Melodic Intonation Therapy (MIT): Goal | Steps | Phrases – Melodic Intonation Therapy (MIT) is a specific speech therapy approach created to aid people with non-fluent aphasia and apraxia of speech in regaining speech function. Beginning with short, incredibly melodious phrases and working up to longer, more complex words, MIT is an organized series of steps. In order to autonomously produce spoken language, patients first practice rhythmic intonations under the direction of their therapists. The approach uses the connections between music and language in the brain to help people improve their quality of life and communication skills.

Melodic Intonation Therapy (MIT)

According to Albert, Sparks, and Helm (1973), the right cerebral hemisphere predominates when it comes to musical and intonation contours. It was created on the basis of the hypothesis that right hemispheric capabilities may be used to help left-brained people recover their ability to speak. The idea is that by activating language-capable areas of the right cerebral hemisphere, patients can acquire a new way to talk through song.

Melodic Intonation Therapy Goals

• The main objective of MIT is to encourage speech and language recovery by engaging the musical processing areas of the brain and using melodic patterns and rhythms to drive speech creation.
• The Melodic Intonation Therapy goal is to revive propositional speech.
• Patients are eventually expected to speak permanently in this manner but refrain from overt singing.

Candidacy for Melodic Intonation Therapy (MIT)

1. It should be easier to understand spoken language through listening (Auditory comprehension).
2. The patient should have a reasonable level of emotional stability and attention span.
3. The source of melodic intonation is: utilizing three aspects of spoken prosody
   1. The lyrical line (pitch variation)
   2. The utterance’s cadence and rhythm
   3. Emphasized or stressed points

Principles of Melodic Intonation Therapy (MIT)

1. The therapeutic tool of repetition is quite powerful. It is regarded as the foundation of MIT.
2. In the therapeutic hierarchy, tasks get harder and longer as they proceed.
3. Direct actions are taken to repair mistakes.
4. There is a delay between the doctor finishing up the stimulus presentation and the aphasic patient starting to respond.
5. The use of written or visual materials as additional stimulation is not advised.
6. Aphasics with severe language impairment require at least two sessions each day.
7. Employing the same material or carrier phrases frequently helps to minimize the practice effect.
8. Suitable reinforcement, which shouldn’t be harmful.

Melodic Intonation Therapy Steps

Seating Position: The aphasic patient is seated across from the clinician, who is holding the patient’s left hand and tapping out the rhythm of the stimulus as it is presented.

Melodic Intonation Therapy (MIT) consists of several key steps designed to help individuals with non-fluent aphasia improve their speech production. Here are the fundamental Levels and Steps of MIT:

• Level 1: Single Step
• Level 2: Four Steps
• Level 3: Three Steps
• Level 4: Four Steps

Level 1: Single Step

Step 1

• The therapy session begins with the clinician tapping out a simple melody twice.
• In response, the patient hums the same melody twice in unison with the clinician.
• The clinician gradually reduces their involvement and fades away during this step.

Score and Progression:

No scoring is necessary at this stage, and the therapy proceeds to the next melody, building upon this foundational exercise.

Level 2: Four Steps

Step 1

1. The clinician initiates the process by selecting a sentence and humming its melody while maintaining the correct intonation.
2. Following the melody, the clinician signals the patient to participate.
3. Both the clinician and the patient engage in unison, intoning the selected sentence.

Scoring and Progression:

• If the patient’s intonation is acceptable and aligns with the melody demonstrated by the clinician, it is considered a successful step, earning 1 point, and proceeds to step 2.
• In case the patient’s intonation is unacceptable or does not match the melody, the progression for the current sentence is discontinued.

Step 2

1. The clinician, armed with expertise and empathy, initiates this step by humming a melodious tune while intoning the same sentence.
2. The clinician signals the patient to join in.
3. Together, in perfect unison, the clinician and patient intone the sentence melodically.
4. As the patient gains confidence and proficiency, the clinician gradually fades into the background, allowing the patient to take the lead in this melodic dialogue.

Scoring and Progression:

• If the patient’s intonation is acceptable and aligns with the melody demonstrated by the clinician, it is considered a successful step, earning 1 point, and proceeds to step 3.
• In case the patient’s intonation is unacceptable or does not match the melody, the progression for the current sentence is discontinued.

Step 3

1. The clinician initiates the step by tapping the patient’s hand, signaling that it’s time to begin the exercise.
2. Following the melody, the clinician cues the patient to participate in intoning the same sentence.
3. Both the clinician and the patient simultaneously intone the sentence, working together to achieve the melodic and rhythmic pattern.
4. The clinician takes the lead in intoning the sentence, guiding the patient throughout the exercise.
5. If the patient encounters difficulty or hesitation, the clinician can provide a cue or additional support to help maintain the flow.

Scoring and Progression:

• If the patient intones the sentence effectively without the need for a cue, they earn 2 points, signifying their readiness to proceed to Step 4 with the same sentence.
• If the patient intones the sentence but requires a cue or assistance from the clinician, they receive 1 point. They still move forward to Step 4 with the same sentence.
• If the patient struggles to intone the sentence, cannot maintain the melodic and rhythmic pattern, or finds it too challenging, progression for that particular sentence is discontinued, and further practice may be needed.

Step 4

1. The clinician begins by intoning, “What did you say?”
2. The clinician then signals the patient.
3. The patient repeats the intoned sentence.
4. If the patient needs a cue, the clinician intones the cue.

Scoring and Progression:

• If the patient repeats the sentence correctly without needing a cue, award 2 points.
• If the patient repeats the sentence correctly but requires a cue, award 1 point and proceed to step 1 for the next sentence.

Level 3: Three Steps

Step 1

1. The clinician starts by intoning a sentence.
2. The clinician signals the patient to join in.
3. Both the clinician and the patient, in unison, intone the sentence together.
4. The clinician gradually fades out, allowing the patient to take the lead.

Score and Progression:

• If the intonation is acceptable (1 point), proceed to step 2 using the same sentence.
• If the intonation is unacceptable, discontinue progression for that sentence.

Step 2

1. The clinician should begin by intoning the same sentence that was used in the previous step.
2. After intoning the sentence, the clinician should signal the patient to wait.
3. After the brief pause, the clinician should signal the patient to begin.
4. Upon receiving the signal, the patient should repeat the intoned sentence.
5. If the patient is unable to repeat the sentence accurately or fluently, despite the backup from step 2, return to step 1 of level 3.

Scoring and Progression:

• If the patient can repeat the intoned sentence accurately and fluently without the need for backup, award 2 points. In this case, proceed to step 3 for the same sentence.
• If the patient requires backup to step 2 but is able to repeat the sentence accurately and fluently, award 1 point and proceed to step 3 for the same sentence.
• If the patient is unable to repeat the sentence accurately or fluently even with backup from step 2, discontinue progression for that sentence.

Step 3

1. The clinician maintains the intonation of the question to the patient.
2. The clinician provides signals to prompt the patient to respond.
3. The patient, in turn, gives an appropriate answer, which can be intoned or spoken.
4. If the patient fails in Step 3, you should return to Step 2.

Scoring and Progression:

• If the patient gives an acceptable response in Step 3 without the need for backup, assign 2 points.
• If the patient requires backup (returning to Step 2) but eventually gives an acceptable response, assign 1 point. After this, you can proceed to Step 1 for the next sentence, indicating progression in the therapy.

Level 4: Four Steps

Step 1

1. The clinician taps their hand to get the patient’s attention. The clinician sings the target sentence using a melodic and rhythmic intonation pattern.
2. After singing the sentence, the clinician signals the patient to wait.
3. The clinician sings the target sentence twice using a technique called “Sprechgesang,” which is a halfway between speaking and singing with a rhythmic quality.
4. The clinician signals the patient to join in.
5. Both the clinician and the patient sing the sentence in unison using the Sprechgesang technique.
6. If the patient has difficulty, the clinician can provide backup by repeating the sentence using Sprechgesang.
7. Both the clinician and the patient try singing the sentence together again.

Score and Progression:

• If the patient is able to sing the sentence correctly without the need for backup, they earn 2 points, and the therapy proceeds to Step 2 with the same sentence.
• If the patient requires backup but is eventually able to sing the sentence correctly, they earn 1 point, and the therapy proceeds to Step 2, where a new sentence is introduced.
• If the patient is unable to sing the sentence correctly even with backup, progression for that sentence is discontinued.

Step 2

1. The clinician begins by presenting the same sentence in a technique known as “sprechgesang.”
2. After presenting the sentence in sprechgesang, the clinician signals the patient to wait.
3. This pause usually lasts for 2 to 3 seconds. During this time, the patient should be prepared to respond.
4. The patient, using the same rhythmic and melodic style as demonstrated by the clinician, repeats the sentence in sprechgesang.
5. If the patient is unable to repeat the sentence acceptably, you should return to Step 1 and retry it before moving on.

Scoring and Progression:

• If the patient successfully repeats the sentence in sprechgesang without needing backup, they earn 2 points and proceed to step 3.
• If the patient’s response is unacceptable, the progression for that particular sentence should be discontinued.

Step 3

1. No hand tapping is required.
2. The clinician begins by presenting the sample sentence twice, maintaining a natural speech prosody.
3. After presenting the sentence, the clinician signals the patient to wait for 2 to 3 seconds before repeating the sentence.
4. The patient then repeats the sentence with normal speech prosody.
5. If the patient fails to repeat the sentence correctly, the clinician provides a backup presentation of the same sentence in normal speech prosody.
6. After the backup presentation by the clinician, the patient is given another chance to repeat the sentence in normal speech prosody.

Scoring and Progression:

• If the patient successfully repeats the sentence without needing the backup presentation, they receive 2 points. The therapy proceeds to step 4 with the same sentence.
• If the patient requires the backup presentation to repeat the sentence correctly, they receive 1 point. The therapy proceeds to step 4 with the next sentence.
• If the patient is unable to repeat the sentence correctly even after the backup presentation, progression for that particular sentence is discontinued.

Step 4

1. The clinician asks the patient a question related to the substantive content of the same sentence.
2. The patient’s response should be an appropriate and meaningful answer to the clinician’s question.
3. If the patient’s response is not acceptable or lacks substantive content, the clinician should revert to Step 3 of the therapy.
4. After the backup step, the clinician can retry Step 4, asking the same or a similar question to assess the patient’s progress and whether they can now produce a substantive response
5. The clinician can proceed to ask questions about associative information related to the sentence.
6. The patient’s response should be an appropriate and meaningful answer to the clinician’s question.

Scoring and Progression:

• If the patient provides a substantive response without needing a backup to Step 3, they earn 2 points.
• If the patient’s response is improved with the backup to Step 3, they earn 1 point.
• If the patient responds to one or more questions about associative information, they receive 3 bonus points.

After assessing the patient’s performance in Step 4 and any associated questions, the clinician can proceed to the next sentence, continuing the therapy process to further improve the patient’s communication skills through melodic intonation therapy.

Summary of the Melodic Intonation Therapy Steps

1. While hearing the hummed and intoned utterances of the clinician, the patient taps out the rhythm.
2. In unison, the patient and the doctor speak.
3. Clinical production stops with the clinician.
4. The patient independently copies the clinician’s intoned utterance model.
5. The patient no longer intones his or her response; instead, it is produced in unison with pronounced inflection before being gradually shaped to resemble more typical speech prosody.
6. Clinical production stops with the clinician.
7. The patient speaks in a manner that is independent of the clinician.
8. When the clinician asks a question, the client stops imitating them and starts speaking on his or her own.

Melody Intonation Therapy (MIT): Aphasia | Dysarthria | Apraxia

Melodic Intonation Therapy: Aphasia

Aphasia is a language disorder that affects one’s ability to understand and produce spoken and written language. MIT aids in rebuilding language skills through its musical and rhythmic components.

• How it Works: MIT for aphasia involves training individuals to sing or intone phrases or sentences using a melodic and rhythmic pattern. This musical element can help bypass areas of damage in the brain and facilitate speech production.
• Goals: The primary goal is to improve verbal expression and communication for people with aphasia by promoting the reactivation of language centers in the brain through the musical elements of MIT.

Melodic Intonation Therapy: Dysarthria

Dysarthria is a motor speech disorder characterized by difficulty in controlling the muscles used for speech. MIT’s emphasis on melodic patterns helps improve muscle coordination and clarity of speech.

• How it works: MIT for dysarthria uses the same melodic and rhythmic patterns as in aphasia treatment, but the focus is on improving the clarity and control of speech movements. By using musical intonation, individuals with dysarthria can work on their breath control, articulation, and vocalization.
• Goals: The main goal is to enhance the overall quality and intelligibility of speech for individuals with dysarthria, allowing them to communicate more effectively.

Melodic Intonation Therapy: Childhood Apraxia of Speech

Apraxia is a condition that affects the planning and execution of speech movements. MIT’s repetitive and rhythmic structure assists individuals in re-establishing speech motor programs.

• How it works: MIT for apraxia combines the use of melodic and rhythmic patterns with a focus on the motor planning and execution of speech movements. It helps individuals with apraxia learn and execute the proper sequence of movements for speech sounds.
• Goals: The primary objective is to improve the precision and accuracy of speech movements in individuals with apraxia, enabling them to produce speech sounds more fluently and coherently.

Melodic Intonation Therapy Phrases List

Certainly, here is a list of 100 categorized phrases for Melodic Intonation Therapy (MIT). These phrases cover a variety of everyday topics and situations to help individuals with communication disorders practice their speech using melodic and rhythmic patterns. Here is a list of 100 categorized phrases for Melodic Intonation Therapy (MIT) presented in a tabular format:

These phrases cover a wide range of topics and can be used flexibly in Melodic Intonation Therapy sessions to improve speech and communication skills.

FAQs on Melodic Intonation Therapy (MIT)

1. Is MIT suitable for all types of aphasia?
   • MIT is most effective for non-fluent aphasia, but its applicability may vary based on individual cases.
2. How long does MIT typically take to show results?
   • Progress varies, but some patients experience improvements in a matter of weeks, while others may take months of consistent therapy.
3. Can MIT be combined with other speech therapy techniques?
   • Yes, MIT can be integrated into a broader speech therapy program to enhance outcomes.
4. Is MIT accessible for home use?
   • With proper guidance and tools, individuals can continue MIT exercises at home.
5. Are there any age restrictions for MIT?
   • MIT can benefit individuals of all ages, from children to seniors.

References:

• Language Intervention Strategies in Aphasia and Related Neurogenic Communication Disorders – Roberta Chapey, Ed.D. (Book)
• Introduction to Neurogenic Communication Disorders – Robert H. Brookshire, PhD (Book)
• Motor Speech Disorders: Substrates, Differential Diagnosis and Management – Joseph R. Duffy (Book)
• ISHA Monograph: Adult Aphasia Language Intervention
• American Speech and Hearing Association (ASHA)

You are reading about:

Melodic Intonation Therapy (MIT): Goal | Steps | Phrases