Group-based Singing Intervention Improves Spoken Language Production and Social Participation in Adults with Chronic Aphasia

by | Feb 22, 2023 | 2023, Alternative Therapies, Brain Health

Written by Taylor Woosley, Staff Writer. Significant findings of the study show that paired t-tests comparing pre- and post-intervention scores across both groups revealed a significant improvement in both the Communication index (p<0.001) and the Responsive speech index (p=0.007). 

singing in choirAphasia, an acquired impairment of expression and comprehension in spoken and written language, is associated with greater negative impact on quality of life1. Chronic aphasia (≥6 months post-onset) affects up to a third of stroke survivors2. In aphasia, language recovery relies on spared left-hemispheric areas surrounding the stroke lesion3.

Despite impairments in speech production, a classical observation in neurology has been the relative preservation of singing ability in aphasic patients4. Singing can help the motor production of words by slowing down the rate of vocal production and increasing the connectedness between syllables/words5. The mechanisms underlying music therapy on recovery are not well-known, although it seems to stimulate brain plasticity by promoting the neuroplastic reorganization of language function, the utilization of shared features of music and language reflecting common processing pathways, and improving the patient’s mood6.

Siponkoski et al. conducted a randomized controlled crossover trial to compare a multicomponent singing intervention (MSI) to standard care in patients with aphasia (PWA) from baseline to 5-month and 9-month follow-up stages. 54 PWAs with a history of cerebrovascular accident (n=53) or traumatic brain injury (n=1) leading to aphasia and their family caregivers (FC) were recruited. Subject inclusion consisted of being age ≥18, with time since stroke/injury >6 months, with at least mild aphasia, with no subjective hearing deficit, with the ability to produce vocal sound through singing/humming.

In two data collection waves (2018: n=33, 2019: n=21), PWA participants were randomly assigned to two groups (AB/BA, A=intervention, B=control) stratified for aphasia severity, FC’s participation in group sessions, sex, age, and time since stroke/injury. Outcome measures included neuropsychological and language tests and questionnaires which were performed at baseline (T1), 5-month mid-point (T2), and 9-month endpoint (T3). Furthermore, MRI and EEG data was gathered from a subgroup of PWAs, with additional quantitative and qualitative feedback collected from PWAs and FCs after the intervention period.

The AB group received the singing intervention during the first 16-week period (T1-T2) and the BA group received it during the last 16-week period (T2-T3). Both groups received standard speech therapy, neuropsychological rehabilitation, and physical/occupational therapy throughout the trial. The multicomponent singing intervention (MSI) was a combination of group training (1 session/week, 1.5 hour/session, total 24 hours) and home training (3 sessions/week, 30 min/session, total 24 hours). The intervention was split into four groups of participants (two AB groups and two BA groups; 10-14 PWAs and 6-10 FCs per group), with thirty-two (AB=14, BA=18) FCs that joined in the group sessions.

The primary outcome was a change in communication ability from T1 to T2. Secondary outcomes consisted of changes in communication ability from T1 to T3 and changes in spoken language production and verbal skills and emotional, social, and functional outcome from T1 to T2 and T1 to T3. Communication ability was measured using the Communicative Activity Log (CAL) and the Communication subscale of the Stroke Impact Scale 3.0, which were self-reported and informant-reported through FCs. Spontaneous speech was analyzed with the Spontaneous speech index of the Western Aphasia Battery (WAB). Functional impairment of PWAs was assessed using four SIS subscales: physical functioning, emotion, memory and thinking, and participation and role function.

Main analyses were conducted using linear mixed effects model (LMM) on the whole sample of participants who took part in the first measurement (n=50). Further long-term effects were investigated within both AB and BA groups over T1-T3. Significant findings of the study are as follows:

  • The intention-to-treat results from communication and spoken language production Time x Group LMM analysis of T1-T2 show significant improvements in the AB group compared to the BA group between T1-T2 in the Communication index (F1,45=8.08, p=0.011, np2=0.140) and in the Responsive speech index (F1,45=4.10, p=0.049, np2=0.084).
  • Results from functional, emotional, and social outcome measures show a significant improvement in the AB vs. BA group between T1-T2 in the SIS Participation and role function subscale (F1,43=6.44, p=0.15, np2=0.139) and in the Caregiver burden index (F1,40=6.77, p=0.014, np2=0.177).

Results of the randomized controlled trial show that, compared to standard care, MSI improved PWAs’ everyday communication ability and spoken language production, improved social participation, and reduced caregiver burden in FCs. Study limitations include the moderate sample size and the inability to make inference about the contribution of the multicomponent nature of the intervention.

Source: Siponkoski, Sini-Tuuli, Anni Pitkäniemi, Sari Laitinen, Essi-Reetta Särkämö, Emmi Pentikäinen, Heidi Eloranta, Leena Tuomiranta et al. “Efficacy of a multicomponent singing intervention on communication and psychosocial functioning in chronic aphasia: a randomized controlled crossover trial.” Brain Communications 5, no. 1 (2023): fcac337.

©The Author(s) 2022. Published by Oxford University Press on behalf of the Guarantors of Brain. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.

Click here to read the full text study.

Posted February 22, 2022.

Taylor Woosley studied biology at Purdue University before becoming a 2016 graduate of Columbia College Chicago with a major in Writing. She currently resides in Glen Ellyn, IL.

References:

  1. Crosson B, Rodriguez AD, Copland D, et al. Neuroplasticity and aphasia treatments: new approaches for an old problem. J Neurol Neurosurg Psychiatry. Oct 2019;90(10):1147-1155. doi:10.1136/jnnp-2018-319649
  2. Kristinsson S, den Ouden DB, Rorden C, Newman-Norlund R, Neils-Strunjas J, Fridriksson J. Predictors of Therapy Response in Chronic Aphasia: Building a Foundation for Personalized Aphasia Therapy. J Stroke. May 2022;24(2):189-206. doi:10.5853/jos.2022.01102
  3. Shah-Basak P, Sivaratnam G, Teti S, et al. Electrophysiological connectivity markers of preserved language functions in post-stroke aphasia. NeuroImage Clinical. 2022;34:103036. doi:10.1016/j.nicl.2022.103036
  4. Martínez-Molina N, Siponkoski ST, Pitkäniemi A, et al. Neuroanatomical correlates of speech and singing production in chronic post-stroke aphasia. Brain Commun. 2022;4(1):fcac001. doi:10.1093/braincomms/fcac001
  5. Siponkoski ST, Pitkäniemi A, Laitinen S, et al. Efficacy of a multicomponent singing intervention on communication and psychosocial functioning in chronic aphasia: a randomized controlled crossover trial. Brain Commun. 2023;5(1):fcac337. doi:10.1093/braincomms/fcac337
  6. Haro-Martínez A, Pérez-Araujo CM, Sanchez-Caro JM, Fuentes B, Díez-Tejedor E. Melodic Intonation Therapy for Post-stroke Non-fluent Aphasia: Systematic Review and Meta-Analysis. Front Neurol. 2021;12:700115. doi:10.3389/fneur.2021.700115