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Randomized Controlled Trial
. 2017 Jul;88(7):586-594.
doi: 10.1136/jnnp-2016-314621. Epub 2017 Mar 4.

Auditory Training Changes Temporal Lobe Connectivity in 'Wernicke's Aphasia': A Randomised Trial

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Free PMC article
Randomized Controlled Trial

Auditory Training Changes Temporal Lobe Connectivity in 'Wernicke's Aphasia': A Randomised Trial

Zoe Vj Woodhead et al. J Neurol Neurosurg Psychiatry. .
Free PMC article

Abstract

Introduction: Aphasia is one of the most disabling sequelae after stroke, occurring in 25%-40% of stroke survivors. However, there remains a lack of good evidence for the efficacy or mechanisms of speech comprehension rehabilitation.

Trial design: This within-subjects trial tested two concurrent interventions in 20 patients with chronic aphasia with speech comprehension impairment following left hemisphere stroke: (1) phonological training using 'Earobics' software and (2) a pharmacological intervention using donepezil, an acetylcholinesterase inhibitor. Donepezil was tested in a double-blind, placebo-controlled, cross-over design using block randomisation with bias minimisation.

Methods: The primary outcome measure was speech comprehension score on the comprehensive aphasia test. Magnetoencephalography (MEG) with an established index of auditory perception, the mismatch negativity response, tested whether the therapies altered effective connectivity at the lower (primary) or higher (secondary) level of the auditory network.

Results: Phonological training improved speech comprehension abilities and was particularly effective for patients with severe deficits. No major adverse effects of donepezil were observed, but it had an unpredicted negative effect on speech comprehension. The MEG analysis demonstrated that phonological training increased synaptic gain in the left superior temporal gyrus (STG). Patients with more severe speech comprehension impairments also showed strengthening of bidirectional connections between the left and right STG.

Conclusions: Phonological training resulted in a small but significant improvement in speech comprehension, whereas donepezil had a negative effect. The connectivity results indicated that training reshaped higher order phonological representations in the left STG and (in more severe patients) induced stronger interhemispheric transfer of information between higher levels of auditory cortex.Clinical trial registrationThis trial was registered with EudraCT (2005-004215-30, https://eudract.ema.europa.eu/) and ISRCTN (68939136, http://www.isrctn.com/).

Keywords: Wernicke’s aphasia; magnetoencephalography; pharmacological trial; phonological training; speech comprehension.

Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Study design showing order of the five time points (baseline, D1, D2, P1 and P2) for the two cross-over groups.
Figure 2
Figure 2
Consolidated Standards of Reporting Trials (CONSORT) trial flow diagram.
Figure 3
Figure 3
Baseline Comprehensive Aphasia Test data and structural brain imaging. Top: average T-scores for severe (n=7) and moderate (n=13) patients. Bottom left: speech comprehension T-scores, showing division of severe and moderate subgroups. Bottom right: lesion overlay maps for severe and moderate patients.
Figure 4
Figure 4
Effects of Earobics and donepezil on speech comprehension in severe and moderate patient subgroups.
Figure 5
Figure 5
Significant changes in phonemic sensitivity between time points. (a) Red connections showed significantly stronger phonemic sensitivity after Earobics training (main effect of Earobics); (b) red connections showed significantly stronger training effects on phonemic sensitivity in the severe patients than the moderate patients (Earobics by severity interaction); (c) main effect of drug and (d) drug by severity interaction.

Comment in

  • Home-based therapy for chronic Wernicke's aphasia.
    Bonilha L, Fridriksson J. Bonilha L, et al. J Neurol Neurosurg Psychiatry. 2017 Jul;88(7):539. doi: 10.1136/jnnp-2017-315842. Epub 2017 Apr 17. J Neurol Neurosurg Psychiatry. 2017. PMID: 28416563 No abstract available.

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