Melodic Intonation Therapy
for Aphasia
Martin L. Albert, MD; Robert W. Sparks, MSc;
Nancy A. Helm, MEd, Boston
A new form of language therapy has been
used successfully with aphasic patients
who had severe, long-term, stable defects
and for whom other forms of therapy had
failed. One explanation for these results
suggests that latent language capacities
of the nondominant hemisphere may be
stimulated.
(29:130-131, 1973)
is well-known that many patients
It with aphasia, even those who are
severely impaired, can sing the lyrics
of popular songs in a unison setting
with good clarity of articulation.
Singing ability has been observed fol¬
lowing total removal of the left
(speech-dominant) hemisphere.1 Sy-
monds2 described a patient who could
sing nursery rhymes, although he
was almost totally mute for propo-
sitional language. Gerstman3 report¬
ed a case in which singing facilitated
"spontaneous recovery" in a severely
aphasie patient. Based on such obser¬
vations, we have developed a new
technique for language rehabilita¬
tion melodic intonation therapy.
—
Accepted for publication April 30,1973.
From the Department of Neurology, Aphasia
Research Section, Boston Veterans Administra-
tion Hospital, and the Department of Neurology,
Aphasia Research Center, Boston University
School of Medicine.
Reprint requests to Boston Veterans Adminis-
tration Hospital, 150 S Huntington Ave, Boston
02130 (Dr. Sparks).
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The results with this program of
therapy have been gratifying in a
small group of severely aphasie pa¬
tients who had not responded to other
forms of therapy.
Melodic intonation therapy in¬
volves imbedding short phrases and
sentences in a simple, nonlinguisti-
cally loaded melody pattern. The first
level of therapy includes unison sing¬
ing of the sentence by the patient and
the therapist, as in operatic recitative.
Progression of the program leads
eventually to repetition of the sen¬
tence in normal speech prosody. As
the aphasie patient improves, the
melodic aspect of the program is fad¬
ed, and confrontation questions are
introduced. If, at this stage, the pa¬
tient has difficulty, he is asked to re¬
vert temporarily to an intonational
response.
The success of this program to date
has been demonstrated in three right-
handed patients in whom other thera¬
peutic approaches had failed.
Report of Cases
Case 1. —A 67-year-old man had been
unable to produce language for 18 months
following a stroke. His comprehension was
good, but his output was limited to mean¬
ingless grunts. During the course of his
illness, he had received three months of
language therapy with no success. Two
days after beginning melodic intonation
therapy he produced a few words. In two
 weeks he had usable verbal output of
a expressive ability in three severely
approximately words. After IV2
100
months he carried on short, meaningful
conversations, many of which he sponta¬
neously initiated. Articulation remained
poor and the prosody was plosive.
Case 2. A 65-year-old man developed a
mixed aphasia following a stroke. Audito¬
—
ry comprehension was fair, but speaking
ability was severely impaired, being limit¬
ed to four to six phonemes which he used
repetitiously. Two months of aphasia
therapy shortly after the onset of his ill¬
ness had produced no improvement. Me¬
lodic intonation therapy was instituted
after the aphasia had been stable for 14
months. Following two weeks of therapy,
he could produce verbal responses to ques¬
tions; some of these responses were full,
grammatically correct sentences. As with
patient 1, he used his new language cap¬
ability in nontherapeutic settings. Dys¬
arthria is marked in his speech, but is
improving.
Case 3. —A 48-year-old woman devel¬
oped severe disturbance of language
expression following occlusion of the left
middle cerebral artery. Auditory compre¬
hension was good, but output was limited
to a restricted range of stereotyped pho¬
nemes. Two months of standard aphasia
therapy produced no improvement. Melod¬
ic intonation therapy facilitated the pro¬
duction of meaningful propositional
speech after only two or three therapy ses¬
sions. Following IV2 months of melodic
intonation therapy, she carried on short
but meaningful conversations over a wide
range of topics. Although her verbal out¬
put was limited to four- or five-word sen¬
tences, the grammatical structure was
correct. Her major problem is also dysar¬
thria.
Comment
Melodic intonation therapy pro¬
duced significant improvement in
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aphasie patients. All three patients
had fair to good language comprehen¬
sion but markedly restricted output.
In contrast, two patients with severe
language comprehension defect (one
with global aphasia, one with Wer¬
nicke's aphasia) did not benefit from
brief exposure to melodic intonation
therapy.
Neither spontaneous recovery
development of new language areas
in the right hemisphere can account
for the improvements noted, since the
recovery of grammatical structure
and vocabulary was too rapid follow¬
ing the beginning of melodic intona¬
tion therapy. We propose as one possi¬
ble explanation that melodic intona¬
tion therapy facilitates use of lan¬
guage by the nondominant right
hemisphere, which had been sup¬
pressed by the dominant left hemi¬
sphere, even though the dominant
hemisphere was damaged. If this
suggestion is correct, it would imply
that the right hemisphere has lan¬
guage areas which perhaps are not
fully utilized under normal condi¬
tions.
In a discussion of childhood apha¬
sia, Geschwind4 has suggested that
the right hemisphere learns language
along with the left and that recovery
from aphasia in childhood is not so
much a matter of relearning by the
right hemisphere as an assumption of
responsibility for language functions
that previously had been controlled
by the dominant left hemisphere. He
added that
the only hope for really effective reha-
. . .
bilitation of the adult aphasie depends on
the possibility that he, like the child, has
language learning in the other hemi¬
sphere which for some reason he is not
capable of using. Perhaps some way
could be found to "attack" the right hemi¬
. . .
sphere of the adult in order to make the
latent language learning become mani¬
fest.
The use of melodic intonation as a
facilitating device may offer such a
nor
method. Bogen and Gordon,5 in a
study using the Wada procedure, in¬
jected amobarbital sodium into the
right carotid arteries of six sub¬
jects with definite righthandedness.
Marked depression of ability to sing
the melody of well-known songs oc¬
curred. These results suggest that
musical ability was controlled by the
right hemisphere, which was non-
dominant for language in these sub¬
jects.
The "success" of this new thera¬
peutic approach should be viewed
with caution. It is not presumed that
melodic intonation therapy will be
appropriate for all types of aphasia.
Further carefully controlled study is
warranted.
References
1. Smith A: Speech and other functions after
left (dominant) hemispherectomy. J Neurol
Neurosurg Psychiatry 29:467-471,1966.
2. Symonds CP: Aphasia. J Neurol Neurosurg
Psychiatry 16:1-6,1953.
3. Gerstman HL: A case of aphasia. J Speech
Hear Disord 29:89-91,1964.
4. Geschwind N: Disorders of higher cortical
function in children. Clin Proc Child Hosp Natl
Med Ctr 28:261-272, 1972.
5. Bogen J, Gordon H: Musical tests for func-
tional lateralization with intracarotid amobarbi-
tal. Nature 230:524-525, 1971.