Behavioral and Neural Correlates of Melodic Intonation Therapy

描述(申请人提供)：为数不多的被接受的治疗严重非流利失语症的方法之一是旋律语调疗法(MIT)。在一种常见的临床观察的启发下，患者实际上可以更好地唱一首歌的歌词，而不是他们说同样的话，麻省理工学院通过使用缓慢、音调的发声(唱歌)来强调讲话的韵律，并已被证明在实际治疗期之后导致命题言语的显著改善。有人假设，这种效应是由于右脑语言区逐渐被招募来进行正常的语音产生，这一点得到了我们自己的功能磁共振成像(FMRI)试点数据的进一步支持。尽管麻省理工学院诱导的治疗效果已经在几个小病例系列中显示出来，但尚不清楚这种效果是由于治疗的强度，还是由于麻省理工学院独特的成分，这些成分在其他基于非语调的干预中没有发现。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使用其旋律和节奏元素来参与和/或揭示能够支持表达语言功能的主要右半球大脑区域来实现的。为了验证这一假设，我们开发了一项实验设计，包括将患有持续性、中度到重度非流利失语症的慢性中风患者随机分为三组，分别接受1)75次旋律语调疗法(约8周)，2)75次同等强度的替代言语治疗方法(言语重复疗法)，或3)同等时期的不治疗。所有患者都将接受两次治疗前和两次治疗后的行为评估，此外还将接受治疗前和治疗后的fMRI研究，以检查公开说出和唱出的单词和短语的神经相关性。这一设计允许我们1)检查MIT相对于非治疗的疗效，2)通过将其与在治疗结构和强度上相似的对照干预(SRT)进行比较，来检查MIT特有的元素(例如，旋律语调和节奏敲击)的影响，3)比较治疗后的效果与治疗前的基线变化，以及4)检查治疗后的维持效果。我们的主要语音结果测量将是在自发语音过程中产生的正确信息单位(CIU)/分钟的数量。次级结果测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测量。

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.