Efficacy of intensive aphasia therapy in patients with chronic stroke: a randomised controlled trial

Abstract

Objective: Recent evidence has fuelled the debate on the role of massed practice in the rehabilitation of chronic post-stroke aphasia. Here, we further determined the optimal daily dosage and total duration of intensive speech-language therapy.

Methods: Individuals with chronic aphasia more than 1 year post-stroke received Intensive Language-Action Therapy in a randomised, parallel-group, blinded-assessment, controlled trial. Participants were randomly assigned to one of two outpatient groups who engaged in either highly-intensive practice (Group I: 4 hours daily) or moderately-intensive practice (Group II: 2 hours daily). Both groups went through an initial waiting period and two successive training intervals. Each phase lasted 2 weeks. Co-primary endpoints were defined after each training interval.

Results: Thirty patients-15 per group-completed the study. A primary outcome measure (Aachen Aphasia Test) revealed no gains in language performance after the waiting period, but indicated significant progress after each training interval (gradual 2-week t-score change [CI]: 1.7 [±0.4]; 0.6 [±0.5]), independent of the intensity level applied (4-week change in Group I: 2.4 [±1.2]; in Group II: 2.2 [±0.8]). A secondary outcome measure (Action Communication Test) confirmed these findings in the waiting period and in the first training interval. In the second training interval, however, only patients with moderately-intensive practice continued to make progress (Time-by-Group interaction: P=0.009, η2=0.13).

Conclusions: Our results suggest no added value from more than 2 hours of daily speech-language therapy within 4 weeks. Instead, these results demonstrate that even a small 2-week increase in treatment duration contributes substantially to recovery from chronic post-stroke aphasia.

Conflict of interest statement

Competing interests: None declared.

© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Figures

Figure 1

Consolidated Standards of Reporting Trials flow diagram.

Figure 2

Lesion overlay maps. Patients received Intensive Language-Action Therapy with 4 hours (Group I; see panel A) or with 2 hours of daily practice (Group II; see panel B). Different colours indicate the degree of lesion overlap in each treatment group.

Figure 3

Aphasia test results. Changes in language performance on the Aachen Aphasia Test (AAT; see panel A) and on the Action Communication Test (ACT; see panel B). Thirty individuals with chronic post-stroke aphasia were randomly assigned to one of the two Groups: patients receiving Intensive Language-Action Therapy with 4 hours (Group I) or with 2 hours of daily practice (Group II). All patients went through an initial waiting period (‘baseline’) and two successive training intervals (‘therapy phase’). Each trial phase lasted 2 weeks. Testing took place at four points in Time: 2 weeks before treatment onset (T0), at treatment onset (T1), after the first training interval (T2) and after the second training interval (T3). Focusing on changes in language performance separately for each trial phase [Δ(T1–T0); Δ(T2–T1); Δ(T3–T2)], statistics refer to significant paired-sample t-tests (asterisks embedded in bar graphs) and to a significant Time-by-Group interaction, as revealed by repeated-measures analyses of variance (asterisks displayed above bar graphs; *P<0.05, **P<0.01). Error bars represent CIs corrected for between-subject variance. Independent-sample t-tests confirmed that Group I and Group II did not differ significantly with regard to their performances on the AAT (P=0.62) or on the ACT (P=0.62) at baseline (T0).