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

本研究为一项前瞻性、单盲、平行、分层、随机化临床试验，通过远程医疗途径旨在探究Startle Adjuvant Rehabilitation Therapy（START）对慢性卒中患者失语症、言语失用症（AOS）以及生活质量的影响。研究假设START在AOS相关指标及病情较重个体中会产生更显著的效果。研究方法：共招募42名患有卒中后失语症、AOS或两者兼有的参与者，随机分配至START组或对照组。两组均在连续三天内接受为期三个小时的77分贝GET READY和GO提示音的词汇复述任务。START组在试验中三分之一的次数额外接受105分贝的白噪声GO提示音。在第一天、第五天以及1个月随访时，对西方失语症电池修订版、成人失用症电池、卒中影响量表以及卒中后沟通结果量表进行了评估。研究结果：START改善了中度/重度失语症患者西方失语症电池某些子测试（理解、复述、阅读）和AOS指标（交替运动速率、增加词汇长度），而中度/重度对照组未观察到任何变化。轻度失语症患者接受START治疗者在阅读方面有所改善，而轻度对照组在理解方面有所提升。START组在第五天时情绪和生活质量感知恢复有所增加，而对照组在生活质量方面未观察到任何变化。研究结论：本研究首次评估了训练中使用惊吓声学刺激对失语症和AOS临床指标的影响。我们的研究结果提示START可以增强中度/重度失语症患者的非训练语音产出和接受性语音任务，可能通过减少卒中后皮质抑制。由于我们的局限性包括效应量小、组内变异性和生活质量评估及随访访问完成率低，因此我们的发现应谨慎考虑。未来的研究应探索作用机制，开展更大规模和更长时间的2期临床试验，并评估长期保留效果。补充材料S1：START组参与者一次会议的示例。Swann, Z., Tesman, N., Rogalsky, C., & Honeycutt, C F. (2023). 将词汇复述与惊吓声学刺激结合可降低从重度到中度卒中患者的失语症和失用症严重程度：一项分层、单盲、随机、1期临床试验。美国言语-语言病理学杂志，32(6)，2630–2653. https://doi.org/10.1044/2023_AJSLP-22-00296