APHASIA REHABILITATION RESULTING

FROM MELODIC INTONATION THERAPY 1

Robert Sparks, Nancy Helm and Martin Albert

(Aphasia Research Center, Boston Veterans Administration Hospital,
and Department of Neurology, Boston University Medical School)

The observation that well-articulated and linguistically accurate words

are often produced by otherwise aphasic patients when they are singing has,
in the past, seemed paradoxical. There is often a dramatic contrast between
the efficient lip-service production of the non-propositional language of well
memorized popular songs and the inefficient quality of propositional language
which requires encoding of even the most basic thoughts. Many well-inten-
tioned speech and music therapists in the past presumed that the non-propo~
sitional language skill required for singing could be useful as an adjunct to
language therapy for aphasic patients. Unfortunately, there seems to be no
evidence that improvement in communication skill occurs as a result of
this form of therapy or any other which puts emphasis on the preserved non-
propositional language skills of many apharsic patients. Needless to say, the
morale value of sing-along" activities is not questioned.
tl

Valuable information concerning the role of the right hemisphere in the

processing and perception of non-verbal istimuli such as music does suggest
that the development of a language therapy which uses 'some form of singing
as a means of imPl10ving the production of propositional language is worth
investigation. Research concerning right hemisphere dominance for music has
been increasing and the results are convincing. Evidence has been reported
by Kimura (1964), Curry (1967), and SpeIlacy (1970). Milner (1962) reported
impaired d1scrimination of music by patients after right temporal lobectomy.
A study by Spinnler and Vignolo (1966) reports that more errors in non-
linguistic acoustic discrimination were made by non-aphasic patientJs with
right hemisphere lesions than by aphasics with Left hemisphere lesions. Their
study supports the observations made in case studies by Spreen, Benton
and Fincham (1965) and by Albert, Sparks, von Stockert and Sax (1972)
both of which reported ddective perception of non-verbal sounds by patient'S
with right hem1sphere lesions. Bogen and Gordon (1971) have reported on

1 This research was supported in part by USPHS grant NS-06209.

304 R. Sparks, N. Helm and M. Albert

the marked depression of ability to sing when sodium amobarbital has been
injected' into the right carotid artery. In a converse way which is of interest
here is the report by Smith (1966) of a patienf.s ability to sing following
total removal of a language-dominant left hemisphere.
More recent research has been concerned with inter-hemisphere process-
ing of prosodic elements of language. Zurif and Mendelsohn (1972) have
shown that right ear supremacy in the task of listening to series of nonsense
syllables is enhanced by use of speech intonation patterns. Van Lancker
and Fromkin (1973) report that for speakers of Thai, a tone language, there
is a right ear superiority for words when pitch is the variable distinguishing
the meaning of two words. Such Istudies 'suggest left hemisphere dominance
for the melodic aspects of language when they are an intrinsic part of language.
A recent study by Blumstein and Cooper (1974) shows, conversely,
that there is left ear dominance for intonational contours in normal sub-
jects when a spoken sentence has been recorded in such a way that
most of the frequencies above 500 Hz have been removed by filtering,
thus effectively destroying the phonetic and syntactic components of the
sentence. Right hemisphere dominance may have occurred because the re-
maining intonational contour is no longer bound to a linguistic unit. Blumstein
and Goodglass (1972) and Boller and Green (1972) have shown that damage
to the language-dominant left hemisphere does not impak the perception of
semantic meaning carried by stress or intonational contours.
Some of the work reviewed here suggests that the perception of music
occurs in the right hemisphere. Other research which is concerned with the
integration of all aspects of ,speech would also suggest that the intonational
patterns of speech involve the right hemisphere but final integration of all
the components of decoding and encoding language occurs in the language-
dominant left temporal lobe.
Earlier preliminary studies as well as the current study of the use of
singing propositional messages has taken place at the Aphasia Research
Center of the Boston Veterans Administration Hospital. The first patients
involved wel'e totally unable to communicate verbally and could repeat
nothing. The almost immediate l'esponses to this therapeutic approach were
remarkably good if the melody patterns used bore no resemblance to PIQPular
songs 'Or universally known "jingles." Experience Isoon showed that when
sentences, were adapted to already linguistically loaded melodies the patient
would revert to the lyrics closely associated with the song. This prompted
the development of a method which avoids any distinct melody even
reminiscent of a popular song or jingle. The l'esulting method, now referred
to as Melodic Intonation Therapy, has a limited range of pitch variation.
Each sentence-item is "composed" so that the inflection pattern, rhythm, and
stress are similar to the speech prosody of that sentence.
There is a similarity between melodic intonation and certain aspects
 Melodic Intonation Therapy 305

of the Kodaly Method of Music Education as it is used with pre-school

children in some nursery schools. An adaptation of the published Kodaly
method of plotting rhythm and stress by Knighton (1973) has been made
for use in Melodic Intonation Therapy so that inflectional contoUl1Si are also
included for each sentence used in the program. Figure 1 illustrates this
adaptation.
MELODIC PATTERNS

Higher pitch >1\ I I

) >1
I
Lower pitch
I I
Sentences I AM HUNG-GRY PLEASE SIT DOWN

Fig. 1 - A single line represents a single word, particularly if stressed. Two lines joined
at the top represent double syllable words or word clusters. Arrows indicate stress.

A search of the literature has yielded little regarding previous use of

methods which were similar to that of Melodic Intonation Therapy (MIT).
Ustvedt (1937) emphasized the importance of stress on singing and the
prosody of speech during rehabilitation of aphasic patients. Gerstman (1964)
reported on an aphasic who responded to the singing of high-probability
propositional sentences as a form of language therapy.

MATERIALS AND METHODS

Subjects

The authors have previously reported a preliminary observation of MIT and

its effect on the speech of three patients (Albert, Sparks and Helm, 1973). The
current report discusses the development of the method and the results based on
its use with nine right-handed patients following left hemisphere cerebro-vascular
accidents. Patients selected for the study were able to act as their own controls
in the following manner: (1) Verbal output was severely impaired with better
preservation of auditory comprehension and other language modalities so they could
not be classified as global aphasics; (2) Each patient had received previous language
therapy; and (3) No improvement in verbal output had occurred for at least six
months. The ninth patient, only recently admitted to the MIT program, is
included because of immediate and dramatic response. He qualifies in the same
way as the other eight patients.
Every patient admitted to the Melodic Intonation Therapy program is tested
prior to commencement of therapy and again at time of discharge. We are fortunate
in being able to compare the pre-MIT and post-MIT results with those of the
306 R. Sparks, N. Helm and M. Albert

examination at time of the first admission when they received the original non-
melodic intonation therapy. The test battery includes the Boston Diagnostic Aphasia
Examination (Goodglass and Kaplan, 1972) and tests of repetition and unison
speech. Needless to say, no items which are part of the test are ever used in the
therapy program.
The eight patients who have completed the program of MIT have been
divided into three groups as to degree of improvement of verbal output. The
three groups are: (1) Best recovery; (2) Moderate recovery; (3) No significant
recovery.

Procedure

The materials used for the sentence-items usually follow a structure pattern
of actor-action-object and the items in any series are related as to subject matter.
Sentences used in the beginning stage of therapy for anyone patient may not use
this general rule when concern for personalized high-probability sentences is of
greater importance.
The program of Melodic Intonation Therapy is divided into two levels of
difficulty. Progression from the first level to the second occurs only after the patient
has had ten successive therapy sessions with scores of ninety percent or better.
What appears to be an unusual prolongation of therapy at the first level is justi;fied
by the possibility that we are activating or disinhibiting certain cortical areas!. If
this is so, a time factor may be an important dimension affecting permanency of
recovery. Scoring is very specific and is explained in the Appendix along ,with
samples of melodic intonation patterns.
The first of the two levels of the program consists of four steps. The tempo
of the melodic intonation, particularly in the first level, is slower than that of
normal speech prosody. The four steps are as follows:
1 - This first step requires no verbal response from the patient. The therapist
intones the sentence and assists the patient in hand-tapping the rhythm-stress
pattern of the sentence. This rhythm tapping accompanies all four steps of the
first level. It is suggested that a preliminary step for each sentence-item may be
used in which the melody pattern is introduced non-vocally by recording, piano,
or some other means. The hand-tapping of the rhythm may be introduced at
this time.
2 - In the second step the patient is asked to join the therapist in repeated
unison intoning of the sentence, being encouraged to increase his participation
with each repetition.
3 - The third step is the same as the second except that the therapist
gradually fades his participation, encouraging the patient to continue "solo."
4 - The fourth step involves intoned presentation of the sentence by the
therapist followed by intoned repetition by the patient.
The second level of the program is divided into five steps, four of them
major ones. The hand-tapping is discontinued after the first step. The use of
" backups" is introduced for each of the major steps if failure occurs at that
step. It is important to note that a sentence unit is discontinued if failure occurs
when a repeat trial of the step is attempted following a backup. This second level
has as its major purpose a return to the use of speech prosody. The abruptness
of transition can be minimized if the intonation patterns have been correctly plotted.
A second means of smoothing the transition from sung intonation to spoken
 Melodic Intonation Therapy 307

intonation is the therapist's use of Sprechgesang (speech-song) technique. The

distinctive quality of this technique is its retentions of the rhythm and stress of a
melodic contour while it substitutes the constantly changing pitch of speech for
the constancy of pitch in sung notes. The five steps of the second level of the
program are as follows:
1 - The first step of the second level involves intoned presentation of
the sentence by the therapist followed by two or three second of enforced latency,
then repetition and hand-tapping of the intoned sentence by the patient. The
backup is intoned phonemic or first-word cueing by the therapist, followed by
intoned repetition of the entire sentence by the patient.
2 - In the second step the patient remains silent while the therapist presents
the sentence in Sprechgesang.
3 - In step three the patient joins the therapist in unison repetition of
the sentence but with fading participation by the therapist. The therapist's
presentation will again be in Sprechgesang. However, the patient may continue to
intone or, ideally, convert to spoken melody at this time. Either type of response
is acceptable. The backup is full unison participation by the therapist.
4 A - Step 4 A involves spoken presentation of the sentence for the first
time by the therapist and immediate spoken repetition by the patient. Conversion
to spoken prosody is required. The backup is unison spoken repetition by therapist
and patient but with fading participation by the therapist.
4 B - A modified fourth step involves an enforced latency of two seconds
between completion of the therapist's presentation and the patient's repetition. The
backup is the same as in step 4 A.
5 A - Step 5 A involves the prompt presentation of an appropriate question
by the therapist which the patient must answer by giving the target sentence.
This, of course, is only slightly removed from actual repetition as it occurred in the
preceeding steps. The backup is spoken presentation of the sentence followed by
two or three seconds of enforced latency, then repetition by the patient.
5 B - A modified fifth step now introduces a latency of two or three
seconds between the completion of the fourth step and the presentation of the
question by the therapist. The latency may be increased as the patient evidences
success in retrieving the target sentence. The backup is cueing by the therapist. At
most, it is the first word of the sentence. Preferably, it is only the first phoneme
of that word.
A post-MIT form of therapy is suggested because it is closely related to the
last step of the second level. Three additional steps use a " reverse chain " method
involving an actor-action-object sentence. The first step is a question about the
object. The second question asks about the action. The final questions is concerned
with the actor of the sentence. Backups would be phonemic cueing for the
target word.
In addition to daily individual therapy, each patient attends group therapy
(" Choir practice") where MIT is less structured. The sessions involve intoned
verbal interaction between the members of the group as much as possible. The
development of this aspect of the MIT program has not, as yet, received as
much attention as it warrants. Group therapy for aphasics should have as its
goal an increase in spontaneous verbal inter-action of aphasics no matter how
verbally impaired the members of the group may be. Melodic intonation does act
as a deterrent to development of a natural social milieu which encourages inter-
308 R. Sparks, N. Helm and M. Albert

action of the members of the group concerning their problems. This is more than
offset by development of the skill of intoning at least the most basic but
purposeful communications.
The last steps of the second level of the program involve transition from
melodic intonation therapy to speech prosody. Experience to date does not
indicate the precise time for replacement of Melodic Intonation Therapy with
other form of therapy. That must depend on the judgment of the well-trained
aphasia therapist. The authors feel that a minimum of three months of daily
therapy is necessary before converting to some other form of language therapy.

RESULTS

Best recovery group

The four patients who made the most gains had commenced Melodic
Intonation Therapy with limited stereotype-like jargon. Although it was
meaningless, it was clearly articulated and had varieties of melodic patterns.
At the time of the completion of the program all four were able to com-
municate by using three or four word phrases or sentences which wereap-
propriate but now labored and dysarthric. There were literal paraphasias,
infrequent within-sphere verbal paraphasias, and evidence of agrammatism
when the phrases were long enough to permit evaluation of syntactical
structure.
The following brief transcription of the speech of one of the four patients
is representative of all as to the pre-MIT quality and at time of discharge.
No attempt has been made to transcribe dysarthria:
(Pre-therapy)
Examiner: "How are you?" Patient: "Goo - go." Examiner: "What
is your full name?" Patient: "Doo - kah." Examiner: "What have you been
doing?" Patient: "Dis - ah - d1s."
(Post-therapy)
Examiner: "How are you?" Patient: "All wight." Examiner: "Where
have you been?" Patient: "This weekend - we - go home." Examiner: "What
did you do?" Patient: "I work." Examiner: "What kind of work?" Patient:
"Carpentry." Examiner: "Did you go out Saturday night?" Patient: "Podish
club." Examiner: "Polish Club? What went on there?" Patient. "A dance."
(Six weeks after discharge)
Examiner: "What brings you here?" Patient: "T come to see a friend."
Examiner: "How did you get here?" Patient: "I came - here - by - by - car."
Examiner: "Did you drive?" Patient: "No. Another friend." Examiner:
"How is your knee?" Patient: "It's better."
 Melodic Intonation Therapy 309

Moderate recovery group

Two of the eight patients made less improvement than those in the
Best recovery group. They aLso entered the MIT program with almost total
absence of meaningful speech other than a few overlearned social phrases.
Unlike the first group, they had no stereotype utterances. At time of discharge
they were using one or two-word phrases. Marked paucity of speech continued
but the linguistic quality of their verbal output was appropriate. As in the
first group, dYisarthria was very apparent in their post-MIT speech. The
telegraphic quality allowed for no observations of grammatical structure.
A brief transcription of the speech of one of these patients follows. It
includes both a pre-therapy and post-therapy section. As in the previous
transcription no attempt has been made to transcribe dysarthria:

(Pre-therapy)
.
Exammer: "How are you!''1" p. me. Exammer:
atlent: "p." . "Have you
been here before?" Patient: "Bah kah - tah." Examiner: "Can we help
you?" Patient: "Uh - uh - -."

(Post-therapy)
Examiner: "How are you?" Patient: "pnne." Examiner: "You've been
here before?" Patient: "Three times." Examiner: "When are you leaving?"
Patient: "Next Thursday." Examiner: "Where will you go?" Patient: "Ja -
Jamaica Plain."

This patient has been seen two months after discharge and he has retained
the level of improvement he had achieved at the time MIT was terminated.

No significant recovery group

The two patients who made no improvement were ,similar to those in

the Moderate recovery group in that there was little verbal output of any
kind prior to MIT. There was little more after therapy terminated. Investiga-
tion of possible cause for failure reveals two diffel'ences between these two
patient'S and the other six. First, their motivation to apply themselves to
this or any other therapy was poor. Secondly, their pre-therapy examinations
showed an ability to repeat one and two words very well in compadson
with the other patients and in comparison with their own performances
on other verbal tests. Speculation as to the possible significance of this
will be discus1sed later.
 310 R. Sparks, N. Helm and M. Albert

Ninth, newly admitted patient

Inclusion of a patient recently admitted to the MIT program cannot
contribute to the data concerning effectiveness of a completed course of
Melodic Intonation Therapy. However, inclusion is based on the fact that
like the other six patients who have made gains he also had no verbal output
other than a very restricted but dearly articulated 'Stereotype utterance. Other
language therapy had not been successful. After several MIT sessions the
patient was able to repeat iSQme of the shorter intoned phrases. After about
three weel{ls he has begun to use some very brief social gesture language
but only with the therap~st. The frequency Qf the stereotype is diminishing.
Like the other patients who made improvement, his evolving language is
d)1lsarthric.
Analysis of examination data
Figure 2 charts the improvement made in Z-'scores of some of the verbal
expression sub-tests of the Boston Diagnostic Aphasia Examination for the
Best recovery and Moderate recovery groups following MIT. Almost no
change in scores occurred between the first examination and the pre~MIT

Responsive Naming Confrontation Naming Phrase Length

BRl BR2 BR3 BR4 MRI MR2 BRI BR2 BR3 BR4 MRI MR2 BRI BR2 BR3 BR4 MRI MR2
1.8
1.7
1.6
1.5
1.4
1.3
1.2
1..1
1,0
,9
.8
.7
.6
.5
.4
.3
::
-
.2
1
-
,I
o 1
1 2 1 2 1 2 1 2 1 2 1 2 1 2 1 2 1 2 1 2 1 2 1 2 1 2 1 2 1 2 1 2 1 2 1 2

Fig. 2 - BR1 through BR4, patients in Best recovery group. MR1 and MR2, patients in
Moderate recovery group. Abscissae represent .1 gradations of Z-score improvement. Column 1
for each subject is improvement between first examination and the pre-MIT examination.
Column 2 is improvement between pre-MIT and post-MIT examinations.
 Melodic Intonation Therapy 311

examination. The obvious improvement seen in the post.MIT examination

resuhs is statistically 'significant on each of the three verbal testis by anal)1ls[s
of variance:
Responsive naming - F = 25.3, df 1, 5; P = .005
Confrontation naming - F = 7.9, df 1, 5; P = .038
Phrase length - F =29 .6, df 1, 5; P = .003.
The most significant and dramatic change is in the test for length of phrase.
The question as to possible "sideceffect" improvement in other Janguage
modalities as a result of MIT was raised by the authors in a paper presented
at the 1973 Academy of Aphasia (Sparks, Helm and Albert, 1973). It was
suggested that improvement in auditory comprehension and reading compre-
hension may also have occurred as a result of MIT. Inspection of the Z-score
improvement in Figure 3 does not ,support that observation and the lack of
statistical significance by analysis of variance is remarkable:
Auditory commands - F = 2.2, df 1, 5; P = .198
Complex auditory material - F = 0.8, df 1, 5; P = .396
Reading comprehension, sentences-paragraphs - F = 0.3, df 1, 5; P = .50.

A.C. - Commands A.C. - Complex Moterial R. C. - Sen tences & Paragra phs

SRI SR2 SR3 SR4 MRI MR2 SRI SR2 SR3 SR4 MRI MR2 SRI SR2 SR3 SR4 MR I MR2
1.8
1.7
..
1.6
1.5 -
1.4 -
1.3 -
1.2
1.1 -
1.0 -
.9 -
.8 -
.7- -
.6 -
.5 -
.4
:: -
-
.3
. - ~ ~

.
.2
•1 I - - -
o -
f-"-
I I I - - --
1 2 2 2 1 2 1 2 2 2 1 2 1 2 2 1 2 1 2 1 2 1 2 1 2 1 2 1 2 1 2

Fig. 3 - BR1 through BR4, patients in Best recovery group. MR1 and MR2, patients in
Moderate recovery group. Abscissae represent .1 gradations of Z-score improvement. Column 1
for each subject is improvement between first examination and the pre-MIT examination.
Column 2 is improvement between pre-MIT and post-MIT examinations.
312 R. Sparks, N. Helm and M. Albert

These results do indicate that areas of recovery were occurring in some

language modalities other than verbal expression, although this improvement
was probably not the result of Melodic Intonation Therapy.

DISCUSSION

Candidacy for Melodic Intonation Therapy

A population of eight patients who have completed the pt'Ogram does

not permit decisive conclusions a!s to which types of aphasia are more
responsive to MIT than others. Admittedly, the patients selected to date
have had certain characteristics which were considered favorable. Observa-
tions and reflec60ns concerning the patients who improved produce the fol-
lowing impressions regarding candidacy when selecting other patients for MIT:

1 - Auditory comprehension was better than verbal expression. All

patients seemed to appreciate the purpose of what must surely have seemed
to be a somewhat bizarre procedure. Auditory comprehension was preserved
enough to include self-criticism of errors in verbal output, particularly after
the patients had adapted to the therapy. The presence of sel£-critidsm and,
ultimately, self-correction is an important pre-requisite to recovery from
aphasia. This has been discussed by Wepman (1958).
2 - These patients had fairly good emodonal stability and reasonably
good attention spans. They demonstrated preserved social graces and a
desire to socially Irelate to other patients on the ward. For the most part
their willingness to attempt to communicate verbally increased as their
language improved.
3 - All the patients had severely impaired or restricted verbal output.
The MIT program is certainly geared to the needs of this type of aphasic
at this time.
4 - The patients who improved the most had the poorest repetition
skill prior to MIT. This may suggest that the patient with repetition skill
which is better than his other verbal abilities may not be a good candidate.
5 - It is noted with caution and no explanation that the four patients
who made the best recovery and the "Ninth" patient whose gains have been
good to date all had pre-MIT restricted but clearly articulated stereotype-
like speech.
The comparison of the data on the sub-tests of the Boston Diagnostic
Aphasia Examination concerned with auditory comprehension and reading
 Melodic Intonation Therapy 313

comprehension has shown that improvement in these areas continued to

occur for the MIT patients from the time of the first admiSision fO'r more
" traditional" language therapy to the time of their discharge from Melodic
Intonation Therapy. It suggest's that the diagnosis of "ChrO'nic aphasia"
should be used with caution when describing the language behavior O'f an
aphasic patient.
A reasonable judgment concerning the efficacy of any language therapy
for aphasia must delimit the goals to that of being an effective catalytic
aid which aims to maximize the on-going recovery disclosed by adequate
language examination. The comprehensive ,study by Sarno, Silverman and
Sands (1970) concludes that language therapy for the truly un improving
global aphasic is nO't effective. It is presumed that MIT will probably not
transcend that limitation.

Theoretical considerations to explain effectiveness of MIT

The answer to the question as to why Melodic Intonation Therapy

"works" is of primary interest to several disciplines involved in aphasiology.
We are not yet in a position to answer that question and two reports
concerning its effectiveness with "global" aphasics are baffling. The fir:st
report is from Dr. Luigi Vignolo of Milan and the second is from Dr.
Martin Albert, currently on leave of absence in Jerusalem. Both describe
recovery of minimal (to date) but pl"Opositional speech in patients who
qualify according to the requirements for candidacy previously described.
Several speculative proposals may be considered. It has been 'suggested that
these new, highly motivating methods may be effecting a psychological
break-through. This cannot be discounted as a factor; however, it is probably
too simplistic an explanation.
Conjecture concerning the physiology of the processes involved 1s worth
consideration. It 1s unlikely that the undamaged right hem1sphere which ffi
the minor one for language in our subjects is suddenly starting to speak for
itself. In addition to the study by Smith previously mentioned are the reports
by Zollinger (1935), Crockett and Estridge (1951), and French, Johnson,
Brown and Van Bergen (1955). They aLso describe language behavior in
patients following total left hemispherectomies. All that remained of ex-
pressive difficulties in these cases were "automatic" speech, expletives, and
words of over-learned 19ongs.
As indicated in the introductory section, there is evidence that the right
hemisphere may be dominant for certain aspects of non-linguistic processing,
including some components of melody. Perhaps the most acceptable hypothesffi
at this time, then, to account for the efficacy of MIT is that increased use of
the right hemispheric dominance for the melodic aspects of speech increases
314 R. Sparks, N. Helm and M. Albert

the role of that hem~sphere in inter-hemispheric control of language, pos-

sibly diminishing the language dommance of the damaged left hemisphere.
The issue concerning existence of language areas in the right hemisphere,
and means of increasing their efficiency is worthy of further investigation,
as Isuggested by Tikofsky, Kooi and Thomas (1960). A study involving
evoked auditory potentia11s being consider'ed.

SUMMARY

A study is presented which is concerned with a new form of language therapy

for aphasia called Melodic Intonation Therapy. This program involves sung intona-
tion of propositional sentences in such a way that the intoned pattern is similar
to the natural prosodic pattern of the sentence when it is spoken. The method
and scoring system are described. Results are based on eight severely, but not
globally, impaired. right-handed aphasic subjects with left hemisphere damage
resulting from cerebro-vascular accidents. Each patient acted as his own control
by having shown no improvement in verbal expression for at least six months
during which time he had received other language therapy. Recovery of some
appropriate propositional language occurred for six of the eight patients as a res,ult
of Melodic Intonation Therapy. It is suggested that both dominance for music
and existence of less developed language areas in the right hemisphere are
perhaps being used to support the damaged left hemisphere which continues to
be language-dominant. Although candidancy for MIT is still subject to further
investigation it is suggested that pre-requisites should include less impaired auditory
comprehension than verbal expression, evidence of self-criticism, good attention
span, and evidence that on-going recovery in some language modalities has or is
occurring. Efficacy of MIT for chronically global aphasics is probably subject to
question.
Acknowledgments. We appreciate the support received by Drs. Frank Benson
and Edith Kaplan when skepticism was shared by all of us. Special thanks are
extended to Dr. Sheila Blumstein for aid in review of the literature and the sug-
gestion that we might label the new therapy "Melodic Intonation." We also
appreciate the statistical analysis assistance given by Ms. Mary Hyde and Mr.
Errol Baker. We are grateful to Mrs. Mary Sparks for observing significant simi-
larities in the methods and purposes of MIT and the Kodaly Method as it is
taught at the nursery school she directs. Important new vistas were opened
for us.

ApPENDIX

Scoring

. First level of MIT program: Success on steps 2, 3, and 4 receive one point
each. Failure of any of these steps terminates further progression for that particular
sentence-item. Maximum score for any sentence is three points.
Second level: Success on steps 1, 3, 4 A or 4 B, and 5 A or 5 B receives
 Melodic Intonation Therapy 315

two points each. Success on any of these steps after a backup has been necessary
receives one point each. Failure after a backup terminates further progression as
in the first level. Maximum score for any sentence is eight points.

Sample melodic patterns

AM HUNG-RY AM HUNG - RY

WANT SOME DIN-NER WANT SOME DIN - NER

MEA T AND PO - TA - TOES MEA T AND PO - TA - TOES

Musical notations are treble clefj, key of C, 3/4 time.

REFERENCES

ALBERT, M., SPARKS, R., and HELM, N. (1973) Melodic intonation therapy for aphasia, "Arch.
Neurol.," 29, 130-131.
- , - , VON STOCKERT, T., and SAX, D. (1972) A case study of auditory agnosia: Linguistic and
non-linguistic processing, "Cortex," 8, 427-443.
BLUMSTEIN, S. and COOPER, W. (1974) Hemispheric processing of intonation contours, "Cortex,"
10, 146-158.
- , and GOODGLASS, H. (1972) The perception of stress as a semantic cue in aphasia, "J. Speech
Hear. Res.," 15, 800-806.
BOGEN, J., and GORDON, H . (1971) Musical tests for functional localization with intracarotid
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Robert Sparks, Aphasia Research Center, Veteran Administration Hospital, 150 South Huntington Avenue, Boston,
Massachusetts 02130, U.S.A.