Intensity of Aphasia Therapy: Evidence and Efficacy

Abstract

Determining the optimal amount and intensity of treatment is essential to the design and implementation of any treatment program for aphasia. A growing body of evidence, both behavioral and biological, suggests that intensive therapy positively impacts outcomes. We update a systematic review of treatment studies that directly compares conditions of higher and lower intensity treatment for aphasia. We identify five studies published since 2006, review them for methodologic quality, and synthesize their findings with previous ones. For both acute and chronic aphasia, results at the language impairment and communication activity/participation levels tend to be more equivocal than previously demonstrated, with no clear differences between intensive and nonintensive treatment emerging across studies. Future research directions are discussed including research design, definitions of treatment intensity, and behavioral and biological measurement of short- and long-term changes following implementation of an intensive treatment.

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

“…Until very recently, the trend has favored this "more is better" framework for treatment intensity (Cherney, Patterson, Raymer, Frymark, & Schooling, 2008). This framework has recently been called into question, however, with one systematic review finding equivocal results in studies directly comparing intensive with nonintensive schedules of treatment delivery (Cherney, Patterson, & Raymer, 2011). It should be noted, however, that the review only included five studies, most of which had low numbers of participants.…”

“…Whether and to what degree massed practice, communication embedding, and/or guidance by constraint are responsible for such improvement is still-and should be-under investigation (Cherney et al, 2008(Cherney et al, , 2011Cherney, Patterson, Raymer, Frymark, & Schooling, 2010). All three principles are based on fundamental principles of aphasia therapy originating in the neuroscience of learning (Berthier & Pulvermüller, 2011;Pulvermüller & Berthier, 2008), and hence these authors have recommended applying them together.…”

Stroke unit treatment: long-term effects

“…In comparison with lack of language treatment, language treatment results in improved functional communication [56]. A debate continues over the effectiveness of intensive treatment with respect to study design, definitions of treatment intensity and measurement of short and long-term changes [57]. Enhanced communication therapy offered by a speech and language therapist and similarly intensive social contacts were equally effective within 2 weeks and 4 months after stroke [58].…”

Outcomes of an Intensive Comprehensive Aphasia Program

“…36,37 Almost a decade later, evidence is still equivocal about the efficacy of intensive aphasia therapy and the specific ingredients that allow for the best outcomes for individual persons with aphasia. [38][39][40][41] Cherney et al examined 11studies and found no clear differences in outcomes between intensive and non-intensive treatment protocols. 41 The recommendations from their review were to examine the behavioural and neuroimaging results of intensive treatment independently and in combination with influencing factors.…”

“…[38][39][40][41] Cherney et al examined 11studies and found no clear differences in outcomes between intensive and non-intensive treatment protocols. 41 The recommendations from their review were to examine the behavioural and neuroimaging results of intensive treatment independently and in combination with influencing factors. Factors that may impact recovery may not be readily measurable.…”