Melodic Intonation Therapy for aphasia: A multi-level meta-analysis

IMPORTANCE: Melodic Intonation Therapy (MIT) is a prominent rehabilitation programme for individuals with post-stroke aphasia. Despite substantial progress in recent years, the efficacy of MIT remains not fully understood. OBJECTIVE: Based on a-priori hypotheses, the present meta-analysis investigated the efficacy of MIT while considering quality of outcomes (psychometrically validated versus unvalidated measures), experimental design (presence versus absence of randomisation and control group), influence of spontaneous recovery (quantified as number of months post-stroke), MIT version applied (original versus modified protocol), and level of generalisation (performance on trained versus untrained items). DATA SOURCES: An extensive literature search in all major online databases, trials registers and the grey literature identified 606 studies (years searched: 1973-2021). STUDY SELECTION: Inclusion criteria: randomised controlled trial (RCT) data or case reports on adults with aphasia; pre-post assessment of language performance. Exclusion criteria: substantial variation from original MIT protocol; unvalidated outcomes, unless both trained and untrained items were compared; essential information not indicated/retrievable. Final sample: 22 studies. DATA EXTRACTION AND SYNTHESIS: Following PRISMA guidelines, studies were double-coded. Multi-level mixed- and random-effects models were used to separately meta-analyse RCT and non-RCT data. MAIN OUTCOMES AND MEASURES: Measures of language performance focused on aphasia severity, everyday communication ability, domain-general function, language comprehension, non-communicative language expression, and speech-motor planning. RESULTS: Unvalidated outcomes appeared to attenuate MIT's effect size by a factor of 0.29-0.43 across study designs when compared to validated outcomes. Moreover, MIT's effect size was 5.7 times larger for non-RCT data compared to RCT data. Effect size also decreased with number of months post-stroke, suggesting confound through spontaneous recovery primarily within the first year post-stroke. In contrast, variation of the original MIT protocol did not systematically alter benefit from treatment. Crucially, analyses demonstrated significantly improved performance on trained and untrained items. The latter finding arose mainly from gains in repetition tasks, rather than other domains of verbal expression including everyday communication ability. CONCLUSIONS AND RELEVANCE: Accounting for various methodological aspects, the current results confirm the promising role of MIT in improving language performance on trained items and in repetition tasks, while highlighting possible limitations in promoting everyday communication ability.

Novel Advances to Post-Stroke Aphasia Pharmacology and Rehabilitation

Aphasia is one of the most common clinical features of functional impairment after a stroke. Approximately 21–40% of stroke patients sustain permanent aphasia, which progressively worsens one’s quality of life and rehabilitation outcomes. Post-stroke aphasia treatment strategies include speech language therapies, cognitive neurorehabilitation, telerehabilitation, computer-based management, experimental pharmacotherapy, and physical medicine. This review focuses on current evidence of the effectiveness of impairment-based aphasia therapies and communication-based therapies (as well as the timing and optimal treatment intensities for these interventions). Moreover, we present specific interventions, such as constraint-induced aphasia therapy (CIAT) and melodic intonation therapy (MIT). Accumulated data suggest that using transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS) is safe and can be used to modulate cortical excitability. Therefore, we review clinical studies that present TMS and tDCS as (possible) promising therapies in speech and language recovery, stimulating neuroplasticity. Several drugs have been used in aphasia pharmacotherapy, but evidence from clinical studies suggest that only nootropic agents, donepezil and memantine, may improve the prognosis of aphasia. This article is an overview on the current state of knowledge related to post-stroke aphasia pharmacology, rehabilitation, and future trends.

Melodic Intonation Therapy for Post-stroke Non-fluent Aphasia: Systematic Review and Meta-Analysis

Introduction: Melodic intonation therapy (MIT) is one of the most studied speech and language therapy (SLT) approaches for patients with non-fluent aphasia, although the methodological quality of the studies has been rated as low in previous reviews. The aim of this study is to update current evidence on the possible efficacy of MIT for the treatment of non-fluent post-stroke aphasia.Methods: A systematic review and meta-analysis. We selected randomized clinical trials (RCT) that included adult patients over 18 years of age with non-fluent post-stroke aphasia, whose intervention was MIT vs. no therapy or other therapy. We excluded non-RCT studies, mixed populations including patients with aphasia of non-stroke etiology, studies with no availability of post-stroke aphasia-specific data, and incomplete studies. Three sections of communicative ability were analyzed as outcomes: functional communication, expressive language (naming and repetition), and comprehension.Results: We identified a total of four eligible RCTs involving 94 patients. Despite the heterogeneity in the psychometric tests employed among the trials, a significant effect of MIT on functional communication (evaluated by the Communication Activity Log) was found (SMD 1.47; 95% CI 0.39–2.56). In addition, a positive effect of MIT on expressive language (repetition) was found (SMD 0.45; 95% CI 0.01–0.90). No significant effects on comprehension measurements were found, despite a lack of significant statistical heterogeneity.Conclusion: This systematic review and meta-analysis shows a significant effect of MIT on improving functional communication and on repetition tasks. Future larger RCT specifically addressing those outcomes should provide the definite evidence on the efficacy of MIT on post-stroke aphasia recovery.Systematic Review Registration:PROSPERO-URL https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020144604.

Effectiveness of Melodic Intonation Therapy in Chinese Mandarin on Non-fluent Aphasia in Patients After Stroke: A Randomized Control Trial

Melodic intonation therapy (MIT) positively impacts the speech function of patients suffering from aphasia and strokes. Fixed-pitch melodies and phrases formulated in MIT provide the key to the target language to open the language pathway. This randomized controlled trial compared the effects of music therapy-based MIT and speech therapy on patients with non-fluent aphasia. The former is more effective in the recovery of language function in patients with aphasia. Forty-two participants were enrolled in the study, and 40 patients were registered. The participants were randomly assigned to two groups: the intervention group (n = 20; 16 males, 4 females; 52.90 ± 9.08 years), which received MIT, and the control group (n = 20; 15 males, 5 females; 54.05 ± 10.81 years), which received speech therapy. The intervention group received MIT treatment for 30 min/day, five times a week for 8 weeks, and the control group received identical sessions of speech therapy for 30 min/day, five times a week for 8 weeks. Each participant of the group was assessed by a Boston Diagnostic Aphasia Examination (BDAE) at the baseline (t1, before the start of the experiment), and after 8 weeks (t2, the experiment was finished). The Hamilton Anxiety Scale (HAMA) and Hamilton Depression Scale (HAMD) were also measured on the time points. The best medical care of the two groups is the same. Two-way ANOVA analysis of variance was used only for data detection. In the spontaneous speech (information), the listening comprehension (right or wrong, word recognition, and sequential order) and repetitions of the intervention group were significantly higher than the control group in terms of the cumulative effect of time and the difference between groups after 8 weeks. The intervention group has a significant time effect in fluency, but the results after 8 weeks were not significantly different from those in the control group. In terms of naming, the intervention group was much better than the control group in spontaneous naming. Regarding object naming, reaction naming, and sentence completing, the intervention group showed a strong time accumulation effect. Still, the results after 8 weeks were not significantly different from those in the control group. These results indicate that, compared with speech therapy, MIT based on music therapy is a more effective musical activity and is effective and valuable for the recovery of speech function in patients with non-fluent aphasia. As a more professional non-traumatic treatment method, MIT conducted by qualified music therapists requires deeper cooperation between doctors and music therapists to improve rehabilitating patients with aphasia. The Ethics Committee of the China Rehabilitation Research Center approved this study (Approval No. 2020-013-1 on April 1, 2020) and was registered with the Chinese Clinical Trial Registry (Registration number: Clinical Trials ChiCTR2000037871) on September 3, 2020.

Adaptation of Melodic Intonation Therapy to Greek: A Clinical Study in Broca’s Aphasia With Brain Perfusion SPECT Validation

Melodic intonation therapy (MIT) is one of the most well-known treatment methods which is based on pitch and rhythm and was developed to increase verbal output in adults with non-fluent aphasia. Although MIT has been adapted to several languages, in Greece it is almost unknown. The aim of the proposed study is twofold: (1) to translate and adapt the MIT to the Greek language, and (2) to conduct an experimental study in order to examine the effect of MIT on Greek patients with Broca’s aphasia. To this aim, a 64-year-old, right-handed male who had a 6-year primary school education level, no musical abilities and poor performance on the recognition of prosody attended the MIT intervention program almost two and a half years after the event of suffering an ischemic stroke. The MIT intervention was administered three times per week for a 12-week period, in which each session lasted from 30 to 40 min. The patient underwent three assessments all using both the Boston Diagnostic Aphasia Examination–Short Form (BDAE-SF) and brain perfusion single-photon emission computed tomography (SPECT); (1) before the MIT, (2) immediately after, and (3) 3 months after the completion of MIT. The results from the BDAE-SF revealed an impressive improvement on both trained and prepositional speech production, immediately after the completion of the MIT, and a stable improved performance 3 months after MIT. The SPECT scan revealed reactivation of the perilesional areas of the left hemisphere, and considerably improved perfusion of the frontal lobe, the anterior temporal lobe, and the upper part of the parietal lobe of the right hemisphere. The improvement persisted and even expanded 3 months after MIT. Therefore, MIT is a promising intervention program and its positive effects last for at least 3 months after the completion of the intervention.

Runas un valodas attīstības traucējumi, to korekcija un profilakse mūzikas terapijas praksē

Language is the most important instrument of communication that permits to express thoughts, feelings, sensations, desires and needs and to describe and comprehend emotions. Music without words can evoke strong emotional reactions by directly affecting emotional centres in the brain. Playing of music instrument or even listening to music can create neuroplastic changes in brain by activating compensatory mechanisms. Whereas during the listening to the music that is pleasant and preferred by the client, dopamine is released which is necessary for creating new neuron connections in the brain. Music therapy provides possibilities of effective treatment, the decrement of complications and disorders, as well as learning and recovering of skills for both children and adults with various speech and language disorders. In Latvia the integrative eclectic approach is being developed in music therapy. It permits to apply both creative music therapy methods and techniques and receptive techniques that are based on listening to music. For children with speech and language disorders more suitable are creative music therapy techniques that facilitate the awareness of oneself and one’s resources, the improvement of interaction, cooperation and communication skills, emotional expressions and control, the development of the speech motor system and the improvement of language skills. Music therapy is one of the few treatment possibilities that includes simultaneous work on improving motor skills and recognition of emotional difficulties and their solving. It is essential for patients that stutter to get help in correcting along with the psychological and emotional support and help. For patients after a stroke and with aphasia of various origins recommended and effective for recovering and improving speech and language skills are Melodic intonation therapy, SIPARI®, listening to music, as well as playing music in both individual and group therapies. Playing music as multisensory activity which activates and connects such areas and systems in the brain that normally are not working together. Therefore, it can stimulate the overtaking of the lost skills by non-damaged brain parts and restores speech and language skills.

Music supported therapy in neurorehabilitation

Music-induced brain plasticity is a powerful means to improve neurologic function in rehabilitation following brain injury or degenerative disease. In motor dysfunctions following stroke, keyboard playing may improve fine motor functions along with neurophysiological changes in audiomotor networks. Rhythmic cueing has a positive effect in gait disorders, improving stride length, speed, and overall mobility. Melodic intonation therapy can improve recovery from non-fluent aphasia via activation of right-hemispheric networks. Music supported therapy can at least temporarily improve cognition in dementia and may have impact on rehabilitation of disorders of consciousness. Effects of music-induced brain plasticity together with music’s ability to tap into the emotion and reward system in the brain can thus be used to facilitate neurorehabilitation.