Melodic-Intonation-Therapy and Speech-Repetition-Therapy for Patients With Non-fluent Aphasia
| Status: | Recruiting |
|---|---|
| Conditions: | Neurology |
| Therapuetic Areas: | Neurology |
| Healthy: | No |
| Age Range: | 21 - 80 |
| Updated: | 1/3/2019 |
| Start Date: | February 2008 |
| End Date: | December 2019 |
| Contact: | Gottfried Schlaug, MD, PhD |
| Email: | gschlaug@bidmc.harvard.edu |
| Phone: | 617-632-8926 |
Behavioral and Neural Correlates of Melodic-Intonation-Therapy (MIT) and Speech-Repetition-Therapy (SRT) for Patients With Non-fluent Aphasia
We are doing this clinical trial in order to evaluate two different treatments for non-fluent
aphasia: Melodic Intonation Therapy (MIT) and Speech Repetition Therapy (SRT). MIT uses a
simple form of singing, while SRT uses intensive repetition of a set of words and phrases. We
want to see which intensive form of treatment is more effective in leading to an improvement
in speech output compared to a no-therapy control period, and whether either treatment can
cause changes in brain activity during speaking and changes in brain structure. We will use a
technique known as functional Magnetic Resonance Imaging (fMRI) to measure blood flow changes
in the brain and structural MRI that assess brain anatomy and connections between brain
regions. We will use fMRI to assess brain activity while a patient speaks, sings, and hums.
We will assess changes in brain activity and in brain structure by comparing scans done prior
to treatment to scans obtained after treatment and we will also examine changes between
treatment groups. We will correlate changes in brain activity and brain structure with
changes in language test scores.
aphasia: Melodic Intonation Therapy (MIT) and Speech Repetition Therapy (SRT). MIT uses a
simple form of singing, while SRT uses intensive repetition of a set of words and phrases. We
want to see which intensive form of treatment is more effective in leading to an improvement
in speech output compared to a no-therapy control period, and whether either treatment can
cause changes in brain activity during speaking and changes in brain structure. We will use a
technique known as functional Magnetic Resonance Imaging (fMRI) to measure blood flow changes
in the brain and structural MRI that assess brain anatomy and connections between brain
regions. We will use fMRI to assess brain activity while a patient speaks, sings, and hums.
We will assess changes in brain activity and in brain structure by comparing scans done prior
to treatment to scans obtained after treatment and we will also examine changes between
treatment groups. We will correlate changes in brain activity and brain structure with
changes in language test scores.
One of the few accepted treatments for severe non-fluent aphasia is Melodic Intonation
Therapy (MIT). Inspired by the common clinical observation that patients can actually sing
the lyrics of a song better than they can speak the same words, MIT emphasizes the prosody of
speech through the use of slow, pitched vocalization (singing), and has been shown to lead to
significant improvements in propositional speech beyond the actual treatment period. It has
been hypothesized that this effect is due to the gradual recruitment of right-hemispheric
language regions for normal speech production, and this is further supported by our
functional magnetic resonance imaging (fMRI) pilot data. Although the MIT-induced treatment
effect has been shown in several small case series, it is not clear whether the effect is due
to the intensity of the treatment or to the unique, components of MIT that are not found in
other, non-intonation-based interventions. Thus, our overall aim is to test our hypothesis
that MIT's rehabilitative effect is achieved by using its melodic and rhythmic elements to
engage and/or unmask the predominantly right-hemispheric brain regions capable of supporting
expressive language function. In order to test this hypothesis, we have developed an
experimental design that includes the randomization of chronic stroke patients with
persistent, moderate to severe non-fluent aphasia into three parallel groups receiving 1) 75
sessions of Melodic Intonation Therapy (approximately 15 weeks), 2) 75 sessions of an equally
intensive, alternative verbal treatment method developed for this study (Speech Repetition
Therapy), or 3) an equal period of No Therapy. All patients will undergo two pre-therapy and
two post-therapy behavioral assessments in addition to the pre- and post-therapy fMRI studies
and structural MRI studies examining the neural correlates of overtly spoken and sung words
and phrases.This design allows us to 1) examine the efficacy of MIT over No Therapy, 2)
examine the effects of elements specific to MIT (e.g., melodic intonation and rhythmic
tapping) by comparing it to a control intervention (SRT) that is similar in structure and
intensity of treatment, 3) compare post-therapy effects with pre-therapy baseline variations,
and 4) examine post-treatment maintenance effects. Our primary speech outcome measure will be
the number of Correct Information Units (CIU)/min produced during spontaneous speech.
Secondary outcome measures include correctly named items on standard picture naming tests,
timed automatic speech, and linguistically-based measures of phrase and sentence analysis.
Therapy (MIT). Inspired by the common clinical observation that patients can actually sing
the lyrics of a song better than they can speak the same words, MIT emphasizes the prosody of
speech through the use of slow, pitched vocalization (singing), and has been shown to lead to
significant improvements in propositional speech beyond the actual treatment period. It has
been hypothesized that this effect is due to the gradual recruitment of right-hemispheric
language regions for normal speech production, and this is further supported by our
functional magnetic resonance imaging (fMRI) pilot data. Although the MIT-induced treatment
effect has been shown in several small case series, it is not clear whether the effect is due
to the intensity of the treatment or to the unique, components of MIT that are not found in
other, non-intonation-based interventions. Thus, our overall aim is to test our hypothesis
that MIT's rehabilitative effect is achieved by using its melodic and rhythmic elements to
engage and/or unmask the predominantly right-hemispheric brain regions capable of supporting
expressive language function. In order to test this hypothesis, we have developed an
experimental design that includes the randomization of chronic stroke patients with
persistent, moderate to severe non-fluent aphasia into three parallel groups receiving 1) 75
sessions of Melodic Intonation Therapy (approximately 15 weeks), 2) 75 sessions of an equally
intensive, alternative verbal treatment method developed for this study (Speech Repetition
Therapy), or 3) an equal period of No Therapy. All patients will undergo two pre-therapy and
two post-therapy behavioral assessments in addition to the pre- and post-therapy fMRI studies
and structural MRI studies examining the neural correlates of overtly spoken and sung words
and phrases.This design allows us to 1) examine the efficacy of MIT over No Therapy, 2)
examine the effects of elements specific to MIT (e.g., melodic intonation and rhythmic
tapping) by comparing it to a control intervention (SRT) that is similar in structure and
intensity of treatment, 3) compare post-therapy effects with pre-therapy baseline variations,
and 4) examine post-treatment maintenance effects. Our primary speech outcome measure will be
the number of Correct Information Units (CIU)/min produced during spontaneous speech.
Secondary outcome measures include correctly named items on standard picture naming tests,
timed automatic speech, and linguistically-based measures of phrase and sentence analysis.
Inclusion Criteria:
1. 21-80 years of age
2. first-time ischemic left-hemispheric stroke or cerebrovascular accident
3. at least 12 months out from first ischemic stroke
4. right-handed (prior to stroke)
5. diagnosis of non-fluent or dysfluent aphasia
Exclusion Criteria:
1. older than 80 years of age
2. more than 1 stroke
3. presence of metal or metallic or electronic devices that cannot be exposed to the MRI
environment
4. a terminal medical condition; history of major neurological or psychiatric diseases
(e.g. epilepsy; meningitis, encephalitis)
5. use of psychoactive drugs/medications such as antidepressants, antipsychotic,
stimulants
6. active participation in other stroke recovery trials testing experimental
interventions
We found this trial at
1
site
Boston, Massachusetts 02115
Principal Investigator: Gottfried Schlaug, MD, PhD
Phone: 617-632-8926
Click here to add this to my saved trials
