Hungarian Aphasia Choir Coping Online During the COVID-19 Pandemic

Introduction

In the case of aphasia, singing has complex rehabilitative value. The ability to sing is a retained resource in people with nonfluent aphasia (Schlaug et al., 2010; Tomaino, 2012; Zumbansen et al., 2017) but the ability to make music together, either by singing or playing instruments, usually remains intact in people suffering from any of the aphasia types (Yamaguchi et al., 2012). The therapeutic use of music gives a unique opportunity to work towards new means of communication. According to neurological findings, singing and speaking have an overlapping neural circuitry; moreover, singing itself involves greater neural circuitry than speaking (Leonardi et al., 2018). This can be one reason why “singing in synchrony (i.e., choral singing) helps improve the number of correct words produced by non-fluent aphasics” (Zumbansen et al., 2017, p. 2).

Singing in an aphasia choir is an active form of music therapy, which is based on a singing community. Singing together can have complex beneficial goals, equally supporting speech production (Schlaug, 2015; Sparks et al., 1974), social belonging (Ansdell, 2002; Tamplin et al., 2013; Tarrant et al., 2021) and improving the quality of life.

The number of studies examining the possible beneficial effects of aphasia choir participation on the quality of life and on communication outcomes is growing. Fogg and Talmage (2011), Tamplin et al. (2013) and Tarrant et al. (2021) all reported unfolding social connections through new friendships between choir participants and an increased sense of belonging after regular choir sessions consisting more than 50% of song singing (Monroe et al., 2020; Tarrant et al., 2016). Moreover, increasing confidence and improvement in the participants’ mood during and in-between choir sessions as well as an increased sense of purpose, and that they liked “the fact that as an individual you are not categorized” (Fogg & Talmage, 2011, p. 267) were themes that also emerged from interviews with choir participants who live with aphasia, and their caregivers (Fogg & Talmage, 2011; Tamplin et al., 2013). Tarrant et al. (2016) adds that an increasing sense of belonging can result in social identity renegotiation, which is a social quality that has a beneficial effect on several health outcomes. Mantie-Kozlowski et al. (2018) suggests that in aphasia choirs “a context where participant enjoyment is viewed as fundamental to social value and hence, ongoing involvement in the activity” (2018, p. 17) should be given a more emphatic role compared to other therapeutic considerations.

Singing together itself can have an equalizing effect (Tamplin et al., 2013). Steele (2016) refers to Procter (2001) in her article explaining the participatory quality of the Community Music Therapy (CoMT) approach by saying that “hearing all that an individual offers as music allows him to focus more on what he may offer to the partnership, and less on diagnosis” (Steele, 2016, para. 1). A sense of purpose, increasing confidence and feeling competent as a result of increased participation as well as the possibility for identity renegotiation engendered by all this resonate with the principles of the CoMT (Ansdell, 2002; Steele, 2016; Stige & Aarø, 2011; Tiszai & Szűcs-Ittzés, 2016) and the identity renegotiation theory in aphasia rehabilitation (Shadden, 2005); both can form the basis of therapeutic choir work.

Research Method

An anonymous online survey was sent to all the 19 choir participants in October, 2020, during the hybrid rehearsal period, seven months after introducing online rehearsals. The age distribution of the choir members, the length of time the respondent has been living with aphasia, and the social conditions are described in Table 1.

The survey consisted of five questions as displayed in Table 2. The questionnaire was conducted in Hungarian, the participants’ native language, and was translated from Hungarian into English by the second author.

Due to the verbal impediments of the choir members, it was important not to rely solely on the questionnaire, since some singers with severe verbal understanding or reading difficulties were not able to provide answers. Therefore, the questionnaire survey was supplemented by an expert opinion on one of the participant’s nonverbal reactions to the first offline reunion of the choir after 3 months of lockdown and online rehearsals.

Results

Discussion

The questionnaire, the observations and the reviewed literature have a lot of correlating elements. Similarly to the findings of Fogg & Talmage (2011), the members of the HAC also mentioned the improvement of mood resulting from new social connections established in the choir, despite the challenges of being restricted to online meetings. The answers of the HAC members about the improvement of psychosocial well-being resonate with the reports of Tamplin et al. (2013) in that aphasia choirs have a beneficial effect on peer support and a general equalizing effect among group members. HAC members found the recreational and mood-lifting effect of the rehearsals as important as Mantie-Kozlowski (2018) accentuates in her study. In Steele’s (2016) review, the importance of “partnership and less focus on diagnosis” was reflected in some answers to the open-ended questions in the HAC questionnaire.

Regarding the advantages of online rehearsals (Question 5), the answers of the participants are diverse. Online presence divides the group in terms of their preferences. For some participants virtual attendance might be more accessible, while other participants ranked mood and motivation lower because of their disappointment with the lack of face-to-face interaction. The choir leaders, therefore, face new challenges in the long term: they have to adapt to the different needs of the group members.

Conclusion

The objective of this article is to underscore the supportive functions aphasia choirs have in the participants’ everyday life and emphasize the significantly increased mental burden they have to manage due to the restrictions during the SARS-CoV-2 pandemic.

It is clear that nearly all of the aphasia choir members would like to reunite face-to-face as soon as possible. Taking the conclusions of this period into account as well as the surprising advantages of online rehearsals necessitated by the SARS-CoV-2 pandemic restrictions, the ‘post-Covid 19’ era will probably differ from the ‘pre-Covid 19’ era in the following perspective: It can be assumed that those aphasia choirs that survive this pandemic period by reverting to online methods will presumably remain more open to online or hybrid meetings in the future.

Based on all our findings and our experiences, more research is required in this field. The following topics can provide a basis for future research: aphasia choirs’ coping methods with the online opportunities globally, changes in the numbers of members during the long-term functioning of the choir and during the SARS-CoV-2 pandemic era, the participants’ challenges since the introduction of online rehearsals, and long-term solutions––online, offline or hybrid. This study is hoped to stimulate more comprehensive research on the topic.

Acknowledgements

The authors are grateful to the members of the Hungarian Aphasia Choir for their cooperation and to the secretary of the Hungarian Aphasia Association, Zsuzsanna Dallos, for her continuous support towards the group.

About the Authors

Zsófia Fekete is a registered music therapist and a member of the Hungarian Music Therapy Association. Zsófia has more than twenty years of clinical experience at the National Institute of Medical Rehabilitation (Hungary). She obtained her PhD degree at the University of Pécs in 2021. She mainly works with patients with serious brain injury, coma and aphasia. She is the founder of the first Hungarian Aphasia Choir (Hangadó Énekegyüttes) with Fanni Eckhardt, where people struggling with severe aphasia can experience the benefits of community singing therapy. She is also the founder of the vocal ensemble Staccato (1996), where she tries to adopt inclusivity, helping people to join the choir after acute rehabilitation. Zsófia has helped and given inspiration to numerous students taking part in Hungarian music therapy trainings. She regularly holds lectures on music therapy in the neurorehabilitation at rehabilitation medicine trainings for graduate doctors.

Fanni Eckhardt is a current Master of Music Therapy student at ArtEZ University, The Netherlands. Her master research topic is self-concept improvement for people with aphasia through therapeutic songwriting or other music therapy interventions. She has been working in aphasia rehabilitation since 2014 as a music teacher and as a music therapy trainee at the National Institute of Medical Rehabilitation (Hungary) and at the Hungarian Aphasia Association. She is a board member of the Association Internationale Aphasie (AIA), and the co-leader of the first Hungarian Aphasia Choir (Hangadó Énekegyüttes), founded in 2016 by Zsófia Fekete. She holds a bachelor and a master’s degree in music education from the Franz Liszt Academy of Music (Hungary) and is an online communication advocate for people with aphasia.