Surgical intervention combined with speech therapy improves speech after a stroke

According to the results of a clinical study published in the BMJ journal, combining surgical intervention on the neck with intensive speech therapy contributes to greater improvement in a person’s communication skills after a stroke than intensive speech therapy alone.

The results show improvement immediately after surgery without any long-term serious side effects or prolonged discomfort, as well as improved quality of life and condition after a stroke within six months.

Stroke is the most common cause of aphasia (problems with communication, including speech, understanding others, reading, and writing). More than 60% of patients suffer from this condition for more than a year, which is called chronic post-stroke aphasia.

Intensive speech therapy is the standard treatment for chronic post-stroke aphasia, but it is unclear whether a combination of neck surgery, called C7 neurotomy (NC7), and speech therapy may be more effective.

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

Participants who spoke Chinese fluently before the stroke were randomly divided into two groups: one group underwent surgery and three weeks of speech therapy (intervention group), and the other underwent only three weeks of speech therapy (control group).

The primary outcome of interest was change in Boston Naming Test (BNT) scores (the ability to name pictures of everyday objects) on day 3, one month, and six months after the start of the study. Other outcomes included changes in aphasia severity, as well as patients’ assessments of quality of daily life and depression.

The results show that the intervention group demonstrated statistically significant improvements on all measured indicators compared to the control group.

After one month, the average increase in BNT scores was 11.16 points in the intervention group and 2.72 points in the control group (difference: 8.51 points). This improvement in language function remained stable after six months (difference: 8.26 points).

The severity of aphasia also improved more in the intervention group than in the control group (difference after one month: 7.06 points), and according to the patients, their activity in daily life and depression after stroke improved significantly compared to the control group.

After six months, no serious adverse events related to the surgical intervention or procedure were reported.

The authors acknowledge that the participants were relatively young, mostly male, and all Chinese speakers, which limits the generalizability of their results, and state that further follow-up research is needed to verify the patients’ results over a longer period of time.

However, they conclude that NC7 combined with three weeks of intensive speech therapy “is a more effective treatment for chronic aphasia after stroke than intensive speech therapy alone” and “may improve patients’ quality of daily life and reduce depression after stroke.” .

This study is an interesting step forward, says Supattana Chatromien of the Neurological Institute of Thailand in an accompanying editorial.

However, she says, some caution should be exercised, but if further data confirm these findings, they appear to offer a glimmer of hope for people with chronic stroke who meet the relevant criteria.

“Although intensive speech therapy remains the mainstay of aphasia treatment, C7 neurotomy may become a potential adjunctive option for carefully selected patients in the future,” she writes.

“This study should stimulate further scientific research and a critical re-evaluation of rehabilitation paradigms and policies in the treatment of chronic stroke, promoting a more optimistic and proactive approach to long-term recovery.”