Melodic-Intonation-Therapy and Speech-Repetition-Therapy for Patients With Non-fluent Aphasia
Condition: Aphasia; Stroke; Cerebrovascular Accident; Apoplexy; Cerebral Infarction
MeSH terms: Stroke; Aphasia; Cerebral Infarction; Aphasia, Broca; Infarction
Study type: Interventional
Phase: Phase 3

Summary: 
      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.
    

Detailed description: 
      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.
    

Intervention name(s): Melodic Intonation Therapy; Speech-Repetition-Therapy
Intervention type(s): Behavioral; Behavioral
Intervention description(s): MIT emphasizes the prosody of speech through the use of slow, pitched vocalization (singing).; Speech-Reception-Therapy is an equally intensive, alternative verbal treatment method developed for this study.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: Aphasia; Speech Impairment; Stroke; Cerebrovascular Accident; Cerebral Infarction; Brain Ischemia; Brain Infarction; Cerebrovascular Disorder