Optimal timing of speech and language therapy for aphasia after stroke: more evidence needed

Nouwens, Femke; Eg, Visch-Brink; Sandt-Koenderman, Van de; Dippel, Diederik W.J.; Pj, Koudstaal; Lau, de

doi:10.1586/14737175.2015.1058161

Cited by 26 publications

(18 citation statements)

References 69 publications

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“…Although several studies point to a larger effect of aphasia therapy if applied in the first 3 months after stroke, (Robey, 1998; Bakheit et al, 2007a) a recent review showed that the currently available evidence on the optimal timing of aphasia therapy is inconclusive and insufficient (Nouwens et al, 2015). The contradictory findings may be related to differences in study populations, e.g., including persons with various types of aphasia and/or receiving different types of aphasia treatment.…”

Section: Discussionmentioning

confidence: 99%

Melodic Intonation Therapy in Chronic Aphasia: Evidence from a Pilot Randomized Controlled Trial

Meulen

Sandt-Koenderman

Heijenbrok

et al. 2016

Front. Hum. Neurosci.

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Melodic Intonation Therapy (MIT) is a language production therapy for severely non-fluent aphasic patients using melodic intoning and rhythm to restore language. Although many studies have reported its beneficial effects on language production, randomized controlled trials (RCT) examining the efficacy of MIT are rare. In an earlier publication, we presented the results of an RCT on MIT in subacute aphasia and found that MIT was effective on trained and untrained items. Further, we observed a clear trend in improved functional language use after MIT: subacute aphasic patients receiving MIT improved considerably on language tasks measuring connected speech and daily life verbal communication. Here, we present the results of a pilot RCT on MIT in chronic aphasia and compare these to the results observed in subacute aphasia. We used a multicenter waiting-list RCT design. Patients with chronic (>1 year) post-stroke aphasia were randomly allocated to the experimental group (6 weeks MIT) or to the control group (6 weeks no intervention followed by 6 weeks MIT). Assessments were done at baseline (T1), after 6 weeks (T2), and 6 weeks later (T3). Efficacy was evaluated at T2 using univariable linear regression analyses. Outcome measures were chosen to examine several levels of therapy success: improvement on trained items, generalization to untrained items, and generalization to verbal communication. Of 17 included patients, 10 were allocated to the experimental condition and 7 to the control condition. MIT significantly improved repetition of trained items (β = 13.32, p = 0.02). This effect did not remain stable at follow-up assessment. In contrast to earlier studies, we found only a limited and temporary effect of MIT, without generalization to untrained material or to functional communication. The results further suggest that the effect of MIT in chronic aphasia is more restricted than its effect in earlier stages post stroke. This is in line with studies showing larger effects of aphasia therapy in earlier compared to later stages post stroke. The study was designed as an RCT, but was underpowered. The results therefore have to be interpreted cautiously and future larger studies are needed.Clinical Trial Registration: www.ClinicalTrials.gov, identifier NTR 1961.

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Section: Discussionmentioning

confidence: 99%

Melodic Intonation Therapy in Chronic Aphasia: Evidence from a Pilot Randomized Controlled Trial

Meulen

Sandt-Koenderman

Heijenbrok

et al. 2016

Front. Hum. Neurosci.

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“…Moreover, the trial also revealed an improvement in communicative quality of life (Cohen's d=0. 27), an important finding that had eluded many earlier trials (e.g., references [23][24][25] ). Taken together, large meta-analyses and the Breitenstein et al 18 trial provide robust evidence in favor of SLT for post-stroke aphasia.…”

Section: Efficacy Of Behavioral Speech and Language Therapy For Aphasiamentioning

confidence: 95%

Current Approaches to the Treatment of Post-Stroke Aphasia

Fridriksson

Hillis

2021

J Stroke

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Aphasia, impairment of language after stroke or other neurological insult, is a common and often devastating condition that affects nearly every social activity and interaction. Behavioral speech and language therapy is the mainstay of treatment, although other interventions have been introduced to augment the effects of the behavioral therapy. In this narrative review, we discuss advances in aphasia therapy in the last 5 years and focus primarily on properly powered, randomized, controlled trials of both behavioral therapies and interventions to augment therapy for post-stroke aphasia. These trials include evaluation of behavioral therapies and computer-delivered language therapies. We also discuss outcome prediction trials as well as interventional trials that have employed noninvasive brain stimulation, or medications to augment language therapy. Supported by evidence from Phase III trials and large meta-analyses, it is now generally accepted that aphasia therapy can improve language processing for many patients. Not all patients respond similarly to aphasia therapy with the most severe patients being the least likely responders. Nevertheless, it is imperative that all patients, regardless of severity, receive aphasia management focused on direct therapy of language deficits, counseling, or both. Emerging evidence from Phase II trials suggests transcranial brain stimulation is a promising method to boost aphasia therapy outcomes.

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“…the interval between stroke onset and start of treatment, and its efficacy is unclear. 4 In a meta-analysis comparing studies with different starting points of SLT, the average effect size in studies evaluating treatment initiated in the first 3 months after stroke was larger than that in studies performed in a later stage. 5 However, this analysis was mainly based on uncontrolled and non-randomised studies.…”

Section: Introductionmentioning

confidence: 96%

Efficacy of early cognitive-linguistic treatment for aphasia due to stroke: A randomised controlled trial (Rotterdam Aphasia Therapy Study-3)

Nouwens

Lau

Visch-Brink

et al. 2017

European Stroke Journal

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IntroductionOne third of patients with acute stroke have aphasia. The majority receive speech and language therapy. There is evidence for a beneficial effect of speech and language therapy on restoring communication, but it is unknown whether and how efficacy of speech and language therapy is influenced by timing of treatment. We studied whether speech and language therapy early after stroke by way of intensive cognitive-linguistic treatment is more effective than no speech and language therapy in the Rotterdam Aphasia Therapy Study-3, a multicentre randomised single-blind trial.Methods and patientsStroke patients with first-ever aphasia were randomised within 2 weeks of onset to either 4 weeks of early intensive cognitive-linguistic treatment (1 h/day) or no language treatment. Hereafter, both groups received regular speech and language therapy. Primary outcome was the score on the Amsterdam-Nijmegen Everyday Language Test, measuring everyday verbal communication, 4 weeks after randomisation. Secondary outcomes were Amsterdam-Nijmegen Everyday Language Test at 3 and 6 months. The study was powered to detect a clinically relevant difference of four points on the Amsterdam-Nijmegen Everyday Language Test.ResultsOf the 152 included patients, 80 patients were allocated to intervention. Median treatment intensity in the intervention-group was 24.5 h. The adjusted difference between groups in mean Amsterdam-Nijmegen Everyday Language Test-scores 4 weeks after randomisation was 0.39, 95% confidence interval: [−2.70 to 3.47], p = 0.805. No statistically significant differences were found at 3 and 6 months after randomisation either.ConclusionFour weeks of intensive cognitive-linguistic treatment initiated within 2 weeks of stroke is not more effective than no language treatment for the recovery of post-stroke aphasia. Our results exclude a clinically relevant effect of very early cognitive-linguistic treatment on everyday language.

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Optimal timing of speech and language therapy for aphasia after stroke: more evidence needed

Cited by 26 publications

References 69 publications

Melodic Intonation Therapy in Chronic Aphasia: Evidence from a Pilot Randomized Controlled Trial

Melodic Intonation Therapy in Chronic Aphasia: Evidence from a Pilot Randomized Controlled Trial

Current Approaches to the Treatment of Post-Stroke Aphasia

Efficacy of early cognitive-linguistic treatment for aphasia due to stroke: A randomised controlled trial (Rotterdam Aphasia Therapy Study-3)

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