Andrea Norton

Beth Israel Deaconess Medical Center | BIDMC · Department of Neurology

Patients with large left-hemisphere lesions and post-stroke aphasia often remain nonfluent. Melodic intonation therapy (MIT) may be an effective alternative to traditional speech therapy for facilitating recovery of fluency in those patients. In an open-label, proof-of-concept study, 14 subjects with nonfluent aphasia with large left-hemisphere les...

We tested an intonation‐based speech treatment for minimally verbal children with autism (auditory‐motor mapping training, AMMT) against a nonintonation–based control treatment (speech repetition therapy, SRT). AMMT involves singing, rather than speaking, two‐syllable words or phrases. In time with each sung syllable, therapist and child tap togeth...

Purpose Understanding what limits speech development in minimally verbal (MV) children with autism spectrum disorder (ASD) is important for providing highly effective targeted therapies. This preliminary investigation explores the extent to which developmental speech deficits predicted by Directions Into Velocities of Articulators (DIVA), a computa...

Purpose To investigate the latent factors underlying signs of childhood apraxia of speech (CAS) in a group of 57 children with CAS. Method The speech of 57 children with CAS (aged 3;5 to 17;0) was coded for signs of CAS. All participants showed at least five signs of CAS and were judged to have CAS by speech pathologists experienced in pediatric s...

Objective: To determine the contributions of apraxia of speech (AOS) and anomia to conversational dysfluency. Methods: In this observational study of 52 patients with chronic aphasia, 47 with concomitant AOS, fluency was quantified using correct information units per minute (CIUs/min) from propositional speech tasks. Videos of patients performin...

INTERNATIONAL STROKE CONFERENCE 2019 ORAL ABSTRACTS SESSION TITLE: CLINICAL REHABILITATION AND RECOVERY ORAL ABSTRACTS I Abstract 67: Contributions of the Unaffected Hemisphere to Outcome Predictions of Acute Aphasia Gottfried Schlaug , Andrea Norton , Karen Chenausky , Sarah Marchina , Julius Kernbach Originally published January 30, 2019 https:...

We investigated the relationship between eight theoretically motivated behavioral variables and a spoken‐language‐related outcome measure, after 25 sessions of treatment for speech production in 38 minimally verbal children with autism. After removing potential predictors that were uncorrelated with the outcome variable, two remained. We used both...

Functional imaging studies have provided insight into the effect of rate on production of syllables, pseudowords, and naturalistic speech, but the influence of rate on repetition of commonly-used words/phrases suitable for therapeutic use merits closer examination. Aim: To identify speech-motor regions responsive to rate and test the hypothesis tha...

Introduction: Making accurate predictions about a stroke patient’s language/speech-motor outcome and recovery potential is a challenge. We previously showed that a combined variable of lesion site and size pertinent to relevant white matter language structures, the Arcuate Fasciculus lesion load (AF-LL), correlated highly with measures of speech fl...

We tested the effect of Auditory-Motor Mapping Training (AMMT), a novel, intonation-based treatment for spoken language originally developed for minimally verbal (MV) children with autism, on a more-verbal child with autism. We compared this child’s performance after 25 therapy sessions with that of: (1) a child matched on age, autism severity, and...

We investigated the relationship between imaging variables for two language/speech-motor tracts and speech fluency variables in 10 minimally verbal (MV) children with autism. Specifically, we tested whether measures of white matter integrity—fractional anisotropy (FA) of the arcuate fasciculus (AF) and frontal aslant tract (FAT)—were related to cha...

This study compared Auditory-Motor Mapping Training (AMMT), an intonation-based treatment for facilitating spoken language in minimally verbal children with autism spectrum disorder (ASD), to a matched control treatment, Speech Repetition Therapy (SRT). 23 minimally verbal children with ASD (20 male, mean age 6;5) received at least 25 sessions of A...

Various therapies exist for teaching first words to minimally verbal (MV) children with autism spectrum disorder (ASD). Previous outcome measures have focused on number of words imitated or produced spontaneously, or on communication rate. No studies thus far have examined phonetic accuracy in MV ASD as a result of therapy, yet understanding whethe...

Objective: We sought to determine via a cross-sectional study the contribution of (1) the right hemisphere's speech-relevant white matter regions and (2) interhemispheric connectivity to speech fluency in the chronic phase of left hemisphere stroke with aphasia. Methods: Fractional anisotropy (FA) of white matter regions underlying the right mid...

Using a pre-post design, eleven chronic stroke patients with large left hemisphere lesions and nonfluent aphasia underwent diffusion tensor imaging and language testing before and after receiving 15weeks of an intensive intonation-based speech therapy. This treated patient group was compared to an untreated patient group (n=9) scanned twice over a...

There is a need for identifying biomarkers that predict chronic speech fluency/language impairment and improvement after stroke. We previously showed that the Arcuate Fasciculus lesion load (AF-LL), a combined variable of lesion site and size, predicted speech fluency in chronic aphasic patients. In the current study, we compared lesion loads of su...

Using an adapted version of Melodic Intonation Therapy (MIT), we treated an adolescent girl with a very large left-hemisphere lesion and severe nonfluent aphasia secondary to an ischemic stroke. At the time of her initial assessment 15 months after her stroke, she had reached a plateau in her recovery despite intense and long-term traditional speec...

Despite the fact that as many as 25% of the children diagnosed with autism spectrum disorders are nonverbal, surprisingly little research has been conducted on this population. In particular, the mechanisms that underlie their absence of speech remain unknown. Using diffusion tensor imaging, we compared the structure of a language-related white mat...

Although up to 25% of children with autism are non-verbal, there are very few interventions that can reliably produce significant improvements in speech output. Recently, a novel intervention called Auditory-Motor Mapping Training (AMMT) has been developed, which aims to promote speech production directly by training the association between sounds...

Research has suggested that a fronto-temporal network in the right hemisphere may be responsible for mediating melodic intonation therapy's (MIT) positive effects on speech recovery. We investigated the potential for a non-invasive brain stimulation technique, transcranial direct current stimulation (tDCS), to augment the benefits of MIT in patient...

Previous studies have suggested that patients' potential for poststroke language recovery is related to lesion size; however, lesion location may also be of importance, particularly when fiber tracts that are critical to the sensorimotor mapping of sounds for articulation (eg, the arcuate fasciculus) have been damaged. In this study, we tested the...

It has been reported for more than 100 years that patients with severe nonfluent aphasia are better at singing lyrics than they are at speaking the same words. This observation led to the development of melodic intonation therapy (MIT). However, the efficacy of this therapy has yet to be substantiated in a randomized controlled trial. Furthermore,...

Individuals with autism show impairments in emotional tuning, social interactions and communication. These are functions that have been attributed to the putative human mirror neuron system (MNS), which contains neurons that respond to the actions of self and others. It has been proposed that a dysfunction of that system underlies some of the chara...

Long-term instrumental music training is an intense, multisensory and motor experience that offers an ideal opportunity to study structural brain plasticity in the developing brain in correlation with behavioral changes induced by training. Here, for the first time, we demonstrate structural brain changes after only 15 months of musical training in...

As the main interhemispheric fiber tract, the corpus callosum (CC) is of particular importance for musicians who simultaneously engage parts of both hemispheres to process and play music. Professional musicians who began music training before the age of 7 years have larger anterior CC areas than do nonmusicians, which suggests that plasticity due t...

Recovery from aphasia can be achieved through recruitment of either perilesional brain regions in the affected hemisphere or homologous language regions in the nonlesional hemisphere. For patients with large left-hemisphere lesions, recovery through the right hemisphere may be the only possible path. The right-hemisphere regions most likely to play...

For more than 100 years, clinicians have noted that patients with nonfluent aphasia are capable of singing words that they cannot speak. Thus, the use of melody and rhythm has long been recommended for improving aphasic patients' fluency, but it was not until 1973 that a music-based treatment [Melodic Intonation Therapy (MIT)] was developed. Our on...

The human brain has the remarkable capacity to alter in response to environmental demands. Training-induced structural brain changes have been demonstrated in the healthy adult human brain. However, no study has yet directly related structural brain changes to behavioral changes in the developing brain, addressing the question of whether structural...

It may be strange to think that singing could help a stroke victim speak again, but this is the goal of Melodic Intonation Therapy (MIT), a speech therapy that emphasizes musical aspects of language. The positive effects of MIT on speech recovery may be mediated by a frontotemporal brain network in the right hemisphere. We investigated the potentia...

PAST RESEARCH HAS SHOWN THAT MUSIC and language skills are related in normal-reading children as well as in children with dyslexia. In both an ongoing longitudinal study with normal-reading children and a pilot study with children with dyslexia, we found a strong relationship between musical discrimination abilities and language-related skills. In...

It has been reported that patients with severely nonfluent aphasia are better at singing lyrics than speaking the same words. This observation inspired the development of Melodic Intonation Therapy (MIT), a treatment whose effects have been shown, but whose efficacy is unproven and neural correlates remain unidentified. Because of its potential to...

In this study we investigated the association between instrumental music training in childhood and outcomes closely related to music training as well as those more distantly related. Children who received at least three years (M = 4.6 years) of instrumental music training outperformed their control counterparts on two outcomes closely related to mu...

The Role of the Right Hemisphere in Post-Stroke Language Recovery. Gottfried Schlaug, Andrea Norton, and Sarah Marchina; Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA Introduction: The neural processes that underlie post-stroke language recovery remain largely unknown and thus, have not been specifically targeted by aph...

Using a modified sparse temporal sampling fMRI technique, we examined both shared and distinct neural correlates of singing and speaking. In the experimental conditions, 10 right-handed subjects were asked to repeat intoned ("sung") and non-intoned ("spoken") bisyllabic words/phrases that were contrasted with conditions controlling for pitch ("humm...

While it is often reported that musical experience can have positive effects on cognitive development in young children, the neural basis of such potential effects remains relatively unexplored. Employing functional magnetic resonance imaging (fMRI) for such research presents as many challenges as possibilities, not least of which is the fact that...

Research has revealed structural and functional differences in the brains of adult instrumental musicians compared to those of matched nonmusician controls, with intensity/duration of instrumental training and practice being important predictors of these differences. Nevertheless, the differential contributions of nature and nurture to these differ...

Adult musician's brains show structural enlargements, but it is not known whether these are inborn or a consequence of long-term training. In addition, music training in childhood has been shown to have positive effects on visual-spatial and verbal outcomes. However, it is not known whether pre-existing advantages in these skills are found in child...

In the adult brain, melody and rhythm processing have been found to show different hemispheric dominance, with the right hemisphere apparently more sensitive to melody and the left hemisphere to rhythm. We used a novel, child-friendly scanning protocol to examine the neural basis of melody and rhythm processing in young children (mean age 6 years 4...