Effectiveness of homebased comprehensive neuropsychological rehabilitation for post stroke aphasia in limited resource settings: An fMRI based randomized controlled trial

Abstract

Cognitive impairment in Post- Stroke Aphasia (PSA) is common and can cause disability with major impacts on quality of life and independence. Present study attempts to establish whether home-based neuropsychological interventions can improve language and cognitive performance in PSA. In this single centre, parallel group, open-label, randomized controlled trial, 58 PSA aged 18-70 years were randomized using computer-generated block randomization to Intervention group (IG) or Control Group (CG). The secondary endpoint of a larger study (ClinicalTrials.nic.in, number CTRI/2014/04/004554) assessed between-group difference in the change in language and cognition from baseline to immediately after 8 weeks and of comprehensive neuropsychological rehabilitation with aphasia therapy or routine treatment using fMRI and neuropsychological assessment. Post intervention, the IG revealed statistically significant improvement on working memory and attention tests despite being clinically impaired but the BOLD activations revealed significant activations on the cognitive & language tasks. The CG didn’t show any significant improvements and were clinically impaired on cognitive tests and fMRI tasks. The results show that attention and working memory deficits also contribute to language recovery, in addition to syntactic impairment which has a strong and direct impact on fluency. The findings support the suggestion that cognition is important for communication and provide evidence that treating cognition can improve skills important for language. PSAs display non-linguistic cognitive deficits and strengths that interact not only with their specific profiles of language impairments and strengths, but also their potential for positive response to communication treatment, and potentially to their quality of life.