Aphasia is characterized as a disorder that affects speech, language comprehension, writing, and understanding speech. It can be caused by many different diagnoses, such as a stroke, head injury, brain tumor, language and speech impairments, autism spectrum disorder, or others. The severity of aphasia is determined by the cause, and every individual will have different strengths, weaknesses, and symptoms. Symptoms may include speaking in short sentences, difficulty putting words together, difficulty understanding conversation, mixing up words, and more.
Aphasia can be defined even further through the part of the brain that is affected, such as Wernicke’s or Broca’s aphasia. Music therapy (MT) has the ability to address and treat these areas of need through music interventions. As evidenced by Koelsch, MT helps aphasia patients with communication because many are able to sing despite their inability to speak. Koelsch also found that the brain networks that control singing and speaking slightly overlap, and singing involves more neural connections (Koelsch, 2009).
There are many different ways that music therapists can work with clients with this diagnosis. There are currently many studies that suggest great success when it comes to using MT in rehabilitation after a stroke, especially Neurologic Music Therapy. The Handbook of Neurologic Music Therapy defines Neurologic Music Therapy (NMT) as, “the therapeutic application of music to cognitive, affective, sensory, language, and motor dysfunctions due to disease or injury to the human nervous system,” (Thaut & Hoemberg, 2014, p. 2). The handbook highlights 20 NMT techniques that are backed by evidence to help people with varying diagnoses. Melodic Intonation Therapy (MIT) is a technique that has been highlighted in many studies for treating patients with Broca’s aphasia. MIT is when a neurologic music therapist assists the client in tapping their left arm or hand while humming or singing words or phrases. The significance of tapping the left hand is that it “activates right hemispheric language networks, as spoken language and arm gestures are controlled by the same motor network,” (Thaut & Hoemberg, 2014, p. 142). Rhythm and melody are important therapeutic functions of music in this technique, and a therapist must be trained in NMT to properly use this intervention.
In a study conducted by Hatayama, et al., the results demonstrated that a patient with nonfluent aphasia (associated with Broca’s area) demonstrated great improvement in fluency of speech, reading, spontaneous speech, and conversation after 52 months of treatment. Before treatment started, the client was only able to speak one word. (Hatayama, et. al, 2021). In a recent meta-analysis by Leonardi, et al., they concluded that music therapy in general has the ability to improve spontaneous speech, communication, naming, and repetition in patients with post-stroke aphasia. (Leonardi, et al., 2018). This study also highlights the progress clients are able to make in MT when therapists utilize Speech-MT for Aphasia (SMTA). Dynamics, tempo, and meter are musical elements that the therapist uses to improve sound, word, and sentence levels. In many interventions that target speech needs, clients and therapists will work on therapeutic singing together or utilize simple melodies to form words and sentences. When therapists look for interventions that will assist in the recovery of speech after a stroke, there are many different evidence-based techniques. It is important to understand the specific parts of the brain that are affected when treating a patient with these needs.
-Lila Finke, Music Therapy Intern
References
Hatayama, Y., Yamaguchi, S., Kumai, K., Takada, J., Akanuma, K., & Meguro, K. (2021). Music intonation therapy is effective for speech output in a patient with non-fluent aphasia in a chronic stage. Psychogeriatrics, 21(3), 430–433. https://doi.org/10.1111/psyg.12667
Koelsch S. A neuroscientific perspective on music therapy. Ann N Y Acad Sci. 2009;1169:374–384.
Leonardi, S., Cacciola, A., De Luca, R., Aragona, B., Andronaco, V., Milardi, D., Bramanti, P., & Calabrò, R. S. (2018). The role of music therapy in rehabilitation: Improving aphasia and beyond. International Journal of Neuroscience, 128(1), 90–99. https://doi.org/10.1080/00207454.2017.1353981
Thaut, M. & Hoemberg, V. (2014). Handbook of neurologic music therapy: Vol. First edition. OUP Oxford.