Neurologic Music Therapy for Speech after a Stroke

 

Neurologic Music Therapy (NMT) is an innovative approach that can assist people recovering from a stroke, particularly in rehabilitating speech. This therapy leverages the plasticity of the brain's cognitive, sensory, and motor systems to stimulate and rewire connections damaged by a stroke. NMT's applicability in speech rehabilitation stems from the principles of melody, rhythm, and synchronization.

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Melodic Intonation Therapy (MIT), a type of NMT, uses song melodies to facilitate verbal expression. The patient is encouraged to hum or sing simple phrases set to a melody, gradually transitioning from singing to a more speech-like prosody. The therapist devises target phrases, ensuring that there is a leap in the vocal line that coincides with the natural stress of the sentence. Over time, this approach has shown significant improvement in speech fluency, articulation, and overall language recovery in stroke patients (Schlaug et al., 2010).

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Another important aspect of NMT is rhythmic auditory stimulation (RAS). RAS uses rhythmic cueing to assist speech therapy, capitalizing on the concept of entrainment - the synchronization of motion or sound with an external rhythm. RAS can facilitate timing and pacing of speech, helping patients to improve their speech rhythm and rate (Thaut & Hoemberg, 2014). I have also found Vocal Intonation Therapy very useful with clients who have dysarthria after a stroke. The clarity of speech appears to be greatly enhanced after singing, and of course it is a lot of fun to sing some of the client's favourite songs. 

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Finally, NMT uses a unique attribute of music – its ability to engage the emotional and reward systems of the brain – to motivate patients and promote participation in therapy. This aspect, combined with the structural benefits of rhythm and melody, makes NMT an effective complement to traditional speech therapy approaches.

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Recent developments in neuroimaging have allowed for a better understanding of how NMT affects the brain. A study by Altenmüller et al., (2013) demonstrated that NMT can induce structural changes in the brain that correlate with improved speech function in stroke patients. In their study, patients who received NMT showed the most significant improvements in speech compared to any other type of therapy, confirming the effectiveness of NMT in stroke rehabilitation.

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NMT offers a promising avenue for speech rehabilitation post-stroke. It leverages the shared brain processes of music and language to stimulate speech mechanisms. Its multi-faceted approach – involving melody, rhythm, and emotional engagement – provides a holistic approach to therapy that not only facilitates speech recovery but also offers a rewarding and motivating experience for patients.

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References:

1. Schlaug, G., Marchina, S., & Norton, A. (2010). From Singing to Speaking: Why Singing May Lead to Recovery of Expressive Language Function in Patients with Broca's Aphasia. Music Perception: An Interdisciplinary Journal, 27(4), 315–323.

2. Thaut, M. H., & Hoemberg, V. (2014). Handbook of neurologic music therapy. Oxford University Press.

3. Altenmüller, E., Marco-Pallares, J., Münte, T. F., & Schneider, S. (2009). Neural reorganization underlies improvement in stroke-induced motor dysfunction by music-supported therapy. Annals of the New York Academy of Sciences, 1169, 395-405.