First Decade of Research on Constrained-Induced Treatment Approaches for Aphasia Rehabilitation

Abstract

Approaches for treating post-stroke language impairments (aphasia) based upon Constraint-Induced (CI) principles were first introduced in 2001. CI principles as previously applied to upper extremity and locomotor retraining in stroke survivors were derived from basic neuroscience. They comprise forced-use of the affected modality, a gradual rebuilding of targeted functions using a highly intensive treatment protocol, administered in a behaviorally-relevant context. CI-based approaches have stimulated considerable neurorehabilitation research interest in the past decade. The original CI aphasia treatment protocol was tailored to improve functional communication in chronic aphasia (i.e., 6–12 months after stroke) and more recently, it has been adapted to treat language impairments in acute stroke survivors as well. Moreover, CI therapy applied to aphasia has been used as a model to assess language network plasticity in response to treatment using functional imaging techniques. In the following paper, we review the first 10 years of behavioral and functional brain imaging research on CI-based approaches for aphasia rehabilitation.

“Do you havemowing the lawn?” – improvements in word retrieval and grammar following constraint-induced language therapy in primary progressive aphasia

“…In the following years, further research has been conducted replicating these findings under modified conditions (e.g., Barthel, Meinzer, Djundja, & Rockstroh, 2008;Meinzer, Rodriguez, & Rothi, 2012). Meinzer, Djundja, Barthel, Elbert, and Rockstroh (2005) developed one of the first modified CIAT protocols: CIATplus.…”

“…Every participant received 10 picture cards at the beginning of each game. They needed to request picture cards from their teammates, aiming to collect as many matching pairs as possible (Meinzer et al, 2012). A student speech pathologist was involved as a third player to increase the number of players and model the required picture description structure.…”

Intensive Language Action Therapy in Chronic Aphasia: A Randomized Clinical Trial Examining Guidance by Constraint

“…However, Pulvermüller and others have since refined the principle to guidance by constraint (i.e., focusing), noting that the aim of avoiding learned nonuse is not to prevent the use of gestures altogether but rather to make it more difficult for persons with aphasia to perform communicative actions without using spoken language (Berthier & Pulvermüller, 2011;Difrancesco et al, 2012;Pulvermüller & Berthier, 2008). Moreover, as Meinzer et al (2012) noted, many recent studies have allowed gesturing during constraint-induced treatment (e.g., Meinzer, Elbert, Djundja, Taub, & Rockstroh, 2007) due to the interdependence of language, action, and perception (Pulvermüller & Fadiga, 2010) and the potential for gesture to facilitate language processing (Rose, 2012).…”

Constraint-Induced Linguistic Therapy for Aphasic Patients in Hungary

“…We can claim that therapeutic language games could regain some of patients' lost linguistic functions in a very short time with a quite intensive guided practice [18][19][20] not to avoid the problematic forms of verbal stimuli but with the help of corporation and motivation. The indicators of this activity and intensity based therapy focus on both the production and the comprehension of speech in an appropriate communicative context.…”