Learning to talk again by singing

NEW YORK -- Few people over the age of 10 would list "Happy Birthday" among their favorite songs. But Harvey Alter, now 62, has a special fondness for it. It helped teach him how to talk.

One morning in June 2003, Alter, then a self-employed criminologist, was putting a leash on his dog, Sam, in preparation for a walk around Greenwich Village, where he has lived for 30 years. Suddenly he felt dizzy and disoriented. "My thoughts were intertwined, not making sense," he said in a recent interview. "I knew I was having a stroke."

At St. Vincent's Hospital, doctors diagnosed an ischemic stroke, caused by a blockage in blood flow to part of the left half of his brain. As a result, the right side of his body was temporarily paralyzed, the right side of his face drooped, and he had trouble coming up with the right words and stringing them into sentences -- a condition called aphasia.

Within hours of his stroke, Alter met with Loni Burke, a speech therapist who now works at Lenox Hill Hospital. At first he was completely nonverbal; within a few days he could say small words.

After Alter spent three weeks in the hospital and two years in painstaking therapy, his paralysis had mostly disappeared. But while he could communicate through small words and with the help of a chalkboard, complex verbal communication remained elusive.

Then one day, Burke asked him to sing. "How can I ever sing? I can't talk," Alter recalled thinking.

But as soon as Burke began to sing "Happy Birthday," he chimed in. "It sounded good," he said. "Almost like I didn't have anything wrong."

The technique, called melodic intonation therapy, was developed in 1973 by Dr. Martin Albert and colleagues at the Boston Veterans Affairs Hospital. The aim was to help patients with damage to Broca's area -- the speaking center of the brain, located in its left hemisphere.

These patients still had relatively healthy right hemispheres. And while the left hemisphere is largely responsible for speaking, the right hemisphere is used in understanding language, as well as processing melodies and rhythms.

Melodic intonation therapy seems to engage the right hemisphere by asking patients to tap out rhythms and repeat simple melodies.

Therapists first work with patients to create sing-song sentences that can be set to familiar tunes, then work on removing the melody to leave behind a more normal speaking pattern.

But relatively little research has been done to understand how this type of therapy affects the brain of a stroke patient.