Afasia Y Muscoterapia

Ann. N.Y. Acad. Sci. ISSN 0077-8923

A N N A L S O F T H E N E W Y O R K A C A D E M Y O F SC I E N C E S
Issue: The Neurosciences and Music IV: Learning and Memory

Effective music therapy techniques in the treatment of nonfluent aphasia
Concetta M. Tomaino
Institute for Music and Neurologic Function, Beth Abraham Family of Health Services, Bronx, New York Address for correspondence:Concetta M. Tomaino, Institute for Music and Neurologic Function, Beth Abraham Family of Health Services, 612 Allerton Avenue, Bronx, NY 10467. ctomaino@bethabe.org

In music therapy for nonfluent aphasia patients who have difficulty producing meaningful words, phrases, and sentences, various benefits of singing have been identified: strengthened breathing and vocal ability, improved articulation andprosody of speech, and increased verbal and nonverbal communicative behaviors. This paper will introduce these various techniques used in clinical music therapy, and summarize findings based on our recent study to illustrate the strength of different techniques emphasizing rhythm, pitch, memory, and vocal/oral motor components dealing with different symptoms. The efficacy of each component is enhancedor diminished by the choice of music and the way it is interactively delivered. This indicates that neural mechanisms underlying speech improvement vary greatly with available acoustic and social cues in aphasic brain. Keywords: singing; stroke; oral motor rehabilitation; prosody; rhythmic cues

Introduction It is well documented that many people with nonfluent aphasia, also known as Broca’saphasia, can sing even though they cannot speak, although some patients who have lost musical abilities would exhibit little or no language-related problems.1 Historically, this dissociation has been seen as evidence of the differentiation between speech and music, i.e., that these are distinct abilities with little overlap in neurological function. However, recently, as the view of brain mechanismssupporting language processing has moved away from focusing on Broca/Wernicke’s areas to a network perspective that emphasizes the contribution from several brain regions in various aspects of language,2,3 different musical features have also been uncovered that may also be processed in widely distributed neural networks.4,5 Accordingly, neuroimaging research has shown evidence for the sharedneural pathways of speech and music.6–8 In addition, various neurological disorders may benefit differently from singing exercises,9 including nonfluent aphasia.10 This corresponds well with clinical observations and trial findings in music therapy that in aphasia treatments, the preserved

speech abilities are enhanced through various types of music-based speech therapy exercises.11–14 Although thebest known of the music-based speech therapy techniques is melodic intonation therapy (MIT),15 which has been studied extensively with neuroimaging,16–18 other techniques have not been examined in terms of specific effects that link behavioral and neurological recoveries. More importantly, however, it has yet to be systematically examined as to which techniques can be most beneficial in improving whattypes of speech deficits in aphasia and what is the “dosage” that could lead to substantial and sustainable recovery. The aim of this paper is to give an overview of various techniques used in music therapy and summarize our findings of the outcomes and benefits of these techniques in our previous research in aphasic patients. In music therapy, therapists consider how to address not only speechdeficits but also other sensory, motor, and cognitive issues by using a variety of therapy techniques to individually optimize the outcomes. For example, facial gestures or exaggerated tonal/rhythmic inflection are used to stimulate existing networks involved in verbal communication by engaging nonverbal communication

doi: 10.1111/j.1749-6632.2012.06451.x
312 Ann. N.Y. Acad. Sci. 1252 (2012)...