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Perspectives from case studies in obtaining evidence for music interventions in aphasia

ABSTRACT Background: Music interventions for aphasia, such as Melodic Intonation Therapy, have often been criticised for a lack of high-quality evidence regarding their efficacy and mechanisms of action. However, attempts to evaluate these interventions and produce an evidence base for or against their use have proven challenging. Aims: We discuss both the challenges in obtaining research evidence and some possible solutions, taking into perspective differences between clinical and research approaches in their aims, orientation, and methodology. Research is generally focused on standardisation, generalisability, and the provision of adequately powered and statistically sound evidence. In contrast, clinical work is usually client-centric, requiring flexibility to address the needs of the individual patient. To illustrate these points, we present case studies of two individuals with chronic post-stroke aphasia, who were pilot participants for a music intervention study. Methods and Procedures: These patients received research-oriented treatment with a standardised audio-visual Melodic Intonation Therapy protocol delivered via DVD over 6 weeks. They underwent comprehensive language assessments before and after therapy, which included functional neuroimaging for one individual. Outcomes and Results: This standardised approach provided modest clinical benefit in one case, although this was not captured in standardised outcome assessments. For the second, more severely aphasic participant, there was no observable benefit, possibly because the standardised approach did not provide the flexibility needed to deal with the severity of his deficit. Conclusions: Through presentation of these case examples, we highlight how heterogeneous clinical presentations and individual differences pose challenges to standardised research designs. We then offer suggestions for how these factors might be accommodated within rigorous research designs to provide a better evidence base for aphasia interventions.