Fleming Victoria, Brownsett Sonia, Krason Anna, Maegli Maria A, Coley-Fisher Henry, Ong Yean-Hoon, Nardo Davide, Leach Rupert, Howard David, Robson Holly, Warburton Elizabeth, Ashburner John, Price Cathy J, Crinion Jenny T, Leff Alexander P
UCL Queen Square Institute of Neurology, University College London, London, UK
School of Health and Rehabilitation Sciences, The University of Queensland, Saint Lucia, Queensland, Australia.
J Neurol Neurosurg Psychiatry. 2020 Nov 5;92(4):418-24. doi: 10.1136/jnnp-2020-324256.
The efficacy of spoken language comprehension therapies for persons with aphasia remains equivocal. We investigated the efficacy of a self-led therapy app, 'Listen-In', and examined the relation between brain structure and therapy response.
A cross-over randomised repeated measures trial with five testing time points (12-week intervals), conducted at the university or participants' homes, captured baseline (T), therapy (T-T) and maintenance (T) effects. Participants with chronic poststroke aphasia and spoken language comprehension impairments completed consecutive Listen-In and standard care blocks (both 12 weeks with order randomised). Repeated measures analyses of variance compared change in spoken language comprehension on two co-primary outcomes over therapy versus standard care. Three structural MRI scans (T-T) for each participant (subgroup, n=25) were analysed using cross-sectional and longitudinal voxel-based morphometry.
Thirty-five participants completed, on average, 85 hours (IQR=70-100) of Listen-In (therapy first, n=18). The first study-specific co-primary outcome (Auditory Comprehension Test (ACT)) showed large and significant improvements for trained spoken words over therapy versus standard care (11%, Cohen's d=1.12). Gains were largely maintained at 12 and 24 weeks. There were no therapy effects on the second standardised co-primary outcome (Comprehensive Aphasia Test: Spoken Words and Sentences). Change on ACT trained words was associated with volume of pretherapy right hemisphere white matter and post-therapy grey matter tissue density changes in bilateral temporal lobes.
Individuals with chronic aphasia can improve their spoken word comprehension many years after stroke. Results contribute to hemispheric debates implicating the right hemisphere in therapy-driven language recovery. Listen-In will soon be available on GooglePlay.
NCT02540889.
针对失语症患者的口语理解疗法的疗效仍不明确。我们研究了一款自主引导式治疗应用程序“倾听”的疗效，并探讨了脑结构与治疗反应之间的关系。
在大学或参与者家中进行了一项交叉随机重复测量试验，有五个测试时间点（间隔12周），记录了基线（T）、治疗（T-T）和维持（T）效果。患有慢性中风后失语症和口语理解障碍的参与者完成了连续的“倾听”和标准护理阶段（均为12周，顺序随机）。重复测量方差分析比较了治疗与标准护理在两个共同主要结局上口语理解的变化。对每个参与者（亚组，n=25）的三次结构MRI扫描（T-T）进行了基于体素的横断面和纵向形态学分析。
35名参与者平均完成了85小时（四分位距=70-100）的“倾听”治疗（先进行治疗，n=18）。第一个特定于研究的共同主要结局（听觉理解测试（ACT））显示，与标准护理相比，治疗后训练口语单词有显著大幅改善（11%，科恩d=1.12）。在12周和24周时，改善基本保持。对第二个标准化共同主要结局（全面失语症测试：口语单词和句子）没有治疗效果。ACT训练单词的变化与治疗前右半球白质体积以及治疗后双侧颞叶灰质组织密度变化有关。
慢性失语症患者在中风多年后口语理解能力可以得到改善。研究结果有助于关于右半球在治疗驱动的语言恢复中作用的半球争论。“倾听”应用程序很快将在谷歌应用商店上架。
NCT02540889。
