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Alicia Petrarca, Sally Galena, Ph.D.

Melodic Intonation Therapy Effects on Phoneme Production and Sequencing in Childhood Apraxia of Speech

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Childhood apraxia of speech (CAS) is a speech sound disorder of impaired motor planning and programming that highly impacts daily activities and education of a child. Not only are speech and phoneme production negatively affected, impaired motor planning and programming impacts language, phonological awareness, and literacy skills in children with CAS (American Speech-Language-Hearing Association [ASHA], 2007a, 2007b; McNeill, Gillon, & Dodd, 2009; Murray, McCabe, & Ballard, 2014).Treatment progress for children with CAS, is reportedly slow because of limited research in assessment, differential diagnosis, and selection of effective treatment methods. Traditionally, children with CAS receive a hierarchical motor therapy, using multimodal cueing, such as Dynamic Temporal and Tactile Cueing (DTTC) treatment (Edeal & Gildersleeve-Neumann, 2011; Maas, Butalla, & Farinella, 2012).

Melodic intonation therapy (MIT), traditionally used to treat generative language in adults with aphasia (a speech and language disorder caused by acquired brain injury), has shown to be most effective for those with Broca’s aphasia, which commonly co-occurs with apraxia of speech (AOS). When using MIT, patients are encouraged to practice speech in a song-like pattern in which rhythm and stress are exaggerated, pitch variability is reduced, and tempo is lengthened and maintained using hand tapping on the patient’s left hand (Zumbansen, Peretz, & Hébert, 2014a, 2014b). The song-like nature and left hand tapping of MIT is believed to utilize the principles of neuroplasticity, compensating for damage to the language centers in the left hemisphere by activating parts of the undamaged right hemisphere for language (Stahl, Kotz, Henseler, Turner, & Geyer, 2011; Zumbansen et al., 2014a, 2014b). Zumbansen et al. (2014b) proposed that rather than improving generative language, MIT is improving motor speech production, treating the AOS, thus improving expressive language in people with Broca’s type aphasia. Therefore, MIT has recently been proposed, but not thoroughly investigated to treat apraxia in children. The current proposal aims to answer the question: Do children with CAS, who receive MIT have improved speech sound production and sequencing compared to matched controls who receive DTTC treatment?

Thirty children with CAS, ages 5 to 12 years, will be matched and randomly assigned to receive either MIT or DTTC treatment three times a week for 6 weeks at the Loyola Clinical Centers. Pre- and post-treatment measures will assess accuracy and rate of connected speech (diadochokinetic rate) and individual phoneme accuracy (Goldman Fristoe Test of Articulation, Third Edition). Within and between group performances will be compared using inferential statistics, with significance level set at p < .05.  


American Speech-Language-Hearing Association. (2007a). Childhood apraxia of speech [Position Statement]. Available from

American Speech-Language-Hearing Association. (2007b). Childhood apraxia of speech [Technical Report]. Available from

Edeal, D. M., & Gildersleeve-Neumann, C. E. (2011). The importance of production frequency in therapy for childhood apraxia of speech. American Journal of Speech-Language Pathology, 20: 95-110. doi: 10.1044/1058-0360(2011/09-0005)

Maas, E., Butalla, C. E., & Farinella, K. A. (2012). Feedback frequency in treatment for childhood apraxia of speech. American Journal of Speech-Language Pathology, 21: 239-257. doi: 10.1044/1058-0360(2012/11-0119)

McNeill, B. C., Gillon, G. T., & Dodd, B. (2009). Effectiveness of an integrated phonological awareness approach for children with childhood apraxia of speech (CAS). Child Language Teaching and Therapy, 23: 341-366. doi:10.1177/0265659009339823

Murray, E., McCabe, P., & Ballard, K. J. (2014). A systematic review of treatment outcomes for children with childhood apraxia of speech. American Journal of Speech-Language Pathology, 23: 486-504. doi:10.1044/2014_AJSLP-13-0035

Stahl, B., Kotz, S. A., Henseler, I., Turner, R., Geyer, S. (2011). Rhythm in disguise: Why singing may not hold the key to recovery from aphasia. Brain, 134: 3083-3093. doi:10.1093/brain/awr240

Zumbansen, A., Peretz, I., & Hébert, S. (2014a). The combination of rhythm and pitch can account for the beneficial effect of melodic intonation therapy on connected speech improvements in Broca’s aphasia. Frontiers in Human Neuroscience, 8: 1-11. doi:10.3389/fnhum.2014.00592

Zumbansen, A., Peretz, I., & Hébert, S. (2014b). Melodic intonation therapy: Back to basics for future research. Frontiers in Neurology, 4: 1-11. doi:10.3389/fneur.2014.00007

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