Norton et al. (2009)

CRITIQUE OF UNSUPPORTED PROCEDURAL DESCRIPTIONS

KEY:

C = clinician

MIT = Melodic Intonation Therapy

P = patient or participant

pmh = Patricia Hargrove, blog developer

SLP = speech-language pathologist

 

Source: Norton, A., Zipse, L., Marchina, S., & Schlaug, G. (2009). Melodic Intonation Therapy: Shared insights on how it is done and why it might help. Annals of the New York Academy of Sciences, 1169, 431-436.

ARTICLE: doi: 10.1111/j.1749-6632.2009.04859.x

REVIEW:

 

 

Reviewer(s): pmh

 

Date: August 6, 2015

 

Overall Assigned Grade (because there are no supporting data, the highest grade will be F): F

 

Level of Evidence: F = Expert Opinion, no supporting evidence for the effectiveness of the intervention although the author may provide secondary evidence supporting components of the intervention.

 

Take Away: The authors describe, but present no supporting evidence for, an alternative version to Melodic Intonation Therapy (MIT) for patients (Ps) with nonfluent aphasia. This alternative MIT is designed to be administered by individuals who are not speech-language pathologists (SLPs.) The alternative version is both a simplification and an augmentation. SLPs may find the augmentations (Inner Rehearsal and Auditory Motor Feedback Training) to be helpful additions to standard MIT.

 

  1. Was there a review of the literature supporting components of the intervention? Limited Narrative Review

 

 

  1. Were the specific procedures/components of the intervention tied to the reviewed literature? Variable. Limited evidence of the effectiveness of MIT was presented but no evidence was provided supporting the use of the recommended changes.

 

 

  1. Was the intervention based on clinically sound clinical procedures? Yes
  1. Did the authors provide a rationale for components of the intervention? Yes
  1. Proposed Outcomes :
  • Outcome #1: To improve fluency
  • Outcome #2: To increase expressive language

 

 

  1. Was generalization addressed? No

 

 

  1. Was maintenance addressed? No

 

 

SUMMARY OF INTERVENTION

 

 

The authors described standard MIT procedures (Intervention #1) and then outlined recommended additional procedures (Intervention #2) which might improve the effectiveness of MIT.

Description of Intervention #1—(Standard MIT)

 

POPULATION: Nonfluent Aphasia; Adults

 

TARGETS: fluency; increased expressive language; to speak in sentences of 5 or more syllables

 

TECHNIQUES: humming, unison intoning, unison intoning with fading, immediate imitating, delayed imitating, sprechgesang with fading, responding to questions, tapping

 

STIMULI: auditory, motor, visual

 

ADMINISTRATOR: SLP

 

PROCEDURES:

  • There are 3 levels of treatment that differ phrase length and the amount of support provided by the clinician (C.)
  • Each level consists of 20 target words/phrases that are highly functional in the patient’s (P’s) environment.
  • Initially, targets are presented with visual cues that are faded as the P progresses.
  • The prosody of the targets is mimicked in the sung productions although there are only 2 pitch levels: stressed syllables are the higher pitch and unstressed syllables are the lower stress.
  • Sung productions are accompanied by tapping of the left hand with each syllable being paired with a tap.
  • Some Cs accompany Ps with musical instruments such as the piano and others use familiar tunes in the sung productions.
  • The steps, depending on treatment level include within a level include

– humming

– unison intoning

– unison intoning with fading

– immediate imitating

– delayed imitating

– sprechgesang with fading

– responding to questions

– tapping

\

RATIONALE/SUPPORT FOR INTERVENTION: Logical—a small number of sources were cited by the quality of the evidence was not analyzed.

 

CONTRAINDICATIONS FOR USE OF THE INTERVENTION: Undocumented claims that MIT works best with Ps with the following characteristics.

  • Left hemisphere brain damage (unilateral)
  • Nonfluent aphasia
  • Restricted expressive output
  • Poor articulation
  • Receptive language/comprehension is relatively unimpaired
  • Motivated
  • Attentive
  • Emotionally stable

 

Description of Intervention #2—Simplified and Augmented Melodic Intonation Therapy

 

POPULATION: Nonfluent Aphasia, Apraxia; Adult

 

TARGETS: to increase fluency and expressive language

TECHNIQUES: humming, immediate imitating, tapping, Inner Rehearsal, Auditory Motor Feedback Training

STIMULI: auditory, motor, visual

 

ADMINISTRATOR: any healthcare therapist, caregivers, Ps

 

PROCEDURES:

  • C models a target word/phrase accompanied by a visual cue. The model is sung with the higher of two pitch being paired with accented syllables and the lower pitch being paired with unaccented syllables.

INNER REHEARSAL

  • The purpose of this procedure is to facilitate the sequencing of motor commands
  • C models Inner Rehearsal by

– tapping P’s hand (1 syllable per second) while humming the targeted song for the targeted word/phrase

– then moving to tapping and singing the target word/phrase

  • C explains to P that he/she should try to hear the word/phrase sung inside his/her head.

AUDITORY MOTOR FEEDBACK TRAINING

  • The purpose of this procedure is to improve P’s ability to self monitoring of phoneme production.
  • The procedure is not clearly described other than noting that Ps listen to C’s production of targets and then compare their own productions to the target.
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