Efficacy of spoken word comprehension therapy in patients with chronic aphasia: a cross-over randomised controlled trial with structural imaging

Victoria Fleming; Sonia Brownsett; Anna Krason; Maria A Maegli; Henry Coley-Fisher; Yean-Hoon Ong; Davide Nardo; Rupert Leach; David Howard; Holly Robson; Elizabeth Warburton; John Ashburner; Cathy J Price; Jenny T Crinion; Alexander P Leff

doi:10.1136/jnnp-2020-324256

Efficacy of spoken word comprehension therapy in patients with chronic aphasia: a cross-over randomised controlled trial with structural imaging

J Neurol Neurosurg Psychiatry. 2020 Nov 5;92(4):418-424. doi: 10.1136/jnnp-2020-324256. Online ahead of print.

Authors

Victoria Fleming^#¹, Sonia Brownsett^#^{2

3}, Anna Krason⁴, Maria A Maegli⁵, Henry Coley-Fisher⁶, Yean-Hoon Ong⁶, Davide Nardo⁷, Rupert Leach⁶, David Howard⁸, Holly Robson⁹, Elizabeth Warburton¹⁰, John Ashburner¹¹, Cathy J Price¹¹, Jenny T Crinion¹², Alexander P Leff^{6

12}

Affiliations

¹ UCL Queen Square Institute of Neurology, University College London, London, UK victoria.fleming@ucl.ac.uk.
² School of Health and Rehabilitation Sciences, The University of Queensland, Saint Lucia, Queensland, Australia.
³ Centre of Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University, Melbourne, Victoria, Australia.
⁴ Department of Psychology and Language Sciences, University College London, London, UK.
⁵ Department of Psychology, Universidad del Valle de Guatemala, Guatemala, Guatemala.
⁶ UCL Queen Square Institute of Neurology, University College London, London, UK.
⁷ MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, Cambridgeshire, UK.
⁸ School of Education, Communication and Language Sciences, Newcastle University, Newcastle upon Tyne, Tyne and Wear, UK.
⁹ Psychology and Clinical Language Sciences, University of Reading, Reading, Berkshire, UK.
¹⁰ Department of Medicine, University of Cambridge, Cambridge, Cambridgeshire, UK.
¹¹ Wellcome Centre for Human Neuroimaging, University College London, London, UK.
¹² Institute of Cognitive Neuroscience, University College London, London, UK.

^# Contributed equally.

Abstract

Objective: 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.

Methods: A cross-over randomised repeated measures trial with five testing time points (12-week intervals), conducted at the university or participants' homes, captured baseline (T₁), therapy (T₂-T₄) and maintenance (T₅) 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 (T₂-T₄) for each participant (subgroup, n=25) were analysed using cross-sectional and longitudinal voxel-based morphometry.

Results: 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.

Conclusions: 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.

Trial registration number: NCT02540889.

Associated data

ClinicalTrials.gov/NCT02540889

Abstract

Associated data

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