Combined Therapy Shows Promise for Post-Stroke Aphasia
Chinese researchers find a novel surgical approach combined with speech therapy boosts language recovery after stroke.
- Combining right-sided cervical C7 neurotomy with intensive speech and language therapy (iSLT) improved language function in chronic aphasia patients after stroke.
- Patients receiving combined treatment showed significant improvements in naming ability, functional language scores, and quality of life.
- The study, conducted in China, involved patients with aphasia for over a year after a left hemisphere stroke.
- Improvements in naming deficits were detectable within 3 days after surgery, suggesting a neuromodulatory effect.
For stroke survivors battling chronic aphasia, a condition that frustratingly impairs communication, hope may be on the horizon; a recent study suggests that combining nerve surgery with speech therapy could significantly improve language skills, as **what impact does combined therapy have on post-stroke aphasia?** The study, conducted in China, found that right-sided cervical C7 neurotomy, when paired with intensive speech and language therapy (iSLT), led to notable gains in language function.
Unlocking Language After Stroke
Chronic aphasia, a persistent communication disorder, affects over 60% of stroke survivors beyond the first year, diminishing their independence and overall quality of life. While iSLT is a standard treatment, its effects can be limited, prompting the search for supplementary therapies.
Intriguingly, earlier observations from C7 nerve transfer surgeries for spastic arm paralysis revealed unexpected improvements in language, especially in naming objects. This led researchers to explore targeted neurotomy as a potential treatment for chronic aphasia.
The Study Design
Juntao Feng, MD, PhD, of Fudan University in Shanghai, China, and colleagues enrolled 50 patients aged 40-65 years. These patients had been living with aphasia for more than a year following a stroke impacting the left side of their brain, the area responsible for language processing. Many also experienced spasticity in their right arm.
The participants were divided into two groups: one receiving right C7 neurotomy at the intervertebral foramen followed by three weeks of iSLT, and the other receiving iSLT alone.
The primary measure of success was the change in scores on the 60-item Boston Naming Test (BNT), where higher scores (ranging from 0-60) indicated better naming ability. Assessments occurred at baseline, 3 days, 1 month, and 6 months.
Significant Improvements Observed
After one month, the group receiving neurotomy plus iSLT showed an average increase of 11.16 points on the BNT, compared to just 2.72 points in the iSLT-only group—a statistically significant difference of 8.51 points (P < .001). This advantage remained consistent at six months, with an 8.26-point difference (P < .001).
Notably, improvements in naming deficits, often resistant to therapy, were seen as early as three days after surgery, before iSLT even began. This suggests a rapid neuromodulatory effect of the neurotomy itself.
“It could be speculated that neurotomy of the seventh cervical nerve triggered changes in plasticity of the brain regions responsible for language,” the researchers wrote in the study, published online June 25 in *The BMJ*.
Furthermore, neurotomy was linked to significant improvements in aphasia severity (a 7.06-point difference on the aphasia quotient at one month; P < .001), daily life activities, and post-stroke depression, as reported by the patients themselves.
Safety Profile
The study reported no major complications or long-term adverse effects. Some patients experienced transient neuropathic pain, decreased sensory and motor function in the right upper limb, and minor blood pressure elevations related to C7 neurotomy, but these issues resolved within two months post-surgery. No adverse events were reported at the 6-month follow-up.
Study Limitations and Future Directions
The researchers acknowledged that their study population was limited to relatively young, Mandarin-speaking Chinese patients treated at four urban centers. This raises questions about how well these findings can be applied to other populations. The follow-up period was also limited to six months.
However, the team plans to monitor participants for five years and explore the therapy’s potential in broader, international groups.
Based on their findings, they concluded that right C7 neurotomy at the intervertebral foramen combined with iSLT is “superior” to iSLT alone for chronic post-stroke aphasia. It “could be considered an evidence-based intervention for patients aged 40-65 years with aphasia for more than 1 year after stroke.”
Expert Perspectives
Larry B. Goldstein, MD, chair of the Department of Neurology and codirector of the Kentucky Neuroscience Institute at the University of Kentucky, Lexington, Kentucky, described the study results as “interesting and provocative.”
Goldstein noted several “caveats,” including that “the participants were predominately men (80%), young (about 52 years; much younger than most stroke patients), and a high proportion had brain hemorrhages (about half; in general only 15% of strokes are from bleeding).”
“The participants’ primary language was Chinese, and there was no control for medications they might have been receiving that could affect brain function. Additionally, both the participants and the therapists were aware of the treatment group (although the assessors were unaware of group assignment),” Goldstein pointed out.
“With those limitations in mind, the reported data suggests the potential viability of the approach. It will need to be assessed in a more typical population of patients (ie, older, a higher proportion of women, a higher proportion of ischemic stroke), account for medication use, blind therapists to treatment group, and involve participants speaking other languages,” Goldstein said.
Another expert, Supattana Chatromyen, MD, with the Neurological Institute of Thailand, Bangkok, Thailand, wrote that the study is “an interesting step forward with room to explore further.”
“Although intensive SLT remains the cornerstone of aphasia treatment, C7 neurotomy could become a potential adjunctive option for carefully selected individuals in the future,” Chatromyen wrote.
“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,” Chatromyen concluded.
