Published online before print December 27, 2007, doi: 10.1161/STROKEAHA.107.504068
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(Stroke. 2008;39:e48.)
© 2008 American Heart Association, Inc.
Letters to the Editor |
The Impact of Intensity of Aphasia Therapy on Recovery
College of Health Sciences, Division of Communication Sciences and Disorders, University of Kentucky, Lexington, Ky, USA
To the Editor:
In a 2003 article in Stroke, Bhogal et al1 concluded intensive aphasia therapy (
9 hours of treatment per week for 11 weeks) had a greater impact on speech and language outcomes for aphasic stroke patients than less intensive treatment (2 hours of treatment per week for 23 weeks). Findings from this article have been used to support the provision of intensive speech and language therapy,2,3 particularly by researchers examining the effects of constraint induced aphasia therapy (CIAT), a promising therapy approach based on intensive treatment.4–7 This letter encourages that the findings of Bhogal et al be interpreted cautiously.
Some of the information in this 2003 Stroke article is inaccurate. For example, the authors reported findings of a study by Marshall et al examining the effects of home treatment of aphasia by trained nonprofessionals.8 They stated that this study included 121 patients with aphasia, but it actually only had 37 patients. These were 37 (the home treatment group) of 121 participants from a study by Wertz et al9 comparing the effects of clinic, home, and deferred treatment of aphasia. Thus, the 37 patients are counted twice in this review article.
A second issue related to the intensity of therapy issue is that Bhogal et al did not include many studies that demonstrate the benefits of aphasia therapy that is not necessarily intensive. Representative examples are (1) a VA cooperative study by Wertz et al10 comparing the effects of individual and group treatment in which patients were given 8 hours of treatment per week for 44 weeks, (2) an article by Denes et al11 that examined treatment outcomes for globally aphasic patients receiving intensive or regular therapy, and other studies demonstrating the benefits of aphasia treatment over the long rather than the short term.12–15
Although most aphasia clinicians, including myself, would welcome empirical studies that supported the use of intensive therapy, no large aphasia treatment studies have been carried out in which patients randomly assigned to intensive and nonintensive treatment and outcomes were compared. Until this is done, any conclusions about intensive treatment being better than, worse than, or the same as nonintensive treatment are premature.
Acknowledgments
Disclosures
None.
References
1. Bhogal SK, Teasell R, Speechley M. Intensity of aphasia therapy, impact on recovery. Stroke. 2003; 34: 987–993.
2. Basso A. How intensive/prolonged should an intensive/prolonged treatment be? Aphasiology. 2005; 19: 975–984.[CrossRef]
3. Hinckley JJ, Carr TH. Comparing the outcomes of intensive and non-intensive context based aphasia treatment. Aphasiology. 2005; 19: 965–974.[CrossRef]
4. Meinzer M, Djundja D, Barthel G, Elbert T, Rockstroh B. Long-term stability of improved language functions in chronic aphasia after constraint-induced therapy. Stroke. 2005; 36: 1462–1466.
5. Meinzer M, Elbert T, Wienbruch C, Djundja D, Barthel G, Rockstroh B. Intensive language training enhances brain plasticity in chronic aphasia. BMC Biology. Available at: http://www.biomedcentral.com/1741-1707/2/20. Accessed in 2007.
6. Maher L, Kendall D, Swearengin JA, Rodriguez A, Leon SA, Pingel K, Holland A, Rothi LJG. A pilot study of use-dependent learning in the context of constraint induced language therapy. J Inter Neuropsych Soc. 2006; 12: 843–852.[CrossRef]
7. Meinzer M, Streiftau, Rockstroh B. Intensive language training in the rehabilitation of chronic aphasia: efficient training by laypersons. J Internat Neuropsych Soc. 2007; 13: 846–853.
8. Marshall RC, Wertz RT, Weiss DB, Aten JL, Brookshire RH, Garcia-Bunuel L. Home treatment for aphasic patients by trained nonprofessionals. J Speech Hearing Dis. 1989; 54: 462–470.[Medline] [Order article via Infotrieve]
9. Wertz RT, Weiss DG, Aten JL, Brookshire RH, Garcia-Bunuel L, Holland AL, Kurtzke JF, LaPointe LL, Milianti FJ, Brannegan R, Greenbaum H, Marshall RC, Vogel D, Carter J, Barnes NS, Goodman R. Comparison of clinic, home, and deferred treatment for aphasia: a Veterans Administration cooperative study. Arch Neurol. 1986; 43: 653–658.
10. Wertz RT, Collins MJ, Weiss DG, Kurtzke JF, Frieden T, Brookshire RH, Pierce J, Holtzapple P, Matovitch V, Mortey GK, Resurreccion E. Veterans Administration cooperative study on aphasia: a comparison of individual and group treatment. J Speech Hearing Res. 1981; 24: 580–594.[Medline] [Order article via Infotrieve]
11. Denes G, Perazzolo C, Piani A, Piccione F. Intensive versus regular speech therapy in global aphasia: a controlled study. Aphasiology. 1996; 10: 385–394.[CrossRef]
12. Marshall RC, Tompkins CA, Phillips DS. Improvement in treated aphasia: examination of selected prognostic factors. Folia Phoniatrica. 1982; 34: 305–315.[Medline] [Order article via Infotrieve]
13. Basso A, Capitani E, Vignolo LA. Influence of rehabilitation of language skills in aphasic patients: a controlled study. Arch Neurology. 1979; 36: 190–196.
14. Hanson WR, Cicciarelli AW. The time, amount, and pattern of language improvement in adult aphasics. British J Disorders Comm. 1978; 13: 59–63.[CrossRef]
15. Elman RJ, Bernstein-Ellis E. The efficacy of group communication treatment in adults with chronic aphasia. J Speech Language Hearing Res. 1999; 42: 411–419.
Related Article:
Stroke 2008 39: e49.
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