During the acute phase following a stroke, around one-third of survivors experience post-stroke motor aphasia, the inability to speak or to organize the muscular movements of speech, with 61% still affected one year after. The disruption to speech and the ability to communicate negatively affects quality of life.

The first-line rehabilitative treatment for post-stroke motor aphasia is behavioral speech and language therapy. In China, acupuncture is regularly recommended as a complementary and alternative therapy for post-stroke aphasia. A new study by researchers at the First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, China, investigated the effect of acupuncture on language function, quality of life and neurological impairment in patients with post-stroke motor aphasia.

The researchers enrolled 252 participants (78.6% men) aged 45 to 75 who received a diagnosis of aphasia following their first ischemic stroke. Eligible participants were those with aphasia lasting from 15 to 90 days and with an aphasia severity score of zero to three, according to the Boston Diagnostic Aphasia Examination (BDAE), where higher grades – out of a total of five – indicate less serious language deficits. Participants were randomized to receive manual acupuncture or ‘sham’ acupuncture (using non-meridian points and shallow needle insertion).

Both groups received 30 sessions over six consecutive weeks, five 30-minute sessions per week, combined with language training and conventional treatment. Manual acupuncture followed the standard Xing-Nao Kai-Qiao protocol and the De Qi sensation induced. The De Qi sensation, considered in Traditional Chinese Medicine theory to be key to a successful acupuncture treatment, refers to the patient’s subjective sensations and objective body responses as well as the acupuncturist’s perceptions felt when certain acupoints are needled.

The primary outcomes were the aphasia quotient (AQ) of the Western Aphasia Battery and the Chinese Functional Communication Profile (CFCP) score at week six. The AQ is a sensitive, valid, and reliable measure of aphasia performance where a lower score (range: zero to 100) indicates a more severe impairment of language function. The CFCP measures the functional communication ability in Mandarin, with a higher score (range: zero to 250) indicating a better ability. Secondary outcomes included an assessment of participants’ stroke-specific quality of life and degree of neurological deficit.

In the manual acupuncture group, the mean AQ score at week six was 69.66, a mean improvement from the baseline of 29.60 points, and 61.68 in the sham acupuncture group, a mean improvement of 17.88 points. The manual acupuncture group had a clinically significant 7.99-point increase in the AQ score compared to the sham group. The mean CFCP scores at week six were 167.60 in the manual acupuncture group and 144.08 in the sham group, a mean improvement from the baseline of 72.68 and 50.52, respectively. Those in the manual acupuncture group also showed significant improvements in AQ and CFCP scores at the end of follow-up at six months.

Compared to sham acupuncture, manual acupuncture also produced significant and continuous improvement in language function, quality of life and neurological impairment through follow-up at six months after the onset of aphasia. Three treatment-related adverse reactions occurred in the manual acupuncture group and three in the sham group, but they were transient and not serious.

To the researchers’ knowledge, theirs is the first randomized controlled trial with a long-term follow-up to evaluate the efficacy of acupuncture in patients with post-stroke motor aphasia. Considering the reasons for the effect of acupuncture on improving language deficits, they concluded that the 30-session treatment provided “a sufficient acupuncture dose” and attributed its effect to strictly following a standard treatment protocol.

“The study results confirmed that post-stroke motor aphasia was the dominant condition affected by the acupuncture treatment, indicating that acupuncture might serve as an adjunctive treatment for patients with post-stroke motor aphasia,” said the researchers. “In addition, the clinical effects and safety results provide evidence for policymakers, clinicians, and patients regarding the management of post-stroke aphasia with acupuncture.”

The study was published in the journal JAMA Network Open.