Modified Melodic Intonation Therapy for Acquired Non-Fluent Aphasia
Journal of Music and Medicine 2018 Dwyer B. Conklyn & Taylor A. Rung Meehan
For decades Melodic Intonation Therapy (MIT) has shown good potential within the aphasia population, yet has seldom been used as a frontline treatment, rather placed within a myriad of treatment techniques utilized during aphasia therapy. Debate continues regarding the mechanisms of change from MIT, both therapeutically and neurologically. Modified Melodic Intonation Therapy (MMIT) has developed through the work of Music Therapists, lessening the steps utilized in MIT to emphasize a more direct transfer to speech. As the main focus of treatment for non-fluent aphasia, MMIT can be an effective means of language re-acquisition. This clinical report will discuss outcomes from seven clients with chronic non-fluent aphasia who received treatment from a home-based Music Therapy service.
Effects of Rhythmic Auditory Stimulation on Gait and on Cortical Activation with Mental Imagery of Walking in Patients with MS
CMSC ACTRIMS Cooperative Meeting 2014 F. Bethoux, M. Lowe, K. Koenig, D. Stough, L. Gallagher, D. Conklyn
Background: Rhythmic auditory stimulation (RAS) was shown to improve gait in patients with central nervous system disorders. Previous studies conducted by our team demonstrated improvement of gait parameters after a home walking program using RAS in individuals with MS. Patterns of cortical activation on functional MRI (fMRI) were identified in relation to walking and mental imagery of walking, in various populations. To our knowledge, there has been no published study on the immediate effects of RAS on gait and on cortical activation in relation to mental imagery of walking in patients with MS. Objectives: To measure immediate changes in spatiotemporal (ST) gait parameters with RAS, and to assess changes in cortical activation induced by RAS in MS patients performing mental imagery of walking. Methods: In this cross-sectional study, subjects with gait disturbance from MS were instructed to perform two series of walks on an electronic gait analysis walkway: 5 walks without RAS (W1), and 5 walks with a fixed sequence (W2: no RAS, RAS at comfortable walking cadence, then 10 and 20% above comfortable walking cadence, then no RAS). A repeated measures ANOVA was used to test for within-subject differences in ST gait parameters. Subjects were scanned while performing walking imagery, with (W+) and without (W-) RAS at their spontaneous walking cadence. For each subject, Student’s t-maps were generated for the W+ and W- conditions. Student’s t-maps were spatially normalized and a voxelwise paired t-test was performed between W+ and W-. Results: Ten subjects were enrolled: age 51+/-5 years, 60% women, duration of symptoms 17+/-8 years, 60% relapsing MS, Timed 25 Foot Walk 7+/-3 s, 50% used a cane or walker. During W1, stride length (p=0.03 left side, p=0.004 right side) and velocity (p=0.02) improved significantly between the first and second walks. During W2, there was a significant improvement in cadence (p=0.01), and a trend for improvement of velocity (p=0.05) with RAS. Analysis of fMRI data showed increased activation of the right cerebellum and right insula during W-, while W+ was associated with increased activation in the supplementary motor area, left middle frontal gyrus, and left anterior cingulate, and decreased activation in the right middle temporal gyrus. The W+/W- comparison showed increased activation in the left superior temporal gyrus and left anterior cingulate in the W+ condition, and increased activation in the right middle temporal gyrus in the W- condition (p<0.01, corrected for multiple comparisons). Conclusions: RAS at a tempo above the subject’s spontaneous walking cadence produced an immediate increase in walking cadence. RAS also produced changes in the pattern of cortical activation associated with mental imagery of walking. These results warrant further studies on the mechanism of action and impact of RAS on walking in individuals with MS.
The Scientific Clinician: Understanding, Implementing,and Integrating Scientific Evidence into Daily Practice
Music Therapy Perspectives 2013 Dwyer B Conklyn & Francois Bethoux
Many healthcare professions have noted challenges in the integration of Evidence-Based Practice (EBP). Of the three areas that make up EBP (research, clinical expertise and patient preference), research implementation appears to be the biggest hurdle for clinicians to overcome. From the perspective of two clinicians who
participate in the design and implementation of research protocols, this paper addresses the issues of reading, understanding, participating in and integrating research evidence, particularly as it pertains to neurological rehabilitation and the use of the neurologic music therapy technique Rhythmic Auditory Stimulation.
The Effects of Modified Melodic Intonation Therapy on Nonfluent Aphasia: A Pilot Study
Journal of Speech Language and Hearing Research 2012 D. Conklyn, E. Novak, A. Boissy, F. Bethoux & K. Chemali
Objective: Positive results have been reported with melodic intonation therapy (MIT) in nonfluent aphasia patients with damage to their left-brain speech processes, using the patient’s intact ability to sing to promote functional language. This pilot study sought to
determine the immediate effects of introducing modified melodic intonation therapy (MMIT), a modification of MIT, as an early intervention in stroke patients presenting with Broca’s aphasia. Method: After a randomized controlled single-blind design, 30 acute stroke survivors with nonfluent aphasia were randomly assigned to receive MIT treatment or no treatment. A pre/post test, based on the responsive and repetition subsections of the Western Aphasia Battery, was developed for this study.
Results: After 1 session, a significant within-subject change was observed for the treatment group’s adjusted total score (p = .02), and a significant difference between groups was found for adjusted total score (p = .02) favoring the treatment group.
The treatment group also showed a significant change in their responsive subsection scores (p = .01) when their pre-tests from Visit 1 to Visit 2 were compared, whereas the control group showed no change, suggesting a possible carry-over effect of MIT treatment. Conclusion: This study provides preliminary data supporting the possible benefits of utilizing MMIT treatment early in the recovery of nonfluent aphasia patients.
(RH43) Impact of a Home Walking Program Utilizing Rhythmic Auditory Stimulation
International Journal of MS Care 2012 F. Bethoux, D. Stough, D. Conklyn, R. Butler
Background: The long-term functional impact of interventions to improve walking relies on the patients’ ability to consistently exercise at home. Rhythmic Auditory Stimulation (RAS) is a modality of music therapy that provides auditory cues while walking. Improvement of gait was demonstrated with RAS in Parkinson’s disease and stroke, but not in multiple sclerosis (MS). Objectives: To evaluate the efficacy of a home-based walking program (HBWP) using RAS on gait parameters and patient-reported walking performance. Methods: MS patients with gait disturbance due to spastic paresis were randomized to a 3-week HBWP (treatment) or to no intervention (control). The HBWP consisted of walking 20 minutes per day while listening to recorded music with an embedded beat (10% above the spontaneous walking cadence) on an MP3 player. The HBWP was performed by all subjects during the fourth week. Assessments were conducted weekly for 4 weeks, and 2 weeks after the end of the intervention. Outcome measures included spatiotemporal parameters of gait (GAITRite device), Multiple Sclerosis Walking Scale-12 (MSWS-12), Multiple Sclerosis Functional Composite (MSFC), manual muscle testing (MMT), Modified Ashworth Scale (MAS), and numeric rating scale (NRS) of pain. Results: Gait parameters were significantly better in the treatment group at baseline, with the exception of step width and functional ambulation profile (FAP) score. Average change between baseline and the end of week 3 was significantly different between groups (in favor of the treatment group) for stride length left (repeated-measures mixed models analysis with Turkey-Kramer adjustments, P = .015) and right (P = .001), cadence (P = .033), velocity (P = .006), and MSWS-12 (one-way analysis of variance [ANOVA], P = .039). The gait improvements persisted 2 weeks after the treatment was discontinued. No significant differences were found for MMT, MAS, pain NRS, or MSFC. Conclusions: These results suggest that an HBWP using RAS is effective in improving walking velocity, cadence, and stride length in patients with MS and gait disturbance. The concomitant improvement in MSWS-12 scores suggests that the treatment effects were functionally meaningful to patients. Further research is needed to better understand the mechanism of action of RAS in MS.
A Home-Based Walking Program Using Rhythmic Auditory Stimulation Improves Gait Performance in Patients With Multiple Sclerosis: A Pilot Study
Neurorehabilitation and Neural Repair 2010 D. Conklyn, D. Stough, E. Novak, S. Paczak, K. Chemali & F. Bethoux
Background. Few interventions have been successful in improving gait dysfunction in patients with multiple sclerosis (MS). Rhythmic auditory stimulation (RAS) has demonstrated positive results on gait performance in other neurologically impaired
populations. Objective. To measure the effects of RAS on quantitative walking parameters in ambulatory patients with MS. Methods. Ten MS patients with gait disturbance were randomly assigned to receive RAS versus no intervention for 2 weeks. All participants received RAS for another 2 weeks. Between weekly clinic visits, they were provided with MP3 players containing songs whose tempo was 10% above the participant’s spontaneous cadence and were instructed to walk to the music 20 minutes daily. Quantitative gait parameters were measured using the GAITRite system. Results. A statistically significant decrease between groups was found for change in double-support time (left, P = .0176; right, P = .0247), whereas trends with medium to high effect sizes were found for other gait parameters, including walking speed. A pooled within-group analysis showed significant improvement of cadence, stride length, step length, velocity, and normalized velocity after 1 week of treatment. Satisfaction level with RAS was high. Conclusions. These results in a convenience sample of MS
patients demonstrate the feasibility and safety of RAS when used at home and suggest a potential benefit on gait parameters.