Effects of melodic intonation therapy in patients with chronic nonfluent aphasia

• Published in: Annals of the New York Academy of Sciences Vol. 1519; no. 1; pp. 173 - 185
• Main Authors: Marchina, Sarah, Norton, Andrea, Schlaug, Gottfried
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 01.01.2023
• Subjects: Aphasia; Aphasia, Broca - pathology; Aphasia, Broca - therapy; Assessments; Auditory stimuli; Feedback control; Feedforward control; Functional magnetic resonance imaging; Hemispheric laterality; Humans; Lesions; Magnetic Resonance Imaging; melodic intonation therapy; MRI; Music therapy; neuroplasticity; neurorehabilitation; Prefrontal Cortex; Speech; Speech Therapy - methods; Stroke; stroke recovery; Supplementary motor area; Therapy; aphasia; stroke recovery; melodic intonation therapy; MRI; neurorehabilitation; neuroplasticity
• ISSN: 0077-8923; 1749-6632; 1749-6632
• DOI: 10.1111/nyas.14927

Patients with large left‐hemisphere lesions and post‐stroke aphasia often remain nonfluent. Melodic intonation therapy (MIT) may be an effective alternative to traditional speech therapy for facilitating recovery of fluency in those patients. In an open‐label, proof‐of‐concept study, 14 subjects with nonfluent aphasia with large left‐hemisphere lesions (171 ± 76 cc) underwent two speech/language assessments before, one at the midpoint, and two after the end of 75 sessions (1.5 h/session) of MIT. Functional MR imaging was done before and after therapy asking subjects to vocalize the same set of 10 bi‐syllabic words. We found significant improvements in speech output after a period of intensive MIT (75 sessions for a total of 112.5 h) compared to two pre‐therapy assessments. Therapy‐induced gains were maintained 4 weeks post‐treatment. Imaging changes were seen in a right‐hemisphere network that included the posterior superior temporal and inferior frontal gyri, inferior pre‐ and postcentral gyri, pre‐supplementary motor area, and supramarginal gyrus. Functional changes in the posterior right inferior frontal gyri significantly correlated with changes in a measure of fluency. Intense training of intonation‐supported auditory‐motor coupling and engaging feedforward/feedback control regions in the unaffected hemisphere improves speech‐motor functions in subjects with nonfluent aphasia and large left‐hemisphere lesions. Patients with large left‐hemisphere lesions and post‐stroke aphasia often remain nonfluent. Melodic Intonation Therapy (MIT) may be an effective alternative to traditional speech therapy. Subjects with nonfluent aphasia and large left‐hemisphere lesions demonstrated long‐lasting, significant improvements in speech output and changes in a right‐hemisphere network after a period of intensive MIT. Intonation‐supported changes in auditory‐motor coupling improves speech‐motor functions in subjects with nonfluent aphasia and large left‐hemisphere lesions.