Purdue researcher explores power of music, audiobooks for attention and language in aphasia

Arianna LaCroix

Written by: Tim Brouk, tbrouk@purdue.edu

More than 2 million people in the United States are living with aphasia, a language disorder that affects the ability to communicate, including speaking, understanding, reading and writing, according to the National Aphasia Association. Some people with aphasia also experience difficulties with cognitive abilities such as attention. The diagnosis usually comes after a stroke or head injury.

To improve the attention deficits in aphasia patients —  which can impact language comprehension, conversational skills and overall rehabilitation outcomes — Arianna LaCroix, assistant professor in the Purdue University Department of Speech, Language, and Hearing Sciences; her lab; and Daniel Evans, assistant professor and director of music therapy in the School of Music at Purdue University Fort Wayne, are conducting a preliminary study examining the effects of music and audiobook listening on attention and language in people with aphasia. Participants were given carefully curated, customized music or audiobook playlists to listen to over eight weeks.

“There’s an active component to music listening,” LaCroix said. “Music can bring up specific memories, make us want to move and engage multiple parts of the brain at the same time. We think that broad engagement may also support attention. A lot of the work in my lab right now is asking whether we can harness music’s ability to activate so many different parts of the brain to help circumvent areas damaged by the stroke and support attention and language through other, relatively intact brain networks.”

Most of the participants were diagnosed with “mild to moderate” aphasia. All could communicate verbally but often had difficulty finding words or gave a small amount of vocal output. The 17 men and women from across the United States had weekly virtual check-ins with Evans and members of LaCroix’s lab. Participants journaled daily to the best of their abilities.

Over the weeks, researchers observed preliminary patterns of change in some measures of attention, although responses varied across participants and intervention groups. Participants also reported positive experiences with the intervention. Because the study is still ongoing, LaCroix cautioned more data are needed to determine whether the interventions reliably improve attention and language, but the preliminary results are encouraging and suggest listening to personally meaningful music or audiobooks may have potential to support aphasia rehabilitation.

This work is funded by the American Heart Association.

Study details

LaCroix separated the participants in three groups: a music playlist group (six), an audiobook playlist group (five) and a control group (six) who were given no playlists but were monitored throughout.

Some patients were assisted by caregivers during the study and the digital journal part consisted mainly of multiple-choice questions for ease of use by the participants with aphasia. An example: “How did (the music) make you feel, and did it bring up any memories?”

The participants ranged in age from 30-70 with most falling in the 40-60 age range.

‘Testing, testing …’

All participants’ visual and auditory attention were tested three times during the study. An example of a visual test involved a series of arrows pointing in one direction, with one arrow pointing in the opposite direction. The time it took the participant to identify the different arrow’s direction was recorded. An auditory test consisted of two tones, and participants had to choose whether the first tone was the same as or different in duration from the second tone. Sometimes the tones were the same duration, and sometimes they were different. Researchers then compared response times between same and different trials.

 “We tell them, ‘It’s important to be fast, but also accurate,’” LaCroix said.

The tests allowed researchers to examine different aspects of attention, including alerting, or maintaining readiness to respond; orienting, or directing attention to relevant information; and executive control, or managing competing information to make an appropriate response.

Preliminary results showed different patterns of change across the groups and measures. Some of the patterns researchers observed included:

• For visual attention, the music group showed patterns of better orienting and executive control over time. The music group also responded more similarly with and without a warning cue, which could potentially reflect more stable alertness that is less dependent on external cueing. The audiobook group showed some improvement in executive control, while the control group showed relatively little change.
• For auditory attention, LaCroix saw a general pattern of better orienting over time in the music and audiobook groups, while the control group showed relatively little change.

“Being able to detect changes in sound and shift attention to relevant auditory information is important for understanding language, so this finding is encouraging” LaCroix said.

Careful curation

Daniel Evans

The music and audiobook groups received two playlists each — one “energizing” and one “relaxing.” Energizing songs were not only chosen for their beats per minute (90 or higher) but also the personal, emotional connections to the tunes. The participants chose between the playlists depending on their mood that day.

Evans interviewed the six music playlist participants and their caregivers thoroughly to gauge their musical tastes as well as background information such as where they grew up.

“Through my conversations with them, I’m trying to find music that will also achieve the aims of the study. One of the activities that we’re doing involves memories and associations. So, you’re trying to get them to think on things through the music,” Evans said. “We can make those direct connections from the music to memories of their own past.”

Each participant received a selection of 300 songs — 150 on each list — to listen to for 30 minutes a day throughout the study. The songs were teed up on Spotify. They would click or tap shuffle so the order would not get monotonous. Most of the participants in his group skewed older, so the lists had multiple Elvis Presley tracks and other tunes released in the 1950s, ’60s and ’70s.

“But that’s not anything to do with Elvis. It’s because that’s a time period meaningful for them. So, it’s more effective,” Evans said.

Addison Vogt, a graduate student in LaCroix’s Aphasia Brain Injury Communication and Cognition Lab, conducted similar interviews with the audiobook group. She selected four titles for her participants, again in “energizing” and “relaxing” lists. An “energizing” book example would be a thriller while a “relaxing” title would be an autobiography by someone the participant admires. Like the music group, these participants listened to their books for 30 minutes a day.

“We teach them these skills of how to think about the narrator’s voice and how that makes them feel — connecting to the story that they’re listening to,” LaCroix said.

Next steps

LaCroix plans to check back in with participants months after the eight-week interventions to see if changes have maintained. She will also increase the number of total participants to 45 for more conclusive findings in this ongoing study, but she is encouraged by the study’s start as well as the healing power of music and audio stimulation that activates multiple parts of the brain.

“The beauty of music is that it’s essentially free intervention for people,” LaCroix said. “Our participants are saying that they’re really enjoying it and they’re looking forward to it. They’re having really interesting and positive interactions with the person they meet with regularly to make sure things are going well. So, we’re getting positive feedback in terms of the music condition and the audiobook.”