Effect of Community Choir Singing in People with Chronic Post-Stroke Aphasia: A Protocol for a Multicenter Single-blind Randomised Pragmatic Trial

RESEARCH TEAM

Anna Zumbansen, PhD • Narges Bayat, MA | University of Ottawa

Arla Good, PhDAlex Pachete, MAFrank A. Russo, PhD | Toronto Metropolitan University 

Carole Anglade, PhDÉlodie Joyal | Université de Montréal

Edith Durand, PhD | Université du Québec à Trois-Rivières

Jennifer Bugos, PhDIsabella Wuest | University of South Florida

BACKGROUND

After a stroke, 64% of people experience language (aphasia) and/or speech (dysarthria, apraxia of speech) disorders (Mitchell et al., 2021). In many cases, these difficulties persist beyond the rehabilitation period usually offered (Zumbansen & Thiel, 2014), with devastating consequences on communication, social participation and quality of life. 

Because singing is often preserved in aphasia (e.g., Racette et al., 2006), it has been studied for its therapeutic effects in rehabilitation, such as in the melodic intonation therapy (MIT, Albert et al., 1973) and in the context of choir singing (Zumbansen et al., 2017). Singing-based therapies have also the potential to help in the rehabilitation process of speech disorders such as dysarthria and apraxia of speech, which are often associated with aphasia (Zumbansen & Tremblay, 2019). There is growing evidence of the benefits of choir singing in the progressive form of dysarthria associated with Parkinson’s disease (Monroe et al., 2020). However, there is a general lack of high-quality studies on group treatment for non-progressive dysarthria (Whillans et al., 2022).

The goal of this randomized controled trial is to test the effects of assigning people with chronic post-stroke aphasia to 12 weekly choir sessions, compared to usual care. The main question it aims to answer is: Does the assignment to a choir singing program causes a beneficial effect on functional communication and language recovery as well as psychosocial outcomes compared to usual care in the rehabilitation of people with chronic post-stroke aphasia?

METHODS

Participants will have 12 in-person choir-singing sessions (1 session/week, 1,5 h/session, total 18h) conducted by a choir master, and home singing training (3 x 30-minutes-sessions/week, total 18h).

A parallel group randomized trial design with a secondary crossover extension was chosen for this study to offer the intervention to all participants. Participants will be randomized in a 1:1 ratio to two study arms (AB/BA, A = 12 weekly choir sessions and home singing training, B = usual care) stratified for aphasia severity (according to the Quick Aphasia Battery overall score), age, time since last stroke and their interest in music (according to the Barcelona Music Reward Questionnaire). Measures at the “macro” level will be collected at Baseline, Completion and 2-months Follow-up time points for each group. At the “micro” level (i.e., at choir sessions 2, 6, 10 and 12) data will be collected during as well as pre and post choir-singing.

To monitor the usual care, each participant (and/or caregiver) will complete a form and/or have a weekly 5-15-minute phone/Zoom call with a research assistant to collect the usual care data including type and time spent in social activities and rehabilitation services, as well as adverse events.

RESULTS

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KNOWLEDGE DISSEMINATION

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