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| Name | Class |
|---|---|
| Helsinki University Central Hospital | OTHER |
| Hospital District of Helsinki and Uusimaa | OTHER |
| Helsinki-Uusimaa Aphasia and Stroke Association | UNKNOWN |
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This study evaluates the verbal, cognitive, emotional, and neural efficacy of a choir singing intervention in chronic aphasic patients and their caregivers. Using a cross-over RCT design, half of the participants receive a 4-month singing intervention during the first half of the study and half of the participants during the second half of the study.
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 study 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, the capacity of singing and music learning in aphasia is explored.
METHODS: Subjects are 60 stroke patients with at least minor aphasia (≥ 6 months post-stroke) and their family members (FMs, N = 60) from Helsinki area recruited to a cross-over RCT study. Participants are randomized to two groups [N = 60 in both (30 patients, 30 FMs)], which receive a 16-week choir intervention either during the first (AB group) or second (BA group) half of the follow-up. The intervention is a combination of group training, which utilizes a novel combination of traditional senior choir singing and MIT-like speech training protocols, and home training in which the choir material is trained with a tablet computer. All patients are evaluated at baseline, 5-month, and 9-month stages with language, cognitive, and auditory-music tests and questionnaires. Half of the patients (N = 30) also undergo electroencephalography (EEG) and structural and functional magnetic resonance imaging (s/fMRI). FMs are evaluated with questionnaires.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Early singing intervention (AB) | Experimental | Participants receive a 16 weeks of singing-based rehabilitation and standard care (SC) followed by 16 weeks of SC only. |
|
| Late singing intervention (BA) | Experimental | Participants receive a 16 weeks of SC only followed by 16 weeks of singing intervention and SC. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Singing-based rehabilitation | Behavioral | The singing-based rehabilitation is a combination of group-training (16 weeks, 1 x week, 90 min), which utilizes a novel combination of traditional senior choir singing and singing-based speech training protocols, and home training (16 weeks, ≥ 3 x week, ≥ 30 min) in which the choir material is trained with a tablet computer. |
| Measure | Description | Time Frame |
|---|---|---|
| Communication ability | Total score of the Communication Action Log (CAL) questionnaire (range 0-180, higher score indicates better outcome) | Change from baseline at 5 months and 9 months |
| Spontaneous speech production | Spontaneous Speech subscale score of the Western Aphasia Battery (WAB) (range 0-20, higher score indicates better outcome) | Change from baseline at 5 months and 9 months |
| Connected speech informativeness | Percentage of correct information units (CIUs) produced in a picture description task | Change from baseline at 5 months and 9 months |
| Repetition of words and sentences | Repetition subscale score of the Western Aphasia Battery (WAB) (range 0-100, higher score indicates better outcome) | Change from baseline at 5 months and 9 months |
| Verbal agility | Verbal Agility subtest score of the Boston Diagnostic Aphasia Examinaton (BDAE) (range 0-14, higher score indicates better outcome) | Change from baseline at 5 months and 9 months |
| Naming and word finding | Naming and Word Finding subscale score of the Western Aphasia Battery (WAB) (range 0-100, higher score indicates better outcome) | Change from baseline at 5 months and 9 months |
| Verbal comprehension | Sequential Commands subtest score of the Western Aphasia Battery (WAB) (range 0-80, higher score indicates better outcome) |
| Measure | Description | Time Frame |
|---|---|---|
| Executive function (correct responses) | Simon Task: score (range 0-100, higher score indicates better outcome) | Change from baseline at 5 months and 9 months |
| Executive function (reaction times) |
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The following inclusion criteria are used in patient recruiment:
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| Name | Affiliation | Role |
|---|---|---|
| Teppo Särkämö, PhD | University of Helsinki | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Helsinki University Central Hospital, Department of Neurology, Rehabilitation Unit | Helsinki | Finland | ||||
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 40738917 | Derived | Martinez-Molina N, Pitkaniemi A, Siponkoski ST, Moisseinen N, Kuusela L, Laitinen S, Sarkamo ER, Pekkola J, Melkas S, Schlaug G, Kleber B, Sihvonen AJ, Sarkamo T. Functional neuroplasticity in chronic post-stroke aphasia following a singing intervention in a cross-over randomised trial. Sci Rep. 2025 Jul 29;15(1):27639. doi: 10.1038/s41598-025-11288-0. | |
| 36687394 |
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| ID | Term |
|---|---|
| D020521 | Stroke |
| D001037 | Aphasia |
| ID | Term |
|---|---|
| D002561 | Cerebrovascular Disorders |
| D001927 | Brain Diseases |
| D002493 | Central Nervous System Diseases |
| D009422 | Nervous System Diseases |
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| ID | Term |
|---|---|
| D059039 | Standard of Care |
| ID | Term |
|---|---|
| D019984 | Quality Indicators, Health Care |
| D011787 | Quality of Health Care |
| D006298 | Health Services Administration |
| D017530 | Health Care Quality, Access, and Evaluation |
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| Finnish Brain Association |
| UNKNOWN |
| Outloud Ltd | UNKNOWN |
| University of Barcelona | OTHER |
| University of Melbourne | OTHER |
| Harvard Medical School (HMS and HSDM) | OTHER |
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|
| Standard care | Other | Standard care comprises all rehabilitation and care services (e.g. speech therapy, physical and occupational therapy, neuropsychological rehabilitation) received by the patients in the Finnish health care system |
|
| Change from baseline at 5 months and 9 months |
Simon Task: reaction time mean (ms)
| Change from baseline at 5 months and 9 months |
| Attention (correct responses) | Flexible Attention Test (FAT): score (range 0-48, higher score indicates better outcome) | Change from baseline at 5 months and 9 months |
| Attention (reaction times) | Flexible Attention Test (FAT): reaction time mean (ms) | Change from baseline at 5 months and 9 months |
| Working memory | Word Span subtest score of the Kielelliset Arviointitehtävät (KAT) (range 0-30, higher score indicates better outcome) | Change from baseline at 5 months and 9 months |
| Verbal memory | Logical Memory subtest score of the Wechsler Memory Scale III (WMS-III) (range 0-80, higher score indicates better outcome) | Change from baseline at 5 months and 9 months |
| Verbal learning | Word Lists subtest score of the Wechsler Memory Scale III (WMS-III) (range 0-84, higher score indicates better outcome) | Change from baseline at 5 months and 9 months |
| Singing ability | Acoustic features (e.g., pitch, rhythm, intensity) analyzed from recorded production of familiar and novel songs using acoustic analysis software | Change from baseline at 5 months and 9 months |
| Music perception | Montreal Battery of Evaluation of Amusia (MBEA) score (range 0-30, higher score indicates better outcome) | Change from baseline at 5 months and 9 months |
| Functional stroke recovery | Total score of the Stroke Impact Scale (SIS) questionnaire (range 0-900, higher score indicates better outcome) | Change from baseline at 5 months and 9 months |
| Depression | Total score of the Center for Epidemiological Studies Depression Scale (CES-D) questionnaire (range 0-60, lower score indicates better outcome) | Change from baseline at 5 months and 9 months |
| Mood | Total score of the Visual Analog Mood Scales (VAMS) questionnaire (range 0-800, higher score indicates better outcome) | Change from baseline at 5 months and 9 months |
| Social interaction | Total score of the Social Provision Scale (SPS) questionnaire (range 24-96, higher score indicates better outcome) | Change from baseline at 5 months and 9 months |
| Caregiver burden | Total score of the Zarit Burden Interview (ZBI-22) questionnaire (range 0-88, lower score indicates better outcome) | Change from baseline at 5 months and 9 months |
| Psychological stress of the caregiver | Total score of the General Health Questionnaire (GHQ-12) (range 0-36, lower score indicates better outcome) | Change from baseline at 5 months and 9 months |
| Electroencephalography (EEG) | Amplitude and latency of event-related potentials (ERPs) associated with learning and memory in two auditory tasks | Change from baseline at 5 months and 9 months |
| Structural magnetic resonance imaging (sMRI): MPRAGE sequence | Grey matter volume in frontotemporal, frontoparietal, and limbic brain regions | Change from baseline at 5 months and 9 months |
| Structural magnetic resonance imaging (sMRI): DTI sequence | Structural connectivity of intra- and interhemispheric white matter tracts | Change from baseline at 5 months and 9 months |
| Functional magnetic resonance imaging (fMRI): resting-state | resting-state fMRI sequence: functional connectivity of frontotemporal, frontoparietal, and limbic brain networks | Change from baseline at 5 months and 9 months |
| Functional magnetic resonance imaging (fMRI): singing-related activity | task-based fMRI sequence: frontotemporal, frontoparietal, and limbic activation patterns associated with the perception, vocal repetition, and recall of novel songs | Change from baseline at 5 months and 9 months |
| Helsinki-Uusimaa Aphasia and Stroke Association |
| Helsinki |
| Finland |
| Siponkoski ST, Pitkaniemi A, Laitinen S, Sarkamo ER, Pentikainen E, Eloranta H, Tuomiranta L, Melkas S, Schlaug G, Sihvonen AJ, Sarkamo T. Efficacy of a multicomponent singing intervention on communication and psychosocial functioning in chronic aphasia: a randomized controlled crossover trial. Brain Commun. 2022 Dec 27;5(1):fcac337. doi: 10.1093/braincomms/fcac337. eCollection 2023. |
| D014652 | Vascular Diseases |
| D002318 | Cardiovascular Diseases |
| D013064 | Speech Disorders |
| D007806 | Language Disorders |
| D003147 | Communication Disorders |
| D019954 | Neurobehavioral Manifestations |
| D009461 | Neurologic Manifestations |
| D012816 | Signs and Symptoms |
| D013568 | Pathological Conditions, Signs and Symptoms |