Music therapy for non-fluent aphasia is a method for treating patients who have lost the ability to speak after a stroke or accident. Non-fluent aphasia, also called expressive aphasia, is a neurological disorder that deprives patients of the ability to express language. It is usually caused by stroke or lesions in Broca's area, which is a language-dominant area that is responsible for speech production located in the left hemisphere of the brain. However, when lesions form in Broca's area this only affects patients’ speech ability, while their ability to sing remains unaffected. Since several studies have shown that right hemispheric regions are more active during singing, music therapy involving melodic elements is deemed to be a potential treatment for non-fluent aphasia, as singing might activate patients’ right hemisphere to compensate with their lesioned left hemisphere. Aside from singing, many other music therapy techniques have also been attempted such as rhythms and poetic emphasis, which is shown to add to the effectiveness. Although there are many possible explanations for the mechanism of music therapy, the underlying mechanism remains unclear, as some studies indicate contradictory results.
Techniques
Therapeutic singing A common method of therapeutic singing is guiding patients to sing familiar songs. Patients are led to sing these familiar songs along with their therapists. Each therapist needs to be cognoscente of what would be familiar to the patients. Having someone in their 70's be asked to sing a Taylor Swift song, would not be deemed appropriate. The therapist also might need to adjust the tempo, volume, and pitch of the songs according to each individual patient. By doing this, it helps someone who might be a struggling to formulate thoughts and words quickly have time to catch up. This can optimize the therapy process. The lyrics that patients can most easily produce are repeated several times. The utilization of singing during the treatment of aphasia is not a novel therapy technique, as in the past therapists already noticed that patients who had difficulty speaking were still able to sing.
Vocal intonation To begin is it needed to define what vocal Intonation. In its simplest terms, it is the rise and fall of voicing at the end of questions, and or statements to convey a meaning, or a mood and anything else that will help the listeners understand what your intentions are. Vocal intonation is introduced to make aphasic patients intentionally exaggerate the intonation of daily phrases. The most well-known application of vocal intonation in music therapy is Melodic Intonation Therapy (MIT). MIT was developed when researchers noticed a pattern which spanned 100 years of observation, it showed patients with aphasia were far better able to sing then to speak in sentences. When receiving MIT, patients intone phrases with 2–3 syllables on only two pitches, which are determined by the natural prosody of phrases. Stressed syllables are intoned on a higher pitch, while unstressed syllables are intoned on a lower pitch. However, various intonation in daily conversational phrases may be used, so patients can practice communicating different meanings through different intonation. In addition, body cues, such as head or hand movement, may be used to help patients perceive different pitch in vocal intonation.
Dynamically cued singing Dynamically cued singing was also used by therapists a long time ago. Therapists will guide patients to finish an incomplete sentence by singing the name of a designated object, such as “hand” if a therapist points to a patient’s hand. Additionally, dynamically cued singing can be employed together with singing familiar songs. Therapists may pause at the end of each phrase of a song to let patients finish the phrase by singing. This technique creates a strong interpersonal interaction that not only enhances patients’ motivation to participate, but also offers a circumstance similar to real conversation that benefits patients’ skills outside of music.
Breathing into syllable sound At beginning, therapists will ask patients to focus on breathing single-syllable sounds only. The effect of this technique is enhanced if therapists can guide patients to produce the sounds with their natural breathing patterns that help them relax, such as yawning, signing, or cleaning voices. Later on, patients will be encouraged to develop the breathing sounds into pitched sounds. Hand movement may be used to help patients synchronize syllable sounds with exhaling. Usually, the single-syllable sounds begin from vowels to consonants. But it is also suggested that the procedure should be from bilabial sounds (i.e. /m/, /b/), tongue-tip sounds (i.e. /n/, /d/), to tongue-base sounds (i.e. /g/, /k/).
Musically assisted speech Patients will produce conversational phrases with melodies that the patients are familiar with to practice the real conversation that the patients may need in their daily life. This technique leads to more successful outcomes if original lyrics of the melodies are presented before the melodies are associated with conversational phrases. The method was also conducted by therapists more than 40 years ago and indicated to be effective. Keith and Aronson had recorded that their stroke patient rehabilitated from aphasia by singing simple conversational phrases to communicate with people.
Rhythmic speech cueing Rhythmic speech cueing is one of the essential components in MIT, which requires patients to use their left hand to tap each syllable of the intoned phrases. In general, therapists will guide patients to clap or tap the speech rhythm to phrases obtained from song lyrics, conversations, or any resources related to the immediate context. Instead of left-hand tapping, clapping or beating a drum are also possible alternatives. Rhythmic cueing speed, which has been shown to be more crucial than the melody, will correspond to the patients’ speech speed, prosodic rhythms of the phrases, or musical rhythms of the lyrics, depending on the circumstances of each individual and the types of phrases.
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