Lauryn Zipse

Melodic Intonation Therapy: Shared Insights on How it is Done and Why it Might Help

For more than 100 years, clinicians have noted that patients with nonfluent aphasia are capable of singing words that they cannot speak. Thus, the use of melody and rhythm has long been recommended for improving aphasic patients’ fluency, but it was not until 1973 that a music‐based treatment [Melodic Intonation Therapy (MIT)] was developed. Our ongoing investigation of MITs efficacy has provided valuable insight into this therapys effect on language recovery. Here we share those observations, our additions to the protocol that aim to enhance MITs benefit, and the rationale that supports them.

From music making to speaking: Engaging the mirror neuron system in autism

Individuals with autism show impairments in emotional tuning, social interactions and communication. These are functions that have been attributed to the putative human mirror neuron system (MNS), which contains neurons that respond to the actions of self and others. It has been proposed that a dysfunction of that system underlies some of the characteristics of autism. Here, we review behavioral and imaging studies that implicate the MNS (or a brain network with similar functions) in sensory-motor integration and speech representation, and review data supporting the hypothesis that MNS activity could be abnormal in autism. In addition, we propose that an intervention designed to engage brain regions that overlap with the MNS may have significant clinical potential. We argue that this engagement could be achieved through forms of music making. Music making with others (e.g., playing instruments or singing) is a multi-modal activity that has been shown to engage brain regions that largely overlap with the human MNS. Furthermore, many children with autism thoroughly enjoy participating in musical activities. Such activities may enhance their ability to focus and interact with others, thereby fostering the development of communication and social skills. Thus, interventions incorporating methods of music making may offer a promising approach for facilitating expressive language in otherwise nonverbal children with autism.

Auditory-motor mapping training as an intervention to facilitate speech output in non-verbal children with autism: a proof of concept study.

Although up to 25% of children with autism are non-verbal, there are very few interventions that can reliably produce significant improvements in speech output. Recently, a novel intervention called Auditory-Motor Mapping Training (AMMT) has been developed, which aims to promote speech production directly by training the association between sounds and articulatory actions using intonation and bimanual motor activities. AMMT capitalizes on the inherent musical strengths of children with autism, and offers activities that they intrinsically enjoy. It also engages and potentially stimulates a network of brain regions that may be dysfunctional in autism. Here, we report an initial efficacy study to provide ‘proof of concept’ for AMMT. Six non-verbal children with autism participated. Prior to treatment, the children had no intelligible words. They each received 40 individual sessions of AMMT 5 times per week, over an 8-week period. Probe assessments were conducted periodically during baseline, therapy, and follow-up sessions. After therapy, all children showed significant improvements in their ability to articulate words and phrases, with generalization to items that were not practiced during therapy sessions. Because these children had no or minimal vocal output prior to treatment, the acquisition of speech sounds and word approximations through AMMT represents a critical step in expressive language development in children with autism.

Paced mating behavior in the naturally cycling and the hormone-treated female rat.

During a sexual encounter with a male rat, a female rat will display both receptive (lordosis) and proceptive (hopping, darting, and ear-wiggling) behaviors. Additionally, if mating occurs in an environment where the female rat may approach and withdraw from the male rat, she will control the timing of the receipt of mounts, intromissions, and ejaculations. This temporal patterning by the female rat is known as paced mating behavior. The present experiment compared paced mating behavior in rats during an intact, proestrous phase and an ovariectomized phase, during which they were treated with estradiol benzoate (10 microg per rat) and progesterone (0.5 mg per rat). Though no differences in sexual receptivity were observed across the two phases, patterns of paced mating behavior were found to differ. Specifically, female rats exhibited significantly longer contact-return latencies when hormone treated than when intact.

When right is all that is left: plasticity of right-hemisphere tracts in a young aphasic patient

Using an adapted version of Melodic Intonation Therapy (MIT), we treated an adolescent girl with a very large left‐hemisphere lesion and severe nonfluent aphasia secondary to an ischemic stroke. At the time of her initial assessment 15 months after her stroke, she had reached a plateau in her recovery despite intense and long‐term traditional speech‐language therapy (approximately five times per week for more than one year). Following an intensive course of treatment with our adapted form of MIT, her performance improved on both trained and untrained phrases, as well as on speech and language tasks. These behavioral improvements were accompanied by functional MRI changes in the right frontal lobe as well as by an increased volume of white matter pathways in the right hemisphere. No increase in white matter volume was seen in her healthy twin sister, who was scanned twice over the same time period. This case study not only provides further evidence for MITs effectiveness, but also indicates that intensive treatment can induce functional and structural changes in a right‐hemisphere fronto‐temporal network.

Effects of phonological neighbourhood on the treatment of naming in aphasia

Background: Phonological treatments to improve naming ability in aphasia focus on re-strengthening connections within the phonological system. Nonetheless, the efficacy of phonological treatments is still being explored with particular consideration of cognitive neuropsychological perspectives. Clinicians may also need to consider lexical factors that interact with the word retrieval process. Researchers have shown that phonological neighbourhood density influences normal language recognition and production, but limited evidence exists for how phonological neighbourhoods may affect the treatment of word retrieval deficits in individuals with aphasia. Aims: The present study explored if manipulating the emphasis on phonological neighbourhood during treatment has an effect on naming ability, particularly in an individual with predominantly phonologically based deficits. We hypothesised that training front- and end-matched words in a condition that emphasised phonological neighbourhood would result in greater naming improvements than training front- and end-matched words in a condition that does not emphasise neighbourhood. Methods & Procedures: In this case study, participant AH had a moderate phonologically based word naming deficit following a stroke. He produced phonemic paraphasias and neologisms in spontaneous speech and other spoken word production tasks. In treatment, AH was asked to name triplets of pictures of items that were phonologically related, sharing initial or final phonemes, or unrelated. Items were from either high- or low-density phonological neighbourhoods. High-density items were trained largely in the context of neighbours, therefore emphasising neighbourhood. Low-density items were not trained within a condition that emphasise neighbourhood. The treatment was administered for 9 weeks (27 sessions), with each condition, front-matched, end-matched and unrelated, trained for 8 consecutive sessions. AH’s naming accuracy on training words was assessed using a basic withdrawal design with three probe naming tests during the treatment phase and at 1-month post-therapy. Naming accuracy was also recorded during treatment sessions. Outcomes & Results: Front-matched words, in a condition that emphasises phonological neighbourhoods, had the greatest treatment effects, with a medium effect size when comparing pre- versus post-measures. A small treatment effect was observed for front-matched items where neighbourhood was not emphasised. Conclusions: Results suggest that front-matched triplets trained within a condition that emphasises phonological neighbourhoods may lead to the greatest treatment effect. Clinicians should be aware that stimulus parameters, such as phonological neighbourhood, may interact with the effectiveness of treatment protocols.

Repetition and a Beat-Based Timing Framework: What Determines the Duration of Intervals Between Repetitions of a Tapping Pattern?

The production of speech and music are two human behaviors that involve complex hierarchical structures with implications for timing. Timing constraints may arise from a human proclivity to form ‘self-organized’ metrical structures for perceived and produced event sequences, especially those that involve repetition. To test whether the propensity to organize events in time arises even for simple motor behaviors, we developed a novel experimental tapping paradigm investigating whether participants use the beat structure of a tapped pattern to determine the interval between repetitions. Participants listened to target patterns of 3, 4, or 5 events, occurring at one of four periodic rates, and tapped out the pattern 11 times, creating 10 inter-pattern intervals (IPIs), which participants chose freely. The ratio between mean IPI and mean inter-tap interval (ITI) was used to measure the beat-relatedness of the overall timing pattern; the closer this ratio is to an integer, the more likely the participant was timing the IPI to match a multiple of the target pattern beat. Results show that a beat-based strategy contributes prominently, although not universally, to IPI duration. Moreover, participants preferred interval cycles with even numbers of beats, especially cycles with four beats. Finally, the IPI/ITI ratio was affected by rate, with more beats of silence for the IPI at faster rates. These findings support the idea that people can generate a larger global timing structure when engaging in the repetition of simple periodic motor patterns, and use that structure to govern the timing of those motor events.

Speak along without the song: what promotes fluency in people with aphasia?

ABSTRACT Background: Melodic intonation therapy (MIT) is a widely used treatment for nonfluent aphasia that builds upon a number of musical elements in order to ultimately improve generative language. These include intoning syllables on different pitches, using a metrically regular speech rhythm, and the clinician and patient producing phrases in unison. Studies have investigated which of these musical elements might be the most clinically facilitating, but important differences in methodology and results across studies leave some questions unanswered. In particular, the relative roles of intoning and unison production remain unclear. Aims: The present study examined these elements in isolation and in combination. Methods & Procedures: Twelve people with aphasia (PWA) and 10 control participants sang and rhythmically spoke unfamiliar song lyrics in unison with a recording and by themselves. A subset of eight of the PWA returned for post-hoc testing to evaluate singing familiar lyrics from memory, and propositional speech. Across all tasks, productions were evaluated for syllable accuracy. Outcomes & Results: On average, PWA benefited from unison over solo production and from rhythmic speech over singing when repeating unfamiliar lyrics. They did show a benefit of singing when producing familiar lyrics from memory, but this post-hoc task did not control for syllable duration or task order. Within-group correlations indicated that those with more severe apraxia of speech, worse single-word auditory comprehension, and poorer repetition ability benefited the most from unison production. Those with better sentence-level auditory comprehension and poorer performance on a perceptual rhythm test tended to benefit more from singing compared to rhythmically speaking unfamiliar lyrics. Conclusions: Unison production is an important element for promoting fluency in many PWA, and perhaps especially for those for whom MIT is considered an appropriate treatment option. However, some candidates for MIT are hindered by the inclusion of even moderately complex melodic information, indicating that this factor should be considered when customizing or adapting the therapy. Finally, PWA who show a striking improvement in fluency when singing familiar songs will not necessarily benefit from singing when the aim is to produce new lyrics or propositional content.

Where is the beat

The ability to find the beat in a sequence of auditory events may be linked to the ability to learn vocal communication, raising the question of how beat structure in speech events relates to that in other event sequences. We conducted a series of entrainment experiments designed to compare spoken syllable repetition with tapping. Producing taps to a periodic string of auditorily-presented spoken /pa/ syllables resulted in the tap falling between the release burst for the /p/ and the onset of voicing for the vowel. This is consistent with participants intending to align their taps with the vowel onsets but exhibiting the well-documented Negative Mean Asynchrony (NMA) effect, such that the taps precede their “target.” The finding of alignment with the voicing onset is reminiscent of a large body of work on the P-center in repeated spoken syllables. In contrast, producing repeated utterances of the syllable /pa/ to an auditorily-presented click train resulted in coincident occurrence of the release burst wi...

Tapped Out: Do People With Aphasia Have Rhythm Processing Deficits?

PURPOSE In this study, the authors tested whether people with aphasia (PWAs) show an impaired ability to process rhythm, both in terms of perception and production. METHOD Two experiments were conducted. In Experiment 1, 16 PWAs and 15 age-matched control participants performed 3 rhythm tasks: tapping along to short rhythms, tapping these same rhythms from memory immediately after presentation, and making same-different judgments about pairs of tapped rhythms that they heard. Comparison tasks measured same-different judgment ability with visual stimuli and nonverbal working memory (Corsi blocks). In Experiment 2, 14 PWAs and 16 control participants made same-different judgments for pairs of auditory stimuli that differed in terms of rhythm or pitch (for comparison). RESULTS In Experiment 1, PWAs performed worse than control participants across most measures of rhythm processing. In contrast, PWAs and control participants did not differ in their performance on the comparison tasks. In Experiment 2, the PWAs performed worse than control participants across all conditions but with a more marked deficit in stimulus pairs that differed in rhythm than in those that differed in pitch. CONCLUSIONS The results support the hypothesis that at least some PWAs exhibit deficits of rhythm and timing. This may have implications for treatments involving tapping or other rhythmic cues.