Choir Singing for Aphasia

Recruiting at 4 trial locations

Overseen By Narges Bayat, Master

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: University of Ottawa

Disqualifiers: Neurological, Psychiatric, Substance abuse, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Approved in 3 Jurisdictions This treatment is already approved in other countries

Compensation: Varies

Number of Visits: 14

Duration: 12 weeks

50 Participants Needed

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial explores whether singing in a choir (Community Choir Singing) can aid people with language challenges after a stroke. It compares 12 weeks of choir sessions to regular stroke care to determine if singing improves communication skills and emotional well-being. Participants will sing weekly with a choir master and practice singing at home. This trial suits individuals who had a stroke over six months ago and experience long-term speech issues, provided they haven't recently engaged in music-making and can sing or hum. As an unphased trial, it offers a unique opportunity to explore innovative rehabilitation methods that could enhance recovery and quality of life.

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications. It is best to consult with the trial coordinators or your doctor for guidance.

What prior data suggests that choir singing is safe for people with chronic post-stroke aphasia?

Research has shown that choir singing therapy is generally safe and well-tolerated for individuals with conditions such as aphasia, stroke, and Parkinson's disease. Participants in these studies have not reported any major problems from the singing sessions. Group singing combines speech with music, providing a fun and engaging way to enhance communication skills.

In earlier research, individuals with aphasia who participated in choir sessions experienced positive outcomes without major safety issues. Thus, choir singing is considered a low-risk activity for those involved in these programs. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about choir singing as a treatment for aphasia because it offers a unique, non-pharmacological approach to therapy. Unlike traditional speech therapy, which often involves repetitive speech exercises, choir singing engages both the musical and linguistic parts of the brain, potentially enhancing communication skills in a more holistic way. This method also fosters social interaction and emotional well-being, elements that are sometimes lacking in standard treatments. By combining these benefits, choir singing could become a valuable addition to existing aphasia therapies.

What evidence suggests that choir singing is effective for aphasia?

Research has shown that singing in a community choir can benefit people with chronic aphasia, a condition affecting speech. A study by Siponkoski et al. found that group singing improved communication and speaking abilities in those with aphasia. Another study found that choir singing helped people speak more clearly and at a better pace. Participants in these singing programs have reported positive experiences without major safety concerns. In this trial, participants will be divided into two groups: the AB Group, which will first participate in choir singing followed by usual care, and the BA Group, which will first receive usual care followed by choir singing. These findings suggest that choir singing might aid language recovery and enhance social and emotional well-being for those with chronic post-stroke aphasia. ^{1 2 3 6 7}

Who Is on the Research Team?

Jennifer Bugos, PhD

Principal Investigator

University of South Florida

Anna Zumbansen, PhD

Principal Investigator

University of Ottawa

Arla Good, PhD

Principal Investigator

Toronto Metropolitan University

Frank Russo, PhD

Principal Investigator

Toronto Metropolitan University

Carole Anglade, PhD

Principal Investigator

Université de Montréal

Édith Durand, PhD

Principal Investigator

Université du Québec à Trois-Rivières

Are You a Good Fit for This Trial?

This trial is for individuals with chronic post-stroke aphasia, which is a language disorder that occurs after a stroke. Participants should be interested in joining choir sessions and committed to additional singing practice at home.

Inclusion Criteria

People with chronic aphasia following stroke

English or French as language of daily use

My last stroke was more than 6 months ago.

Exclusion Criteria

Regular music making in the past 6 months

Hearing deficit that cannot be corrected and might impair testing

Presence of neurological/psychiatric co-morbidity or substance abuse

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants engage in 12 weekly choir sessions and home singing training

12 weeks

12 in-person sessions, weekly home training

Follow-up

Participants are monitored for safety and effectiveness after treatment

2 months

Follow-up assessments at 2 months post-treatment

Crossover Extension

Participants in the usual care group receive the choir intervention

12 weeks

What Are the Treatments Tested in This Trial?

Interventions

• Community Choir Singing

Trial Overview The study tests if joining a choir and practicing singing at home can help improve communication skills, language abilities, and overall well-being compared to the usual care received after a stroke.

How Is the Trial Designed?

Group I: BA Group Experimental Treatment 2 Interventions

First usual care, then choir

Group II: AB Group Experimental Treatment 2 Interventions

First choir, then usual care

Community Choir Singing is already approved in Canada, United States for the following indications:

Approved in Canada as Community Choir Singing for:

• Rehabilitation of chronic post-stroke aphasia

Approved in United States as Community Choir Singing for:

• Rehabilitation of chronic post-stroke aphasia

Who Is Running the Clinical Trial?

University of Ottawa

Lead Sponsor

Trials

231

Recruited

267,000+

Toronto Metropolitan University

Collaborator

Trials

95

Recruited

19,300+

Université de Montréal

Collaborator

Trials

223

Recruited

104,000+

University of South Florida

Collaborator

Trials

433

Recruited

198,000+

Université du Québec à Trois-Rivières

Collaborator

Trials

48

Recruited

4,500+

Published Research Related to This Trial

Music therapy can significantly benefit nonfluent aphasia patients by improving their breathing, vocal abilities, and overall communication skills, as highlighted by various techniques focusing on rhythm, pitch, and memory.

The effectiveness of these music therapy techniques is influenced by the choice of music and the interactive delivery method, suggesting that different acoustic and social cues can enhance or hinder speech improvement in patients.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effective music therapy techniques in the treatment of nonfluent aphasia. Tomaino, CM.[2012]

In a study involving eight brain-damaged patients with speech disorders, singing did not improve the pronunciation of familiar lyrics compared to speaking, but notes were produced better than words.

However, when patients sang along with an auditory model while learning new songs, they recalled more words than when they spoke, suggesting that choral singing can be a beneficial method for improving speech intelligibility in therapy.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Making non-fluent aphasics speak: sing along! Racette, A., Bard, C., Peretz, I.[2006]

Choral singing therapy (CST) is perceived by individuals with stroke and Parkinson's disease as an enjoyable way to improve mood, communication, and overall quality of life, addressing their unmet needs.

Participation in CST helps individuals self-manage symptoms related to their conditions, such as social isolation and communication difficulties, suggesting it could be a valuable addition to rehabilitation programs.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Choral singing therapy following stroke or Parkinson's disease: an exploration of participants' experiences. Fogg-Rogers, L., Buetow, S., Talmage, A., et al.[2019]

A study involving 54 patients with chronic aphasia showed that a 4-month group-based singing intervention significantly improved communication and speech production compared to standard care, with benefits lasting up to 9 months.

The singing intervention also enhanced social participation for patients and reduced caregiver burden, indicating positive effects on both patients' and caregivers' psychosocial well-being.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Efficacy of a multicomponent singing intervention on communication and psychosocial functioning in chronic aphasia: a randomized controlled crossover trial. Siponkoski, ST., Pitkäniemi, A., Laitinen, S., et al.[2023]

A survey of 395 speech-language pathologists in France revealed that 98% recognize singing as a therapeutic tool for communication disorders, but many lack training in its application, particularly in structured melodic therapy.

While 62% of clinicians acknowledge the benefits of group singing for patients, they often do not implement it due to a lack of accessible choirs, highlighting a need for more community resources and research to support this therapeutic approach.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Singing for the Rehabilitation of Acquired Neurogenic Communication Disorders: Continuing the Evidence Dialogue with a Survey of Current Practices in Speech-Language Pathology. Behaghel, E., Zumbansen, A.[2022]

Neurologic music therapy (NMT) significantly improved language function, including the aphasia quotient, in post-stroke patients, particularly in those with subacute aphasia, after one month of treatment.

Speech language therapy (SLT) also showed benefits, but primarily in chronic stroke patients, with no significant improvements observed in subacute patients, highlighting the potential advantages of NMT in earlier recovery stages.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The therapeutic effect of neurologic music therapy and speech language therapy in post-stroke aphasic patients. Lim, KB., Kim, YK., Lee, HJ., et al.[2021]

The Speech-Music Therapy for Aphasia (SMTA) method showed promising results in improving speech production in a 5-year-old boy with childhood apraxia of speech (CAS) after 10 weeks of treatment, indicating its potential efficacy.

Improvements were noted in speech motor skills, particularly in producing consonant clusters and consistency, suggesting that SMTA may help with complex speech tasks, although measuring overall intelligibility in daily communication remains challenging.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Speech and Music Therapy in the Treatment of Childhood Apraxia of Speech: An Introduction and a Case Study. van Tellingen, M., Hurkmans, J., Terband, H., et al.[2023]

Music therapy was successfully used to treat a 79-year-old patient with chronic severe aphasia, demonstrating that patients with severe cognitive impairments can still benefit from rehabilitation techniques.

The patient showed significant improvements in communication skills, including the ability to sing spontaneously, memorize meaningful words, and identify body parts, indicating the potential efficacy of music therapy in speech rehabilitation.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Singing therapy can be effective for a patient with severe nonfluent aphasia. Yamaguchi, S., Akanuma, K., Hatayama, Y., et al.[2015]

In a study involving 20 stroke patients with chronic aphasia, those who received 30 sessions of active music therapy (MT) alongside speech language therapy (SLT) showed significant improvements in spontaneous speech compared to those who only received SLT.

Additionally, 50% of the patients in the experimental group reported enhanced vitality, suggesting that combining MT with SLT may provide greater overall benefits in rehabilitation for aphasia.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Improvement of spontaneous language in stroke patients with chronic aphasia treated with music therapy: a randomized controlled trial. Raglio, A., Oasi, O., Gianotti, M., et al.[2017]

The pilot randomized controlled trial (RCT) successfully recruited 42 participants with post-stroke aphasia, achieving an 83% retention rate, indicating that the SPA intervention is feasible for a larger study.

Participants found the singing groups acceptable and manageable, with high attendance and adherence to the intervention, suggesting that a definitive RCT could effectively assess the impact of the SPA intervention on well-being and social participation.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Singing for people with aphasia (SPA): results of a pilot feasibility randomised controlled trial of a group singing intervention investigating acceptability and feasibility. Tarrant, M., Carter, M., Dean, SG., et al.[2021]

Citations

1. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC9847537/

Efficacy of a multicomponent singing intervention on ... Siponkoski et al. report that group-based multicomponent singing training can enhance communication and spoken language production in chronic aphasia as well as ...

2. clinicaltrials.gov clinicaltrials.gov/study/NCT03501797

NCT03501797 | Choir Singing in Aphasia Rehabilitation This study evaluates the verbal, cognitive, emotional, and neural efficacy of a choir singing intervention in chronic aphasic patients and their caregivers.

3. withpower.com withpower.com/trial/phase-aphasia-3-2024-81bc0

Choir Singing for Aphasia Participants have reported positive experiences, and no significant safety concerns have been highlighted in the studies.

4. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC7812101/

Singing for people with aphasia (SPA): results of a pilot ... Some research has shown that group singing can improve the rate of speech and its intelligibility among people with aphasia, and wider research ...

5. clinicaltrials.gov clinicaltrials.gov/study/NCT06368323

Effect of Community Choir Singing in People With Chronic ... 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, ...

6. researchgate.net researchgate.net/publication/250919185_'Stroke_a_Chord'_The_effect_of_singing_in_a_community_choir_on_mood_and_social_engagement_for_people_living_with_aphasia_following_a_stroke

(PDF) 'Stroke a Chord': The effect of singing in a community ... To explore the effects of group singing for people with aphasia. A community choir was established and facilitated by a neurologic music therapist.

7. bmjopen.bmj.com bmjopen.bmj.com/content/11/1/e040544

Singing for people with aphasia (SPA): results of a pilot ... This is the first randomised controlled trial (RCT) of a singing intervention for people with post-stroke aphasia designed specifically to address psychosocial ...