Combining neck surgery with intensive speech therapy improves post-stroke communication more than speech therapy alone.
This is based on a clinical trial published in The BMJ that demonstrates immediate post-surgery improvements, with no serious adverse events or lasting discomfort.
It also reports enhancements in quality of life and a reduction in post-stroke depression over six months.
Stroke is the leading cause of aphasia, a condition that affects communication, including speaking, understanding, reading and writing.
More than 60% of patients are affected for up to one year, a condition known as chronic post-stroke aphasia.
Intensive speech and language therapy (iSLT) is a standard treatment for chronic post-stroke aphasia. However, it remains unclear whether combining a type of neck surgery called C7 neurotomy (NC7) with iSLT might be more effective.
To investigate this, researchers in China identified 50 patients aged 40 to 65 years who had aphasia and muscle stiffness (spasticity) in their right arm for more than a year following a single stroke affecting the left side of the brain, which controls language.
All participants, who were fluent Chinese speakers before their stroke, were randomly assigned to either receive surgery plus three weeks of iSLT (intervention group) or three weeks of iSLT alone (control group).
The primary measure of interest was the change in Boston Naming Test (BNT) score (the ability to name pictures of everyday objects) at three days, one month, and six months into the trial. Other measures included changes in aphasia severity, as well as patient-reported quality of daily life and depression.
The results show that the intervention group experienced statistically significant improvements across all measured outcomes compared with the control group.
At one month, the average increase in BNT score was 11.16 points in the intervention group, compared to 2.72 points in the control group (difference: 8.44 points). This improvement in language function remained stable at six months (difference: 8.26 points).
Aphasia severity also improved more in the intervention group than in the control group (difference at one month 7.06 points), alongside significant improvements in patient-reported activity of daily life and post-stroke depression compared with controls.
No severe adverse events related to surgery or procedures were reported at the six-month follow-up.
The authors acknowledge that participants were relatively young, predominantly male, and all native Chinese speakers, which may limit the generalisability of their findings. They indicate that an extended follow-up study is necessary to verify patients’ progress over a more extended period.
However, they conclude that NC7 combined with three weeks of 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 represents a promising step forward, says Supattana Chatromyen at the Neurological Institute of Thailand, in a linked editorial.
She advised some caution, but noted that if further evidence supports these findings, they could offer hope for individuals with chronic stroke who meet the appropriate criteria.
She said: ‘Although intensive SLT remains the cornerstone of aphasia treatment, C7 neurotomy could become a potential adjunctive option for carefully selected individuals in the future. This research should inspire further scientific investigation and a reassessment of rehabilitation paradigms and policies for chronic stroke care, fostering a more optimistic and proactive approach to long-term recovery.’
