Current Approaches to the Treatment of Post-Stroke Aphasia

Abstract

Aphasia, impairment of language after stroke or other neurological insult, is a common and often devastating condition that affects nearly every social activity and interaction. Behavioral speech and language therapy is the mainstay of treatment, although other interventions have been introduced to augment the effects of the behavioral therapy. In this narrative review, we discuss advances in aphasia therapy in the last 5 years and focus primarily on properly powered, randomized, controlled trials of both behavioral therapies and interventions to augment therapy for post-stroke aphasia. These trials include evaluation of behavioral therapies and computer-delivered language therapies. We also discuss outcome prediction trials as well as interventional trials that have employed noninvasive brain stimulation, or medications to augment language therapy. Supported by evidence from Phase III trials and large meta-analyses, it is now generally accepted that aphasia therapy can improve language processing for many patients. Not all patients respond similarly to aphasia therapy with the most severe patients being the least likely responders. Nevertheless, it is imperative that all patients, regardless of severity, receive aphasia management focused on direct therapy of language deficits, counseling, or both. Emerging evidence from Phase II trials suggests transcranial brain stimulation is a promising method to boost aphasia therapy outcomes.

Clinical and Neural Predictors of Treatment Response to Music Listening Intervention after Stroke

“…In other words, patients with a more severe initial deficit and more education (for verbal memory only) benefited more from the music listening intervention. This seems to be at odds with findings from previous studies in aphasia where more severe aphasia has been linked to worse outcome in spontaneous recovery and in response to speech and language therapy [44]. Our result could be interpreted as indicating that music listening might be particularly beneficial and useful in patients with higher severity of aphasia, but then again it may also reflect the current study population, which did not include patients with global or very severe aphasia.…”

Disrupted Functional Connectivity Within and Between Resting-State Networks in the Subacute Stage of Post-stroke Aphasia

“…Language function remodeling in PSA is characterized by temporal and spatial variability ( Stefaniak et al, 2020 ). The reperfusion and inflammatory response of the perilesional tissue largely disappears in the subacute phase of PSA, and the brain is considered to be in a relatively more stable state than in the acute stage ( Fu et al, 2015 ; Boyd et al, 2017 ); this is also an effective therapeutic window for speech rehabilitation ( Brady et al, 2016 ; Fridriksson and Hillis, 2021 ). Therefore, understanding the pathophysiological mechanism of the subacute stage of PSA is very important for aphasia treatment, as the field moves from standardized therapies toward more targeted individualized treatment strategies ( Thiel and Zumbansen, 2016 ).…”

Predictors of Therapy Response in Chronic Aphasia: Building a Foundation for Personalized Aphasia Therapy

“…However, few generalizable and clinically applicable predictors of therapy response have been identified to date. The primary cause likely stems from the fact that the relevant literature is predominated with single-subject and small group studies [ 13 , 17 ]. While single-subject and small group study designs are well-suited to acquire detailed accounts of the experiences of individuals with specific characteristics, they are, by definition, not intended to reflect population parameters.…”