Melodic Intonation Therapy for Aphasia & Apraxia in 8 Easy Steps

In this article, you’ll learn how to do Melodic Intonation Therapy for aphasia and apraxia of speech.

Plus, you’ll get a phrase list and goal bank to use with your speech therapy patients!

For more evidence-based materials, see the bestselling Adult Speech Therapy Starter Pack.

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Melodic Intonation Therapy Visual

Save or print the Melodic Intonation Therapy infographic to remind you of the steps!

What is Melodic Intonation Therapy? 

melodic intonation therapy for aphasia

Melodic Intonation Therapy (MIT) is an evidence-based treatment that uses elements of music, including pitch, rhythm, and stress, to improve speech production (ASHA-2, n.d.)

Over a century ago, clinicians observed that some people with nonfluent aphasia could still sing (‘intone’) words they could no longer speak. Melodic Intonation Therapy was developed based on this observation (Norton, 2009).

MIT also uses the tactile cue of tapping on a patient’s left hand to further activate their brain’s right hemisphere.

Is MIT Evidence-Based?

Yes it is!

MIT has been shown to successfully treat both nonfluent aphasia and acquired apraxia of speech (Sparks et al., 1974; Sparks & Holland, 1976; Zumbansen et al., 2014).

Recent meta-analysis and systematic reviews found that MIT improves repetition and may improve functional communication and phrase length in people with non-fluent aphasia (Popescu, 2022; Zhang, 2022; Haro-Martínez, 2021).

While another systematic review found that MIT improved speech and language better in patients with both apraxia of speech and aphasia (vs only aphasia). Which led them to hypothesize that MIT may use a motor speech pathway to treat aphasia (Zumbansen, 2019).

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When to Use Melodic Intonation Therapy

when to use melodic intonation therapy

The best candidates for MIT treatment are patients with most or all of the following (list from Norton, 2009):

  • a unilateral, left-hemisphere stroke
  • poorly articulated, nonfluent, or severely restricted speech output
  • ability to produce some intelligible words while singing familiar songs
  • poor repetition, even for single words
  • moderately well-preserved auditory comprehension
  • poorly articulated attempts at speech
  • good motivation, emotional stability, and good attention span

Melodic Intonation Therapy for Apraxia

For both apraxia of speech and aphasia, you’ll start with functional daily phrases to improve communication effectiveness. Keep scrolling for an MIT phrase list.

MIT with apraxia will first focus on functional communication (e.g. words like “help” or “thank you”). As patients improve, your focus may switch to intelligibility by adding in more difficult consonant-loaded phrases.  

Melodic Intonation Therapy for Aphasia

For aphasia, MIT starts by increasing verbal output and functional communication. Essentially, you want your patient to be able to produce anything by speech.

As they progress, you may switch the focus to increasing the length of utterances with a variety of phrases and sentences.

Melodic Intonation Therapy Steps

melodic intonation therapy steps

Below is a beginner’s MIT protocol (summarized from Norton et al., 2009).

Read their article for intermediate and advanced protocols.

  1. Present the phrase. Show the patient the target phrase
  2. Hum the phrase. Hum at a rate of 1 syllable per second
    • Use a higher-pitched note on the stressed syllable or word
  3. Sing the phrase and tap. Sing the phrase twice. While singing, you tap the patient’s left hand on each syllable
    • Again, sing a higher-pitched note on the stressed syllable or word
    • For example, with the word “apple,” the first syllable “ah” will be high-pitched and the second syllable “ple” will be low-pitched
  4. Sing together. Sing the phrase in unison with your patient while tapping their left hand on each syllable
  5. Fade out. Continue to sing the phrase together while tapping their left hand. Gradually fade your singing
    • Now, the patient is singing alone while you tap their left hand (don’t give verbal or oral/facial cueing)
  6. Take turns singing. You sing the phrase while the patient listens. Stop singing so that the patient sings the phrase alone, but keep tapping their left hand
  7. Patient sings alone. Immediately after a correct production, ask, “What did you say?” Tap the patient’s hand as they sing the target phrase
  8. Repeat. Repeat a new phrase

Melodic Intonation Therapy Example

melodic intonation therapy for aphasia

Here’s an example of how to use Melodic Intonation Therapy with a patient:

Target phrase: Good morning

  1. Clinician presents the written phrase good morning.
  2. Clinician hums “good morningusing rising pitches on the stressed syllables.
  3. Clinician sings “good morning” twice while tapping the patient’s left hand on each syllable.
  4. Clinician and patient sing “good morning” together.
    • Clinician taps the patient’s left hand on each syllable as they sing.
  5. Clinician and patient keep singing “good morning.”
    • Clinician stops singing but keeps tapping the patient’s left hand on each syllable. Patient continues to sing “good morning.”
  6. Clinician then sings “good morning” while the patient taps along.
    • Then, the patient sings “good morning” while the clinician taps along.
  7. Patient sings “good morning” alone.
    • After a correct repetition, the clinician asks, “What did you say?” Then taps on each syllable as the patient sings “good morning” again.
  8. Repeat the steps with a new phrase.

Melodic Intonation Therapy Example: Video

Here’s a video example of Melodic Intonation Therapy that was posted by MedRhythms Therapy.

Melodic Intonation Therapy Phrase List

melodic intonation therapy phrase list

Here is a functional Melodic Intonation Therapy phrase list to use with your patients:

  1. Good morning!
  2. Nice to meet you!
  3. Thank you!
  4. How are you?
  5. I am tired.
  6. I’m in pain.
  7. I’m hungry.
  8. I’m thirsty.
  9. Bathroom please.
  10. My name is ______.
  11. See you later.
  12. I love you!
  13. What’s new?
  14. Let’s go.
  15.  I don’t know.

Melodic Intonation Therapy Goals

melodic intonation therapy goals

MIT Apraxia Goals

  1. The patient will produce 10 functional phrases with 80% intelligibility independently in 4 weeks.
  2. The patient will produce 5 functional phrases with 80% intelligibility with moderate verbal/visual cues in 2 weeks.

MIT Aphasia Goals

  1. The patient will produce 2-4 word functional phrases in 8/10 opportunities given moderate verbal/visual cues in 2 weeks.
  2. The patient will produce 5+ word functional phrases and sentences independently in 4 weeks.

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References

  • American Speech-Language-Hearing Association-1. (n.d.). Acquired Apraxia of Speech. (Practice Portal). Retrieved April 18, 2024 from www.asha.org/practice-portal/clinical-topics/acquired-apraxia-of-speech/.
  • American Speech-Language-Hearing Association-2. (n.d.). Aphasia. (Practice Portal). Retrieved April 20, 2024 from Aphasia (asha.org)
  • Brewer, C., Aparo, M. (2021) The Adult Speech Therapy Starter Pack. Harmony Road Design LLC.
  • Duffy, J. R. (2020). Motor speech disorders: Substrates, differential diagnosis, and management (4th ed.). Elsevier.
  • Haro-Martínez, A., Pérez-Araujo, C. M., Sanchez-Caro, J. M., Fuentes, B., & Díez-Tejedor, E. (2021). Melodic Intonation Therapy for Post-stroke Non-fluent Aphasia: Systematic Review and Meta-Analysis. Frontiers in neurology, 12, 700115. https://doi.org/10.3389/fneur.2021.700115
  • 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. https://doi.org/10.1111/j.1749-6632.2009.04859.x
  • Popescu, T., Stahl, B., Wiernik, B. M., Haiduk, F., Zemanek, M., Helm, H., Matzinger, T., Beisteiner, R., & Fitch, W. T. (2022). Melodic Intonation Therapy for aphasia: A multi-level meta-analysis of randomized controlled trials and individual participant data. Annals of the New York Academy of Sciences, 1516(1), 76–84. https://doi.org/10.1111/nyas.14848
  • Sparks, R., Helm, N., & Albert, M. (1974). Aphasia rehabilitation resulting from melodic intonation therapy. Cortex, 10(4), 303–316. https://doi.org/10.1016/S0010-9452(74)80024-9
  • Sparks, R., & Holland, A. (1976). Method: Melodic intonation therapy for aphasia. Journal of Speech and Hearing Disorders, 41(3), 287–297. https://doi.org/10.1044/jshd.4103.287
  • Zumbansen, A., Peretz, I., & Hébert, S. (2014). Melodic intonation therapy: Back to basics for future research. Frontiers in Neurology, 5, 1–11. https://doi.org/10.3389/fneur.2014.00007
  • Zumbansen, A., & Tremblay, P. (2019). Music-based interventions for aphasia could act through a motor-speech mechanism: A systematic review and case–control analysis of published individual participant data. Aphasiology, 33(4), 466–497. https://doi.org/10.1080/02687038.2018.1506089
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