eCALAP and music listening for aphasia rehabilitation: a single-case experimental design study protocol (Preprint)

BACKGROUND Aphasia, a language impairment caused by stroke, affects daily life and impedes autonomy. Despite recent advances showing that personalized, targeted language therapy yields better outcomes than conventional approaches, access to individualized and intensive rehabilitation remains limited due to logistical and clinical barriers. The eCALAP digital tool we developed addresses these challenges by delivering personalized and targeted therapy, while also offering self-rehabilitation sessions to increase intensity. In parallel, music listening has emerged as a complementary tool, with studies suggesting that it can enhance cognitive and emotional recovery post-stroke. OBJECTIVE The aim of the project described in this protocol is to evaluate the effects of the eCALAP rehabilitation program on language performance in aphasia. The secondary objective is to assess whether combining music listening with eCALAP therapy further enhances language outcomes. METHODS This project uses two multiple baseline single-case experimental designs (SCED). For the duration of protocol in both SCEDs, repeated measures will consist of picture naming, sentence comprehension, word or non-word repetition tasks, collected three times a week. In SCED-1, participants will complete a baseline phase (randomized between 5 to 9 points or repeated measures, 2-3 weeks) followed by an intervention phase. During baseline, no language rehabilitation is provided. After baseline, a personalized rehabilitation plan is generated using the eCALAP-rehabilitation tool, and participants engage in 10 rehabilitation sessions over 3 weeks, supplemented by self-rehabilitation exercises to increase therapy intensity. In SCED-2, participants similarly undergo a randomized baseline phase (5-9 points) during which participants receive eCALAP-rehabilitation without music. During the intervention phase (10 sessions), participants continue eCALAP-rehabilitation but also engage in daily passive music listening (≥1 hour/day) using Spotify. Music listening adherence is objectively monitored via the Trackify website. RESULTS The results of this study will include repeated single-case analyses of language performance across baseline and intervention phases, allowing estimation of individual-level treatment effects of eCALAP rehabilitation, as well as the additional contribution of music listening on language outcomes. CONCLUSIONS This study aims to provide new insights into effective language rehabilitation strategies for post-stroke aphasia. By using a digital tool to personalize and intensify therapy, and by integrating music listening as a potential enhancer, we explore innovative approaches to address current limitations in aphasia care. If effective, the results could support the incorporation of music listening into standard rehabilitation protocols and promote broader access to individualized digital therapy. CLINICALTRIAL NCT06817642 (First Posted 2025-02-10); APHP220542