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A structured, hierarchical program aimed at

increasing expressive language skills.
Words and phrases are produced in an intoned and
rhythmic manner (like singing) to facilitate verbal Levels of Evidence
production with speech-like prosody. Class II: Evidence from one or more randomized
clinical studies such as case-control, cohort studies,
- Randomized control trial
- Too many patients dropped out for
it to be class 1
- Studies on sub-acute patients did
not report any maintenance data
- This leaves the question did the
therapy work after treatment
- Few randomized control trials exist--many
are pilot studies, so further studies need to
be completed

HOW DOES IT W ORK? Dwyer, C., Novak, E., Boissy, A., Bethoux, F., Chemali, K. (2012) The effects of
modified melodic intonation therapy on nonfluent aphasia: A pilot study.Journal
of Speech, Language, and Hearing Research, 55, 1463-1471. doi:

St imulat ion Approach 10.1044/1092-4388(2012/11-0105)

Mauszycki, S. C., Nessler, C., & Wambaugh, J. L. (2016). Melodic intonation therapy
Uses auditory bombardment and repetition to applied to the production of questions in aphasia. Aphasiology, 30(10),
restore language function 1094-1116. doi:10.1080/02687038.2015.110904

Recruit ment Murray, L. L., & Clark, H. M. (2006).Neurogenic disorders of language: Theory driven
clinical practice. Clifton Park, NY: Thomson Delmar Learning.
Damage to left hemisphere speech areas inhibits
speech production, so recruitment of other areas in Rau, M., & Fox, L. (2009). Treatment approaches to aphasia: contributions of VA
clinicians.Aphasiology,23(9), 1101-1115.
the brain assist in the production of speech
Funct ional Takeover
van der Meulin, I., van de Sandt-Koenderman, W.M.E., Heijenbrok-Kal, M.H.,
Visch-Brink, E.G., (2016). Melodic intonation therapy in chronic aphasia: evidence
from a pilot randomized controlled trial.Frontiers In Human Neuroscience, 10,
Damage occurs to left hemisphere resulting in doi:10.3389/fnhum.2016.00533/full
severe or total loss of expressive language, so the van der Meulen, I., van de Sandt-Koenderman, W.M.E., Heijenbrok-Kal, M.H.,
right brain structures attempt to take control of the Visch-Brink, E.G., & Ribbers, G.M. (2014). The efficacy and timing of melodic
intonation therapy in subacute aphasia.Neurorehabilitation and Neural Repair,
facilitation of speech processes 28(6)536-544. doi: 10.1177/1545968313517753
Limit at ions of M IT Sample Goals
CANDIDATES The creators of Modified Intonation Therapy Long Term Goal:
(MMIT) argue that there are two major limitations - By the end of a 6 week therapy block, the
The following populations qualify as the best patient will use functional spoken output
within the MIT framework: with communicative partners as measured
candidates for MIT: - Begins with producing 1-2 word phrases by patient/caregiver reports.

- Non-fluent aphasia and apraxia of speech - Small pitch range Short Term Goal:
- The patient will produce phrase-level
- Left Hemisphere stroke M odified M elodic Int onat ion material in response to a question using
- Poor repetition MIT strategies, with minimal articulatory
Therapy (M M IT) errors at 80% accuracy in three out of five
- Poorly articulated speech therapy sessions.
MMIT differs from MIT in two major ways: First,
- Moderate to good auditory comprehension
MMIT utilizes phrases in the beginning of therapy Phrase +/-
as opposed to single words. The rationale for this
I want coffee
change comes from the patient's ability to sing
"Happy Birthday to You." If a patient can sing a six I am hungry
syllable phrase, they are capable of producing I need medicine
higher level material. Second, MMIT utilizes
I need the bathroom
prosody (pitch and rhythm) that matches
spontaneous speech for a smoother transition to I don?t feel well
spoken speech.


1 Level 1 2 Level 2 3 Level 3

1. Humming 1. Int roduce t he t arget 1. Delayed repet it ion
clinician simultaneously humsa tonal pattern for a target same asStep 1 of Level 1 same asStep 3 of Level 2
word/phrase, pointsto a picture , and tapsthe patient'sleft hand 2. Unison wit h fading 2. Int roduce sprechgesang
once for each syllable; no patient response necessary same asStep 3 of Level 1 clinician modelsthe target word/phrase in sprechgesang
2. Unison singing 3. Delayed repet it ion (speaking with accentuated rhythm and stress, but normal
clinician and patient hum/intone a target word/phrase together patient repeatsmodeled and tapped word/phrase after a intonation/pitch) and tapsthe patient'shand; no patient
while clinician tapsthe patient's hand delay of approximately 6 seconds; clinician still taps the response required
3. Unison singing wit h fading patient'shand during patient production 3. Sprechgesang wit h fading
same asstep 2, except halfway through the word/phrase the 4. Response t o a probe quest ion Like Step 2 of Level 2, except using sprechgesang instead of
clinician stopsintoning approximately 6 seconds after patient successfully completes intoning
4. Immediat e repet it ion Step 3, the clinician intones a probe question to elicit another 4. Delayed spoken repet it ion
patient repeatsthe modeled intoned word/phrase; clinician stills production of the intoned target using normal prosody, patient repeatsthe clinician'sspoken
tapspatient'shand during patient production model of the target word/phrase after a delay of approximately
5. Response t o a probe quest ion 6 seconds; no hand-tapping isprovided
after patient successfully repeatsthe intoned word/phrase, the 5. Response t o a probe quest ion
clinician asksa question which can be answered using the target Like Step 4 of Level 2, except both the clinician'squestion and
word/phrase; clinician may still tap the patient'shand during the patient's response should be produced with normal speech
patient response prosody