What is Melodic Intonation Therapy?

Have you ever met someone who always seems to take forever to get their name out but has no trouble singing? These people have a condition known medically as ‘aphasia’, which is often caused by injury to the brain. Apart from their slow and halting speech and restricted verbal output, these people are great at auditory comprehension.

Over 100 years of research on individuals with nonfluent aphasia revealed that they can sing words they ordinarily cannot speak. Until 1973 (1), which was when MIT was introduced, melody and rhythm were used to help improve aphasic patients’ fluency. Since its discovery, researchers have investigated the efficacy of Melodic Intonation Therapy on language recovery in aphasic patients. In this article, you will learn what MIT Therapy is, how it works, and who it is often used for.

Key Takeaways
● Medical intonation therapy is a common and effective rehabilitation program used for individuals who develop communication problems after a brain injury or stroke.
● It uses well-structured and repetitive rhythms, melody, and hand-tapping to improve your speech and communication.
● Although MIT therapy is primarily used for people with severe non-fluent aphasia, it can also be used to treat people with apraxia (difficulty moving the mouth or tongue to speak or form words).
● Melodic intonation is done using five major steps including humming, intoning together, fading, repetition, and response.

MIT Therapy Explained: How Does Melodic Intonation Therapy Work?

To understand how medical intonation therapy works, let’s first answer the question ‘what is Medical Intonation Therapy?’ Medical Intonation Therapy is a treatment method that uses intoning or singing to improve expressive language in aphasic patients, with evidence (1) backing it. Typically, the right part of the brain of these individuals is still intact, which is what this therapy takes advantage of.

MIT engages the areas in the right hemisphere that are capable of language, gradually reducing dependence on the left hemisphere. Typically, a Melodic Intonation Therapy session lasts about 30 to 60 minutes four to seven days per week. Meanwhile, the overall treatment may last as long as three to six weeks, depending on several factors such as your availability.

Materials Needed for Melodic Intonation Therapy

Before we talk about how melodic intonation therapy is performed, let’s discuss the materials needed to get it done. You would need two things basically: phrases to provide stimuli and melodic patterns for the actual therapy.

● Phrases
The goal of MIT goes beyond just learning how to speak; it is also to help the individual recall sentences. Therefore, there must be more than enough stimuli, not to mention varieties. The first four stages of this therapy should involve statements of no more than four syllables, and then we can increase it gradually.

Furthermore, the specialist will work with you and your caregiver to choose syllables that are particularly relevant to you. The stimuli will be more effective if it is composed of words you use in everyday conversation.

● Melodic Patterns
The next thing needed is melodic patterns, which would include only 2 to 4 musical notes. And resemble natural prosody patterns. Meanwhile, to make the process easier, try writing the chosen phrases and sentences down, and arranging them according to syllable length.

The Process: How Is Melodic Intonation Therapy Performed?

There are five major steps involved in melodic intonation therapy (MIT), starting with listening and rehearsing humming. Here is a brief breakdown of the process involved in MIT therapy:

● Humming: The therapy starts with your therapist humming the chosen phrase once and then intoning it twice with hand-tapping. You’ll listen and rehearse what you hear in your head;

● Intone Together: Keep rehearsing what you hear until your therapist signals you to repeat it with them, along with the hand tapping;

● Fading: As you sing the target phrase in unison with your therapist, their voice will fade as yours takes over, but they’ll continue hand-tapping.

● Repetition: At this stage, your therapist will signal you to stop and listen again as they intone the target phrase while hand-tapping. Afterward, you’ll be told to repeat only the target phrase while they assist with the hand-tapping. If you’re finding this target initiation difficult, your therapist can provide a phonemic cue.

● Responding to a Question: When you’ve successfully repeated the target phrase in step 4 above, your therapist will initiate a probe question. You will answer the target phrase alone, although they may hand-tap the syllables if you need assistance.

As you master singing together, your therapist will start with simple phrases and move on to more difficult exercises. In some cases, your therapist may give you longer phrases to make it more challenging. The goal of each MIT session is to enable you to sing the lines you tackle daily all by yourself.

Depending on your lifestyle, singing basic phrases may be enough to help you communicate effectively on a daily basis. However, you can ask your therapist to wean you off song-speech if you don’t want to rely on rhythms to talk.

When Is Melodic Intonation Therapy Most Effective?

Melodic Intonation Therapy is the most effective in individuals who have the nonfluent type of aphasia. In simpler terms, it works best if you understand words you hear but find it difficult to respond. If you have this type of aphasia, you may find it hard to organize your thoughts to form a coherent response. Typically, nonfluent aphasia, or Broca’s aphasia tends make you to skip over words or repeatedly pause to remember a name.

Also, MIT can be effective in apraxia patients, a motor speech disorder that causes difficulty in coordinating the muscles to form speech. These are individuals who struggle to coordinate or direct their tongue and mouth to form the right sounds. These two conditions are typically caused by stroke, and MIT therapy works soon after the stroke.

Furthermore, your MIT therapist doesn’t have to be a musical genius, but they should at least be familiar with music. If you love listening to music or you enjoy singing, studies show you will experience progress faster than those who don’t.

Research on MIT and the Brain: Is MIT Really Effective?

There is sufficient evidence that MIT can improve functional communication, which experts believe works through neuroplasticity (the brain’s ability to rewire its neurons). While both sides of the brain process speaking and singing, speaking is particularly left-brained while singing is right-brained. Aphasia is a result of damage to the left brain, which means damage to the part that controls your speech.

Thus, what MIT does is prompt your brain to reassign the duties that were originally for the left hemisphere to the right. Studies (2) on brain imaging show the post-MIT results where neurons in the right hemisphere become more active in language tasks. That means the right hemisphere has taken over speech functions, although researchers aren’t entirely sure how MIT accomplishes this relocation.

However, they postulate that song may be one mechanism since the right part of your brain processes musical elements, which are used in MIT. They suggest that singing words retain the neurons in the right hemisphere, which treats them as elements of music rather than speech.

Also, MIT works probably because of the tapping you do alongside the rhythm, which activates the motor cortex in your right hemisphere. Since the sections of the motor cortex that control your mouth and hand movements are close, tapping might awaken your brain’s mouth area. Therefore, this gives you more control over your tongue and lips, improving your ability to form words.

In addition, scientists believe MIT therapy works because it engages mirror neurons (3) that help you copy other people’s actions. MIT involves you listening to your therapist sing and watching them hand-tap. As you do so, your mirror neurons start processing what you hear and see immediately to help you repeat them. Essentially, the neurons’ processing power has reduced the workload the rest of your brain has to manage when you speak.

Conclusion

According to a neurology study (4), over two million Americans live with aphasia and one in three stroke patients develop it. This condition can reduce your quality of life significantly, especially since it limits opportunities both socially and occupationally. However, with MIT, you can learn to use your tongue and lips again through musical intonation and left-hand tapping.

Written by Dr. Ori Otokpa, MBBS
Medically Reviewed by Dr. Danielle Kelvas, MD

References
1. Norton, A., Zipse, L., Marchina, S., & Schlaug, G. (2009). Melodic Intonation Therapy: Shared insights on how it is done and why it might help. Annals of the New York Academy of Sciences, 1169(1), 431–436. https://doi.org/10.1111/j.1749-6632.2009.04859.x
2. Merrett, D. L., Peretz, I., & Wilson, S. J. (2014). Neurobiological, Cognitive, and Emotional Mechanisms in Melodic Intonation Therapy. Frontiers in Human Neuroscience, 8. https://doi.org/10.3389/fnhum.2014.00401
3. Winerman, L. (2005, October). The Mind’s Mirror. American Psychological Association. https://www.apa.org/monitor/oct05/mirror
4. Devine, G. (2024). Musical Medicine: Melodic Intonation Therapy for Aphasia (P11-5.021). Neurology, 102(17_supplement_1). https://doi.org/10.1212/wnl.0000000000205989