The Effectiveness of Addition of Melodic Intonation Therapy on Language Ability in Stroke Patients with Broca’s Aphasia: A Pilot Randomized Controlled Trial
Keywords:
aphasia, speech therapy, stroke, rehabilitationAbstract
Objectives: To evaluate the effectiveness of adding melodic intonation therapy (MIT) to conventional therapy in improving language abilities in Thai-speaking stroke patients with Broca’s aphasia
Study design: A pilot randomized controlled trial
Setting: Three government hospitals in Thailand
Subjects: Eleven stroke survivors diagnosed with Broca’s aphasia were enrolled in the study; eight completed the intervention and were analyzed.
Methods: Participants were randomly assigned to receive either conventional speech therapy or conven-tional therapy combined with MIT. Participants received three hours of therapy a week for eight weeks (two 30-minute sessions with a speech-language pathologist (SLP) and four 30-minute home-based sessions conducted by a caregiver). A blinded SLP assessed outcomes using the Thai adaptation of the Western Aphasia Battery (WAB) at baseline and three months post-baseline. Non-parametric tests (Wilcoxon Signed-Rank and Mann-Whitney U tests) were used due to the small sample size.
Results: The median age of participants was 56.5 years (IQR: 50.8-57.8) in the conventional group and 58.0 years (IQR: 33.5-67.5) in the conventional with MIT group. The median post-onset duration was longer in the conventional group (5.4 months, IQR: 2.4-9.8) compared to the MIT group (2.6 months, IQR: 1.0-4.6). Both groups showed improvements in fluency, comprehension, repetition, naming, and Aphasia Quotient (AQ). The MIT group demonstrated significantly greater gains in repetition and naming (p < 0.05).
Conclusions: The findings of this pilot study suggest that adding MIT to conventional therapy may enhance repetition and naming abilities in Thai-speaking individuals with Broca’s aphasia. This finding supports the adaptation of MIT for tonal language contexts and highlights its potential in aphasia rehabilitation programs in Thailand. However, due to the limited sample size and statistical power, further research with larger samples is needed to confirm these findings.
References
World Health Organization. The top 10 causes of death [Internet]. 2021 [cited 2024 Feb 1]. Available from: https://www.who.int/news-room/fact-sheets/detail/the-top-10-causes-of-death
Department of Disease Control, Ministry of Public Health. Stroke awareness campaign for World Stroke Day 2021: “Recognize the warning signs of stroke, every second counts” [Internet]. 2021 Oct 28 [cited 2024 Feb 1]. Available from: https://ddc.moph.go.th/brc/news.php?news=29284&deptcode=
Jariengprasert C. Speech therapy in cerebrovascular disease patient with communication problems. Vichaiyut Newsletter. 2005 [cited 2020 June 17].
Engelter ST, Gostynski M, Papa S, Frei M, Born C, Ajdacic-Gross V, et al. Epidemiology of aphasia attributable to first ischemic stroke: incidence, severity, fluency, etiology, and thrombolysis. Stroke. 2006 Jun [cited 2020 June 17];37(6):1379-84. doi: 10.1161/01.STR.0000221815.64093.8c. Epub 2006 May 11. PMID: 16690899
Ruamsuk S, Ngamsri A. The study of speech and language scores of Thai adaptation of Western Aphasia Battery in normal Thai participants aged 15-24 years old. J Dep Med Serv. 2015:40;66-79.
Pedersen PM, Vinter K, Olsen TS. Aphasia after stroke: type, severity and prognosis. The Copenhagen aphasia study. Cerebrovasc Dis. 2004 [cited 2020 June 17];17(1):35-43. doi: 10.1159/000073896. Epub 2003 Oct 3. PMID: 14530636.
Kelly H, Brady MC, Enderby P. Speech and language therapy for aphasia following stroke. Cochrane Database Syst Rev. 2010 May [cited 2020 June 17];(5):CD000425. doi: 10.1002/14651858.cd000425.pub2. PMID: 20464716.
Hillis AE. The ‘standard’ for poststroke aphasia recovery. Stroke. 2010 Jul[cited 2020 June 17];41(7):1316-7. doi: 10.1161/STROKEAHA.110.585364. Epub 2010 Jun 10. PMID: 20538691.
Brady M, Ali M, Vandenberg K, Williams L, Williams L, Abo M, et al. RELEASE: a protocol for a systematic review based, individual participant data, meta-and network meta-analysis, of complex speech-language therapy interventions for stroke-related aphasia. Aphasiology. 2020 Feb [cited 2020 June 17];34(2):137-157. doi: 10.1080/02687038.2019.1643003. PMID: 37560459; PMCID: PMC7614912.
Berthier ML, Pulvermüller F. Neuroscience insights improve neurorehabilitation of poststroke aphasia. Nat Rev Neurol. 2011 Feb [cited 2020 June 17];7(2):86-97. doi: 10.1038/nrneurol.2010.201. PMID: 21297651.
Marini A, Caltagirone C, Pasqualetti P, Carlomagno S. Patterns of language improvement in adults with non-chronic non-fluent aphasia after specific therapies. Aphasiology. 2007 [cited 2020 June 17];21(2):164-86. doi:10.1080/02687030600633799.
Albert ML, Sparks RW, Helm NA. Melodic intonation therapy for aphasia. Arch Neurol. 1973 Aug [cited 2020 June 17];29(2):130-1. doi: 10.1001/archneur.1973.00490260074018. PMID: 4717723.
Helm-Estabrooks N, Nicholas M, Morgan A. Melodic Intonation Therapy program. Austin, TX: PRO-ED Publishers; 1989.
Norton A, Zipse L, Marchina S, Schlaug G. Melodic intonation therapy: shared insights on how it is done and why it might help. Ann N Y Acad Sci. 2009 Jul [cited 2020 June 17];1169:431-6. doi: 10.1111/j.1749-6632.2009.04859.x. PMID: 19673819; PMCID: PMC2780359.
Chen W, Qian Q, van de Weijer J, Zhu S, Wang M. Adaptation of Melodic Intonation Therapy to a Tone Language: A Pilot Study of Tone-Rhythmic Therapy in Mandarin Chinese. Folia Phoniatr Logop. 2023 [cited 2024 Feb 1];75(2):104-116. doi: 10.1159/000527225. Epub 2022 Sep 27. PMID: 36167033.
Moher D, Hopewell S, Schulz KF, Montori V, Gøtzsche PC, Devereaux PJ, Elbourne D, Egger M, Altman DG; CONSORT. CONSORT 2010 explanation and elaboration: updated guidelines for reporting parallel group randomised trials. Int J Surg. 2012 [cited 2025 June 10];10(1):28-55. doi: 10.1016/j.ijsu.2011.10.001. Epub 2011 Oct 12. PMID: 22036893.
Ngamjarus C. n4Studies: Sample size calculation for an epidemiological study on a smart device. Siriraj Med J. 2016 [cited 2020 June 17];68(3):160-70.
Lim KB, Kim YK, Lee HJ, Yoo J, Hwang JY, Kim JA, Kim SK. The therapeutic effect of neurologic music therapy and speech language therapy in post-stroke aphasic patients. Ann Rehabil Med. 2013 Aug [cited 2020 June 17];37(4):556-62. doi: 10.5535/arm.2013.37.4.556. Epub 2013 Aug 26. PMID: 24020037; PMCID: PMC3764351.
The Committee Prepared the Preliminary Brain Test-Thai version. Mini Mental Examination Thai-2002 (MMSE-2002) [in Thai]. Nonthaburi: Institute of Geriatric Medicine, Department of Medical Services, Ministry of Public Health; 2002.
Teerapong W. The comparison of language abilities of Thai aphasic patients and Thai normal subjects by using Thai adaptation of Western Aphasia Battery [thesis]. Mahidol University; 2000.
Kertesz A, Poole E. The aphasia quotient: the taxonomic approach to measurement of aphasic disability. 1974. Can J Neurol Sci. 2004 May [cited 2020 June 17];31(2):175-84. doi: 10.1017/s0317167100120736. PMID: 15198441.
Helm-Estabrooks N, Albert M. Manual of aphasia and aphasia therapy. Austin, TX: PRO-ED Publishers; 2004.
Hough MS. Melodic intonation therapy and aphasia: another variation on a theme. Aphasiology. 2010 [cited 2020 June 17];24(6-8):775-86. doi:10.1080/02687030903501941.
Schlaug G, Marchina S, Norton A. From Singing to Speaking: Why Singing May Lead to Recovery of Expressive Language Function in Patients with Broca’s Aphasia. Music Percept. 2008 Apr 1[cited 2020 June 17];25(4):315-323. doi: 10.1525/MP.2008.25.4.315. PMID: 21197418; PMCID: PMC3010734.
Sirindhorn National Medical Rehabilitation Institute. Guidelines for assessment and diagnosis of disabilities. Nonthaburi: Ministry of Social Development and Human Security; 2012.
Tompkins CA, Scharp VL, Marshall RC. Communicative value of self cues in aphasia: A re-evaluation. Aphasiology. 2006 Jul 1 [cited 2020 June 17];20(7):684-704. doi: 10.1080/02687030500334076. PMID: 20090926; PMCID: PMC2808031.
Best W, Greenwood A, Grassly J, Herbert R, Hickin J, Howard D. Aphasia rehabilitation: does generalisation from anomia therapy occur and is it predictable? A case series study. Cortex. 2013 Oct [cited 2020 June 17];49(9):2345-57. doi: 10.1016/j.cortex.2013.01.005. Epub 2013 Feb 4. PMID: 23608067.
Ivanova MV, Hallowell B. A tutorial on aphasia test development in any language: Key substantive and psychometric considerations. Aphasiology. 2013 Jan 1 [cited 2024 Feb 1];27(8):891-920. doi: 10.1080/02687038.2013.805728. PMID: 23976813; PMCID: PMC3747007.
Hopewell S, Chan AW, Collins GS, Hróbjartsson A, Moher D, Schulz KF, et al. CONSORT 2025 statement: updated guideline for reporting randomised trials. Lancet. 2025 [cited 2024 Feb 1]. doi:10.1016/S0140-6736(25)00672-5.
Mumby PJ. Statistical power of non-parametric tests: a quick guide for designing sampling strategies. Mar Pollut Bull. 2002 Jan [cited 2025 June 10];44(1):85-7. doi: 10.1016/s0025-326x(01)00097-2. PMID: 11883688.
Lenhard W, Lenhard A. Computation of effect sizes [Internet]. Psychometrica; 2022 [cited 2025 Jun 21]. Available from: https://www.psychometrica.de/effect_size.html. doi:10.13140/RG.2.2.17823.92329
Cohen J. Statistical Power Analysis for the Behavioral Science. 2nd ed. New York: Routledge; 1988.
Thaut MH, Hoemberg V. Handbook of neurologic music therapy. New York, NY: Oxford University Press; 2014.
Liang B, Du Y. The Functional Neuroanatomy of Lexical Tone Perception: An Activation Likelihood Estimation Meta-Analysis. Front Neurosci. 2018 Jul 24 [cited 2024 Feb 1];12:495. doi: 10.3389/fnins.2018.00495. PMID: 30087589; PMCID: PMC6066585.
Zhang X, Li J, Du Y. Melodic Intonation Therapy on Non-fluent Aphasia After Stroke: A Systematic Review and Analysis on Clinical Trials. Front Neurosci. 2022 Jan 27 [cited 2024 Feb 1];15:753356. doi: 10.3389/fnins.2021.753356. PMID: 35153655; PMCID: PMC8829877.
Ashaie SA, Hurwitz R, Cherney LR. Depression and Subthreshold Depression in Stroke-Related Aphasia. Arch Phys Med Rehabil. 2019 Jul [cited 2024 Feb 1];100(7):1294-1299. doi: 10.1016/j.apmr.2019.01.024. Epub 2019 Mar 2. PMID: 30831094.
Mitchell AJ, Sheth B, Gill J, Yadegarfar M, Stubbs B, Yadegarfar M, Meader N. Prevalence and predictors of post-stroke mood disorders: A meta-analysis and meta-regression of depression, anxiety and adjustment disorder. Gen Hosp Psychiatry. 2017 Jul [cited 2024 Feb 1];47:48-60. doi: 10.1016/j.genhosppsych.2017.04.001. Epub 2017 Apr 3. PMID: 28807138.
Brady MC, Kelly H, Godwin J, Enderby P, Campbell P. Speech and language therapy for aphasia following stroke. Cochrane Database Syst Rev. 2016 Jun 1 [cited 2020 June 17];2016(6):CD000425. doi: 10.1002/14651858.CD000425.pub4. PMID: 27245310; PMCID: PMC8078645.
Shafer JS, Shafer PR, Haley KL. Caregivers navigating rehabilitative care for people with aphasia after stroke: a multi-lens perspective. Int J Lang Commun Disord. 2019 Jul [cited 2020 June 17];54(4):634-644. doi: 10.1111/1460-6984.12467. Epub 2019 Mar 18. PMID: 30884057; PMCID: PMC6609487.
Johansson MB, Carlsson M, Sonnander K. Working with families of persons with aphasia: a survey of Swedish speech and language pathologists. Disabil Rehabil. 2011 [cited 2024 Feb 1];33(1):51-62. doi: 10.3109/09638288.2010.486465. Epub 2010 May 10. PMID: 20455706.
Hassan FH, Zakaria AS, Ahmad Rusli Y, Haris SM, Mohd Azraai H. Comparisons of Clients’ and Caregivers’ Satisfaction Across Conventional, Virtual, and Hybrid Speech-Language Therapy Services in Malaysia. Patient Prefer Adherence. 2023 Jul 19 [cited 2024 Feb 1];17:1731-1740. doi: 10.2147/PPA.S407347. PMID: 37492636; PMCID: PMC10363485.
Wanicharoen N, Boonrod V, Kalaysak T, Samueanjai S. A systematic review of melodic intonation therapy used by speech therapists on speech recovery for patients with non-fluent aphasia. J Assoc Med Sci. 2024 [cited 2024 Feb 1];57(3):212-20.
Haro-Martínez A, Pérez-Araujo CM, Sanchez-Caro JM, Fuentes B, Díez-Tejedor E. Melodic Intonation Therapy for Post-stroke Non-fluent Aphasia: Systematic Review and Meta-Analysis. Front Neurol. 2021 Aug 4 [cited 2024 Feb 1];12:700115. doi: 10.3389/fneur.2021.700115. PMID: 34421802; PMCID: PMC8371046.
Graff-Radford J, Jones DT, Strand EA, Rabinstein AA, Duffy JR, Josephs KA. The neuroanatomy of pure apraxia of speech in stroke. Brain Lang. 2014 Feb [cited 2025 June 10];129:43-6. doi: 10.1016/j.bandl.2014.01.004. Epub 2014 Feb 18. PMID: 24556336; PMCID: PMC4004427.
Slavin D, Fabus R. A Case Study Using a Multimodal Approach to Melodic Intonation Therapy. Am J Speech Lang Pathol. 2018 Nov 21 [cited 2025 June 10];27(4):1352-1362. doi: 10.1044/2018_AJSLP-17-0030. PMID: 30120439.
Robey RR. A meta-analysis of clinical outcomes in the treatment of aphasia. J Speech Lang Hear Res. 1998 Feb [cited 2020 June 17];41(1):172-87. doi: 10.1044/jslhr.4101.172. PMID: 9493743.
van der Meulen I, van de Sandt-Koenderman ME, Ribbers GM. Melodic Intonation Therapy: present controversies and future opportunities. Arch Phys Med Rehabil. 2012 Jan [cited 2020 June 17];93(1 Suppl):S46-52. doi: 10.1016/j.apmr.2011.05.029. PMID: 22202191.
Saur D, Lange R, Baumgaertner A, Schraknepper V, Willmes K, Rijntjes M, Weiller C. Dynamics of language reorganization after stroke. Brain. 2006 Jun [cited 2024 Feb 1];129(Pt 6):1371-84. doi: 10.1093/brain/awl090. Epub 2006 Apr 25. PMID: 16638796.
Popescu T, Stahl B, Wiernik BM, Haiduk F, Zemanek M, Helm H, Matzinger T, Beisteiner R, Fitch WT. Melodic Intonation Therapy for aphasia: A multi-level meta-analysis of randomized controlled trials and individual participant data. Ann N Y Acad Sci. 2022 Oct [cited 2024 Feb 1];1516(1):76-84. doi: 10.1111/nyas.14848. Epub 2022 Aug 2. PMID: 35918503; PMCID: PMC9804200.
Schlaug G, Marchina S, Norton A. Evidence for plasticity in white-matter tracts of patients with chronic Broca’s aphasia undergoing intense intonation-based speech therapy. Ann N Y Acad Sci. 2009 Jul [cited 2025 June 10];1169:385-94. doi: 10.1111/j.1749-6632.2009.04587.x. PMID: 19673813; PMCID: PMC2777670.
Stefaniak JD, Halai AD, Lambon Ralph MA. The neural and neurocomputational bases of recovery from post-stroke aphasia. Nat Rev Neurol. 2020 Jan [cited 2025 June 10];16(1):43-55. doi: 10.1038/s41582-019-0282-1. Epub 2019 Nov 26. PMID: 31772339.
Kośla K, Pfajfer L, Bryszewski B, Jaskólski D, Stefańczyk L, Majos A. Functional rearrangement of language areas in patients with tumors of the central nervous system using functional magnetic resonance imaging. Pol J Radiol. 2012 Jul [cited 2025 June 10];77(3):39-45. doi: 10.12659/pjr.883373. PMID: 23049580; PMCID: PMC3447432.
Patel R, Connaghan KP, Campellone PJ. The effect of rate reduction on signaling prosodic contrasts in dysarthria. Folia Phoniatr Logop. 2013 [cited 2020 June 17];65(3):109-16. doi: 10.1159/000354422. Epub 2013 Nov 26. PMID: 24296946.
Gentilucci M, Dalla Volta R. Spoken language and arm gestures are controlled by the same motor control system. Q J Exp Psychol (Hove). 2008 Jun [cited 2020 June 17];61(6):944-57. doi: 10.1080/17470210701625683. PMID: 18470824.
Morrow-Odom KL, Swann AB. Effectiveness of melodic intonation therapy in a case of aphasia following right hemisphere stroke. Aphasiology. 2013 [cited 2020 June 17];27(11):1322-38. doi:10.1080/02687038.2013.817522.
Katz RC, Wertz RT. The efficacy of computer-provided reading treatment for chronic aphasic adults. J Speech Lang Hear Res. 1997 Jun [cited 2025 June 10];40(3):493-507. doi: 10.1044/jslhr.4003.493. PMID: 9210109.
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