A groundbreaking clinical trial published in The BMJ reveals that combining neck surgery with intensive speech therapy delivers superior outcomes for patients with chronic post-stroke aphasia compared to speech therapy alone. The study demonstrates significant improvements in communication abilities, quality of life, and depression symptoms without serious adverse events.
Study Design and Patient Population
Researchers in China conducted a randomized controlled trial involving 50 patients aged 40 to 65 years who had experienced chronic post-stroke aphasia and right arm muscle stiffness for more than a year following a single stroke affecting the left side of the brain. All participants were fluent Chinese speakers before their stroke and had aphasia and spasticity in their right arm for more than a year.
The participants were randomly divided into two groups: an intervention group receiving C7 neurotomy (NC7) surgery plus three weeks of intensive speech and language therapy (iSLT), and a control group receiving three weeks of iSLT alone.
Significant Communication Improvements
The primary outcome measured was the change in Boston Naming Test (BNT) scores, which assess the ability to name drawings of everyday objects. The results demonstrated statistically significant improvements across all measured outcomes in the intervention group compared to controls.
At one month, the intervention group showed an average increase of 11.16 points in BNT scores, while the control group improved by only 2.72 points, representing a difference of 8.51 points. This substantial improvement in language function remained stable at six months, with a difference of 8.26 points between groups.
Broader Quality of Life Benefits
Beyond communication improvements, the study revealed additional benefits for patients receiving the combined treatment. Aphasia severity improved more significantly in the intervention group than the control group, with a difference of 7.06 points at one month. Patients also reported significant improvements in their activity of daily life and reduced post-stroke depression compared to the control group.
Safety Profile
The safety profile of the combined intervention proved favorable, with no surgery or procedure-related severe adverse events reported at six months. The results showed improvements immediately after surgery without any long-term severe adverse events or lasting discomfort.
Clinical Context and Implications
Stroke represents the most common cause of aphasia, affecting problems with communication including speaking, understanding others, reading, and writing. More than 60% of patients experience these difficulties for up to one year, a condition referred to as chronic post-stroke aphasia. While intensive speech and language therapy serves as the standard treatment for chronic post-stroke aphasia, the effectiveness of combining surgical intervention with therapy had remained unclear until this study.
Expert Commentary and Future Directions
Supattana Chatromyen at the Neurological Institute of Thailand, writing in a linked editorial, described the trial as "an interesting step forward" while noting that some caution is warranted. She emphasized that if further evidence supports these findings, they offer "a glimmer of hope for people with chronic stroke who meet the appropriate criteria."
The study authors acknowledge several limitations, including that participants were relatively young, mostly male, and all native Chinese speakers, which limits the generalizability of their findings. They emphasize that an extended follow-up study is needed to verify patients' performance over a longer time period.
Research Implications
The researchers conclude that NC7 plus three weeks of intensive speech and language therapy "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."
Chatromyen notes that while intensive speech and language therapy remains the cornerstone of aphasia treatment, "C7 neurotomy could become a potential adjunctive option for carefully selected individuals in the future." She suggests 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."
