Speak to the rhythm: how melodic intonation therapy helps stroke survivors learn to talk again
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by Emily Swaim
Each year 795,000 Americans have a stroke. Roughly one third of stroke survivors develop a condition called aphasia, which is when damage to the language centers in your brain may make it hard to speak, read, or understand words.
Even if a stroke has damaged the language parts of your brain, the areas that process music could still be intact. If you have aphasia, melodic intonation therapy (MIT) can teach you to “sing” your speech so you produce words more easily.
How does melodic intonation therapy work?
“A typical MIT session is 30 to 60 minutes, four to seven days per week,” says Danielle Porter, MM, MT-BC, music therapy coordinator at Brooks Rehabilitation. Treatment sessions may last between three and six weeks.
To start, you and your therapist sit across from each other. Your therapist sings a short, simple phrase, such as “Time to wake UP” or “Take a BUB-ble bath.”
The tune is basically an exaggerated version of typical speech rhythms: stressed syllables have higher notes for emphasis, and syllables in the same word are sung quickly together. But unlike everyday speech, the melody is slower and more clearly defined.
After you hear the phrase, you and the therapist repeat it together. You also tap along with the rhythm with your left hand — this movement helps you keep the beat. You practice singing around 20 everyday phrases together until you can say them all.
Once you’ve mastered singing together with the therapist, you’ll level up to more difficult exercises. The therapist may give you longer phrases to speak, up to. Or they may sing the first half of a melody with you, then fade off so you finish alone. The end goal is to be able to sing the lines all by yourself.
Depending on your situation, being able to sing basic phrases may be enough to communicate in your daily life. If you want to go further, your therapist can wean you off of the song-speech, helping you rely less on exaggerated notes and rhythms to talk. This way, your communication takes on the subtler melodies of everyday speech.
Alissa Thaler
When does melodic intonation therapy work best?
MIT works best if you have the non-fluent type of aphasia, meaning you can still understand the words you hear but have trouble organizing your thoughts into a response. You may skip over words or repeatedly pause to recall a name on the tip of your tongue.
MIT can also help with apraxia, which is when you struggle to direct your mouth and tongue to make the right sounds.
Ideally, a speech-language pathologist or music therapist will start performing MIT shortly after your stroke. “It is always best to capitalize on neuroplasticity and brain recovery earlier in the rehabilitation process,” Porter says. “However, this intervention can be done at any time.”
While you don’t need to be a musical genius to benefit from MIT, some familiarity with music can help. “Patients who are avid music listeners, enjoy singing, or are musicians or singers tend to progress more quickly than those who are not,” Porter says.
Melodic intonation therapy and the brain
Evidence shows MIT can improve functional communication (getting your basic wants and needs known). Experts believe this therapy works through neuroplasticity, your brain’s ability to rewire its neurons. Speaking and singing are processed on both sides of the brain, but in general, speaking is a left-brained activity and singing is a right-brained one. When your brain’s language center in the left hemisphere is damaged, MIT can prompt your brain to reassign language duties to the right hemisphere.
Brain imaging studies show that after MIT, neurons in the right hemisphere are often more active during language tasks, suggesting they’ve taken over speech functions. Scientists aren’t fully sure how MIT accomplishes this relocation, though.
One mechanism may be the song itself. Your right hemisphere specializes in processing musical elements like rhythm and pitch. Singing your words may retrain the neurons there to treat words like another element of music. Another reason MIT works may be the tapping you perform alongside the rhythm. Tapping your left hand activates the motor cortex in your right hemisphere. The sections of your motor cortex that control hand movement and mouth movement sit very close together. Activating the hand area may “wake up” the neighboring mouth area in your brain. This gives you more control over your lips and tongue so you can articulate your words better.
Lastly, some people believe MIT engages your mirror neurons, which help you copy the actions of others. As you watch and listen to your therapist sing practice phrases, your mirror neurons immediately start processing those sights and sounds so you can repeat them. This extra processing power can lighten the workload for the rest of your brain while you try to speak.
Alissa Thaler
How to get melodic intonation therapy
The doctors treating you for stroke will likely refer you to rehabilitative services like MIT when they feel you have recovered enough to work on therapy. Typically, MIT specialists hold sessions in person. But some providers, like the Evelyn Hendren Cassat Speech-Language-Hearing Clinic, have begun providing telehealth MIT.
“One benefit of teletherapy is that a client may be able to receive therapy services from an excellent therapist without distance being a limiting factor,” says Erin O’Bryan, PhD, CCC-SLP, a speech-language pathologist at the Evelyn Hendren Cassat Speech-Language-Hearing Clinic and assistant professor of communications sciences and disorders at Wichita State University.
During the early pandemic, O’Bryan worked on the first study to use telehealth MIT. She says most of the procedures were the same, although the two study participants were inconsistent with their hand-tapping without a clinician in the room to help. Even so, both saw notable improvement in their ability to produce words.
In addition, some speech therapy apps, like Tactus Therapy, use elements of MIT. However, there are no studies yet measuring how well MIT apps work. You may want to consult with your care team before adding a particular app to your therapy program.