A SINGLE-CASE STUDY OF USING MUSIC THERAPY TO IMPROVE EXPRESSIVE LANGUAGE IN A STROKE PATIENT WITH BROCA'S APHASIA

Abstract

Background and Objectives: This research examines the effect of music therapy on improving expressive language in stroke patients with Broca’s aphasia. Broca’s aphasia is a form of language impairment characterized by a significant difficulty in speaking and constructing grammatically correct sentences, particularly affecting conjunctions and prepositions such as ‘and,’ ‘or,’ and ‘but.’ Broca’s aphasia patients may also struggle with using prepositions. Although they retain an understanding of language and are aware of their communicative intentions, damage to the brain regions involved in speech production hinders their ability to articulate thoughts accurately, resulting in limited vocabulary. For example, a patient who wishes to say, ‘Take the dog for a walk,’ might express it as simply, ‘Dog walk.’ The rehabilitation of these skills often focuses primarily on speech therapy. Speech therapists provide various assessments and exercises to help patients practice and regain their speech abilities, aiming to restore them as closely as possible to their original state. Besides speech therapy, music therapy is another professional field commonly used abroad, either on its own or alongside speech therapy. Numerous studies have highlighted the positive impact of music therapy on the recovery from Broca’s aphasia. Music therapy is defined as the use of musical activities to support individualized therapeutic goals, emphasizing the dynamic interaction between the music therapist, music, and the client. These activities must be grounded in research, and music therapists are required to have completed accredited music therapy training. Through the researcher’s investigation, it was found that, in Thailand, a considerable number of stroke patients experience significant challenges in communication. However, music therapy has not yet been incorporated into the rehabilitation process for improving communication skills in stroke patients. Furthermore, the adaptation of music therapy to align with Thailand’s unique linguistic context remains underdeveloped. Internationally, numerous studies have explored the benefits of music therapy in stroke patients with Broca’s aphasia. These studies highlight that musical tones and rhythms can stimulate the right hemisphere of the brain, compensating for damage to the left hemisphere, enabling patients to use singing as an alternative means of communication. International research has investigated the use of music—particularly pitch, melody, and rhythm—to engage undamaged brain regions and facilitate recovery. Neurologic Music Therapy commonly employs techniques such as Melodic Intonation Therapy (MIT) and Therapeutic Singing (TS). While most studies focus on English-speaking populations, research on music therapy for stroke patients with Broca’s aphasia in Thailand remains lacking, despite the significant number of individuals affected and their unique linguistic needs. This study aims to examine the impact of music therapy on the rehabilitation of language skills in stroke patients with Broca’s aphasia. It seeks to provide guidelines for patients and families on utilizing music therapy for speech recovery and to offer insights for music therapists on effective rehabilitation methods. Additionally, this research will contribute valuable knowledge for further studies in this area.

Methods: This research employs a mixed-method incorporating both A-B single-case and a case-study design. Using Melodic Intonation Therapy and Therapeutic Singing, this study focuses on four key areas of speaking skills: intelligible verbalizations, verbalizing single words, verbalizing phrases, and verbalizing sentences. The music therapy intervention consisted of eight sessions in total. The Individualized Music Therapy Assessment Profile (IMTAP) and Thai Adaptation Aphasia Battery (T-WAB) were used to measure the outcome. The researcher employed the Thai Adaptation of the Western Aphasia Battery (T-WAB) to evaluate and classify the type and severity of aphasia. This assessment includes four key areas: 1) Spontaneous Speech, 2) Auditory Verbal Comprehension, 3) Repetition, and 4) Naming. Testing occurred both before and after the music therapy interventions, with assessments conducted by a speech therapist. Furthermore, the researcher used the Individualized Music Therapy Assessment Profile (IMTAP), a tool that music therapists utilize to evaluate various abilities in both children and adults. This study focuses on the language skills section (Expressive Communication), particularly subcategory E: Verbalizations, which encompasses assessments of comprehension, single-word responses, phrase construction, and sentence formation.

Results: The results showed that intelligible verbalizations during the baseline phase had an average of 40%, which steadily increased to 80% and even 100% during the music therapy phase. Verbalization of single words averaged 50% at the baseline, but scores gradually increased throughout the music therapy sessions, reaching a peak at 100%. For phrase-length verbalizations, the baseline average was 33.3%, which improved to 80% and eventually to 100% during the music therapy phase. Verbalization of sentences showed a baseline average of 0%, but increased to 40%, 80%, and 100% over the course of the therapy sessions.

Conclusions: This research provides guidelines for using music therapy to enhance the speaking skills of stroke patients with Broca’s aphasia. From this study, music therapists can gain valuable methods and procedures for applying music therapy techniques to improve expressive language in such patients, while those interested in further studying this population can also receive useful insights and guidelines for using music therapy in future research and development.