After a stroke or traumatic brain injury, patients often suffer a more or less pronounced loss of speech. Melodic intonation therapy has been used for some time to help patients regain speech. This is a treatment method that enables patients to learn to speak again through singing.
What is melodic intonation therapy?
To regain speech, after a stroke or traumatic brain injury, Melodic Intonation Therapy has been used for some time. A treatment method that enables patients to learn to speak again through singing. The so-called Broca’s center in the left hemisphere of the brain is the speech center and thus responsible for speech. If this area is destroyed by a stroke or accident, patients are either unable to speak at all or only rudimentarily. Their sentences do not sound fluent, but choppy, as if in telegram style. The loss of speech is a considerable psychological burden for all those affected. And relearning words and sentences proves to be an arduous and long path. Melodic Intonation Therapy, or MIT for short, has made this much easier and has been very successful. The first approaches to this came from the American neurologist Charles Mills, who observed as early as 1904 that stroke patients could no longer speak, but could still sing. Based on these findings, melodic intonation therapy was developed in the course of the 1970s. In doing so, neurologists took advantage of the fact that the brain is very capable of learning. Once the brain is stimulated to do so, new connections between neurons are constantly formed. If one part of the brain is damaged, another part takes over its work. This is also the case when Broca’s center is destroyed. This center is located in the left hemisphere of the brain in right-handed people (and vice versa in left-handed people). In this respect, the right brain hemisphere is able to take over the tasks of the damaged left brain hemisphere. While language is processed in the left brain hemisphere, the right brain hemisphere is responsible for music. This is also true for speech melody, for the musical aspects of speech, and for important functions that support singing. However, recent research suggests that it is not sounds alone that enable people to speak again after brain failure. Rhythm apparently plays a major, if not the major, role. Especially in the case of a stroke, patients have difficulty with the beat. A rhythmic beat generator, such as a metronome, or targeted rhythmic speaking, clapping or tapping seem to significantly improve patients’ speech motor skills. Therefore, music and rhythm are combined in MIT.
Function, effect, and goals
To achieve success with Melodic Intonation Therapy, some prerequisites are necessary. Only one hemisphere of the brain must be affected, and only Broca’s area, that is, the speech center. While the patient himself can hardly or no longer speak, his speech comprehension should still function to some extent. It is important that he is at least aware of his linguistic errors and has the ability to self-correct. It is also necessary that the patient is exceptionally motivated. MIT requires a high attention span and a lot of patience from the therapy participants. The treatment itself is offered as group or individual therapy. Usually, individual therapy is started with sessions no more than twice a week, each lasting 30 minutes. As treatment progresses, most patients readily take up the group offering. MIT consists of two basic elements: melody and rhythm. Therapy begins with simple phrases or word sequences, such as “Good morning.” The therapist sings these words to the patients, accompanied by rhythmic tapping. Patients chant the words and in turn tap the rhythm with their right hand to activate the damaged left brain area. The goal is to help patients regain simple everyday communication. The therapy consists of four stages, which in turn are made up of several steps. MIT is considered complete when an average of 90 percentage points has been achieved in the last stage. Almost all patients show a significant improvement after just a few weeks.They are again able to articulate small sentences such as, “I’m hungry” in an understandable way. Studies show that after 75 therapy sessions, patients have a vocabulary of several thousand words who were unable to speak a single word before treatment began. And there are examples of patients giving fluent lectures after MIT. Magnetic resonance images have also shown that patients’ brains changed after MIT. For example, the right side of the brain was shown to be more active than before MIT began. Evidence that the right side took over the failed functions of the left side of the brain.
Risks, side effects, and hazards
Melodic intonation therapy is not the only speech therapy used after brain failures, to be sure. However, it offers an opportunity to all those patients for whom conventional treatment methods fail. This is the case when patients with particularly severe damage have completely lost their ability to speak. This is where conventional speech therapies reach their limits, as they require at least some residual speech to be able to start treatment at all. With MIT, these patients have the opportunity to first learn a few words and simple sentences. This, in turn, opens the way for them to continue with other therapies later on to continually increase their speech and word shank.
