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

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 participant’s homes, captured baseline (T1), therapy (T2-T4), and maintenance (T5) effects. Participants with chronic post-stroke aphasia and spoken language comprehension impairments completed consecutive Listen-In and standard care blocks (both 12-weeks with order randomised). Repeated measures ANOVAs 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 pre-therapy right hemisphere white matter; and post-therapy grey matter tissue density changes in the right temporal lobe. Conclusions. Individuals with chronic aphasia can improve 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.