Melodic Intonation Therapy and aphasia: Another variation on a theme

Background: Melodic Intonation Therapy (MIT) is a therapeutic approach used to increase verbal output in adults with aphasia through combination of melodic intoning and rhythmic tapping with simple phrase production. Although MIT was developed in the 1970s, few studies have been conducted relative to determining the programme's overall effectiveness as well as examining ability to generalise skills to other communicative contexts. Aims: The purpose of the current investigation was to examine the effectiveness of MIT as a means of increasing verbal output in a gentleman with chronic Broca's aphasia. Methods Procedures: A modified version of MIT without the tapping component was implemented with BR, 69-year-old male with chronic Broca's aphasia of 4 years' duration. BR had tried MIT previously with little success: he had difficulty with the tapping element and the packaged phrases lacked functionality, adversely affecting his motivation. A set of automatic and self-generated phrases were developed and implemented with a multiple baseline design across phrase type with an established criterion of 75% accuracy over two consecutive sessions for both stimulus sets. Generalisation stimuli were presented at the last weekly session. BR attended three hour-long weekly sessions, for 8 weeks. Follow-up probing with all stimuli occurred at 2 and 4 weeks post-treatment. A set of standardised tests and social validation measures were administered pre- and post-treatment. Outcomes Results: BR reached 75% accuracy on automatic phrases at 4 weeks into the treatment programme, which was retained throughout the maintenance phase and both follow-up sessions. Performance on self-generated phrases was 55% at 8 weeks -post-treatment, which was maintained at both follow-up sessions. Separate Welch two s-ample t-tests used to analyse the automatic and self-generated phrase data, yielded highly significant treatment effects for both data sets, with non-significant findings for autocorrelation. Improved performance on standardised tests was observed most no-tably for auditory comprehension and reading and writing skills, with some improvement in spontaneous speech and naming. Increased perception of communicative effectiveness was reported independently by both BR and his spouse. Conclusions: Overall, BR significantly increased his ability to produce short phrases using MIT without tapping. Thus MIT appears to be a viable option for enhancing verbal output for some individuals with non-fluent aphasia, regardless of time post-stroke. Additional investigations are needed to examine generalisation effects to other linguistic contexts. Efficiency issues (treatment length, intensity) require further exploration relative to MIT efficacy and effectiveness and its variations.