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Music Therapy Gives Voice to the Voiceless

SAN DIEGO—It's an impressive video. An elderly man in thick eyeglasses and a blue shirt sits in a wheelchair. A therapist sits across from him, off-camera. She tries to get him to say he's thirsty, but he can't produce the words. Several years ago, the man had a stroke that damaged the part of his brain that lets him talk, a condition known as aphasia.

Then, slowly, things begin to change. The therapist starts humming a simple, haunting melody: two notes at the same pitch, a third a bit higher, then back down. "I am thi-i-rsty," she sings. Resting her hand on the table, she taps the man's hand in time, encouraging him to sing along. "I am thirsty," he sings, in harmony. She sings the sentence; he sings it back. She says the sentence. He says it back. What would you say on a hot day like today, she asks. "I am thirsty," he answers. In a matter of minutes, a stroke patient who's been unable to speak for years has learned to express a basic human need.

The patient is undergoing Melodic Intonation Therapy. The technique was developed because a lot of patients who can't talk can still sing. Gottfried Schlaug, a neurologist at Harvard University, is studying how and why this treatment seems to work for many patients who have failed at other forms of speech therapy. He's running a randomized clinical trial of the therapy and, so far, finding that it looks pretty good. He spoke at a session here yesterday on music-language interactions in the brain at the annual meeting of the American Association for the Advancement of Science (which publishes ScienceNOW).

The stroke patients have had damage to the part of the left side of their brain involved in speech. But similar areas on the right side of the brain can also be used, if therapy can reach them. Making music turns on much of the brain at once. It engages the hearing, emotion, and motor skills. "Singing can give entry into a broken system by engaging the right hemisphere," says Schlaug. He has compared images of patients' brains before and after the therapy and found that the right side of the brain changes, both structurally and functionally.

And the patients change, too. In another video clip, a man tries to give his address. He struggles, but he can’t get the words out. He’s clearly frustrated. It’s 4 years after a stroke, and the man has tried many speech therapies—all to no avail. Then, in a second video, taken after 75 Melodic Intonation Therapy sessions, the man is reciting his house number, street, and town.

Schlaug thinks music therapy isn't more widely used partly because so many people are embarrassed about singing. "The therapists might have a problem singing with a patient," he says. And not just the therapists. "Most of our male patients have a problem with this." But they settle in, and the therapy itself is easy, he says. “Our next goal is to teach caregivers of patients."