Surgery and speech therapy improve chronic post-stroke aphasia

Combining neck surgery with intensive speech therapy is associated with greater improvements in a person's ability to communicate after a stroke than intensive speech therapy alone, finds a clinical trial published by The BMJ today.

The results show improvements immediately after surgery without any long-term severe adverse events or lasting discomfort, as well as reported improvements in quality of life and post-stoke depression over six months.

Stroke is the most common cause of aphasia (problems with communication, including speaking, understanding others, reading and writing). More than 60% of patients are affected up to one year, referred to as chronic post-stroke aphasia.

Intensive speech and language therapy (iSLT) is a standard treatment for chronic post-stroke aphasia, but it's not clear if combining a type of neck surgery called C7 neurotomy (NC7) and iSLT might be more effective.

To find out, researchers in China identified 50 patients aged 40 to 65 years with aphasia and muscle stiffness (spasticity) in their right arm for more than a year after a single stroke affecting the left side of the brain, which is responsible for language.

The participants, who all spoke fluent Chinese before their stroke, were randomly assigned to receive either surgery plus 3 weeks iSLT (intervention group) or 3 weeks iSLT alone (control group).

The main measure of interest was the change in Boston Naming Test (BNT) score (ability to name drawings of everyday objects) at day 3, one, and six months into the trial. Others included changes in aphasia severity and patient reported quality of daily life and depression.

The results show that the intervention group demonstrated statistically significant improvements across all measured outcomes compared with controls.

At 1 month, the average increase in BNT score was 11.16 points in the intervention group, and 2.72 points in the control group (difference: 8.51 points). This increase in language function remained stable at 6 months (difference: 8.26 points).

Aphasia severity also improved more in the intervention group than the control group (difference at one month 7.06 points) and patient-reported activity of daily life and post-stroke depression significantly improved compared with controls.

No surgery or procedure related severe adverse events were reported at 6 months.

The authors acknowledge that participants were relatively young, mostly male, and all native Chinese speakers, which limits the generalisability of their findings, and say an extended follow-up study is needed to verify patients' performance over a longer time period.

However, they conclude that NC7 plus 3 weeks intensive SLT "is a superior treatment for chronic post-stroke aphasia compared with intensive speech and language therapy alone" and "can benefit patients in quality of daily life and post-stroke depression."

This trial is an interesting step forward, says Supattana Chatromyen at the Neurological Institute of Thailand, in a linked editorial.

Some caution is, however, warranted, she says, but if further evidence supports these findings, they seem to offer a glimmer of hope for people with chronic stroke who meet the appropriate criteria.

"Although intensive SLT remains the cornerstone of aphasia treatment, C7 neurotomy could become a potential adjunctive option for carefully selected individuals in the future," she writes. "This research should spark further scientific research and a critical re-evaluation of rehabilitation paradigms and policies for chronic stroke care, fostering a more optimistic and proactive approach to long term recovery."