Efficacy of choir singing on verbal, cognitive, emotional, and neural recovery from aphasia

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 present project 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, we explore the capacity of singing and music learning in aphasia.Study design: 60 stroke patients with at least minor aphasia (≥ 3 months post-stroke) and their family members (FMs, estimated N = 40) from Helsinki area are recruited to a cross-over RCT study. Participants are randomized to two groups [N = 50 in both (30 patients, 20 FMs)], which receive a 16-week choir intervention either during the first (AB group) or second (BA group) half of the follow-up. Outcome measures are performed three times: at baseline, 5-month, and 10-month stages.Intervention: The intervention is a combination of group-training (16 weeks, 1 x week, 90 min), which utilizes a novel combination of traditional senior choir singing and MIT-like speech training protocols, and home training (16 weeks, ≥ 3 x week, ≥ 30 min) in which the choir material is trained with a tablet computer. The choir will also train singing an entirely novel song, which will be used as an experimental stimulus.Outcome measures: All patients are evaluated at baseline, 5-month, and 10-month stages with language tests (spontaneous speech, repetition, naming and word finding, comprehension), cognitive tests (attention, executive function, working and episodic memory), and auditory and music tests (music perception, singing), questionnaires (communication, quality of life, social participation, mood and depression). Half of the patients (N = 30) also undergo electroencephalography (EEG; tasks: rapid automatic word learning & memory for trained vs. untrained songs), structural magnetic resonance imaging (sMRI: MPRAGE, 3D-FLAIR, DTI), and functional MRI (fMRI: resting state & task: passive listening of trained vs. untrained songs). FMs are evaluated with questionnaires (stress, caregiver burden, informant-responses to patient questionnaires).