W HAT IS M IT?
A structured, hierarchical program aimed at
increasing expressive language skills.
HOW IS M IT USED?
Words and phrases are produced in an intoned and
rhythmic manner (like singing) to facilitate verbal
production with speech-like prosody.
HOW DOES IT W ORK?
St imulat ion Approach
Uses auditory bombardment and repetition to
restore language function
Recruit ment
Damage to left hemisphere speech areas inhibits
speech production, so recruitment of other areas in
the brain assist in the production of speech
Funct ional Takeover
Damage occurs to left hemisphere resulting in
severe or total loss of expressive language, so the
right brain structures attempt to take control of the
facilitation of speech processes
M ELODIC
INTONATION
THERAPY (M IT)
Levels of Evidence
Class II: Evidence from one or more randomized
clinical studies such as case-control, cohort studies,
etc.
- Randomized control trial
- Too many patients dropped out for
it to be class 1
- Studies on sub-acute patients did
not report any maintenance data
- This leaves the question did the
therapy work after treatment
stopped
- Few randomized control trials exist--many
are pilot studies, so further studies need to
be completed
CITATIONS
Dwyer, C., Novak, E., Boissy, A., Bethoux, F., Chemali, K. (2012) The effects of
modified melodic intonation therapy on nonfluent aphasia: A pilot study.Journal
of Speech, Language, and Hearing Research, 55, 1463-1471. doi:
10.1044/1092-4388(2012/11-0105)
Mauszycki, S. C., Nessler, C., & Wambaugh, J. L. (2016). Melodic intonation therapy
applied to the production of questions in aphasia. Aphasiology, 30(10),
1094-1116. doi:10.1080/02687038.2015.110904
Murray, L. L., & Clark, H. M. (2006).Neurogenic disorders of language: Theory driven
REBECCA CIAFRE
clinical practice. Clifton Park, NY: Thomson Delmar Learning.
Rau, M., & Fox, L. (2009). Treatment approaches to aphasia: contributions of VA
clinicians.Aphasiology,23(9), 1101-1115.
LAURA NYGARD
van der Meulin, I., van de Sandt-Koenderman, W.M.E., Heijenbrok-Kal, M.H.,
Visch-Brink, E.G., (2016). Melodic intonation therapy in chronic aphasia: evidence
ELIZABETH WARE
from a pilot randomized controlled trial.Frontiers In Human Neuroscience, 10,
doi:10.3389/fnhum.2016.00533/full
van der Meulen, I., van de Sandt-Koenderman, W.M.E., Heijenbrok-Kal, M.H.,
Visch-Brink, E.G., & Ribbers, G.M. (2014). The efficacy and timing of melodic
intonation therapy in subacute aphasia.Neurorehabilitation and Neural Repair,
28(6)536-544. doi: 10.1177/1545968313517753
 Limit at ions of M IT
CANDIDATES The creators of Modified Intonation Therapy
(MMIT) argue that there are two major limitations
The following populations qualify as the best
within the MIT framework:
candidates for MIT: - Begins with producing 1-2 word phrases
Sample Goals
Long Term Goal:
- By the end of a 6 week therapy block, the
patient will use functional spoken output
with communicative partners as measured
by patient/caregiver reports.

- Non-fluent aphasia and apraxia of speech - Small pitch range Short Term Goal:
- The patient will produce phrase-level
- Left Hemisphere stroke M odified M elodic Int onat ion material in response to a question using
- Poor repetition MIT strategies, with minimal articulatory
Therapy (M M IT) errors at 80% accuracy in three out of five
- Poorly articulated speech therapy sessions.
MMIT differs from MIT in two major ways: First,
- Moderate to good auditory comprehension
MMIT utilizes phrases in the beginning of therapy Phrase +/-
as opposed to single words. The rationale for this
I want coffee
change comes from the patient's ability to sing
"Happy Birthday to You." If a patient can sing a six I am hungry
syllable phrase, they are capable of producing I need medicine
higher level material. Second, MMIT utilizes
I need the bathroom
prosody (pitch and rhythm) that matches
spontaneous speech for a smoother transition to I don?t feel well
spoken speech.

TREATM ENT PROTOCOL

1 Level 1 2 Level 2 3 Level 3

1. Humming 1. Int roduce t he t arget 1. Delayed repet it ion
clinician simultaneously humsa tonal pattern for a target same asStep 1 of Level 1 same asStep 3 of Level 2
word/phrase, pointsto a picture , and tapsthe patient'sleft hand 2. Unison wit h fading 2. Int roduce sprechgesang
once for each syllable; no patient response necessary same asStep 3 of Level 1 clinician modelsthe target word/phrase in sprechgesang
2. Unison singing 3. Delayed repet it ion (speaking with accentuated rhythm and stress, but normal
clinician and patient hum/intone a target word/phrase together patient repeatsmodeled and tapped word/phrase after a intonation/pitch) and tapsthe patient'shand; no patient
while clinician tapsthe patient's hand delay of approximately 6 seconds; clinician still taps the response required
3. Unison singing wit h fading patient'shand during patient production 3. Sprechgesang wit h fading
same asstep 2, except halfway through the word/phrase the 4. Response t o a probe quest ion Like Step 2 of Level 2, except using sprechgesang instead of
clinician stopsintoning approximately 6 seconds after patient successfully completes intoning
4. Immediat e repet it ion Step 3, the clinician intones a probe question to elicit another 4. Delayed spoken repet it ion
patient repeatsthe modeled intoned word/phrase; clinician stills production of the intoned target using normal prosody, patient repeatsthe clinician'sspoken
tapspatient'shand during patient production model of the target word/phrase after a delay of approximately
5. Response t o a probe quest ion 6 seconds; no hand-tapping isprovided
after patient successfully repeatsthe intoned word/phrase, the 5. Response t o a probe quest ion
clinician asksa question which can be answered using the target Like Step 4 of Level 2, except both the clinician'squestion and
word/phrase; clinician may still tap the patient'shand during the patient's response should be produced with normal speech
patient response prosody