Editing Expressive aphasia (section)

===Melodic intonation therapy===
[[Melodic intonation therapy]] was inspired by the observation that individuals with non-fluent aphasia sometimes can sing words or phrases that they normally cannot speak. "Melodic Intonation Therapy was begun as an attempt to use the intact melodic/prosodic processing skills of the right hemisphere in those with aphasia to help cue retrieval words and expressive language."<ref>{{cite journal|title=A Case Study of the Efficacy of Melodic Intonation Therapy|journal=Music Perception |volume=24|issue=1 |year=2006 |pages=23–36 |issn=0730-7829 |doi=10.1525/mp.2006.24.1.23 |author=Wilson Sarah J|url=http://espace.library.uq.edu.au/view/UQ:186051/UQ186051_OA.pdf }}</ref> It is believed that this is because singing capabilities are stored in the right hemisphere of the brain, which is likely to remain unaffected after a stroke in the left hemisphere.<ref name='Schlaug'>{{cite journal|doi=10.1525/mp.2008.25.4.315|title=From Singing to Speaking: Why singing may lead to recovery of expressive language function in patients with Broca's Aphasia|journal=Music Perception|year=2008|first=Gottfried|last=Schlaug|author2=Sarah Marchina|author3=Andrea Norton|volume=25|issue=4|pages=315–319|pmid=21197418|pmc=3010734}}</ref> However, recent evidence demonstrates that the capability of individuals with aphasia to sing entire pieces of text may actually result from rhythmic features and the familiarity with the lyrics.<ref name='Stahl a'>{{cite journal|last1=Stahl|first1=Benjamin|last2=Kotz|first2=Sonja A.|last3=Henseler|first3=Ilona|last4=Turner|first4=Robert|last5=Geyer|first5=Stefan|title=Rhythm in disguise: why singing may not hold the key to recovery from aphasia|journal=Brain |volume=134|issue=10 |year=2011 |pages=3083–3093 |issn=0006-8950|doi=10.1093/brain/awr240 |pmid=21948939 |pmc=3187543}}</ref>

The goal of Melodic Intonation Therapy is to utilize singing to access the language-capable regions in the right hemisphere and use these regions to compensate for lost function in the left hemisphere. The natural musical component of speech was used to engage the patients' ability to produce phrases. A clinical study revealed that singing and rhythmic speech may be similarly effective in the treatment of non-fluent aphasia and apraxia of speech.<ref name='Stahl b'>{{cite journal|last1=Stahl|first1=Benjamin|last2=Henseler|first2=Ilona|last3=Turner|first3=Robert|last4=Geyer|first4=Stefan|last5=Kotz|first5=Sonja A.|title=How to engage the right brain hemisphere in aphasics without even singing: Evidence for two paths of speech recovery|journal=Frontiers in Human Neuroscience |volume=7 |issue=35 |year=2013 |pages=1–12 |issn=1662-5161 |doi=10.3389/fnhum.2013.00035|pmid=23450277|pmc=3583105|doi-access=free }}</ref> Moreover, evidence from [[randomized controlled trial]]s is still needed to confirm that Melodic Intonation Therapy is suitable to improve propositional utterances and speech intelligibility in individuals with (chronic) non-fluent aphasia and apraxia of speech.<ref name='van der Meulen a'>{{cite journal|last1=van der Meulen|first1=I.|last2=van de Sandt-Koenderman|first2= M. W.|last3=Heijenbrok-Kal|first3=M. H.|last4=Visch-Brink|first4=E. G.|last5=Ribbers|first5=G. M.| title=The efficacy and timing of Melodic Intonation Therapy in subacute aphasia.|journal=Neurorehabil. Neural Repair|year= 2014|volume=28|issue=6|doi=10.1177/1545968313517753|pmid=24449708|pages=536–544|s2cid=6495987}}</ref><ref name='Zumbansen a'>{{cite journal|last1=Zumbansen|first1=Anna|last2=Peretz|first2=Isabelle|last3=Hébert|first3=Sylvie| title=Melodic Intonation Therapy: Back to Basics for Future Research.|journal=Frontiers in Neurology|year= 2014|volume=5|issue=7|pages=7|doi=10.3389/fneur.2014.00007|pmid=24478754|pmc=3904283|doi-access=free }}</ref>

Melodic Intonation Therapy appears to work particularly well in patients who have had a unilateral, left hemisphere stroke, show poor articulation, are non-fluent or have severely restricted speech output, have moderately preserved auditory comprehension, and show good motivation. MIT therapy on average lasts for 1.5 hours per day for five days per week. At the lowest level of therapy, simple words and phrases (such as "water" and "I love you") are broken down into a series of high- and low-pitch syllables. With increased treatment, longer phrases are taught and less support is provided by the therapist. Patients are taught to say phrases using the natural melodic component of speaking and continuous voicing is emphasized. The patient is also instructed to use the left hand to tap the syllables of the phrase while the phrases are spoken. Tapping is assumed to trigger the rhythmic component of speaking to utilize the right hemisphere.<ref name='Schlaug' />

[[FMRI]] studies have shown that Melodic Intonation Therapy (MIT) uses both sides of the brain to recover lost function, as opposed to traditional therapies that utilize only the left hemisphere. In MIT, individuals with small lesions in the left hemisphere seem to recover by activation of the left hemisphere perilesional cortex. Meanwhile, individuals with larger left-hemisphere lesions show a recruitment of the use of language-capable regions in the right hemisphere.<ref name="Schlaug"/> The interpretation of these results is still a matter of debate. For example, it remains unclear whether changes in neural activity in the right hemisphere result from singing or from the intensive use of common phrases, such as "thank you", "how are you?" or "I am fine." This type of phrases falls into the category of [[formulaic language]] and is known to be supported by neural networks of the intact right hemisphere.<ref name='Stahl c'>{{cite journal|last1=Stahl|first1=Benjamin|last2=Kotz|first2=Sonja A.|title=Facing the music: Three issues in current research on singing and aphasia|journal=Frontiers in Psychology |volume=5 |issue=1033 |year=2013 |pages=1–4 |issn=1664-1078 |doi= 10.3389/fpsyg.2014.01033|pmid=25295017|pmc=4172097|doi-access=free }}</ref>

A pilot study reported positive results when comparing the efficacy of a modified form of MIT to no treatment in people with nonfluent aphasia with damage to their left-brain. A randomized controlled trial was conducted and the study reported benefits of utilizing modified MIT treatment early in the recovery phase for people with nonfluent aphasia.<ref>{{cite journal|last1=Conklyn|first1=D|last2=Novak|first2=E|last3=Boissy|first3=A|last4=Bethoux|first4=F|last5=Chemali|first5=K|title=The Effects of Modified Melodic Intonation Therapy on Nonfluent Aphasia: A Pilot Study|journal=Journal of Speech, Language, and Hearing Research|date=2012|volume=55|issue=5|pages=1463–1471|doi=10.1044/1092-4388(2012/11-0105)|pmid=22411278}}</ref>

Melodic Intonation Therapy is used by music therapists, board-certified professionals that use music as a therapeutic tool to effect certain non-musical outcomes in their patients. Speech language pathologists can also use this therapy for individuals who have had a left hemisphere stroke and non-fluent aphasias such as Broca's or even apraxia of speech.

{{Further|Music therapy for non-fluent aphasia}}