From singing to speaking: facilitating recovery from nonfluent aphasia.
From singing to speaking: facilitating recovery from nonfluent aphasia.
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DOI：
10.2217/fnl.10.44
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发表时间：
2010-09
期刊：
影响因子：
1.3
通讯作者：
Wan CY
中科院分区：
文献类型：
--
作者：
Schlaug G;Norton A;Marchina S;Zipse L;Wan CY
100多年来一直有报道说，患有严重非流利性失语症的患者唱歌词的能力比说同样的单词的能力强。这一发现导致了旋律语调疗法（MIT）的发展。然而，这种疗法的疗效尚未在随机对照试验中得到证实。此外，其潜在的神经机制仍不清楚。MIT的两个独特组成部分是单词和简单短语的语调，使用遵循语音韵律的旋律轮廓，以及伴随每个音节产生的左手的有节奏的敲击，并作为流畅性的催化剂。研究表明，这两种成分都能够参与右半球的额颞区，因此MIT特别适合患有非流利性失语症的左半球大病变患者。失语症的恢复有两种方式：一种是通过受影响半球的病灶周围脑区的募集，如果病灶较小，则右半球区域的募集是可变的;另一种是通过未受影响半球的同源语言和言语运动区域的募集，如果受影响半球的病灶广泛。接受MIT的患者的治疗相关神经变化表明，右半球结构的独特参与（例如，上级颞叶、初级感觉运动、运动前回和额下回区域）以及跨越这些脑区域的连接的变化可能是其治疗效果的原因。
It has been reported for more than 100 years that patients with severe nonfluent aphasia are better at singing lyrics than they are at speaking the same words. This observation led to the development of melodic intonation therapy (MIT). However, the efficacy of this therapy has yet to be substantiated in a randomized controlled trial. Furthermore, its underlying neural mechanisms remain unclear. The two unique components of MIT are the intonation of words and simple phrases using a melodic contour that follows the prosody of speech and the rhythmic tapping of the left hand that accompanies the production of each syllable and serves as a catalyst for fluency. Research has shown that both components are capable of engaging fronto–temporal regions in the right hemisphere, thereby making MIT particularly well suited for patients with large left hemisphere lesions who also suffer from nonfluent aphasia. Recovery from aphasia can happen in two ways: either through the recruitment of perilesional brain regions in the affected hemisphere, with variable recruitment of right-hemispheric regions if the lesion is small, or through the recruitment of homologous language and speech-motor regions in the unaffected hemisphere if the lesion of the affected hemisphere is extensive. Treatment-associated neural changes in patients undergoing MIT indicate that the unique engagement of right-hemispheric structures (e.g., the superior temporal lobe, primary sensorimotor, premotor and inferior frontal gyrus regions) and changes in the connections across these brain regions may be responsible for its therapeutic effect.