Schlaug et al. (NM III no. 57, pp. 374-384) have studied the changes in brain connections in six pa-
tients with large left-hemisphere strokes, who were treated with long-term melodic intonation therapy.
These patients suffered from nonfluent aphasia, that is, they could understand the speech of others,
but were unable to produce words themselves. The treatment of melodic intonation therapy consist-
ed of 75-80 daily sessions. The sessions were based on melodic intonation, singing words on two
pitches to exaggerate the normal melodic content of speech. The therapist also employed rhythmic
tapping of each syllable, using the patient’s left hand. The idea of the therapy is to create and acti-
vate language ability in the patient’s right hemisphere to replace the destroyed language functions in
the left hemisphere.
The patients were scanned before and after the long-term treatment by means of the diffusion
tensor imaging technique (DTI), which produces images of white-matter connections in the brain.
Of particular interest was the arcuate fasciculus (AF), a major fiber tract which connects brain areas
important for speech, notably the regions known as Broca’s area and Wernicke’s area. This tract is
normally better developed in the left hemisphere, dominant for speech.
The study showed a significant increase in AF fibers in the right hemisphere after treatment.
The authors suggest that intense, long-term melodic intonation therapy leads to a remodeling of the
right arcuate fasciculus, which may explain the sustained therapy effects in these six patients. They
suppose that the regions which play a role in the recovery process are the superior temporal lobe,
which is important for auditory feedback control, the premotor regions, important for planning of mo-
tor actions, and the primary motor cortex, important for execution of vocal motor actions (p. 385).
Music-supported therapy
Altenmüller et al. (NM III no. 58, pp. 395-405) have studied the effects of music-supported therapy
(MST) in patients with motor impairments after stroke. The treatment consisted of motor-skill exercis-
es on a MIDI piano and an 8-pad electronic drum set. The exercises began with one tone, and were
systematically increased to songs of 5-8 tones. The instructor played first, and asked the patient to
repeat. The patient started playing with the affected arm, later helped by the healthy arm.
32 stroke patients received 15 sessions of MST plus conventional therapy. 30 patients in a
control group received conventional therapy only. The study demonstrated a pronounced effect of
MST on the recovery of motor functions, and EEG measurements showed profound therapy-related
changes (p. 395). The authors suggest that audiomotor coupling is a powerful mechanism for shap-
ing motor functions (p. 403). Auditory feedback enhances the outcome of motor-skill training. The
authors have published further details of the study (Schneider et al. 2010).
Neurologic music therapy
Thaut et al. (NM III no. 59, pp. 406-416) have examined the effects of neurologic music therapy
(NMT) with brain-injured persons. NMT is taught and practiced according to a training manual by
Thaut (1999). It comprises a wide range of treatments, including rhythmic auditory stimulation, in-
strumental music performance, structuring and cueing functional movements by means of kinematic
patterns, vocal intonation, and auditory perception and attention training.
The researchers compared a group of brain-injured patients who received treatment in 30
minute sessions with a group who rested for 30 minutes. The treatment consisted of four sessions
on four different days, focusing on emotional adjustment, executive function, attention, and memory.
Pre-tests and post-tests by means of established questionnaires showed that the treatment patients
improved in excutive function, emotional adjustment, and lessening of depression and anxiety (p.
406). The authors add that this is an exploratory study which provides preliminary evidence, as the
participants were not randomly assigned to the treatment group or the control group.