Choir Singing in Aphasia Rehabilitation
- Conditions
- AphasiaStroke
- Registration Number
- NCT03501797
- Lead Sponsor
- University of Helsinki
- Brief Summary
This study evaluates the verbal, cognitive, emotional, and neural efficacy of a choir singing intervention in chronic aphasic patients and their caregivers. Using a cross-over RCT design, half of the participants receive a 4-month singing intervention during the first half of the study and half of the participants during the second half of the study.
- Detailed Description
BACKGROUND: Singing is a highly stimulating and versatile activity for the brain, combining vocal-motor, auditory, linguistic, cognitive, emotional, and social brain processes, both in the left and right hemisphere. The capacity to sing is often preserved in aphasia after stroke, and singing-based methods, such as Melodic Intonation Therapy (MIT), can be effective in rehabilitating speech production in aphasics. Also emotionally and socially, singing could provide a powerful alternative channel for aphasic patients to express their emotions and interact with others, but the communal or group-level use of singing in aphasia rehabilitation has not been systematically studied.
AIMS: The purpose of the study is to determine the clinical and neural efficacy of a novel choir singing intervention in subacute/chronic aphasia. Specifically, the targeted outcomes are (i) verbal and vocal-motor skills, (ii) cognitive skills, (iii) emotional functioning and quality of life, (iv) caregiver psychological well-being, and (v) structural and functional neuroplasticity. In addition, the capacity of singing and music learning in aphasia is explored.
METHODS: Subjects are 60 stroke patients with at least minor aphasia (≥ 6 months post-stroke) and their family members (FMs, N = 60) from Helsinki area recruited to a cross-over RCT study. Participants are randomized to two groups \[N = 60 in both (30 patients, 30 FMs)\], which receive a 16-week choir intervention either during the first (AB group) or second (BA group) half of the follow-up. The intervention is a combination of group training, which utilizes a novel combination of traditional senior choir singing and MIT-like speech training protocols, and home training in which the choir material is trained with a tablet computer. All patients are evaluated at baseline, 5-month, and 9-month stages with language, cognitive, and auditory-music tests and questionnaires. Half of the patients (N = 30) also undergo electroencephalography (EEG) and structural and functional magnetic resonance imaging (s/fMRI). FMs are evaluated with questionnaires.
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 100
Not provided
Not provided
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- CROSSOVER
- Primary Outcome Measures
Name Time Method Verbal agility Change from baseline at 5 months and 9 months Verbal Agility subtest score of the Boston Diagnostic Aphasia Examinaton (BDAE) (range 0-14, higher score indicates better outcome)
Verbal comprehension Change from baseline at 5 months and 9 months Sequential Commands subtest score of the Western Aphasia Battery (WAB) (range 0-80, higher score indicates better outcome)
Connected speech informativeness Change from baseline at 5 months and 9 months Percentage of correct information units (CIUs) produced in a picture description task
Communication ability Change from baseline at 5 months and 9 months Total score of the Communication Action Log (CAL) questionnaire (range 0-180, higher score indicates better outcome)
Repetition of words and sentences Change from baseline at 5 months and 9 months Repetition subscale score of the Western Aphasia Battery (WAB) (range 0-100, higher score indicates better outcome)
Spontaneous speech production Change from baseline at 5 months and 9 months Spontaneous Speech subscale score of the Western Aphasia Battery (WAB) (range 0-20, higher score indicates better outcome)
Naming and word finding Change from baseline at 5 months and 9 months Naming and Word Finding subscale score of the Western Aphasia Battery (WAB) (range 0-100, higher score indicates better outcome)
- Secondary Outcome Measures
Name Time Method Executive function (correct responses) Change from baseline at 5 months and 9 months Simon Task: score (range 0-100, higher score indicates better outcome)
Attention (reaction times) Change from baseline at 5 months and 9 months Flexible Attention Test (FAT): reaction time mean (ms)
Verbal learning Change from baseline at 5 months and 9 months Word Lists subtest score of the Wechsler Memory Scale III (WMS-III) (range 0-84, higher score indicates better outcome)
Psychological stress of the caregiver Change from baseline at 5 months and 9 months Total score of the General Health Questionnaire (GHQ-12) (range 0-36, lower score indicates better outcome)
Electroencephalography (EEG) Change from baseline at 5 months and 9 months Amplitude and latency of event-related potentials (ERPs) associated with learning and memory in two auditory tasks
Structural magnetic resonance imaging (sMRI): DTI sequence Change from baseline at 5 months and 9 months Structural connectivity of intra- and interhemispheric white matter tracts
Functional magnetic resonance imaging (fMRI): resting-state Change from baseline at 5 months and 9 months resting-state fMRI sequence: functional connectivity of frontotemporal, frontoparietal, and limbic brain networks
Verbal memory Change from baseline at 5 months and 9 months Logical Memory subtest score of the Wechsler Memory Scale III (WMS-III) (range 0-80, higher score indicates better outcome)
Music perception Change from baseline at 5 months and 9 months Montreal Battery of Evaluation of Amusia (MBEA) score (range 0-30, higher score indicates better outcome)
Depression Change from baseline at 5 months and 9 months Total score of the Center for Epidemiological Studies Depression Scale (CES-D) questionnaire (range 0-60, lower score indicates better outcome)
Caregiver burden Change from baseline at 5 months and 9 months Total score of the Zarit Burden Interview (ZBI-22) questionnaire (range 0-88, lower score indicates better outcome)
Structural magnetic resonance imaging (sMRI): MPRAGE sequence Change from baseline at 5 months and 9 months Grey matter volume in frontotemporal, frontoparietal, and limbic brain regions
Functional magnetic resonance imaging (fMRI): singing-related activity Change from baseline at 5 months and 9 months task-based fMRI sequence: frontotemporal, frontoparietal, and limbic activation patterns associated with the perception, vocal repetition, and recall of novel songs
Executive function (reaction times) Change from baseline at 5 months and 9 months Simon Task: reaction time mean (ms)
Attention (correct responses) Change from baseline at 5 months and 9 months Flexible Attention Test (FAT): score (range 0-48, higher score indicates better outcome)
Functional stroke recovery Change from baseline at 5 months and 9 months Total score of the Stroke Impact Scale (SIS) questionnaire (range 0-900, higher score indicates better outcome)
Social interaction Change from baseline at 5 months and 9 months Total score of the Social Provision Scale (SPS) questionnaire (range 24-96, higher score indicates better outcome)
Working memory Change from baseline at 5 months and 9 months Word Span subtest score of the Kielelliset Arviointitehtävät (KAT) (range 0-30, higher score indicates better outcome)
Singing ability Change from baseline at 5 months and 9 months Acoustic features (e.g., pitch, rhythm, intensity) analyzed from recorded production of familiar and novel songs using acoustic analysis software
Mood Change from baseline at 5 months and 9 months Total score of the Visual Analog Mood Scales (VAMS) questionnaire (range 0-800, higher score indicates better outcome)
Trial Locations
- Locations (2)
Helsinki University Central Hospital, Department of Neurology, Rehabilitation Unit
🇫🇮Helsinki, Finland
Helsinki-Uusimaa Aphasia and Stroke Association
🇫🇮Helsinki, Finland
Helsinki University Central Hospital, Department of Neurology, Rehabilitation Unit🇫🇮Helsinki, Finland