Long-Term Stability of Improved Language Functions in Chronic Aphasia After Constraint-Induced Aphasia Therapy

Abstract

Background and Purpose-In response to the established notion that improvement of language functions in chronic aphasia only can be achieved through long-term treatment, we examined the efficacy of a short-term, intensive language training, constraint-induced aphasia therapy (CIAT). This program is founded on the learning principles of prevention of compensatory communication (constraint), massed practice, and shaping (induced). Methods-Twenty-seven patients with chronic aphasia received 30 hours of training over 10 days. Twelve patients were trained with the CIAT program. For 15 patients the training included a module of written language and an additional training in everyday communication, which involved the assistance of family members (CIATplus). Outcome measures included standardized neurolinguistic testing and ratings of the quality and the amount of daily communication. Results-Language functions improved significantly after training for both groups and remained stable over a 6-month follow-up period. Single case analyses revealed statistically significant improvements in 85% of the patients. Patients and relatives of both groups rated the quality and amount of communication as improved after therapy. This increase was more pronounced for patients of the group CIATplus in the follow-up. Conclusions-Results confirm that a short-term intense language training, based on learning principles, can lead to substantial and lasting improvements in language functions in chronic aphasia. The use of family and friends in the training provides an additional valuable element. This effective intervention can be successfully used in the rehabilitation of chronic aphasia patients. Additionally, its short-term design makes it economically attractive for service providers.

Intensive language training in the rehabilitation of chronic aphasia: Efficient training by laypersons

“…However, no significant differences were present between groups. These findings replicate previous studies that report substantial improvement in language functions and measures of connected speech after CIAT in patients with different aphasia syndromes and levels of aphasia severity (Barthel et al, 2006;Maher et al, 2006;Meinzer et al, 2005;Pulvermueller et al, 2001). These results also agree with previous evidence of effective treatment provided by trained laypersons (David et al, 1982;Lesser et al, 1986;Marshall et al, 1989;Meikle et al, 1979;Shewan & Kertesz, 1984;Wertz et al, 1986;Worrall & Yiu, 2000).…”

“…As a consequence of the random assignment, patients of group B were significantly older than patients of group A [F(1,18) 5 7.62; p , .012]. As treatment success was not correlated with age in a previous study (Meinzer et al, 2005) …”

“…In a review of the literature, Bhogal et al (2003b) concluded that improvement was found only in studies, in which intense treatment was provided within a short time (ø intensity, 8.8 hr0week; ø duration, 11.2 weeks), but not when training sessions were spread across extended time intervals (ø intensity, 2 hr0week; ø duration, 22.9 weeks). Meinzer et al (2005) found substantial improvement of language functions in 27 chronic aphasia patients after 2 weeks of intensive training. However, no further improvement during a 6-month follow-up period during which patients received approximately 2 hr0week outpatient language therapy.…”

“…All patients received the same standardized intensive training, Constraint-Induced Aphasia Therapy (CIAT, Meinzer et al, 2005;Pulvermueller et al, 2001). CIAT is an adaption of Constraint-Induced Movement Therapy (CIMT), a well-evaluated therapeutic tool for the treatment of poststroke paresis (Taub et al, 1999).…”

“…In the present study, we selected CIAT as the treatment of choice because substantial and stable improvement of language function in chronic aphasia has been demonstrated (Maher et al, 2006;Meinzer et al, 2005;Pulvermueller et al, 2001). The short-term nature of the treatment controls for confounds related to extended treatment intervals (e.g., dropouts, influence of unspecific factors).…”