April 24, 2008
Music Therapy Helps Stroke Patients Recover
Few people over the age of 10 would list "Happy Birthday" among their favorite songs. But Harvey Alter, now 62, has a special fondness for it. It helped teach him how to talk.
One morning in June 2003, Alter, then a self-employed criminologist, was putting a leash on his dog, Sam, in preparation for a walk when suddenly he felt dizzy and disoriented."My thoughts were intertwined, not making sense," he said in a recent interview. "I knew I was having a stroke."
At St. Vincent's Hospital, doctors diagnosed an ischemic stroke, caused by a blockage in blood flow to part of the left half of his brain. As a result, the right side of his body was temporarily paralyzed, the right side of his face drooped and he had trouble coming up with the right words and stringing them into sentences - a condition called aphasia.
Within hours of his stroke, Alter met with Loni Burke, a speech therapist. At first he was completely nonverbal; within a few days he could say small words.
"Mostly, he said, 'No,' " Burke recalled, "because he was frustrated that he couldn't speak."
After two years of painstaking therapy, Alter's paralysis had mostly disappeared and his smile was back to normal. But while he could communicate through small words and the help of a chalkboard, complex verbal communication remained elusive.
Using standard speech therapy techniques like reviewing lists of numbers and the days of the week, Burke helped her patient piece together short phrases. But they came slowly and sounded robotic.
Then one day, she asked him to sing.
"How can I ever sing? I can't talk," Alter recalled thinking. But as soon as Burke began to sing "Happy Birthday," he chimed in. "It sounded good," he said. "Almost like I didn't have anything wrong."
The technique, called melodic intonation therapy, was developed in 1973 by Dr. Martin Albert and colleagues at the Boston Veterans Affairs Hospital. The aim was to help patients with damage to Broca's area - the speaking center of the brain, located in its left hemisphere.
These patients still had relatively healthy right hemispheres. And while the left hemisphere is largely responsible for speaking, the right hemisphere is used in understanding language, as well as processing melodies and rhythms.
"You ask yourself, 'What specifically engages the right hemisphere?' " said Dr. Gottfried Schlaug, a neurologist at Beth Israel Deaconess Medical Center in Boston who studies music's effect on the brain.
Melodic intonation therapy seems to engage the right hemisphere by asking patients to tap out rhythms and repeat simple melodies.
Therapists first work with patients to create sing-song sentences that can be set to familiar tunes, then work on removing the melody to leave behind a more normal speaking pattern. But relatively little research has been done to understand how this type of therapy affects the brain of a stroke patient.
In a study completed in 2006, Schlaug and colleagues at Harvard tracked the progress of eight patients with Broca's aphasia as they underwent 75 sessions of melodic intonation therapy. MRI scans taken when the patients were speaking showed that activity in the right hemisphere had changed significantly over the course of treatment.
"The combination of melodic intonation and hand-tapping activates a system of the right side of the brain that is always there, but is not typically used for speech," Schlaug said.
He recommends melodic intonation therapy for patients who have no meaningful form of speech, but can understand language and have the patience for therapy sessions.
Alter still speaks somewhat haltingly, with a noticeable lilt, but he no longer struggles to find the right word, and he will happily serenade anyone with conversation about his condition. While he attributes most of his success to melodic intonation therapy, Burke says it was only one tool she used among a host of others.
Still, she agrees that the therapy was crucial. "It may have caused an initial reaction of, 'Wow, maybe I can speak,' " she said.
As he has recovered, Alter has devoted his life to increasing awareness about aphasia. He created the International Aphasia Movement two years ago and spends much of his time leading support groups for stroke survivors. and their families.