Ineke van der Meulen

The Efficacy and Timing of Melodic Intonation Therapy in Subacute Aphasia

Background. Little is known about the efficacy of language production treatment in subacute severe nonfluent aphasia. Although Melodic Intonation Therapy (MIT) is a language production treatment for this disorder, until now MIT effect studies have focused on chronic aphasia. Purpose. This study examines whether language production treatment with MIT is effective in subacute severe nonfluent aphasia. Methods. A multicenter, randomized controlled trial was conducted in a waiting-list control design: patients were randomly allocated to the experimental group (MIT) or the control group (control intervention followed by delayed MIT). In both groups, therapy started at 2 to 3 months poststroke and was given intensively (5 h/wk) during 6 weeks. In a second therapy period, the control group received 6 weeks of intensive MIT. The experimental group resumed their regular treatment. Assessment was done at baseline (T1), after the first intervention period (T2), and after the second intervention period (T3). Efficacy was evaluated at T2. The impact of delaying MIT on therapy outcome was also examined. Results. A total of 27 participants were included: n = 16 in the experimental group and n = 11 in the control group. A significant effect in favor of MIT on language repetition was observed for trained items, with mixed results for untrained items. After MIT there was a significant improvement in verbal communication but not after the control intervention. Finally, delaying MIT was related to less improvement in the repetition of trained material. Conclusions. In these patients with subacute severe nonfluent aphasia, language production treatment with MIT was effective. Earlier treatment may lead to greater improvement.

Melodic Intonation Therapy: Present Controversies and Future Opportunities

This article describes the state of the art of Melodic Intonation Therapy (MIT), a structured aphasia therapy program using the melodic aspects of language (intonation, rhythm, and stress) to improve language production. MIT was developed in the 1970s and is still used worldwide. Nevertheless, we argue that many questions crucial for the clinical application of MIT are still unanswered. First, a review of MIT effect studies is presented showing that evidence from well-designed group studies is still lacking. It is also unclear which aspects of MIT contribute most to its therapeutic effect and which underlying neural mechanisms are involved. Two cases are presented illustrating unsolved questions concerning MIT in clinical practice, such as candidacy and the best timing of this therapy.

Melodic Intonation Therapy in Chronic Aphasia: Evidence from a Pilot Randomized Controlled Trial

Melodic Intonation Therapy (MIT) is a language production therapy for severely non-fluent aphasic patients using melodic intoning and rhythm to restore language. Although many studies have reported its beneficial effects on language production, randomized controlled trials (RCT) examining the efficacy of MIT are rare. In an earlier publication, we presented the results of an RCT on MIT in subacute aphasia and found that MIT was effective on trained and untrained items. Further, we observed a clear trend in improved functional language use after MIT: subacute aphasic patients receiving MIT improved considerably on language tasks measuring connected speech and daily life verbal communication. Here, we present the results of a pilot RCT on MIT in chronic aphasia and compare these to the results observed in subacute aphasia. We used a multicenter waiting-list RCT design. Patients with chronic (>1 year) post-stroke aphasia were randomly allocated to the experimental group (6 weeks MIT) or to the control group (6 weeks no intervention followed by 6 weeks MIT). Assessments were done at baseline (T1), after 6 weeks (T2), and 6 weeks later (T3). Efficacy was evaluated at T2 using univariable linear regression analyses. Outcome measures were chosen to examine several levels of therapy success: improvement on trained items, generalization to untrained items, and generalization to verbal communication. Of 17 included patients, 10 were allocated to the experimental condition and 7 to the control condition. MIT significantly improved repetition of trained items (β = 13.32, p = 0.02). This effect did not remain stable at follow-up assessment. In contrast to earlier studies, we found only a limited and temporary effect of MIT, without generalization to untrained material or to functional communication. The results further suggest that the effect of MIT in chronic aphasia is more restricted than its effect in earlier stages post stroke. This is in line with studies showing larger effects of aphasia therapy in earlier compared to later stages post stroke. The study was designed as an RCT, but was underpowered. The results therefore have to be interpreted cautiously and future larger studies are needed. Clinical Trial Registration: www.ClinicalTrials.gov, identifier NTR 1961.

Aphasia rehabilitation: more than treating the language disorder.

This supplement focuses on the neurorehabilitation of language disorders. It offers a broad survey of this field, with state-of-the-art contributions from various disciplines. In doing so, it aims to show that treating the devastating consequences of neurological language disorders requires a prolonged interdisciplinary effort.

Insight into the neurophysiological processes of melodically intoned language with functional MRI

Melodic Intonation Therapy (MIT) uses the melodic elements of speech to improve language production in severe nonfluent aphasia. A crucial element of MIT is the melodically intoned auditory input: the patient listens to the therapist singing a target utterance. Such input of melodically intoned language facilitates production, whereas auditory input of spoken language does not.

Language lateralisation after Melodic Intonation Therapy: an fMRI study in subacute and chronic aphasia

ABSTRACT Background: There is an ongoing debate whether the effect of Melodic Intonation Therapy (MIT) in patients with severe non-fluent aphasia depends on recruitment of right hemisphere (RH) structures for language functioning or on re-recruitment of left hemisphere (LH) language structures. So far, neuroimaging studies have produced conflicting evidence. Aims: To investigate whether a shift in language lateralisation occurs after intensive treatment in subacute (<3 months post onset) and chronic (>1 year post onset) stroke patients with aphasia. Method & Procedures: In a multiple case pilot study with pre-post-design 5 subacute and 4 chronic stroke patients received intensive MIT (6 weeks, 30 sessions). Pre- and post-treatment they underwent functional MRI scanning with a passive listening task to determine language lateralisation indices (LIs). Outcomes & Results: No consistent shift of language activation was found either to the LH or to the RH. With one exception, subacute patients showed symmetrical or right-lateralised language activation pretreatment, which tended to become more right lateralised after treatment. Language activation in chronic patients was left lateralised in two of the four participants, with a tendency towards stronger left lateralised activation after treatment. Conclusions: Data for the subacute patients provide some support for the classical notion that MIT promotes recruitment of RH structures for language processing. However, the contrasting activation patterns in chronic participants before as well as after treatment suggest that reorganisation of language after MIT occurs in interaction with a dynamic recovery process after stroke. Time post onset should be addressed systematically in studies of treatment-induced language recovery.

Doel en inhoud

Motor-control = stabiliteit Balans en stabiliteitstraining is een cursus voor therapeuten die zich willen toeleggen op het herleren van motor-control bij patiënten met pijn en functieverlies. Uit de literatuur is gebleken dat bij patiënten de neuro-musculatoire timing en samenwerking van spieren of spierketens gewijzigd is; instabiliteit (Motor Control Impairment). Pijn, verloren motorische ervaring, zwakte maar ook gedrag, cognities, het sociale doemein en emoties spelen hierbij een rol als oorzaak en het onderhouden van klachten. Hier vinden we ook de ingangen voor behandelbare grootheden.