Differential Effects of Speech and Language Therapy and rTMS in Chronic Versus Subacute Post-stroke Aphasia: Results of the NORTHSTAR-CA Trial.
Anna Zumbansen, Heike Kneifel, Latifa Lazzouni and 17 others
PMID 35337223WHAT IT FOUND
Adding 1-Hz rTMS to speech therapy did not improve language outcomes more than sham stimulation plus therapy in chronic post-stroke aphasia.
Patients in both groups improved during therapy and held gains at one month, but the brain stimulation itself provided no extra benefit.
Key findings
01Changes in naming, fluency, comprehension, and overall aphasia severity did not differ between the rTMS and sham groups in chronic patients at either day 1 or day 30.
02When looking at all chronic patients together regardless of group, language scores improved significantly from baseline to immediately post-treatment and remained stable through the 30-day follow-up.
03The study was a proof-of-concept trial that terminated early after enrolling 28 participants, fewer than the 30 originally planned, because of recruitment difficulties.
STILL TO COME
How it was doneWhat they foundWhat it means for SLPs
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What it does not show
The study was a small proof-of-concept trial with only 28 patients, which makes it underpowered to detect small differences between groups. The trial stopped early due to low recruitment rates, further reducing its statistical power. Chronic patients in this study had significantly larger brain lesions and more frequent damage to Broca's complex compared to the subacute patients, which might have made them less responsive to stimulation. The chronic patients were recruited through advertisements, which may have introduced selection bias compared to the consecutive recruitment of subacute patients.
Declared interests
The authors declared no conflicts of interest. The work was funded by non-profit research grants from the Canadian Institutes for Health Research, the W.-D. Heiss Foundation, and the Lady Davis Institute at the Jewish General Hospital.
The easy way to misread this
Do not conclude that speech therapy is ineffective for chronic aphasia. The patients did improve, but the improvement was seen in both the real and sham stimulation groups, meaning it was likely due to the therapy itself rather than the added rTMS.