The Use of Melodic Intonation Therapy to Improve Communication Skills

The ability to effectively communicate is a need for all humans. There are many modes of communication, but the ability to speak and be understood is a goal for many individuals. Music therapy is beneficial for the improvement of speech, and can have a profound impact on an individual’s sense of well-being and social functioning. Melodic Intonation Therapy (MIT) was developed in the early 1970’s, and is a useful technique used for speech development. MIT greatly benefits patients with traumatic brain injury, adults in rehabilitation settings, patients with evidence of apraxia, and those who are verbal, yet non-fluent. MIT targets the damaged, dominant left-hemisphere of the brain (which primarily controls language) by “exaggerating the intonation (rhythm, stress, and melodic contours) of speech in the undamaged right hemisphere” (Norton, 2009). As the right hemisphere of the brain recognizes language in melodic and rhythmic structure, it essentially learns language along with the left hemisphere.

In practice, MIT assigns a simple rhythm and melody to a short word or phrase. MIT is designed to take patients through a series of steps, and each step is slightly more complex than the one preceding it. Each syllable of every word is assigned a beat and a specific amount of stress. The higher stressed syllables have higher pitches, and the lower stressed syllables have lower pitches. Here is a visual example of a useful phrase for MIT:

With this phrase, the syllables how, do, and to are the most stressed, and are assigned to higher pitches.

There are approximately five steps to take in each word (or phrase) of MIT. Once these steps are completed with 90% accuracy, the therapist can transition the patient to a phrase that is longer and more difficult to enunciate (such as the phrase above). In beginning MIT, an ideal first phase would be the use of a single word. The steps of each phase are listed below:

Step 1: Humming. The therapist will tap the patient’s left hand (triggering the undamaged right hemisphere of the brain, and the sensorimotor cortex of the right hemisphere) and simply hum each syllable with their assigned pitches. The patient will then hum with the therapist.

Step 2: Unison Intoning. The therapist will say the word/phrase along with the patient.

Step 3: Unison with Fading. The therapist will say the first half of the word/phrase with the patient, and then stop speaking halfway through. This allows the patient to complete the rest alone.

Step 4: Immediate Repetition. The patient will immediately say the complete phrase alone.

Step 5: Response to Probe. The therapist will ask a question prompting the patient to say the word/phrase being practiced. For example, if my patient is named Mia and I ask for her name, she will respond with “Mia.” Here is a video putting each of these steps into action.

Whether our friends at Therabeat are learning language, reganing language, or learning to use language more effectively, MIT is indicated for all cases. The use of MIT allows for both sides of the brain to work on the apprehension of language. Results from MIT include improvement in articulation, fluency, and prosody of speech. This gives our patients the tools to be confident in communicating with others. As therapists, furthering our knowledge in these research-based techniques can better our efforts in aiding our patients in successful speech and enunciation!

Until next time,

Mia Cellino, Music Therapy Intern

References:

C, Cait. (2013, November 21). Melodic Intonation Therapy clip [Video File]. Retrieved from https://youtu.be/zr69bmqBU14

Norton, A., Zipse, L., Marchina, S., & Schlaug, G. (2009). “Melodic intonation therapy: shared insights on how it is done and why it might help.” Ann N Y Acad Sci, 1169(1), 431-436. Doi: 10.1111/j.1749-6632.2009.04859.x

Welcome, Ms. Mia!

If you have been to In Harmony sometime these past two weeks and have seen a new, curly headed Italian silently observing various therapy sessions, that would be me! My name is Mia Cellino, and I am so thrilled to be the music therapy intern at Therabeat. I’m coming from the University of Georgia, and I am completing the homestretch of my education here at Therabeat. During my time at UGA, I worked with a wide variety of populations, but I was most drawn to working with children after having a clinical at a local elementary school.

Throughout the past two weeks, I have observed a wide variety of music therapy sessions, as well as occupational, speech, and physical therapy. I also had the opportunity to begin forming relationships with the kids and adults that I will get to spend the next six months working with. I am already learning so much through osmosis and soaking in all I have seen and heard in these sessions! For example, I am learning about the various types of sensory processing disorder, both from observing sessions and reading The Out-Of-Sync Child by Carol Kranowitz. In a session, a child may show difficulty integrating various inputs of the room--the sound of my voice, the feel of an instrument, the lights in the room, or even a specific song selection. I am learning that it is important to identify each child’s sensory needs and address those through positive multi-sensory interventions. By planning music interventions that cater to a child’s sensory needs, we create an environment that is most beneficial for the child.

A unique aspect of starting my internship at Therabeat at this time is that I am coming in as soon as the staff became settled into the new clinic. We had a ribbon cutting ceremony a couple of weeks ago to celebrate the new clinic opening and all of the hard work that went into making the building fit for therapy. I feel as though I am the new kid on the block coming into a community full of therapists who are passionate about giving the best care possible. I cannot express how grateful I am to be here, because I am privileged enough to arrive after the challenges of moving, and I can reap all the benefits of interning somewhere so well-established and full of love. I am eager to start putting everything I have learned through observation into practice, because I want to contribute to the music therapy sessions in any way that I am able!

Until next time,

Mia Cellino, Music Therapy Intern

Reference:

Kranowitz, C. S. (2005). The out-of-sync child. New York, NY: The Penguin Group.

Reaching Beyond Pediatrics

            It has probably been awhile since you have read a blog post from a non-intern at Therabeat Inc. That is because we have been a little busy around here! Each of us at Therabeat Inc. has been working hard to turn our new clinic space into an environment where each child and parent who walks in will feel welcomed and loved. We are so blessed to have this new space, and if you haven’t checked it out yet, you definitely should! We had our ribbon cutting last Friday and it was such a wonderful day. Friends, family and members of our community came out to celebrate with us. We feel so blessed to work in such an inviting and beautiful place. 

            With our new clinic has come new opportunities, new experiences and new clientele. Ms. Chelsea Kinsler & I have especially enjoyed working with a group of 15-20 adults with intellectual and developmental disabilities from the Marietta Enrichment Center. These friends join us for a music class in our group room each Monday and Thursday morning. We have been working with this group for about 4 months now, and Ms. Chelsea and I both agree that we have developed a special bond with these precious people, and their caregivers also.

            We have had so much fun with this group. They cheer each other on so well, and I am convinced that if we were all encouraging and supportive like these friends, this world would be a much better place. One of the individuals did a special rap for the group one week while the rest cheered and hollered for him as if he had just performed at the Grammy’s. Another voluntarily got up out of his seat to assist another group member with the rhythm sticks while we were playing instruments and said to me, “I just need to help my friend.”  

            The sweetest moment happened this past week when I introduced a new instrument to the group-the ukulele. One of the precious men in the group said it reminded him of a song that was played at his father’s graveside-it was one of his father’s favorite songs. He told me a little bit about the song but couldn’t remember the name of it. I quickly searched it on the internet & figured it out! He wanted me to play “Somewhere Over the Rainbow” the version by Israel Kamakawiwo’ole. As soon as I began playing & singing the song, my sweet friend began to cry & tell us how wonderful his father was. At first, I was worried that I had used poor judgment by playing this song & bringing up negative emotions, but then I asked him if he wanted me to stop and he said “No, I love it.” with tears falling down his face. I kept singing along as we gathered around this sweet man & allowed him to cope and find peace in the midst of his grief. I can’t even explain how special this moment was. 

            This is what music does. It connects us. It allows us to share in the celebrations & hardships in life. It brings us together in good & bad times. I am so thankful for the gift of music. I am also thankful that because of our new facility at 9880 Hickory Flat Highway, Woodstock GA 30075, we are able to reach beyond just the pediatric population and also bring in adults who are just as much in need.

-Hayley Echols, LPMT, MT-BC

Music Therapy with Children with Hearing Impairments

For our friends with hearing loss (mild-severe) there is often a misconception about their ability to experience music and to become musicians. Music Therapy is an effective mode of therapy for children with varying degrees of hearing impairments--especially in the areas of speech & language development, cognitive development, social/emotional development, and listening skills. Team Therabeat had the opportunity to present to the Georgia Bell Event at Atlanta Speech School about this topic, so we would like to share a little bit about our presentation here as well!

Research shows that children with hearing impairments share or surpass children without hearing impairments in rhythmic competency (Gfeller, 2016). This is due to the way we “hear” music. In the absence of normal hearing, people may experience music through vibrotactile input via percussive instruments. Children may also rely on visual cueing via therapist/educator demonstrating rhythmic patterns. A therapist or music educator should always be aware of how each individually child experiences music. Each child with hearing impairments has varying degrees of ability to perceive pitches, varying ways of hearing music, and has varying degrees of perception of music. Hearing aids and cochlear implants are formatted for speech sounds, not musical pitches. Therefore, a music therapist should be aware of each child’s preference for timbres and choose instruments accordingly.

Once a therapist knows what kind of musical interventions will work best for the child (or group of children), the following are goal areas that are addressed. These goal areas are based on clinical practice, and peer-review/evidence-based research for music therapy with children with. pre- or per- lingual hearing loss.

·      Language Development: increase of vocabulary, increase of spontaneous speech, increase of sophisticated language structures such as metaphors/figures of speech, and pragmatics

·      Speech Production: increase vocalizations, increase speech prosody,

·      Listening Skills: increase in sound detection, sound discrimination, sound comprehension, and sound identification

·      Social Development: improvement in turn-taking, increased self-expression, and working cooperatively with others

(Gfeller, 2016)

Music Therapists address the goals above through the following music interventions:

·      Lyric Analysis & Song Writing: music therapists engage individuals in discussion or rewriting of lyrics to address learning and comprehension of age appropriate vocabulary and syntax to facilitate language development

·      Movement to Music: rhythmic movement in a predictable tempo can reinforce language development by performing movement paired with action words.

·      Therapeutic Singing: singing at slow, sustained tempos to facilitate accurate phonation of sounds. Rhythmic repetitions of target sounds happen in controlled and predictable tempo.

·      Instrument Play: Listening skills may be improved by auditory training through the play of percussive instruments that create sounds that can be experienced through tactile vibrations, or through instruments that create different timbres.

·      Music Therapy Groups: creating music with others provides a structured and motivating space to learn how to attend with others, take turns, and work well with others to create an aesthetic that is pleasing to the group.

(Gfeller, 2016)

We are always honored and excited to share information about how beneficial music therapy is in our community! We were able to demonstrate first hand some interventions we might use in a  group with the children who attended the event. We enjoyed seeing seeing the concepts we discussed in action.

-Perry Wright, LPMT, MT-BC

Reference:

Gfeller, K.(2016). Music Therapy for Children and Adults who are Deaf or Hard of Hearing. In The Oxford Handbook

of Music Therapy: Oxford University Press. Retrieved from

www.oxfordhandbooks.com/view/10.1093/oxfordhb/9780199639755.001.0001/oxfordhb-9780199639755-e-31.
 

Senior Adult Fair Extravaganza

Music therapy advocacy, in all forms, is such an important and efficient way to express the effectiveness of music therapy. For that reason, Therabeat, Inc. continues to support and advocate for music therapy in many wonderful ways, and for many wonderful populations.

This past weekend, Jennifer, our music therapy intern Alaina, and I were pleased to be one of many vendors for the Cherokee Triad S.A.L.T. Senior Adult Fair Extravaganza at the First Baptist Church Woodstock Conference Center. We had the pleasure of spreading the joy of music to a wide variety of listeners with our display of instruments, music therapy fact sheets, and smiling faces! We also enjoyed walking around and meeting all of the other vendors in attendance. It was a phenomenal teaching and learning experience for us, and we look forward to continuing our mission to advocate for music therapy throughout the community!

-Morgan Minyard, LPMT, MT-BC