Improvement of language function after Contralateral Seventh Cervical Nerve Transfer in hemiplegic patients combined with post-stroke aphasia: a prospective observational cohort study

Background While the contralateral seventh cervical nerve (CC7) cross transfer was designed to reconstruct paralyzed arm function after stroke, improvement in language function was found in patients combined with aphasia. Objective To evaluate the effect of improvement in language function after CC7 cross transfer in stroke patients with chronic aphasia and explore its potential mechanism. Methods In a prospective observative cohort, patients diagnosed with hemiplegia combined with aphasia were included. The language function was evaluated through the changes of Aphasia Quotient evaluated by Western Aphasia Battery (WAB-AQ) as well as its four subtests from baseline to 1 week and 6 months after the surgery. Patients also received oral agility test by Boston Diagnostic Aphasia Examination (BDAE-OA). Resting-state functional MRI (rs-fMRI) was scanned before and over 6 months after the surgery to explore the potential central mechanism in language improvements. Results The average increase of WAB-AQ was 8.08 points from baseline to 1 week post-operatively (P<0.001, 95%CI: 5.05-11.10), and 9.51 from baseline to 6-month (P<0.001, 95%CI: 6.75-12.27). In 8 patients who participant in BDAE-OA, the average increase was 3.7 points (95%CI: 0.56-6.84; corrected P =0.023) from baseline to 1-week follow-up, and 5.3 points from baseline to 6 months follow-up. Significant higher local activity was detected at right precentral cortex, right gyrus rectus, and right anterior cingulate cortex after the surgery from rs-fMRI. Conclusions Immediate and stable improvement in language function was detected after CC7 cross transfer in hemiplegic patients combined with aphasia, which may be realized through enhanced function of language network in the right hemisphere. ### Competing Interest Statement The authors have declared no competing interest. ### Clinical Trial ChiCTR2200060235 ### Funding Statement This study was funded by the National Natural Science Foundation of China (82021002, 81830063 and 82072539), CAMS Innovation Fund for Medical Sciences (2019-I2M-5-007), Shanghai Clinical Research Center for Aging and Medicine (19MC1910500), National key R&D program of China (2022YFC3602701), Youth Talent Project of Shanghai Municipal Health Commission (2022YQ009). ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Institutional review board of Shanghai Jing An District Central Hospital gave ethical approval for this work. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data produced in the present study are available upon reasonable request to the authors.