Intensive language therapy in chronic aphasia: Which aspects contribute most?

Barthel, Gabriela; Meinzer, Marcus; Djundja, Daniela; Rockstroh, Brigitte

doi:10.1080/02687030701415880

Cited by 90 publications

(87 citation statements)

References 20 publications

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“…Forced use of the impaired system, combined with high intensity and high frequency of treatment seems to prevent or reverse learned non-use, according to Taub and others [12][13][14]. This concept of forced use, high intensity, high frequency was introduced to the field of aphasia therapy by Pulvermüller et al [6] and has been replicated by others, with verbal communication as the targeted outcome [15][16][17]. Forced use of the impaired communication system, with high frequency and high intensity therapy is now known as constraint induced aphasia therapy (CIAT) [6,18,19].…”

Section: Original Articlementioning

confidence: 99%

Stress and language recovery in individuals with aphasia: constraint induced aphasia therapy

Sharp

Shaughnessy

Berk

et al. 2013

PTRS

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Objective: Constraint induced aphasia therapy (CIAT) is a more intensive form of language treatment for aphasia as compared to traditional treatments. This study examined whether there are differences in cortisol stress levels between the two methods of aphasia treatment as well as effects on language skills. Design: Randomized controlled trial. Methods: A total of 20 participants with expressive aphasia were randomly placed into one of the two treatment groups. The CIAT group received 10 days of intensive treatment over two weeks. The traditional therapy group received 6 days of treatment over 2 weeks. All participants in each group provided salivary cortisol samples before treatment, at the mid-point of treatment, and at the conclusion of treatment. Language skills were assessed before treatment and at the conclusion of treatment. Results: A significantly higher proportion of individuals in the CIAT treatment group had increased salivary cortisol stress levels when compared to the traditional treatment group at the mid-point of the program (80% versus 30% respectively, p<0.05). There was no significant difference in the proportion of individuals with increased cortisol stress by the end of the treatment. Language scores for word repetition and overall aphasia quotient significantly improved for the CIAT group when compared to the traditional group (p<0.05). Conclusions:The CIAT treatment appears to initially create increased psychophysiological stress as compared to the traditional treatment. In spite of the initial increases in psychophysiological stress, participants appear to become conditioned to the challenge and ultimately have enhanced benefit from CIAT treatment.

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Section: Original Articlementioning

confidence: 99%

Stress and language recovery in individuals with aphasia: constraint induced aphasia therapy

Sharp

Shaughnessy

Berk

et al. 2013

PTRS

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“…Barthel, Meinzer, Djundja, and Rockstroh (2008) compared treatment outcomes following application of model-oriented aphasia therapy (MOAT, a model-based approach that was based on Nickels, 2002) in 12 participants with chronic aphasia (PWAs) to outcomes previously described for constraintinduced aphasia therapy (CIAT; Meinzer, Djundja, Barthel, Elbert, & Rockstroh, 2005). In the CIAT study, 12 of 27 participants had been treated with CIAT (also known as CILT), whereas the other 15 underwent CIATplus (i.e., CIAT with additional reading and other training modules) and involvement of family members.…”

mentioning

confidence: 99%

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

Kurland

Stanek

Stokes

et al. 2016

Am J Speech Lang Pathol

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Purpose Intensive language action therapy (ILAT) can be effective in overcoming learned nonuse in chronic aphasia. It is suggested that all three guiding principles (constraint, communication embedding, massed practice) are essential to ILAT's success. We examined whether one of these, guidance by constraint, is critical. Method Twenty-four participants with aphasia (PWAs) were assigned to ILAT or a modified version of promoting aphasic communicative effectiveness (PACE) in a randomized block, single-blind, parallel-group treatment study. Blocking was by severity (mild/moderate, moderate to severe, severe). Both groups received intensive treatment in the context of therapeutic language action games. Whereas the ILAT group was guided toward spoken responses, the PACE group could choose any response modality. Results All participants, whether assigned to ILAT or PACE groups, improved on the primary outcome measure, picture naming. There was a Severity × Treatment interaction, with the largest effects estimated for PWAs with mild/moderate and moderate to severe aphasia. Regardless of severity, the ILAT group outperformed the PACE group on untrained pictures, suggesting some benefit of ILAT to generalization. However, this difference was not statistically significant. Conclusion Although the groups differed in subtle ways, including better generalization to untrained pictures for ILAT, the study was inconclusive on the influence of guidance by constraint.

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“…Barthel, Meinzer, Djundja and Rockstroh (2008) found that group-based CIAT provided equivalent gains to individually-delivered model-oriented aphasia therapy of the same intensity. This suggests that CIAT should provide a cost-saving relative to individual provision of therapy.…”

Section: Introductionmentioning

confidence: 96%

“…Pulvermüller and Berthier (2008) note "As the word "constraint" can be misunderstood in the negative sense of "restraint", it may appear more appropriate to speak about "focusing" in this context: The idea is to help the patient focus on those language tools that are in their range of capabilities although they frequently remain unused" (p570; see also Meinzer et al, 2012 pS36;Difrancesco, Pulvermüller & Mohr, 2012). Similarly, following their finding of similar outcomes between CIAT and an unconstrained, model-oriented, aphasia therapy, Barthel et al (2008) suggest that constraining nonverbal compensatory communication could be a dispensable element of CIAT. While some studies have suggested a benefit for CIAT over group programmes of the same intensity which do not constrain communication to oral language (e.g.…”

Section: Introductionmentioning

confidence: 99%

Constraint Induced Aphasia Therapy: Volunteer-led, unconstrained and less intense delivery can be effective

Nickels

Osborne

2016

NRE

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Abstract.BACKGROUND: Constraint Induced Aphasia Therapy (CIAT) has been shown to be effective in the treatment of aphasia, but clinicians have expressed concern regarding how far CIAT is practical to implement in clinical practice. OBJECTIVE: To determine whether CIAT delivered in a less-intense, lower dose, reduced constraint and volunteer-led format could produce positive outcomes in people with chronic aphasia. METHODS: Two groups were run, each with two people with chronic aphasia. Treatment involved a standard CIAT cardexchange game, supplemented by a home activity. Spoken language was required for responses but alternative modalities of communication were also permitted. Each group was led by a trained volunteer, lasted 90 minutes and was delivered twice a week for four weeks. RESULTS: Three of the four participants showed significant improvements in target word retrieval following treatment. No significant improvements were observed for untreated stimuli or language tasks. Two participants showed increases in the elaboration of their responses, and the same two showed an increase in the frequency with which they engaged in communication activities. CONCLUSIONS: Clear gains in performance were observed for the majority of people with aphasia who participated in a less intense format, considerably lower dose and less constrained form of CIAT led by trained volunteers. This suggests that this 'clinically realistic' service delivery model for CIAT could be added to the clinical repertoire of speech pathologists.

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Intensive language therapy in chronic aphasia: Which aspects contribute most?

Cited by 90 publications

References 20 publications

Stress and language recovery in individuals with aphasia: constraint induced aphasia therapy

Stress and language recovery in individuals with aphasia: constraint induced aphasia therapy

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

Constraint Induced Aphasia Therapy: Volunteer-led, unconstrained and less intense delivery can be effective

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