From Singing to Speaking: Suggestions For Using Music With People With Aphasia

The following is excerpted from the article “From Singing to speaking,” Stroke Connection Magazine, September/October 2005

Singing familiar songs is psychologically and emotionally uplifting. Provide opportunities for individuals with aphasia to sing their favorite songs. In addition to purchasing albums, put together tapes or CDs of their “all-time” favorites.

It is now possible to legally purchase and download songs from the Internet to record them on CDs or digital MP3 players that store many songs.

Make singing a part of social events that might otherwise be difficult for a person with aphasia.

Good candidates for melodic intonation therapy have:

severely restricted speech that may be limited to nonsense words or syllables except when singing
along to popular songs;
poor ability to repeat words spoken by others;
relatively good ability to understand the speech of others;
good motivation, cooperation and attentiveness; and
a single, left hemisphere lesion that spares Wernicke’s area (the speech comprehension center of the brain).
If this seems like a match, survivors should ask a speech-language pathologist to determine whether an individual with severely restricted speech output might be a good candidate for melodic intonation therapy. The program, including a manual, videotape and stimulus cards, can be implemented by family members. For more information on how to obtain it, call 1-888-488-7653 (1-888-4STROKE).

The Music and Neuroimaging Lab

The Music and Neuroimaging Laboratory at Beth Israel Deaconess and Harvard Medical School

Mission Statement

The human brain has the remarkable ability to adapt in response to changes in the environment over the course of a lifetime. This is the mechanism for learning, growth, and normal development. Similar changes or adaptations can also occur in response to focal brain injuries, e.g., partially-adapted neighboring brain regions or functionally-related brain systems can either substitute for some of the lost function or develop alternative strategies to overcome a disability.

Through ongoing research, the Music and Neuroimaging Laboratory’s mission is to:

• Reveal the perceptual and cognitive aspects of music processing including the perception and memory for pitch, rhythmic, harmonic, and melodic stimuli.
• Investigate the use of music and musical stimuli as an interventional tool for educational and therapeutic purposes.
• Reveal the behavioral and neural correlates of learning, skill acquisition, and brain adaptation in response to changes in the environment or brain injury in the developing and adult brain.
• Reveal the determinants and facilitators for recovery from brain injury.

Projects

The Music and Neuroimaging Laboratory is currently involved in a variety of neurology/neuroscience research projects, ranging from studies examining the effects of instrumental music training on children’s brain and cognitive development to studies examining the neural correlates of absolute pitch, congenital and acquired amusia, neural effects of auditory and motor learning, neural correlates of singing and speaking in normal subjects as well as aphasic patients, to studies examining the effects of therapies that could facilitate the recovery from aphasia and sensorimotor deficits after a stroke. We have also recently begun to examine the effects of a non-invasive, electrical stimulation technique (TDCS - transcranial direct current stimulation) on blocking or enhancing regional brain activity.

• Children’s Music Studies
• Adult Musician Studies
• Amusia Studies
• Absolute Pitch Studies
• Acute-Stroke Studies
• Stroke Recovery Studies
• Aphasia-Therapy Studies

Our Main Research Interests

1. The Brain that Makes Music or the Musical Brain. We are studying the cerebral correlates of musical abilities and the functional/structural cerebral adaptations of music training using musicians as a model. This work is supported by the NSF and the International Foundation for Music Research (IFMR). For a sample of recent papers please see Publications (Schlaug et al., 1995a,b; Amunts et al., 1997; Jaencke et al., 1997; Schlaug, 2001; Keenan et al., 2001; Muente et al., 2002; Lee et al., 2003; Hutchinson et al., 2003; Gaser et al., 2003).

2. The Effects of Music Training on Cognitive and Brain Development in Children. In longitudinal and cross-sectional studies we are examining the effects of learning to play a musical instrument as well as the effects of enriched music instruction in school on various behavioral and cognitive measures as well as brain development. This work is supported by NSF, the International Foundation for Music Research, and the Grammy Foundation.

3. Neural Correlates of Absolute Pitch. We are examining the structural and functional brain markers of this unique ability. We are also interested in the incidence of this ability in special populations and the familial occurrence of absolute pitch. For a sample of recent papers see Publications (Schlaug et al., 1995; Keenan et al., 2001; Schlaug, 2003).

4. Behavioral and Neural Effects of Auditory Learning. We are examining the behavioral and brain effects of acquiring auditory skills in adults, mainly in those without any musical training.

5. Pathophysiology of Acute Human Stroke. We are using new magnetic resonance imaging methods such as perfusion and diffusion weighted imaging to select patients for treatment, to determine the benefit/risk ratios of experimental treatment approaches, and to assess tissue outcome after an intervention is done. This work is supported by the NIH and the Doris Duke Charitable Foundation. For a sample of recent papers please see Publications (Schlaug et al., 1997, 1999; Fink et al., 2002a,b; Selim et al., 2002; Linfante et al., 2002).

6. Determinants and Facilitators of Stroke Recovery. W are using functional magnetic resonance imaging (fMRI) and transcranial magnetic stimulation (TMS) to study stroke recovery. This research is supported by the Dana Foundation and the NIH. For a sample of relevant papers please see Publications (Hutchinson et al., 2002; Kobayashi et al., 2002; Mottaghy et al., 2002).

7. Singing and Speaking in Normal Subjects and in Patients with Aphasia. We are examining the sharing of neural substrates when subjects sing and speak. This work will be used the examine the neural correlates of innovative therapies in aphasia rehabilitation.

Rehab

Not the Same Old Song

By Jennifer A. Rathbun, MM, MT-BC

Music, Speech, and Language

Melodic intonation therapy (MIT) has been widely used by speech-language pathologists with aphasic patients. According to Sparks and Holland,5 MIT is a step-by-step procedure that uses melody based on the natural prosody of functional phrases to stimulate verbal expression. Later, the melody is faded into chant and finally, the chant is faded into normal speech. At TIRR, both musical speech stimulation (MSS) and a modified form of MIT are used during sessions with a music therapist and speech-language pathologist.

MSS is the musical form of phrase completion. It uses the unimpaired ability to sing in order to facilitate spontaneous verbalizations. Patients are asked to complete phrases within familiar songs, such as "You Are My Sunshine." This automatic singing is practiced and then transferred into functional expression as automatic speech emerges.

Apraxic patients benefit from MSS because familiar songs have a predictable rhythm, which facilitates oral-motor timing. In addition, songs are directional-the chord progressions, or musical building blocks, lead the song to resolution.

Music therapists also provide simple instruments to facilitate the coordination of the breathing mechanism. The music made by these instruments, such as harmonicas, recorders, and melody horns (instruments with a small keyboard connected to a mouthpiece), motivates the patients to exercise breath control.

Marc Black: Stroke of Genuis

Everything Not Lost and karaoke

I'll be counting up my demons, yeah,
Hoping everything's not lost,
Everything's not lost,
When I'm counting up my demons.

There's always one for everyday,
With the good ones on my shoulder,
I drove the other ones away.

If you ever feel neglected,
If you think all is lost,
I'll be counting up my demons, yeah,
Hoping everything's not lost.

When you thought it was over,
You could feel it all around,
Everybody's out to get you,
Don't you let it drag you down.

Cos if you eve feel neglected,
If you think that all is lost,
I'll be counting all the demons, yeah.

Singing out o yeah [x3]

Everything's not lost,
Come on yeah, o yeah, come on yeah,
Everything's not lost,
O yeah, [x3]
Everything's not lost,
Come on yeah, o yeah,
Come on yeah [x2]
O yeah, Come on yeah,
Everything's not lost, Sing out yeah,

Come on yeah [x2]
Everything's not lost,
Come on yeah, o yeah,
Sing out yeah,
Everything's not lost.

Clock and karaoke

Lights go out and I can't be saved,
Tides that I tried to swim against,
Have put me down upon my knees,
Oh I beg, I beg them please,
Singing, come out of things I've said,
Shoot an apple off my head,
And I, Trouble that can't be named,
The tigers waiting to be tamed,

Singing, you are,
You are.

Confusion never stops,
Closing walls and ticking clocks,
Gonna, come back and take you home,
I could not stop what you now know,
Singing, come out upon my seas,
Cursed missed opportunities,
Am I a part of the cure,
Or am I part of the disease?

Singing, you are,
You are,
You are,
You are.

And nothing else compares,
Oh nothing else compares,
And nothing else compares.

You are,
You are.

Home, where I wanted to be home,
Home, where I wanted to be home,
Home, where I wanted to be home.