Long-Term Stability of Short-Term Intensive Language–Action Therapy in Chronic Aphasia: A 1–2 year Follow-Up Study

Abstract

Background. Intensive aphasia therapy can improve language functions in chronic aphasia over a short therapy interval of 2–4 weeks. For one intensive method, intensive language–action therapy, beneficial effects are well documented by a range of randomized controlled trials. However, it is unclear to date whether therapy-related improvements are maintained over years. Objective. The current study aimed at investigating long-term stability of ILAT treatment effects over circa 1–2 years (8–30 months). Methods. 38 patients with chronic aphasia participated in ILAT and were re-assessed at a follow-up assessment 8–30 months after treatment, which had been delivered 6–12.5 hours per week for 2–4 weeks. Results. A standardized clinical aphasia battery, the Aachen Aphasia Test, revealed significant improvements with ILAT that were maintained for up to 2.5 years. Improvements were relatively better preserved in comparatively young patients (<60 years). Measures of communicative efficacy confirmed improvements during intensive therapy but showed inconsistent long-term stability effects. Conclusions. The present data indicate that gains resulting from intensive speech–language therapy with ILAT are maintained up to 2.5 years after the end of treatment. We discuss this novel finding in light of a possible move from sparse to intensive therapy regimes in clinical practice.

Melodic Intonation Therapy for aphasia: A multi‐level meta‐analysis of randomized controlled trials and individual participant data

“…In our meta‐analysis, the influence of time post‐onset of stroke was seen only for IPD, not for RCT data. We submit two potential reasons for this differential finding: first, it may be a statistical artifact (fewer data points in the RCT category); second, substantial heterogeneity may exist among post‐stroke recovery trajectories, which does not “subtract out” during a treatment‐versus‐control comparison 33 . The latter conjecture would require consolidation by behavioral data in analogy to neurobiological models of language recovery 34 …”

“…8 To date, randomized controlled trial (RCT) data have confirmed the efficacy of MIT on validated outcomes in the late subacute or consolidation stage of aphasia (i.e., up to 12 months after stroke), 9 but not in the chronic stage of symptoms (i.e., more than 6-12 months after stroke). 10 From a methodological perspective, influences of spontaneous recovery are generally lower in the chronic stage of aphasia, as suggested by RCT data 11 and meta-analyses. 12 This points out the need to carefully consider the stage of symptoms post-stroke in research on MIT.…”

Melodic Intonation Therapy for aphasia: A multi-level meta-analysis of randomised controlled trials and individual participant data

“…We submit two potential reasons for this differential finding: first, it may be a statistical artifact (fewer data points in the RCT category); second, substantial heterogeneity may exist among post-stroke recovery trajectories, which does not “subtract out” during a treatment-vs.-control comparison. 33 The latter conjecture would require consolidation by behavioural data, possibly incorporating Saur et al’s model of language recovery. 34…”

“…From a methodological point of view, influences of spontaneous recovery are generally lower in the chronic stage of aphasia, as suggested by RCT data 10 and meta-analyses 11 . Therefore, it is important to consider stage of symptoms post-stroke.…”

“…8 To date, randomised controlled trial (RCT) data have confirmed the efficacy of MIT on validated outcome measures in the late subacute or consolidation stage of aphasia (i.e., up to 12 months after stroke), 9 but not in the chronic stage of symptoms (i.e., more than 6-12 months after stroke). 10 From a methodological perspective, influences of spontaneous recovery are generally lower in the chronic stage of aphasia, as suggested by RCT data 11 and meta-analyses. 12 This points out the need carefully to consider stage of symptoms post-stroke in research on MIT.…”