School of Life Sciences, Arizona State University, Tempe.
School of Biological and Health Science Engineering, Arizona State University, Tempe.
Am J Speech Lang Pathol. 2023 Nov 6;32(6):2630-2653. doi: 10.1044/2023_AJSLP-22-00296. Epub 2023 Sep 12.
This prospective, single-blinded, parallel, stratified, randomized clinical trial via telehealth aimed to investigate the impact of Startle Adjuvant Rehabilitation Therapy (START) on aphasia, apraxia of speech (AOS), and quality of life in individuals with chronic stroke. The study hypothesized that START would have a greater effect on AOS-related measures and more severe individuals.
Forty-two participants with poststroke aphasia, AOS, or both were randomly assigned to the START or control group. Both groups received 77-dB GET READY and GO cues during a word repetition task for three 1-hr sessions on consecutive days. The START group additionally received 105-dB white noise GO cues during one third of trials. The Western Aphasia Battery-Revised, Apraxia Battery for Adults, Stroke Impact Scale, and Communication Outcomes After Stroke scale were administered at Day 1, Day 5, and 1-month follow-up.
START improved performance on some subtests of the Western Aphasia Battery (Comprehension, Repetition, Reading) and measures of AOS (Diadochokinetic Rate, Increasing Word Length) in individuals with moderate/severe aphasia, whereas moderate/severe controls saw no changes. Individuals with mild aphasia receiving START had improved Reading, whereas mild controls saw improved Comprehension. The START group had increased mood and perceived communication recovery by Day 5, whereas controls saw no changes in quality of life.
This study is the first to evaluate the impact of training with startling acoustic stimuli on clinical measures of aphasia and AOS. Our findings suggest START can enhance both nontrained speech production and receptive speech tasks in moderate/severe aphasia, possibly by reducing poststroke cortical inhibition. Our findings should be considered carefully, as our limitations include small effect sizes, within-group variability, and low completion rates for quality-of-life assessments and follow-up visits. Future studies should explore a mechanism of action, conduct larger and longer Phase 2 clinical trials, and evaluate long-term retention.
本前瞻性、单盲、平行、分层、随机临床试验通过远程医疗旨在研究惊吓辅助康复疗法（START）对慢性脑卒中患者的失语症、言语失用症（AOS）和生活质量的影响。研究假设 START 对 AOS 相关指标的影响更大，对更严重的患者影响更大。
42 名脑卒中后失语症、AOS 或两者兼有患者被随机分配到 START 组或对照组。两组患者在连续 3 天的每天 1 小时的 3 次重复单词任务中均接受 77dB 的 GET READY 和 GO 提示。在三分之一的试验中，START 组还接受了 105dB 的白噪声 GO 提示。在第 1 天、第 5 天和 1 个月随访时，采用西方失语症成套测验修订版、成人失语症评估量表、中风影响量表和中风后沟通量表进行评估。
在中重度失语症患者中，START 改善了西方失语症成套测验的一些子测验（理解、重复、阅读）和 AOS 测量（双音节词流畅度、单词长度递增）的表现，而中度/重度对照组则没有变化。接受 START 的轻度失语症患者阅读能力有所提高，而轻度对照组理解能力有所提高。第 5 天，START 组的情绪和感知沟通恢复有所增加，而对照组的生活质量没有变化。
本研究首次评估了使用惊吓声刺激进行训练对失语症和 AOS 临床指标的影响。我们的研究结果表明，START 可以增强中重度失语症患者的非训练性言语产生和接受性言语任务，可能是通过减少中风后的皮质抑制。我们的研究结果应谨慎考虑，因为我们的研究存在一些局限性，如效应量小、组内变异性大、生活质量评估和随访的完成率低。未来的研究应探讨其作用机制，进行更大、更长的 2 期临床试验，并评估长期保留率。
