Dr Miranda Rose Senior Research Fellow, Faculty of Health Sciences of La Trobe University discusses her research on developing effective treatments for aphasia.
For people suffering a stroke, the loss of the ability to perform normally in a range of areas can have a significant impact on their ability to live meaningful and independent lives. While impairments in motor function can significantly limit mobility or the ability to independently dress, cook, clean or take part in normal leisure activities, an impaired ability to understand or communicate language (often referred to as aphasia) can be even more devastating for the person and their families or carers (Liechty & Braun, 2006).
Recent research has shown that people living with severe aphasia experience a significantly worse quality of life compared to the remainder of the population (Hilari & Byng, 2009). Effective communication is often the basis for establishing and maintaining friendships or relationships, or participating socially in many leisure activities. People experiencing aphasia often say that their communication difficulties are the main thing that take away from their quality of life (Cruice, Worrall, & Flickson, 2006), and can directly impact on the quality and nature of friendships (Davidson, Howe, Worrall, Hickson, & Togher, 2008). For some, these difficulties can lead to an experience of isolation where they increasingly withdraw to avoid the challenge of communication. The loss of participation in meaningful activities or friendships is also accompanied by significant distress and even depression. Post-stroke depression is experienced by between 14-46% of stroke survivors (Roger & Johnson-Greene, 2009), and can further rob the person of the motivation to go out and seek to engage with people, or enjoy the things they usually enjoy.
The change to the nature of the friendship or relationship as a result of aphasia, and often the distress experienced by the person experiencing aphasia, can also have a significant negative effect on partners or friends, who often take on the role of carer, instead of simply being the partner or friend they have always been (Franzén-Dahlin, et al., 2008). Providing opportunities for both the families as well as the stroke survivors to receive support are therefore critical to enhancing each of their well-being.
One area that has received some attention as having the potential to significantly improve the quality of life for people living with aphasia, is participation in music therapy or social musical activities. Early research exploring the impact of participation of stroke survivors in music activities observed that music enhances general mobility, social interaction and can improve emotional stability (Cross, 1984). A randomised control study with stroke survivors found that music therapy decreased depression and anxiety (Purdie, Hamilton, & Baldwin, 1997) and more recent studies have indicated a positive effect for music therapy on mood for people following stroke (Magee & Davidson, 2002; Nayak, Wheeler, Shiflett, & Agostinelli, 2000). Participation in musical activities such as singing in choirs provides an opportunity to meet with and work with like-minded people to jointly work on and produce a meaningful performance (Bailey & Davidson, 2005). The act of singing or listening to music also has both direct benefits on mood through providing a pleasurable experience for participants, but also indirect benefits through lowering levels of stress hormones in the body that indirectly lead to improvements in mood but also other areas such as the immune system (Kreutz, Bongard, Rohrmann, Hodapp, & Grebe, 2004).
Research has also shown that even in people suffering severe aphasia, there can be a preserved ability to sing or enjoy music, thought to be associated with language and musical ability to some extent being processed by different parts of the brain (Peretz, 2001). Supporting this idea, some people suffering a left sided stroke experience aphasia, whereas the can still sing or produce familiar songs, a pattern that in some cases is reversed in people with a stroke affecting the right side of the brain Functional imaging of patterns of brain activity when listening to speech or melody in health people have also shown that different brain regions play the major role in the different abilities (Ohnishi, et al., 2001). Clearly, this highlights that despite often severe language difficulties, enjoyment of music is still very possible for even severely aphasic people (Sarkamo, et al., 2008).
Even more encouraging, therapeutic techniques that use melodic or rhythm exercises to re-train production of specific speech phrases, can improve aspects of the language ability in people suffering aphasia (Belin, et al., 1996; Schlaug, Marchina, & Norton, 2008). Recovery of the brain following stroke can be enhanced through participation in enriching environments or activities, that can lead to the brain involving more heavily areas in the right side of the brain or areas in the left that are not damaged by the stroke to improve aspects of language (Crinion & Leff, 2007). Activities encouraging stroke survivors to sing or tap out rhythms activate in particular areas in the left side of the brain that may have been ‘taken off-line’ by the stroke, but can be reconnected through training to help to recover some aspects of speech in some people (Kim & Tomaino, 2008; Sarkamo, et al., 2008).
With speech intelligibility benefits also found in people singing in choirs (Racette, Bard, & Peretz, 2006), coupled with the broader social and emotional benefits associated with participation in such group music activities described earlier, establishing a similar group to assist in improving the quality of life of people living with aphasia in Melbourne will have significant benefits for a very vulnerable group. There have been no similar groups conducted to date in Australia, and with very few similar groups conducted internationally, this is an opportunity to establish and evaluate the impact of an innovative, recovery focused intervention for stroke survivors living with aphasia.