From Singing to Speaking

It’s Amazing To See

It’s amazing to see stroke survivors who’ve lost the ability to speak suddenly produce accurate words when singing familiar songs. This phenomenon was first reported by Swedish physician Olaf Dalin in 1736. Dr. Dalin described a young man who had lost his ability to talk as a result of brain damage, but who surprised townsfolk by singing hymns in church.

The acquired language disorder now called “aphasia” became a subject of clinical study and a target for rehabilitation beginning in the mid-1880s. Since that time, every clinician working with aphasia has seen individuals who can produce words only when singing. Indeed, this observation prompted American neurologist Charles Mills to suggest (in 1904!) that it might help to play the piano and encourage patients with aphasia to sing well-known songs.

There appear to be psychological benefits, but singing familiar songs alone doesn’t seem to improve the speech of people with aphasia. This is probably because words that come automatically when singing are intricately linked to the melodies and are not easily separated.

The spoken word is a different matter. We know the brain has difficulty starting in the middle of highly memorized spoken passages (such as the “Pledge of Allegiance”). We need a “running start” to prime the pump of recall.

Songs themselves might be used to communicate. I had a patient who struggled to tell his son he wanted to go to a Boston Red Sox game. He finally got his point across by bursting forth with “Take Me Out to the Ball Game.” Unfortunately, there aren’t appropriate songs for every communication need, so it would be better if singing could be used to unblock residual speech abilities. This was the motivation for the aphasia treatment approach known as “Melodic Intonation Therapy,” which we began to develop in 1972.

Why Does It Work For Some People?

We know that aphasia typically results from a stroke or other damage that affects the left hemisphere of the brain, where language ability usually is located. We thought it might be because a stroke increased the use of the brain’s right hemisphere, where many aspects of music and the melody of speech are located. Using this treatment, the dominance of the damaged left hemisphere language areas might diminish while the right hemisphere became more involved.

A recent study using functional magnetic resonance imaging with individuals treated with melodic intonation therapy showed that the right hemisphere does, indeed, play a role in response to this method. Preliminary results suggest that the amount of speech recovery may be associated with how much and what part of the right hemisphere is activated. This study demonstrates the flexibility of adult brains, even those with stroke-related damage.

It is encouraging to know that with special treatment we can learn to use undamaged portions of our brains to perform “new tricks” – even one as complicated as speaking.

Trial And Error

Robert Sparks, a speech-language pathologist, Martin Albert, a behavioral neurologist, and I were working on the Aphasia Unit of the Boston VA Hospital. We saw a woman whose only purposeful speech was the combination of nonsense syllables: “nee-nee-nah-nah.”

At that time, a hospital volunteer was coming to each inpatient ward with a piano on wheels and conducting sing-along sessions with the patients. One day we observed our patient sitting beside him in her wheelchair and singing many of the words of popular songs. Though we had seen this before, this new example convinced us we had to try to develop a method that capitalized on this preserved ability to produce speech when singing.

We knew that simply singing familiar songs with this woman would not do the trick. Through trial and error, we discovered that if we melodically intoned everyday phrases such as “open the window” while helping her tap out the syllables with her unaffected hand, she could produce phrases in unison with us. Then she could intone the phrases with just a little help at the beginning. Finally, she could produce them on her own.

From this experience, we created a treatment program using melodically intoned and tapped out phrases of increasing length. Usually within a few sessions, patients’ production of nonsense syllables had disappeared and they began to communicate verbally in everyday situations. Our continued research helped identify the best candidates for this method.

Suggestions For Using Music With People With Aphasia

• 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, DVD and stimulus cards, can be implemented by family members.

Norma