Singing May Improve Stroke Recovery in Patients With Chronic Aphasia

A group-based singing intervention improved communication, spoken language production, and psychosocial wellbeing among patients with chronic aphasia, according to study findings published in the journal Brain Communications.

Aphasia often occurs after stroke and associates with communication impairment which often causes social isolation and detriments to emotional wellbeing. Music has been found to be an effective tool for supporting motor and cognitive recovery after stroke. However, it has not been translated for aphasia-specific rehabilitation.

Researchers recruited individuals with aphasia (n=50) and their family caregivers (n=43) through the Helsinki-Uusimaa Stroke Association and Finnish Brain Association in the Helsinki area for this crossover randomized controlled trial, Choir Singing in Aphasia Rehabilitation (ClinicalTrials.gov Identifier: NCT03501797) . Patients received a 16-week intervention comprising a 1.5-hour-long weekly group session and 3 30-minute-long home practice sessions. The sessions were led by a choir conductor and music therapist and the groups included 10-14 patients and 6-10 caregivers. During the group sessions, the participants spent 20 minutes warming up, 40 minutes singing, and 30 minutes receiving melodic intonation therapy. At the last session the choir performed a small concert for family and friends. Participants were randomly assigned to receive the intervention followed by usual care or usual care followed by the intervention. The outcomes of interest were changes to communication and speech production, emotional and social functioning, and caregiver well-being.

The patients with aphasia were mean age, 64.0 (standard deviation [SD], 12.3) years, 28 were women, 28 had an ischemic stroke, 16 had a hemorrhagic stroke, the aphasic injury occurred 73.3 (SD, 68.4) months previously, and 16 had moderate or severe aphasia.

At 5 months, patients who received the intervention had significant changes from baseline for communication index (F, 7.082; P =.011), Stroke Impact Scale (SIS) participation and role function (F, 6.440; P =.015), and responsive speech index (F, 4.100; P =.049) compared with the usual care recipients. Caregivers of intervention recipients also reported a significant decrease in caregiver burden (F, 6.765; P =.014).

At follow-up, no significant changes in communication and responsive speech index were observed, suggesting that the improvements observed post-interventions were maintained through month 9.

The intervention did not appear to have an effect on spontaneous speech index, articulatory agility, verbal memory index, SIS physical functioning, SIS emotion, SIS memory and thinking, Center for Epidemiological Studies (CED)-Depression total score, or Social Provision Scale (SPS) total score (all P ≥.191).

Results in the per protocol analysis were consistent with the main analysis.

Study limitations included the small sample size and the inclusion of patients with differing aphasia etiologies and severities.

The researchers noted that a group-based singing intervention had encouraging results with significant improvement to communication and psychosocial outcomes.

“[O]ur results demonstrate this type of novel intervention model provides a versatile, motivating, scalable, and potentially cost-effective approach to aphasia rehabilitation,” they concluded.