Behavioral and Neural Correlates of Melodic Intonation Therapy

旋律语调疗法的行为和神经相关性

• 批准号: 7859440
• 负责人: GOTTFRIED SCHLAUG
• 金额: $ 18.02万
• 依托单位: BETH ISRAEL DEACONESS MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-07-17 至 2010-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7859440
• 关键词: Acute; Adult; Aftercare; Animal Welfare; Aphasia; Behavior assessment; Behavioral; Bibliography; Brain; Brain Injuries; Brain region; Case Series; Chronic; Clinical; Communication; Complication; Comprehension; Control Groups; Country; Cues; Data; Elements; Environment; Environmental Impact; Equipment; Experimental Designs; Financial compensation; Functional Imaging; Functional Magnetic Resonance Imaging; Hand; Homologous Gene; IACUC; Image; Inferior; Interdisciplinary Study; International; Intervention; Language; Lateral; Lead; Left; Lesion; Linguistics; Magnetic Resonance Imaging; Maintenance; Measures; Methods; Motor; Music; Names; Nature; Neurorehabilitation; Outcome Measure; Output; Patient observation; Patients; Pattern; Phase; Pre-Post Tests; Precentral gyrus; Principal Investigator; Procedures; Process; Production; Published Comment; Publishing; Randomized; Receptive aphasia; Recovery; Rehabilitation therapy; Reporting; Research; Research Ethics Committees; Resources; Sampling; Scanning; Signal Transduction; Speech; Speech Therapy; Stroke; Structure; Suggestion; Superior temporal gyrus; Techniques; Temporal Lobe; Testing; Therapeutic; Time; Training; Variant; Vertebrates; Visual; abstracting; alternative treatment; aphasic; base; chronic stroke; design; expiration; human subject; improved; interest; melodic intonation therapy; neuroimaging; phrases; post stroke; programs; relating to nervous system; research study; secondary outcome; therapy design; treatment duration; treatment effect; visual stimulus; vocalization

One of the few accepted treatments for severe non-fluent aphasia is Melodic Intonation Therapy (MIT). Inspired by the common clinical observation that patients can actually sing the lyrics of a song better than they can speak the same words, MIT emphasizes the prosody of speech through the use of slow, pitched vocalization (singing), and has been shown to lead to significant improvements in propositional speech beyond the actual treatment period. It has been hypothesized that this effect is due to the gradual recruitment of right- hemispheric language regions for normal speech production, and this is further supported by our own functional magnetic resonance imaging (fMRI) pilot data. Although the MIT-induced treatment effect has been shown in several small case series, it is not clear whether the effect is due to the intensity of the treatment or to the unique, components of MIT that are not found in other, non-intonation-based interventions. Thus, our overall aim is to test our hypothesis that MIT's rehabilitative effect is achieved by using its melodic and rhythmic elements to engage and/or unmask the predominantly right-hemipsheric brain regions capable of supporting expressive language function. In order to test this hypothesis, we have developed an experimental design that includes the randomization of chronic stroke patients with persistent, moderate to severe non-fluent aphasia into three parallel groups receiving 1) 75 sessions of Melodic Intonation Therapy (approximately 8 weeks), 2) 75 sessions of an equally intensive, alternative verbal treatment method developed for this study (Speech Repetition Therapy), or 3) an equal period of No Therapy. All patients will undergo two pre-therapy and two post-therapy behavioral assessments in addition to the pre- and post-therapy fMRI studies examining the neural correlates of overtly spoken and sung words and phrases.This design allows us to 1) examine the efficacy of MIT over No Therapy, 2) examine the effects of elements specific to MIT (e.g., melodic intonation and rhythmic tapping) by comparing it to a control intervention (SRT) that is similar in structure and intensity of treatment, 3) compare post-therapy effects with pre-therapy baseline variations, and 4) examine post-treatment maintenance effects. Our primary speech outcome measure will be the number of Correct Information Units (CIU)/min produced during spontaneous speech. Secondary outcome measures include correctly named items on standard picture naming tests, timed automatic speech, and linguistically-based measures of phrase and sentence analysis. One of the few accepted treatments for severe non-fluent aphasia is Melodic Intonation Therapy (MIT). Inspired by the common clinical observation that patients can actually sing the lyrics of a song better than they can speak the same words, MIT emphasizes the prosody of speech through the use of slow, pitched vocalization (singing), and has been shown to lead to significant improvements in propositional speech beyond the actual treatment period. It has been hypothesized that this effect is due to the gradual recruitment of right- hemispheric language regions for normal speech production, and this is further supported by our own functional magnetic resonance imaging (fMRI) pilot data. Although the MIT-induced treatment effect has been shown in several small case series, it is not clear whether the effect is due to the intensity of the treatment or to the unique, components of MIT that are not found in other, non-intonation-based interventions. Thus, our overall aim is to test our hypothesis that MIT's rehabilitative effect is achieved by using its melodic and rhythmic elements to engage and/or unmask the predominantly right-hemipsheric brain regions capable of supporting expressive language function. In order to test this hypothesis, we have developed an experimental design that includes the randomization of chronic stroke patients with persistent, moderate to severe non-fluent aphasia into three parallel groups receiving 1) 75 sessions of Melodic Intonation Therapy (approximately 8 weeks), 2) 75 sessions of an equally intensive, alternative verbal treatment method developed for this study (Speech Repetition Therapy), or 3) an equal period of No Therapy. All patients will undergo two pre-therapy and two post-therapy behavioral assessments in addition to the pre- and post-therapy fMRI studies examining the neural correlates of overtly spoken and sung words and phrases.This design allows us to 1) examine the efficacy of MIT over No Therapy, 2) examine the effects of elements specific to MIT (e.g., melodic intonation and rhythmic tapping) by comparing it to a control intervention (SRT) that is similar in structure and intensity of treatment, 3) compare post-therapy effects with pre-therapy baseline variations, and 4) examine post-treatment maintenance effects. Our primary speech outcome measure will be the number of Correct Information Units (CIU)/min produced during spontaneous speech. Secondary outcome measures include correctly named items on standard picture naming tests, timed automatic speech, and linguistically-based measures of phrase and sentence analysis.

旋律语调疗法（MIT）是严重非浮力失语症的少数公认治疗方法之一。 受到常见的临床观察的启发，即患者实际上可以通过使用缓慢的，倾斜的发声（唱歌）来强调演讲的歌词比他们所说的词相同，并强调了语音的韵律，并且已被证明可以在实际治疗期之外的命题演讲中显着改善。已经假设这种效果是由于正常语音产生的右半球语言区域逐渐募集，这进一步得到了我们自己的功能磁共振成像（fMRI）试验数据。尽管在几个小病例系列中已经显示了MIT诱导的治疗效果，但尚不清楚该效果是由于治疗的强度还是由于其他基于非智能的干预措施中未发现的MIT的独特成分。因此，我们的总体目的是检验我们的假设，即通过使用其旋律和有节奏的元素来吸引和/或揭露能够支持表达语言功能的主要右脊椎大脑区域，从而实现了MIT的康复效应。为了检验这一假设，我们开发了一种实验设计，其中包括持续，中度至严重的非素质失语的慢性中风患者，分为三个接受的平行组1）75个平行疗法的旋律式疗法（约8周），2），2）75个均等的，替代性言语治疗的替代性疗法或三个疗法的疗法或三个疗法的疗法（或三个疗法）或3个疗法（或三个疗法）或3个疗法（或三个疗法）或三个疗法（或三个疗法）或3次治疗方法或3次治疗方法。除了检查公开口语和促进术的神经相关性外，所有患者还将接受两次疗法和两次疗法后的行为评估，除了进行促进和插入的神经相关性外，该设计允许我们对MIT的功效进行。干预措施（SRT）在治疗的结构和强度上相似，3）将治疗后疗法与疗法前基线变异进行比较，4）检查治疗后维持效果。我们的主要语音结果指标将是自发演讲过程中产生的正确信息单位（CIU）/最小值的数量。次要结果度量包括在标准图片命名测试中正确命名的项目，定时自动语音以及基于语言的短语和句子分析的度量。 旋律语调疗法（MIT）是严重非浮力失语症的少数公认治疗方法之一。 受到常见的临床观察的启发，即患者实际上可以通过使用缓慢的，倾斜的发声（唱歌）来强调演讲的歌词比他们所说的词相同，并强调了语音的韵律，并且已被证明可以在实际治疗期之外的命题演讲中显着改善。已经假设这种效果是由于正常语音产生的右半球语言区域逐渐募集，这进一步得到了我们自己的功能磁共振成像（fMRI）试验数据。尽管在几个小病例系列中已经显示了MIT诱导的治疗效果，但尚不清楚该效果是由于治疗的强度还是由于其他基于非智能的干预措施中未发现的MIT的独特成分。因此，我们的总体目的是检验我们的假设，即通过使用其旋律和有节奏的元素来吸引和/或揭露能够支持表达语言功能的主要右脊椎大脑区域，从而实现了MIT的康复效应。为了检验这一假设，我们开发了一种实验设计，其中包括持续，中度至严重的非素质失语的慢性中风患者，分为三个接受的平行组1）75个平行疗法的旋律式疗法（约8周），2），2）75个均等的，替代性言语治疗的替代性疗法或三个疗法的疗法或三个疗法的疗法（或三个疗法）或3个疗法（或三个疗法）或3个疗法（或三个疗法）或三个疗法（或三个疗法）或3次治疗方法或3次治疗方法。除了检查公开口语和促进术的神经相关性外，所有患者还将接受两次疗法和两次疗法后的行为评估，除了进行促进和插入的神经相关性外，该设计允许我们对MIT的功效进行。干预措施（SRT）在治疗的结构和强度上相似，3）将治疗后疗法与疗法前基线变异进行比较，4）检查治疗后维持效果。我们的主要语音结果指标将是自发演讲过程中产生的正确信息单位（CIU）/最小值的数量。次要结果度量包括在标准图片命名测试中正确命名的项目，定时自动语音以及基于语言的短语和句子分析的度量。