Efficacy of early cognitive-linguistic treatment for aphasia due to stroke: A randomised controlled trial (Rotterdam Aphasia Therapy Study-3)

Abstract

IntroductionOne third of patients with acute stroke have aphasia. The majority receive speech and language therapy. There is evidence for a beneficial effect of speech and language therapy on restoring communication, but it is unknown whether and how efficacy of speech and language therapy is influenced by timing of treatment. We studied whether speech and language therapy early after stroke by way of intensive cognitive-linguistic treatment is more effective than no speech and language therapy in the Rotterdam Aphasia Therapy Study-3, a multicentre randomised single-blind trial.Methods and patientsStroke patients with first-ever aphasia were randomised within 2 weeks of onset to either 4 weeks of early intensive cognitive-linguistic treatment (1 h/day) or no language treatment. Hereafter, both groups received regular speech and language therapy. Primary outcome was the score on the Amsterdam-Nijmegen Everyday Language Test, measuring everyday verbal communication, 4 weeks after randomisation. Secondary outcomes were Amsterdam-Nijmegen Everyday Language Test at 3 and 6 months. The study was powered to detect a clinically relevant difference of four points on the Amsterdam-Nijmegen Everyday Language Test.ResultsOf the 152 included patients, 80 patients were allocated to intervention. Median treatment intensity in the intervention-group was 24.5 h. The adjusted difference between groups in mean Amsterdam-Nijmegen Everyday Language Test-scores 4 weeks after randomisation was 0.39, 95% confidence interval: [−2.70 to 3.47], p = 0.805. No statistically significant differences were found at 3 and 6 months after randomisation either.ConclusionFour weeks of intensive cognitive-linguistic treatment initiated within 2 weeks of stroke is not more effective than no language treatment for the recovery of post-stroke aphasia. Our results exclude a clinically relevant effect of very early cognitive-linguistic treatment on everyday language.

The Role of the BDNF Val66Met Polymorphism in Recovery of Aphasia After Stroke

“…One recent study has found no difference in language recovery between a group receiving intensive aphasia treatment compared to a group receiving no treatment. 50 In the context of the present study, it would be interesting to investigate how BDNF may interact with SLT in the chronic phase.…”

Early Rehabilitation After Stroke: a Narrative Review

“…The largest and most robust of these is the Rotterdam Aphasia Therapy Study-3(RATS-3) [69], which enrolled 152 subjects in 14 centers across the Netherlands. RATS-3 enrolled patients within 14 days of a first stroke causing aphasia, randomized them to intensive speech therapy (ST), 1 h/day, 5 days/week for 4 weeks, or no therapy, and used the Amsterdam-Nijmegen Everyday Language Test (ANELT) at 4 weeks as the primary outcome.…”

Validation of a prediction model for long-term outcome of aphasia after stroke

“…For external validation of the SPEAK-model we used data from the Rotterdam Aphasia Therapy Study (RATS) – 3, a randomized controlled trial (RCT) studying the efficacy of early initiated intensive cognitive-linguistic treatment for aphasia due to stroke, conducted between 2012 and 2014 [ 21 , 22 ]. RATS-3 was approved by an independent medical ethical review board.…”

“…RATS-3 was approved by an independent medical ethical review board. Details about the study design, methods and results have been reported elsewhere and a summary will be provided below [ 21 , 22 ].…”