Effect of Community Choir Singing in People With Chronic Post-stroke Aphasia

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?

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)

Study Overview

• Status: Recruiting
• Conditions: Aphasia
• Intervention / Treatment: Behavioral: Choir singing; Other: Usual care

Detailed Description

Description of study population Additional information: Participants with chronic aphasia due to stroke will be recruited from four participating centers in Canada and the United States.

Study design Additional information: 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.

Intervention Additional information: The repertoire in the comunity choir activity will consist of popular songs in English or French. Half of the songs will be pre-determined and half will be chosen by the choir members from a list, based on a vote during the first week of the intervention. Eligible songs will remain within the range of an octave and include a variety of tempi (but fast tempi will be slowed down if needed to facilitate word production). Depending on the group's abilities, the Choir Director will decide in which keys the songs will be performed, and whether they will be sung in unison or with simple harmonies. Songs in canon will be included in the predetermined repertoire to easily create harmonies. Each session will include (in this order): 15 minutes for vocal warm-up; 25 minutes of work on the song repertoire; 20 minutes for a social break with refreshments.

For the home training, participants will be instructed to sing at home with a video guide on an online platform. Each home training session will include (in this order): 10 minutes for vocal warm-up; and 20 minutes sing-along using songs of the repertoire. Song lyrics will be displayed on the video.

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.

Randomization and concealment For randomization, an online system will be used by a researcher not involved in data collection.

Each participant will be assigned an identification number upon inclusion in the study. After completion of the baseline assessments, the independent researcher will receive the list of participants' IDs with their stratification data (age, time post-stoke, aphasia severity, level of interest in music) to perform the randomization.

Blinding:

Outcomes will be measured by blinded assessors where possible, based on video or audio recordings.

Planned analyses:

Primary hypothesis:

Participants assigned to the choir intervention over 12 weeks will demonstrate a significantly larger improvement in macro-level measures compared to those receiving usual care.

Secondary hypothesis:

Participants who completed the choir intervention with 80% adherence over 12 weeks will demonstrate a larger improvement in macro-level measures compared to those receiving usual care.

The gains will be maintained for the participants with 80% adherence.

There will be immediate changes in micro-level measures after a choir session (Session 6).

There will be differences in pre-post-session variations of micro-level measures between Session 2, 6 and 10.

There will be differences in pre-post-session variations between the usual rehearsal (Session 10) and the Concert (Session 12).

• Study Type: Interventional
• Enrollment (Estimated): 50
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Anna Zumbansen, PhD; Phone Number: 8393 613-562-5800; Email: azumbans@uottawa.ca
• Study Contact Backup: Name: Narges Bayat, Master; Phone Number: 8393 613-562-5800; Email: nbaya063@uottawa.ca

Study Locations

• Canada
  • Ontario
    • Ottawa, Ontario, Canada, K1N 6N5
      • Completed
      • University of Ottawa
    • Toronto, Ontario, Canada, M5B 0C3
      • Recruiting
      • Toronto Metropolitan University
      • Contact: Arla Good, Ph.D.; Email: arla.good@torontomu.ca
  • Quebec
    • Montreal, Quebec, Canada, H3C 3J7
      • Completed
      • Université de Montréal
• United States
  • Florida
    • Tampa, Florida, United States, 33620
      • Not yet recruiting
      • University of South Florida
      • Contact: Jennifer Bugos, Ph.D.; Email: bugosj@usf.edu

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• People with chronic aphasia following stroke
• English or French as language of daily use
• Last stroke must have occurred at least 6 months before the start of the first assessments in the study protocol.

Exclusion Criteria:

• Regular music making in the past 6 months
• Visual deficit that cannot be corrected and might impair testing
• Hearing deficit that cannot be corrected and might impair testing
• Presence of neurological/psychiatric co-morbidity or substance abuse
• No ability to produce vocal sound through singing/humming
• Legally considered unable to make decisions for oneself

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: AB Group; First choir, then usual care	Behavioral: Choir singing; The 12-week intervention will consist of 12 in-person choir-singing sessions (1 session/week, 1,5 h/session, total 18h) conducted by a choir master in addition to home training (3 x 30-minutes-sessions/week, total 18h). In total, participants will undergo the intervention for 3 hours/week for 12 weeks (i.e., 36 hours).; Other: Usual care; Rehabilitation services received by patients and social activities will be monitored and documented.
Experimental: BA Group; First usual care, then choir	Behavioral: Choir singing; The 12-week intervention will consist of 12 in-person choir-singing sessions (1 session/week, 1,5 h/session, total 18h) conducted by a choir master in addition to home training (3 x 30-minutes-sessions/week, total 18h). In total, participants will undergo the intervention for 3 hours/week for 12 weeks (i.e., 36 hours).; Other: Usual care; Rehabilitation services received by patients and social activities will be monitored and documented.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Communication Index	The ability to communicate one's feelings and basic needs effectively / is computed by averaging the percentage scores (score/total×100) of the Communicative Activity Log (CAL) and the communication subscale of the Stroke Impact Scale 3.0 (SIS). Minimum value=0; Maximum value=100; Higher scores mean a better outcome.	T1 (baseline, week 1), T2 (week 15), T3 (week 16), T4 (week 30), T5 (week 31)

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Level of confidence in communication	Individual's subjective perception of their ability to effectively communicate in various situations / assessed with the Communication Confidence Rating Scale for Aphasia (CCRSA), a self-reported assessment in 10 questions. Minimum value=4; Maximum value=40; Higher scores mean a better outcome.	T1 (baseline, week 1), T2 (week 15), T3 (week 16), T4 (week 30), T5 (week 31)
Aphasia severity index	The aphasia severity index quantifies the extent of language impairment experienced by individuals with aphasia / assessed using the Quick Aphasia Battery (QAB). Minimum value=0; Maximum value=10; Higher scores mean a better outcome.	T1 (baseline, week 1), T2 (week 15), T3 (week 16), T4 (week 30), T5 (week 31)
Speech and language in functional communication	The ability of an individual to effectively use verbal communication skills / assessed with a part of the AphasiaBank protocol to elicit connected speech in participants Minimum value=0; Maximum value=100; Higher scores mean a better outcome.	T1 (baseline, week 1), T2 (week 15), T3 (week 16), T4 (week 30), T5 (week 31)
Apraxia of speech severity	The degree or level of impairment in the motor planning and execution of speech movements / assessed with the Apraxia of Speech Rating Scale (ASRS-3.5) experienced by individuals with apraxia Minimum value=0; Maximum value=52; Higher scores mean a worse outcome.	T1 (baseline, week 1), T2 (week 15), T3 (week 16), T4 (week 30), T5 (week 31)
Emotional wellbeing	The state of an individual's mental and emotional health, encompassing their overall mood, psychological resilience, and ability to cope with stressors and life challenges / assessed using the General Health Questionnaire (GHQ-12) Minimum value=0; Maximum value=36; Higher scores mean a worse outcome.	T1 (baseline, week 1), T2 (week 15), T3 (week 16), T4 (week 30), T5 (week 31)
Social participation	Active engagement of individuals within their community or society, involving various social activities, interactions, and roles. / assessed using the corresponding SIS participation subscale. Minimum value=8; Maximum value=40; Higher scores mean a better outcome.	T1 (baseline, week 1), T2 (week 15), T3 (week 16), T4 (week 30), T5 (week 31)
Generic measure of health	Short-Form 6-Dimension version 2 (SF-6Dv2) is a survey on 6 health domains: Physical functioning, Role functioning, Pain, Vitality, Social functioning, Mental health. Minimum value= 0; Maximum value= 100;Higher scores mean a better outcome.	T1 (baseline, week 1), T2 (week 15), T3 (week 16), T4 (week 30), T5 (week 31)
Appetence to music	An individual's inclination or attraction towards music / Barcelona Music Reward Questionnaire (BMRQ) Minimum value= 20; Maximum value= 100 ; Higher scores mean a better outcome.	T1 (baseline, week 1), T2 (week 15), T3 (week 16), T4 (week 30), T5 (week 31)
Health related quality of life assessed by the the Stroke and Aphasia Quality of Life Scale-39 (SAQOL-39)	Individual's subjective perception of their physical, emotional, mental, and social well-being in relation to their health status and the impact of illness or treatment on their overall quality of life / assessed with the Stroke and Aphasia Quality of Life Scale-39 (SAQOL-39) Minimum value=39; Maximum value=195; Higher scores mean a better outcome.	T1 (baseline, week 1), T2 (week 15), T3 (week 16), T4 (week 30), T5 (week 31)
Singing voice abilities	Overall singing voice quality, tuning and rhythmic accuracy / assessed following a standardized protocol	T1 (baseline, week 1), T2 (week 15), T3 (week 16), T4 (week 30), T5 (week 31)

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Voice - Pitch	Pitch mean, standard deviation, and range in spontaneous speech based on a quick standardized voice production protocol	Before and afrer choir sessions 2, 6, 10 and 12
Voice - Maximum Phonation Time	Maximum Phonation Time based on a quick standardized voice production protocol	Before and afrer choir sessions 2, 6, 10 and 12
Voice - Dynamic range	Dynamic range based on a quick standardized voice production protocol	Before and afrer choir sessions 2, 6, 10 and 12
Biosocial indexes	Cortisol and oxytocin measures / measured in salivary samples	Before and afrer choir sessions 2, 6, 10 and 12
Mood	Temporary state of mind or temper / assessed with the Observed Emotion Rating Scale (OERS), an observational tool for rating two positive emotions (pleasure and general alertness) and three negative emotions (anger, anxiety or fear, and sadness) over a defined 10-minute period. A longer display of emotion is indicated by higher scores.	The first and last 10 minutes of sessions 2, 6, 10 and 12 as well as the last 10 minutes of the break.
Expectations on a 100-scale	Measures expectations based on a feedback questionnaire. Minimum value=0; Maximum value=100; Higher scores mean a better outcome.	T1 (baseline, week 1),T5 (week 31)
Satisfaction on a 100-scale	Measures satisfaction based on a feedback questionnaire. Minimum value=0; Maximum value=100; Higher scores mean a better outcome.	T1 (baseline, week 1),T5 (week 31)

Collaborators and Investigators

• Sponsor: University of Ottawa
• Collaborators: University of South Florida; Université du Québec à Trois-Rivières; Université de Montréal; Toronto Metropolitan University
• Investigators: Principal Investigator: Frank Russo, PhD, Toronto Metropolitan University; Principal Investigator: Anna Zumbansen, PhD, University of Ottawa; Principal Investigator: Arla Good, PhD, Toronto Metropolitan University; Principal Investigator: Carole Anglade, PhD, Université de Montréal; Principal Investigator: Édith Durand, PhD, Université du Québec à Trois-Rivières; Principal Investigator: Jennifer Bugos, PhD, University of South Florida

Publications and helpful links

General Publications

• 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.
• Anna Zumbansen, Isabelle Peretz, Carole Anglade, Josée Bilodeau, Suzanne Généreux, Michelyne Hubert & Sylvie Hébert (2017) Effect of choir activity in the rehabilitation of aphasia: a blind, randomised, controlled pilot study, Aphasiology, 31:8, 879-900, DOI: 10.1080/02687038.2016.1227424

Helpful Links

• The SingWell Project

Study record dates

Study Major Dates

• Study Start (Actual): April 22, 2024
• Primary Completion (Estimated): September 30, 2027
• Study Completion (Estimated): September 30, 2027

Study Registration Dates

• First Submitted: April 1, 2024
• First Submitted That Met QC Criteria: April 10, 2024
• First Posted (Actual): April 16, 2024

Study Record Updates

• Last Update Posted (Actual): February 17, 2026
• Last Update Submitted That Met QC Criteria: February 12, 2026
• Last Verified: February 1, 2026

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Neurologic Manifestations; Nervous System Diseases; Neurobehavioral Manifestations; Communication Disorders; Language Disorders; Speech Disorders; Pathological Conditions, Signs and Symptoms; Signs and Symptoms; Aphasia
• Other Study ID Numbers: H-01-24-9931

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No