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Melodic Intonation Therapy (MIT)

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Stacy Jackson

on 30 October 2013

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Transcript of Melodic Intonation Therapy (MIT)

Melodic
Intonation
Therapy
(MIT)

Neuroplasticity
The ability of the brain to change with experiences
The 3 Levels of MIT
Elementary, Intermediate, and Advanced
What is Melodic Intonation Therapy???
Developed in the 1970’s by Helm-Estabrooks and Albert
Based on observations of patients with severe aphasia who retained ability to sing
Right hemisphere functions may help to rehabilitate left-brain damage
Musical elements of speech—melody and rhythm—used to improve expressive language


Characteristics of
Good vs. Poor
candidates of MIT

Good Candidates
Elementary Level
Five steps
No score for the first step
Each consecutive step can earn 1 point
Intermediate Level
Four Steps
No score for the first step
Step 2 can earn 1 point
Steps 3 and 4 can earn 2 points
"Back-ups" can be used (If the pt. cannot produce the target following a delay,
a back up to the previous step is allowed
Efficacy
Early studies proved it is NOT successful with individuals with aphasia who have a comprehension disorder or good verbal repetition
In brain injury recovery, it refers to the ability of specific cortical areas to take over or become involved with functions once dedicated to now damaged areas
Melodic Intonation Therapy
was created on this premise!
What is Melodic Intonation Therapy???
Ozdemir, Norton, and Schlaug, 2006; Schlaug, Marchina, and Norton, 2009
• Treatment used for severe, nonfluent aphasia

• Often recommended 6+ months post-stroke

• Begin by intoning 2-3 syllable phrases,
to speaking phrases of 5 or more syllables across three levels of treatment (Elementary, Intermediate, Advanced)

• Therapists with little to no musical background can administer
o Well-trained patients and caregivers can learn to apply method

Uncover inherent melody in speech to gain fluency and increase expressive output!
Poor Candidates
• Unilateral, left-hemi stroke (Broca’s area)
• Poorly articulated, nonfluent, restricted verbal output
• Auditory comprehension that is moderately preserved
- Exceeding 45th percentile on
BDAE Rating Scale
• Poor repetition and articulated speech
- Rating of 3 or less on the
BDAE Profile of Speech Characteristics
• Well-motivated, emotionally stable, with good attention span

• Closed head trauma, bilateral strokes/surgery
• Moderately well-articulated speech, with
phrase length of four or more words
• Poor auditory comprehension, good word repetition, normal articulation for familiar words and phrases
• Emotionally unstable and/or pseudobulbar affect, poorly motivated, poor attention span


• Patient and therapist sit across from one another at table
• Table is necessary for the hand-tapping component
• Stimulus items should be high probability words, phrases, sentences
Preparing for an MIT session
• Consider phonological and syntactic complexity of words, as well as functionality for the client!
• Include pictures and/or
environmental cues
for saliency

Administering Stimulus Items

• Intone slowly, with constant voicing and the high/low tones, stress and rhythm associated with normal speech
- Continuous voicing facilitates verbal production

• Make sure patient can see how sounds are formed

• Right hand should be used to tap patient’s left; left hand is used to signal patient participation

• Hand tapping acts as a metronome and provides a continuous cue for syllable production
Advanced Level
Designed for return to normal prosody
5 steps
No score for step 2
Sprechgesang or speech-song is used

Immediate Repetition
Unison Singing
Clinician and patient tap the target in unison

*If client is unable to do this after four repetitions, a score of 0 is given and the next item is administered at step 1

*If the client is successful, move to step 3
Clinician hums the target
Clinician sings the target twice

*No response is required from the client, therefore no score is obtained
Humming
Unison with Fading
Clinician and client tap the target together but at the halfway point, the clinician fades out.

This should be done twice

If the client fails, the target is dropped and a new one is introduced at step 1

If the client is successful individually, move to step 4
In order to progress from one level to the next, the client must earn an overall score of 90% for 5 consecutive sessions
The clinician intones and taps the target while the patient listens.

Immediately following, the patient intones the target while the clinician taps on his/her hand

If the patient fails, the target is dropped and a new one is introduced at Step 1

If the patient is successful, move to Step 5
Response to a Question
Clinician immediately asks, "What did you say?" and then taps the client to assist them in answering the question

If the patient fails, score 0, drop the item and introduce a new item at Step 1

If the patient is successful, score a 1 and introduce a new item at Step 1
Step 5
Step 4
Step 3
Step 2
Step 1
Introducing the Item
Clinician intones the target phrase twice while tapping the client's hand

No response is required, no score is posible
Step 1
Unison with Fading
Clinician and client tap the target together but at the halfway point, the clinician fades out.

This should be done twice

If the client fails, the target is dropped and a new one is introduced at step 1

If the client is successful individually, move to step 3
Delayed Repetition
Clinician intones and taps the target and waits approximately 6 seconds

Clinician taps the client, the client has to verbalize the target individually

If the client is successful, the client gets a score of 2 and moves to step 4

If the patient fails, the clinician can back up to step 2 and try step 3 again.If the client is successful following the back up, he/she receives a 1 and moves to step 4

If he/she fails following a back up, the target is discontinued, a score of 0 is given and a new item is introduced at step 1
Step 2
Response to a Question
Clinician waits 6 seconds and intones, "What did you say?" without hand tapping

If the client is successful, the client gets a score of 2 and a new item is introduced

If the patient fails, the clinician backs up to step 3 and tries step 4 again.If the client is successful following the back up, he/she receives a 1 and a new item is introduced

If he/she fails following a back up, the target is discontinued, a score of 0 is given and a new item is introduced at step 1
Step 3
Step 4
Inner-Rehearsal
• Hand-over-hand tapping while therapist hums, then softly sings the words
- What patient is “hearing” sung “inside”
• Covert production creates auditory target to compare
- Helps to promote carry over
• May be particularly effective for addressing apraxia
• Beneficial in making the program more individualized; however, negatively affects treatment studies

Modified Melodic
Intonation Therapy
(MMIT)
• Clinician uses his/her judgment in developing treatment plans
• Modifications include:
- Therapist composes/uses novel melodic phrases
- Use of full phrases during initial treatment
- Work within early intervention/right hemisphere recruitment framework
• May make rehab more efficient and consistent
• May lessen frustration and withdrawal within individual patient
Resources
Albert, M., Sparks, R., & Helm, N. (1973). Melodic intonation therapy for aphasia. Archives Of
Neurology, 29(2), 130-131.Norton, A., Zipse, L., Marchina, S., & Schlaug, G. (2009).

Assessment: melodic intonation therapy. Report of the Therapeutics and Technology
Assessment Subcommittee of the American Academy of Neurology. (1994). Neurology, 44(3 Pt 1), 566-568.

Conklyn, D, Novak, E., Boissy, A., Franscois, B., & Chemali, K. (2012). The effects of Melodic
Intonation Therapy on nonfluent aphasia: A pilot study. Journal of Speech, Language, and Hearing Research, 55, 1463-1471.

Helm-Estabrooks, N. & Albert, M. L. (1991). Manual of aphasia therapy. Austin, TX: Pro-Ed.

Hough, M. S. (2010). Melodic Intonation Therapy and aphasia: Another variation on a theme.
Aphasiology, 24 (6-8), 775-786.

Norton, A., Zipse, L, Marchina, S., & Schlaug, G.Melodic Intonation Therapy: Shared insights on
how it is done and why it might help. The Neurosciences and Music III: Disorders and Plasticity: Annals of the New York Academy of Sciences, 1169, 431-436.

Sprechgesang or Speech-song
Transitional technique
Rhythm and stress are accentuated
Intonational characteristics are replaced by constantly changing pitch of speech, like choral speaking
Step 1
Delayed Repetition
Step 2
Introducing
Sprechgesang
Step 3
Sprechgesang
with Fading
Step 4
Delayed
Spoken Repetition
Step 5
Response to a
Question
Clinician intones and taps the target and waits approximately 6 seconds

Clinician taps the client's hand, the client has to verbalize the target individually

If the client is successful, the client gets a score of 2 and moves to step 2

If the patient fails, the clinician can provide a back-up (unison intoning of the phrase with the clinician fading) and tries step 1 again. If the client is successful following the back up, he/she receives a 1 and moves to step 2

If he/she fails following a back up, the target is discontinued, a score of 0 is given and a new item is introduced at step 1
Clinician introduces the target in sprechgesang twice.

Words are NOT sung, but are slow with exaggerated rhythm and stress

Hand tapping occurs

No response is required so no score is given
Clinician and patient start saying the target together in sprechgesang, clinician fades out and hand tapping stops

If the patient is successful, he/she receives a score of 2 and moves to step 4

If the patient fails, the clinician backs up to step 2 and tries step 3 again

If he/she is successful after a back up, give a score of 1 and move to step 4

If he/she fails following a back up, give a score of 0 and begin a new target at step 1

Clinician presents the target in normal speech prosody without hand tapping

The patient repeats the target in normal speech prosody

If the patient is successful, he/she gets a score of 2 and move to step 5

If he/she fails, back up to step 3 and try step 4 again. If he/she is successful following a back up, give a score of 1 and move to step 5

If he/she fails following a back up, give a score of 0 and introduce a new target at step 1
Clinician waits 6 seconds and intones, "What did I say?" with normal speech prosody and without hand tapping

The client must say the target with normal prosody

If the client is successful, the client gets a score of 2 and a new item is introduced

If the patient fails, the clinician backs up to step 4 and tries step 5 again. If the client is successful following the back up, he/she receives a 1 and a new item is introduced at step 1

If he/she fails following a back up, the target is discontinued, a score of 0 is given and a new item is introduced at step 1
Results vary:
Some believe MIT to be useless and some view it as very useful

Many individuals who utilize MIT only use selected aspects of it and do not follow the entire outlined program. This could contribute to its presumed effectiveness

Also, selection criteria is not strictly adhered to. MIT is not appropriate for many people with aphasia

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