from the natural rhythm of speech; this was the repetition group. Both Groups 1 and 2 were recorded for practice use in between sessions. Group 3 were unrehearsed phrases, which KL saw for the first time in therapy.
The procedure for the study had KL's responses recorded throughout the sessions with a baseline performance taken prior to the start of therapy by having him say phrases from each group from a picture prompt, written word prompt, or spoken word prompts. He attended four weeks of therapy with a Music Therapist and a named researcher. KL had bi-weekly rehearsal seesions of both Group 1 and 2 phrases with identicaly training conditions. The rehearsal followed the MIT method that has six levels of phrase production graded by the level of phrase difficulty and the degree of prompting provided by the therapist. Level 6 is the goal as it is when the participant can produce an answer using the target phrase with no prompting. KL was allowed three attempts to complete each level and a melody was not incorporated into rehearsal of Group 2. Group 3 phrases were presented at baseline and at week 5, one week after the end of therapy.
A first follow up was presented at week five, with a second at week 9. In these sessions, phrases from each group were presented in a random order. He was first given a picture prompt then a melodic prompt for the MIT phrases, and finally a spoken or sung prompt until he was able to compete the phrase. The melodic and sung word prompts used the melodies accompanying the Group 1 phrases.
The results were taken by way of a 't' test by comparing the mean number of times KL reached Level 6 across the 8 sessions of therapy. This showed the he had a significant performance advantage for phrases using MIT vs. Repetition. A Repeated Measures Analysis of Covariance (ANCOVA) test was used to examine the proportion of words KL correctly produced with baseline vs. follow up 1 and among the phrase groups. KL's performance of the MIT and repetition phrases was significantly better than his performance of unrehearsed phrases across time. ANCOVA tests were also used to assess the long term effacicy of MIT by examining the proportion of words correctly produced by KL for the rehearsed phrases. His performance of the repetition phrases deteriorated at a faster rate than the MIT phrases, creating a performance advantage for MIT phrases. The therapy also showed that KL was significantly more likely to reach the stage where he could answer a question with a sung target phrases than a spoken phrase. Also KL's MIT phrases were more commonly produced without a prompt and more likely to be complete utterances. All this proves that the effects of MIT are longer lasting after therapy and is very helpful in helping people with aphasia learn to comprehend and produce phrases.


At 12/03/2006 6:33 PM, Blogger Renee said...

mo, i liked the way you presented... breaking it into 3 sections made it easier to understand :)

At 12/03/2006 7:39 PM, Blogger Kitt_Katt said...

it would be really neat to see what later studies find out about this

At 12/03/2006 10:54 PM, Blogger Becca said...

Very clear and thorough. Too bad your powerpoint didn't work out. This is an interesting topic.

At 12/03/2006 11:07 PM, Blogger Melissa said...

I saw this episode of House, and they could have used this concept.

At 12/03/2006 11:18 PM, Blogger Godfather Outlaw said...

your language is keen. this is a very interesting article!

At 12/03/2006 11:22 PM, Blogger Nat said...

This was a very interesting article, all though I was very distracted by the fuzziness(sp?) of your powerpoint, and I know you were so excited about it. :)

At 12/03/2006 11:52 PM, Blogger Andrew said...

nice barage of information, very thorough as Becca said

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At 4/23/2010 3:09 PM, Anonymous Singing Lessons said...

It is so amazing how much singing can play a role in medial health. Thanks for your article.


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