Amount of Therapy Matters in Very Early Aphasia Rehabilitation after Stroke: A Clinical Prognostic Model

Godecke, Erin; Rai, Tapan; Ciccone, Natalie; Armstrong, Elizabeth; Granger, Andrew; Hankey, Graeme J.

doi:10.1055/s-0033-1358369

Cited by 32 publications

(17 citation statements)

References 39 publications

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“…Taken together with the fact that the intensity (duration and frequency) of both intensive therapy periods were equal and different from the conventional therapy period, it is most likely that the intensity influenced RL's therapeutic outcome (alterations of the behavioural PALPA 1 and neurophysiological N400 PW amplitude). Although a large number of studies provide evidence for the efficacy of intensive treatment (e.g., Breitenstein et al, 2009;Meinzer, Rodriguez, & Gonzalez Rothi, 2012;Godecke et al, 2013;Pulvermüller et al, 2005), other studies claim that intensity does not provide an added value to therapy results (Bakheit et al, 2007;Cherney, Patterson, & Raymer, 2011;Hinckley & Carr, 2005). However, when taking a closer look at the methodology, there seems to be a difference compared to the present study concerning the actual definition of intensity and type of therapy.…”

Section: Effect Of Therapy Per Periodcontrasting

confidence: 61%

“…In terms of timing of therapy after stroke, language treatment seems to improve communication outcome in people with moderate to severe aphasia in both very early and chronic stages of recovery from stroke, independent of type and content of treatment (Allen et al, 2012;Corsten et al, 2007;Godecke, Hird, Lalor, Rai, & Phillips, 2012;Godecke et al, 2013). However, others have suggested that aphasia therapy might not provide added value in the acute stage, as functional communication sometimes improves equally after speech and language therapy, with regular social contacts or even without therapy (Bowen et al, 2012;Laska, Kahan, Hellblom, Murray, & von Arbin, 2011).…”

Section: Introductionmentioning

confidence: 99%

“…The role of intensity (frequency and duration) of therapy has recently been postulated to be a predictive factor for aphasia recovery (Godecke et al, 2013). As treatment intensity increases, therapy outcome seems to improve (Cherney, Patterson, Raymer, Frymark, & Schooling, 2008).…”

Section: Introductionmentioning

confidence: 99%

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Aphasia therapy early after stroke: behavioural and neurophysiological changes in the acute and post-acute phases

et al. 2015

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Background: There is reasonable evidence to suggest that speech and language therapy can be effective in the chronic stages of stroke recovery. However, the active ingredients remain unknown and several variables can influence therapy outcome, such as content, type, and amount of therapy. Neurophysiological measures, event-related brain potentials such as the N400 and P300, have shown to be sensitive markers of therapeutic effects. As a supplement to the usual behavioural evaluation methods, neurophysiological measures might help to further disentangle the effect of content, type, and/or amount of therapy. Aims: The present single case study aims to investigate the effect of language therapy by combining behavioural and neurophysiological outcome measures in a patient with aphasia during the acute and post-acute stage after stroke. By further subdividing the therapy period into different therapy blocks, possible influences of content, type, and/or amount of therapy are investigated. Methods & Procedures: RL is a 47-year-old man with a moderate non-fluent aphasia, who received three periods of therapy in the first fourmonths after his stroke. The initial evaluation moment occurred 10days post-stroke. First, he received an intensive language treatment of 30hr in 3weeks, which was followed by a conventional treatment of 30hr in 7weeks. Then, RL received a second, intensive language therapy of 30hr in 3weeks. This was followed by a period of 6months without any form of language treatment. Behavioural and neurophysiological measures were collected after every therapy and therapy-free period. The effect of therapy was examined by comparing the whole therapy period with the therapy-free period, without differentiating between the intensive and conventional treatment. In a second analysis, a comparison was made between the intensive therapy periods and the conventional therapy programme. Outcomes & Results: RL showed a general improvement on both behavioural and neurophysiological measures after the whole therapy period, which was preserved throughout the therapy-free period. Intensive treatment yielded better language outcomes as indicated by a behavioural and neurophysiological improvement in contrast with the behavioural deterioration of auditory discrimination of pseudowords and decline of the N400 neurophysiological marker, after the conventional therapy. Conclusions: The present study demonstrates the outcome of early language treatment after stroke in which intensity can play an important role. In addition, the use of neurophysiological outcome measures provides added value to the behavioural evaluations in the context of therapeutic follow-up

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Section: Effect Of Therapy Per Periodcontrasting

confidence: 61%

Section: Introductionmentioning

confidence: 99%

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Aphasia therapy early after stroke: behavioural and neurophysiological changes in the acute and post-acute phases

et al. 2015

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“…This investigation was prompted by research indicating that persons with acute aphasia benefit from speech and language therapy that is more intensive (Brady et al, 2012; Godecke et al, 2013; Martins et al, 2013). Although we found that an additional daily hour of CILT was feasible to implement during the two-week course of the study, there were major barriers with regard to pairing participants and scheduling the sessions.…”

Section: Discussionmentioning

confidence: 99%

“…We also hypothesized that the participants receiving CILT would show greater gains on standardized measures selected from the BDAE as compared to participants receiving usual care. These hypotheses were based on evidence suggesting that more intensive treatment would benefit participants with acute/subacute aphasia (Godecke et al, 2013; Kirmess & Maher, 2010; Martins et al, 2013). …”

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confidence: 99%

Increasing aphasia treatment intensity in an acute inpatient rehabilitation programme: a feasibility study

Carpenter

Cherney

2015

Aphasiology

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Background Intensity of therapy is a critical factor influencing outcomes in aphasia. However, there are many barriers to increasing treatment intensity for those with acute/subacute aphasia including the demands of the inpatient medical facilities and the endurance of the participants. Nevertheless, with some modifications to its original procedures, evidence suggests that Constraint Induced Language Therapy (CILT) may yield positive outcomes when given in the early stages of recovery. Aims To investigate the feasibility of increasing the amount of therapy provided to individuals with aphasia on an inpatient rehabilitation unit by adding CILT at a modified intensity, and to assess whether those receiving two weeks of the additional CILT show more improvement than control participants who did not receive the additional treatment. Methods and Procedures A case-series single-subject design study was conducted. All participants received usual care of approximately an hour of speech and language treatment, five to six days a week. Participants in the experimental condition received an additional hour-long CILT session, five days per week, for two weeks. Trained, untrained, and generalization probes comprising naming of pictured items and oral reading of sentences were taken at baseline, during treatment, and at post-treatment. All participants were probed equally. Probe performance was scored and effect sizes were calculated and compared. Performance gains from pre- to post-treatment on subtests of the Boston Diagnostic Aphasia Examination were also compared. Outcomes and Results Thirteen individuals with aphasia onset ranging from 7 to 68 days were recruited, with 6 allocated to the experimental Usual Care + CILT condition and 7 allocated to the control Usual Care condition. Increasing the amount of speech and language therapy by adding an hour of daily CILT was feasible. Individual performance varied within and across conditions with large gains noted in some, but not all participants. As a group, there was a small to medium effect size of the Usual Care + CILT condition over Usual Care alone for trained and untrained oral reading probes and untrained naming probes. Conclusions It is feasible to increase the amount of treatment provided to participants with aphasia on an acute inpatient rehabilitation unit. Preliminary results suggest that there may be better outcomes for those who receive more treatment. Further research using larger numbers of homogeneous participants and controlling for content of therapy as well as amount of therapy is warranted.

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Person-centered Neurology

Kesselring

Narotam-Jeena²

2023

Person Centered Medicine

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Amount of Therapy Matters in Very Early Aphasia Rehabilitation after Stroke: A Clinical Prognostic Model

Abstract: Background and Aim

Cited by 32 publications

References 39 publications

Aphasia therapy early after stroke: behavioural and neurophysiological changes in the acute and post-acute phases

Aphasia therapy early after stroke: behavioural and neurophysiological changes in the acute and post-acute phases

Increasing aphasia treatment intensity in an acute inpatient rehabilitation programme: a feasibility study

Person-centered Neurology

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