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: 7547020
• 负责人: GOTTFRIED SCHLAUG
• 金额: $ 36.13万
• 依托单位: BETH ISRAEL DEACONESS MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2008
• 资助国家: 美国
• 起止时间: 2008-01-01 至 2012-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7547020
• 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

DESCRIPTION (provided by applicant): 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-hemispheric 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. Aphasia is a common and devastating complication of stroke or other brain injury that causes severe communication difficulties for tens of thousands of adults each year, yet surprisingly the neural processes that underlie language recovery from stroke or traumatic brain injury remain largely unknown and therefore, have not been specifically targeted by aphasia therapies. One of the few accepted treatments for severe non-fluent aphasic patients is Melodic Intonation Therapy (MIT) with melodic intonation of words/phrases and rhythmic hand tapping as specific elements. In a randomized clinical trial, we will test the efficacy of MIT over no treatment and an alternative intervention that controls for the intensity of the therapy and therapist-patient interaction, but does not have any of the specific elements of MIT.

描述（由申请人提供）：旋律语调疗法（MIT）是为数不多的公认的严重非流利失语症治疗方法之一。受常见临床观察的启发，即患者实际上可以更好地唱出一首歌的歌词，而不是说出相同的单词，麻省理工学院通过使用缓慢的、音调高的发声（唱歌）来强调言语的韵律，并且已被证明可以在实际治疗期间之外带来命题性言语的显着改善。据推测，这种效应是由于右半球语言区域逐渐募集以进行正常言语产生所致，并且我们自己的功能磁共振成像（fMRI）试验数据进一步支持了这一点。尽管 MIT 诱导的治疗效果已在几个小型病例系列中得到证实，但尚不清楚这种效果是由于治疗强度还是由于其他非语调干预措施中未发现的 MIT 独特成分所致。因此，我们的总体目标是检验我们的假设，即麻省理工学院的康复效果是通过利用其旋律和节奏元素来参与和/或揭露能够支持表达语言功能的主要右半球大脑区域来实现的。为了检验这一假设，我们开发了一种实验设计，其中将患有持续性中度至重度不流利失语症的慢性中风患者随机分为三个平行组，接受1）75次旋律语调治疗（约8周），2）75次为本研究开发的同等强度的替代言语治疗方法（言语重复治疗），或3）相同时间段的无治疗。除了检查公开说出和唱出的单词和短语的神经相关性的治疗前和治疗后功能磁共振成像研究之外，所有患者还将接受两次治疗前和两次治疗后行为评估。这种设计使我们能够 1) 检查 MIT 相对于无治疗的功效，2) 通过将其与治疗结构和强度相似的控制干预 (SRT) 进行比较，检查 MIT 特有元素（例如旋律语调和节奏敲击）的效果，3) 将治疗后效果与治疗前基线变化进行比较，4) 检查治疗后维持效果。我们的主要言语结果衡量标准是自发言语期间每分钟产生的正确信息单位 (CIU) 的数量。次要结果测量包括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测量。失语症是中风或其他脑损伤的一种常见且具有破坏性的并发症，每年给数以万计的成年人造成严重的沟通困难，但令人惊讶的是，中风或创伤性脑损伤中语言恢复的神经过程仍然很大程度上未知，因此，失语症治疗还没有专门针对这些过程。针对严重不流利失语症患者的少数接受的治疗方法之一是旋律语调疗法（MIT），以单词/短语的旋律语调和有节奏的手敲击作为特定元素。在一项随机临床试验中，我们将测试 MIT 相对于不进行治疗和控制治疗强度以及治疗师与患者互动的替代干预措施的疗效，但不包含 MIT 的任何特定要素。