It’s moments like the adamant “no” to the suggestion that Randy Travis get back in therapy years after his stroke that make you desperately want to connect him with a Neurologic Music Therapist who could help him regain his voice through the medium he knows best … music. This video provides a great example of a good candidate for music therapy, though music therapy can be effective for people with no musical abilities. Please note, that the video does not demonstrate music therapy in action.
There are several ways that Neurologic Music Therapy (NMT) can be utilized to rehabilitate speech after a stroke. Melodic Intonation Therapy (MIT) is a NMT technique that uses rhythm, melody, and movement to activate and strengthen new neural pathways for speech for individuals with Broca’s aphasia (left hemisphere injury), which presents as a loss of ability to speak, due to a stroke. Within this technique, functional phrases are intoned into musical ones with melody and rhythm activating areas of the brain that processes melody and rhythm, and tapping the beat activating the movement centers of the brain. A precise order of repetitions is utilized combining listening, unison repetition, fading of the therapist, solo repetition, repetition in response to a question, and transitioning the musical elements out of the speech to return the phrase to normal speech.
Randy’s ability to finish the last word in the phrase, “amen”, provides an example for another NMT technique, Musical Speech Stimulation (MUSTIM) which is good for clients with progressive aphasia or apraxia who may not be able to follow the precise process of MIT but can still sing. Within this technique, familiar songs with overlearned phrases (ones that we know very well from long ago) are utilized. Words placed in key musical places are left off. The brain knows that something is missing and will search for it until it finds the appropriate word to finish the phrase. For example “You are my sunshine.”
Vocal Intonation Therapy (VIT) and Oral Motor and Respiratory Exercises (OMREX) can be utilized to improve the quality of the voice (inflection, pitch, breath control, timbre, and dynamics), articulation and clarity, and breath support. These interventions involve many exercises similar to those used by a choir director to warm up the choir. Special attention is given to articulators (lips, teeth, and tongue), the shape of the vocal apparatus, and breathing.
We have successfully rehabilitated speech for clients who have not responded to traditional speech-language pathology because much more of the brain is activated for musical tasks than nonmusical tasks (speaking, reciting poetry, etc). This allows us to find alternative neural pathways to do the same task (speak, move, plan) impaired by the stroke, and for these new neural pathways to be strengthened. I like the analogy of a road detour for the formation of alternate neural pathways. The first time you are confronted with a detour it throws you for a loop, frustrates you, and takes a long time and full concentration to follow. As you follow this detour every day, however, it becomes more natural and faster, until you potentially like this new route better than the old one.
For more information on how music therapy can help with stroke rehabilitation go to: