Tuesday, November 11, 2014

The Therapeutic Effect of Neurologic Music Therapy and Speech Language Therapy in Post-Stroke Aphasic Patients

The Therapeutic Effect of Neurologic Music Therapy and Speech Language Therapy in Post-Stroke Aphasic Patients 

Source: Lim, K.B., Kim, Y.K., Lee, H.J., Yoo, J., Hwang, J.Y., Kim, J.A., & Kim, S.K. (2013). Thetherapeutic effect of neurologic music therapy and speech language therapy in post-stroke aphasic patients. Annals of Physical Rehabilitation Medicine, 37(4), 556-562. http://dx.doi.org/10.5535/arm.2013.37.4.556

Review:
Aphasia is common among those who have suffered a stroke. It affects the left middle cerebral artery. There are several types of aphasia, however, only non-fluent aphasia will be examined in this study. Non-fluent aphasia, also known as Broca’s aphasia, is a result of injury to the left frontal lobe. It reduces expressivity of speech output and can limit someone to as little as four words. 
There are several methods that can be used to treat aphasia such as intensive language-action therapy, language-oriented treatment, and melodic intonation therapy (MIT). Intensive language-action therapy is a form of speech therapy that has shown to improve language performance of chronic aphasia patients. Language-oriented treatment, another form of speech therapy, involves using the auditory sense, expression training through spoken language, pictures and texts. MIT is a method that induces speech by using rhythm and musical tones in the uninjured part of the brain. It can be used to treat severe aphasiac patients. 
A study was conducted to examine the therapeutic effects of neurologic music therapy (NMT) and speech language therapy (SLT) on post-stroke aphasic patients. 21 patients were recruited from two university hospitals with non-fluent aphasia, according to The Korean version-Western Aphasia Battery (K-WAB). 
The participants of one hospital received one-on-one speech therapy and NMT which consisted of MIT while rhythmically tapping with their uninjured hand, and singing. Singing involved voice training, respiratory training, automated speech and automated singing using familiar songs.
The patients from the other hospital received one-on-one speech therapy and language-oriented treatment through expression training via spoken language, articulation training of various syllables, consonants and vowels, and pictures and texts. 
Each group received two hour-long sessions each week, for a month. 
The researchers further divided the participants into a Subacute group or a Chronic group. Those in the Subacute group had suffered from a stroke within the last three months whereas those in the Chronic group had suffered a stroke more than three months prior to the experiment, making for a total of four groups (Chronic NMT, Chronic SLT, Subacute NMT, Subacute SLT). 
The study only used the oral language domain of the K-WAB. Four sub-tests are included in this section: spontaneous speaking (20 points), understanding (200 points), repetition (100 points) and naming (100 points). The K-WAB was used before and after every session.
The results revealed that there were significant improvements in repetition and naming in the Chronic NMT group. The Chronic SLT group showed a significant increase in repetition only. The Subacute NMT group showed significant improvements in spontaneous speaking, understanding and naming. The Subacute SLT group showed no improvements. It was therefore concluded that both NMT and SLT were effective in treating those in those with chronic non-fluent aphasia. NMT was also effective in treating language function in subacute patients. 


Reflection:
This study was interesting to me because I have not yet researched post-stroke aphasic patients, therefore, it is new to me. Although this study has shown positive results as both NMT and SLT were effective in treating chronic non-fluent aphasia patients, there were some limitations that must be considered. For example, the study was short and limited in its number of subjects, the participants were of different ages, and there was a difference in cognitive function. The NMT group consisted of participants with right and left cerebral lesions, however, the SLT group only consisted of patients with left cerebral lesions. Also, the therapies were used in two hospitals, conducted by different therapists. In the future, more controlled studies are needed to confirm the findings of this current study. 
I also thought it was interesting that NMT could be so powerful as it benefited more people in this study. According to researchers, NMT can “stimulate the speaking pathway in the left cerebral hemisphere or the singing pathway in the right side of both cerebral hemispheres.” Both cerebral hemispheres are important in vocal cord production and sensorimotor functions, involved in speaking and singing. Another reason why NMT may have been successful is that words can be pronounced slower when singing, allowing for more opportunities to distinguish between words and phrases. There is also a rhythmic aspect to singing which also aids in speaking words.
Since taking this course, I have come across many readings that use speech-vocal therapy and/or singing to alleviate some of the symptoms of an illness or disease. Singing is useful because it involves “an auditory-motor feedback loop in the brain more intensely than other music making activities such as instrumental playing” (Wan, Ruber, Hohmann, & Schlaug, 2010, p. 287). It also directly stimulates the musculature associated with respiration, articulation, phonation, and resonance and is therapeutic. This is especially important for those who suffer from neurological diseases such as Parkinson’s Disease or aphasia as it offers another option that is nonpharmacologic and non-invasive. As Oliver Sacks (2007) once said, “music is a remedy, a tonic, orange juice for the ear. But for many neurological patients, music is even more - it can provide access, even when no medication can, to movement, to speech, to life. For them, music is not a luxury, but a necessity.”

References:
Lim, K.B., Kim, Y.K., Lee, H.J., Yoo, J., Hwang, J.Y., Kim, J.A., & Kim, S.K. (2013). The therapeutic effect of neurologic music therapy and speech language therapy in post-stroke aphasic patients. Annals of Physical Rehabilitation Medicine, 37(4), 556-562. http://dx.doi.org/10.5535/arm.2013.37.4.556


Wan., C. Y., Ruber, T., Hohmann, A., & Schlaug, G. (2010). The therapeutic effects of singing in neurological disorders. Music Perception, 27(4), 287-295. http:// search.proquest.com/docview/89184449?accountid=14771

1 comment:

Eventide said...

It’s amazing how not only months but years after a stroke patients can start to regain speech using NMT techniques. I had the opportunity to work with a client in long term care diagnosed with aphasia who was not receiving any speech language therapy support. It seems that once a client is moved to long term care, the additional rehabilitative support provided is minimal. Anyway, he made good progress, and by the end was able to generate phrases and sentences on his own. It’s such a shame this therapy can’t be continued because of lack of funding.

With another client, I had the opportunity to work with a speech language therapist for 2 or 3 sessions. It was a wonderful learning opportunity, and the client really benefitted. It’s such a powerful combination when both approaches can be used. Perhaps if further research continues to support the effectiveness of both NMT and SLT when working with clients with aphasia, this approach will become the norm rather than the exception.