MIT and AAC

Specialized Aphasia Interventions

When to Use Specialized Interventions

  • Severe expressive aphasia

  • Moderate-to-severe apraxia of speech

  • Applicable in chronic phase without effectiveness of traditional interventions

  • AAC can be utilized in acute phase for immediate communication needs

  • MIT & AAC focus on enhancing language production

Melodic Intonation Therapy (MIT)

  • Principle: Using intact right hemisphere capabilities, such as musicality and prosody, to facilitate language production in individuals with aphasia. (when speech alone is not conveying the message that they want)

  • Objective: Utilizes prosody to improve expressive language by engaging right hemisphere regions (DOES NOT IMPROVE PROSODY, USES IT)

  • Avoid familiar song melodies, focus on spoken prosody (pitch, tempo, rhythm)

Candidacy for MIT

  • Good candidate: Good auditory comprehension, limited verbal output, emotional stability

  • Poor candidate: (not for those with auditory comprehension, or those who are fluent, Wernicke’s/global aphasia, poor comprehension, transcortical aphasias (they can repeat what u say, but cannot apply it)

Principles of MIT

Exaggerating a phrase’s intonation by slowing it down- then having patient pat each syllable with their LEFT hand (takes advantage of the right hemisphere's strengths) facilitates the connection between speech and motor output, enhancing the patient's ability to produce fluent speech.

Objective: recover ability to use some spoken language accurately in severe expressive aphasia

  1. Gradual progression and reduction of clinician dependence

  2. Do not correct failed attempts; revert to previous step

  3. Emphasize repetition

  4. Control response latency

  5. Use meaningful stimuli

  6. Clinician restraint in reinforcement

  7. Avoid written/pictorial materials as stimuli

  8. Aim for 2 sessions per day

MIT Levels

Elementary

  • Steps: Humming, Unison Singing, Fading, Immediate Repetition, Response to Question

Intermediate

  • Steps: Introducing item, Unison with Fading, Delayed Repetition, Response to Question

Advanced

  • Steps: Transition to normal prosody, incorporating complex phrases and Sprechgesang technique

Mit Mechanism

  • Uses intonation to engage right hemisphere, tapping engages sensorimotor networks, and inner rehearsal aids skill transfer

Augmentative Alternative Communication (AAC)

  • AAC maximizes communication skills for interaction, not just speech recovery

  • Target population: Difficulty with verbal communication, improving but not fully effective through speech

AAC Assessment

  • Components include language, cognitive, symbol,

  • Literacy assessments (can they read and write? Can they spell, at least the first letter?)

Types of Communication for AAC

  • Simple: Drawing, writing, gestures

  • Independent: Communication board/book, devices (low/high tech)

Resources for AAC

  • Links to assessment tools, templates, software, and communication board examples

Case Reviews

  • Evaluate candidate suitability for AAC based on specific characteristics and communication needs for assigned case studies

  • Need to ensure

Assignment Goals

  • Develop treatment goals for patients with varying levels of aphasia, focusing on communication needs and support strategies.

Case 3 Goals

AAC for needs he cannot communicate, or more complex thoughts (visual or gestural)

MIT for verbal expression (I want.. I like..) only verbal cues (give him the word if he dont know, no phonological cues)