START improves poststroke aphasia and apraxia (Swann et al., 2023)

Purpose: 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.Method: 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.Results: 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.Conclusions: 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.Supplemental Material S1. Example of a session for a participant in the START group.Swann, Z., Tesman, N., Rogalsky, C., & Honeycutt, C F. (2023). Word repetition paired with startling stimuli decreases aphasia and apraxia severity in severe-to-moderate stroke: A stratified, single-blind, randomized, Phase 1 clinical trial. American Journal of Speech-Language Pathology, 32(6), 2630–2653. https://doi.org/10.1044/2023_AJSLP-22-00296### 研究目的 本项通过远程医疗开展的前瞻性单盲平行分层随机临床试验，旨在探究惊吓辅助康复疗法（Startle Adjuvant Rehabilitation Therapy, START）对慢性脑卒中患者失语症、言语失用症（apraxia of speech, AOS）及生活质量的影响。本研究假设START对与AOS相关的评估指标以及病情更严重的患者具有更显著的改善效果。 ### 研究方法 本研究纳入42名卒中后失语症、言语失用症或同时罹患两种病症的受试者，将其随机分配至START组与对照组。两组受试者在连续3天、每天1小时的词汇重复任务训练中，均接收77分贝的"准备就绪（GET READY）"与"开始（GO）"提示音。其中START组在三分之一的试次中，额外接收105分贝的白噪音"开始"提示音。研究分别在第1天、第5天及1个月随访时，对受试者实施西方失语症成套测验修订版（Western Aphasia Battery–Revised）、成人失用症评估量表（Apraxia Battery for Adults）、脑卒中影响量表（Stroke Impact Scale）以及卒中后沟通结局量表（Communication Outcomes After Stroke scale）的评估。 ### 研究结果 对于中重度失语症患者，START可改善其在西方失语症成套测验修订版部分子测验（理解、复述、阅读）以及言语失用症相关评估指标（交替运动速率、词汇长度递增任务）中的表现，而中重度对照组受试者的相关指标无显著变化。对于轻度失语症患者，START组受试者的阅读能力得到提升，而轻度对照组受试者的理解能力有所改善。至第5天时，START组受试者的情绪状态与主观沟通恢复感知均有所提升，而对照组受试者的生活质量无明显变化。 ### 研究结论 本研究为首项评估惊吓性听觉刺激训练对失语症与言语失用症临床评估指标影响的研究。研究结果表明，START可提升中重度失语症患者非训练性言语产出与接受性言语任务的表现，其潜在机制可能为降低卒中后皮层抑制作用。需谨慎解读本研究结果，本研究存在的局限性包括效应量较小、组内变异性较高，以及生活质量评估与随访就诊的完成率偏低。未来研究可进一步探究其作用机制，开展规模更大、周期更长的II期临床试验，并评估干预效果的长期留存性。 ### 补充材料S1 START组受试者单次训练示例。 ### 参考文献 Swann, Z.、Tesman, N.、Rogalsky, C. 与 Honeycutt, C. F.（2023）. 搭配惊吓刺激的词汇重复训练可减轻中重度卒中患者的失语症与言语失用症严重程度：一项分层单盲随机I期临床试验. 《美国言语语言病理学期刊》, 32(6), 2630–2653. https://doi.org/10.1044/2023_AJSLP-22-00296