Behavioral and Neural Correlates of Melodic Intonation Therapy

描述（由申请人提供）：重度非流利性失语症的少数接受治疗之一是旋律语调疗法（Melodic Intonation Therapy， MIT）。通常的临床观察发现，患者唱一首歌的歌词比他们说同样的单词的效果更好，MIT的灵感来自于这一点，它强调通过使用缓慢的、有音调的发声（唱歌）来提高语言的韵律，并且已经被证明在实际治疗期之后，这种方法可以显著改善语音的韵律。有一种假设认为，这种影响是由于右半脑语言区域逐渐被用于正常的语言产生，这一假设得到了我们自己的功能性磁共振成像（fMRI）试点数据的进一步支持。尽管MIT诱导的治疗效果已在几个小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在其他非基于语调的干预措施中未发现的MIT的独特成分。因此，我们的总体目标是验证我们的假设，即MIT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性语言功能的主要右半脑区域来实现的。为了验证这一假设，我们开发了一个实验设计，包括将持续性、中度至重度非流利性失语症的慢性中风患者随机分为三个平行组，分别接受1)75次旋律语调治疗（大约8周），2)75次为本研究开发的同等强度的替代语言治疗方法（言语重复治疗），或3)同等时间的无治疗。所有患者将接受两次治疗前和两次治疗后的行为评估，以及治疗前和治疗后的功能磁共振成像研究，以检查公开说出和唱出的单词和短语的神经相关性。该设计允许我们1)检查MIT相对于无治疗的疗效，2)通过将其与结构和治疗强度相似的对照干预（SRT）进行比较，检查MIT特有的元素（例如，旋律语调和节奏敲击）的效果，3)比较治疗后效果与治疗前基线变化，以及4)检查治疗后维持效果。我们的主要语音结果测量将是自发语音中每分钟产生的正确信息单位（CIU）的数量。次要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测量。失语症是中风或其他脑损伤的一种常见的毁灭性并发症，每年导致成千上万的成年人出现严重的沟通困难，然而令人惊讶的是，中风或创伤性脑损伤后语言恢复的神经过程在很大程度上仍然未知，因此，失语症治疗并没有专门针对失语症。重度非流利失语症患者的少数接受治疗之一是旋律语调疗法（Melodic Intonation Therapy， MIT），以单词/短语的旋律语调和有节奏的手拍作为特定元素。在一项随机临床试验中，我们将测试MIT与不治疗和替代干预的疗效，该干预控制治疗强度和治疗师-患者互动，但不具有MIT的任何特定元素。

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.