After a stroke or traumatic brain injury, patients often experience more or less pronounced speech loss. To regain the language, the melodic intonation therapy has been used for some time. A treatment method that allows patients to learn to speak again through singing.

What is melodic intonation therapy?

To regain the language, after a stroke or traumatic brain injury, the melodic intonation therapy has been used for some time. A treatment method that allows patients to learn to speak again through singing.

The so-called Broca center in the left brain is the language center and thus responsible for the language. If this area is destroyed by a stroke or accident, the patients are either no longer able to speak or only rudimentary. Their sentences do not sound fluid, but choppy, as in telegram style. The loss of language is a significant psychological burden for all those affected. And the re-learning of words and sentences turns out to be a tedious and long journey.

This has been greatly facilitated by the melodic intonation therapy, short MIT, and has great success. The first approaches to this come from the American neurologist Charles Mills, who observed as early as 1904 that although stroke patients could no longer speak, they still could sing. On the basis of these findings, the melodic intonation therapy was developed during the 1970s. The neurologists took advantage of the fact that the brain is very adaptive. As soon as the brain is stimulated, new connections are constantly being created between the nerve cells.

If one part of the brain gets damaged, another part takes over its work. This is also the case when the Broca center is destroyed. This center is located in right-handers in the left hemisphere (reversed accordingly for left-handers). In this respect, the right hemisphere is able to take over the tasks of the damaged left hemisphere. While speech is being processed in the left hemisphere, the right half of the brain is responsible for music. This also applies to the speech melody, the musical aspects of the language, and important functions that support singing.

However, recent research suggests that it is not just the sounds that make it possible for people to speak after a brain failure. A big, if not the biggest, role is obviously played by the rhythm. Especially with a stroke patients have difficulties with the clock. A rhythmic clock, a metronome, for example, or deliberate rhythmic speaking, clapping or tapping seem to significantly improve the patients' motor skills. Therefore, in the MIT music and rhythm are connected.

Function, effect & goals

In order to achieve success with melodic intonation therapy, some prerequisites are necessary. Only one half of the brain may be affected, and only the Broca area, ie the language center. While the patient himself can barely or not at all speak, his speech comprehension should still work reasonably well.

It is important that he is at least aware of his linguistic errors and the ability to self-correct. What is also required is an extraordinary motivation of the patient. MIT requires a lot of attention from the participants and a lot of patience. The treatment itself is offered as a group or individual therapy. As a rule, individual therapies are started that do not take place more than twice a week and each last 30 minutes. As treatment progresses, most patients will be happy to take advantage of the group offer.

The MIT consists of two basic elements: melody and rhythm. Therapy begins with simple sentences or phrases, such as "Good morning". The therapist sings these words to the patient, whom he accompanies with a rhythmic tapping. The patients sing the words and tap the rhythm with their right hands to activate the damaged left brain area. The aim is to enable the patient again a simple everyday communication. The therapy consists of four stages, which in turn consists of several steps. MIT is considered complete when 90 percentage points have been reached on average in the last stage. Almost all patients showed a clear improvement after only a few weeks. They are able to articulate sentences like "I'm hungry".

Studies show that after 75 sessions of therapy, patients have a vocabulary of a few thousand words that could not speak a single word before starting treatment. And there are examples of patients who gave fluid presentations after a MIT. Magnetic resonance imaging also showed that the patient's brain changed after MIT. It turned out that the right hemisphere was more active than before MIT began. A proof that the right side has taken over the failed functions of the left hemisphere.

Risks, side effects & dangers

Although melodic intonation therapy is not the only speech therapy used after brain failure. But it offers a chance to those patients who fail conventional treatments. For example, when severely damaged patients have completely lost their ability to speak.

Here conventional speech therapies reach their limits, since they require at least a residual amount of speech to start the treatment at all. With MIT, these patients have the opportunity to learn a few words and simple sentences. This, in turn, opens the way for those affected to continue with other therapies later, in order to continuously increase their language and vocabulary.