Published online before print December 27, 2007, doi: 10.1161/STROKEAHA.107.506931
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(Stroke. 2008;39:e49.)
© 2008 American Heart Association, Inc.
Letters to the Editor |
Response to Letter by Marshall
Department of Epidemiology and Biostatistics, McGill University, Montreal, Quebec, Canada
Department of Physical Medicine and Rehabilitation, St. Joseph’s Health Care London, Parkwood Hospital, London, Ontario, Canada
Department of Epidemiology and Biostatistics, University of Western Ontario, London, Ontario, Canada
Response:
We thank Dr Marshall for his interest in our article and welcome this opportunity to respond to his 2 concerns. In our 2003 review article,1 we concluded that intensive speech language therapy was more effective than less intense therapy.
Dr Marshall states that there were inaccuracies in the reporting of one of his studies included in our review.2 It was brought to our attention that the results from 37 patients had been counted twice in our analyses. Dr Marshall is correct. We had not realized that his article reported on a subset of patients from the original3 study examining aphasia therapy among 3 treatment groups. We regret the oversight; however, when the results from these 37 patients are removed, our results are changed only slightly from the original (Table). Our central conclusion remains unaltered. Subjects from positive studies received more intensive therapy (hours/week) compared with subjects from studies where no treatment benefit was reported.
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The second concern was the exclusion of many studies that demonstrated the benefits of aphasia therapy that were not necessarily intensive. Dr Marshall lists 6 potentially eligible studies that were not captured in our original literature search. However, on inspection, 5 of these studies did not meet our inclusion criteria. Two studies lacked a control group,4,5 two trials were not included because the comparative contrast was group treatment and not another form of individual SLP6,7 and one study was excluded because patients were recruited after they received speech language therapy, and the assessment of speech language therapy was not within the context of a controlled trial.8 The study authored by Denes et al9 did compare intensive (daily) with less-intensive (3 days/week) patient-level aphasia therapy and does meet our inclusion criteria. However, the journal in which it appeared was not indexed on Medline at the time of our search, and this article was not captured. Had we included the results from this trial, it would have strengthened our argument because subjects who received more intensive therapy performed better on the written language subtest of the Aachener Aphasia Test.
Our study provided preliminary evidence of an association between intensity of aphasia therapy and improved outcome. We still await a large methodologically rigorous randomized controlled trial to establish this link more conclusively. In 2003, The Canadian Stroke Network and the Stroke Canada Optimization of Rehabilitation through Evidence (SCORE) met to prioritize future research and compiled a consensus list of 5 priority areas in stroke rehabilitation that require further investigation—the ideal timing and intensity of aphasia therapy was on this list.10 Unfortunately, 4 years after the publication of our review and after the Canadian Stroke Network Consensus Conference, such a study has yet to be published.
Acknowledgments
Disclosures
None.
References
1. Bhogal SK, Teasell R, Speechley M. Intensity of aphasia therapy, impact on recovery. Stroke. 2003; 34: 987–993.
2. Marshall RC, Wertz RT, Weiss DB, Aten JL, Brookshire RH, Gracia-Bunuel L. Home treatment for aphasic patients by trained nonprofessionals. J Speech Hearing Dis. 1989; 54: 462–270.[Medline] [Order article via Infotrieve]
3. Wertz RT, Weiss DG, Aten JL, Brookshire RH, Garcia-Bunuel L, Holland AL, Kurtzke JF, LaPointe LL, Milianti FJ, Brannegan R. Comparison of clinic, home, and deferred language treatment for aphasia: a Veterans Administration Cooperative Study. Arch Neurol. 1986; 43: 653–658.
4. Hanson WR, Cicciarelli AW. The time, amount and pattern of language improvement in adult aphasics. British J Disorders Comm. 1978; 13: 59–63.[CrossRef]
5. Marshall RC, Tompkins CA, Phillips DS. Improvement in treated aphasia: examination of selected prognostic factors. Folia Phoniat. 1982; 34: 305–315.[Medline] [Order article via Infotrieve]
6. Wertz RT, Collins MJ, Weiss DG, Kurtzke JF, Frieden T, Brookshire RH, Pierce J, Holtzapple P, Hubbard DJ, Porch BE, West JA, Davis L, Matovitch V, Morley 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]
7. Elman RJ, Bernstein-Ellis E. The efficacy of group communication treatment in adults with chronic aphasia. J Speech Language Hearing. 1999; 42: 411–419.
8. Basso A, Capitani E, Vignolo LA. Influence of rehabilitation of language skills in aphasic patients: a controlled study. Arch Neurology. 1979; 36: 190–196.
9. Denes G, Perazzolo C, Piani A, Piccione F. Intensive versus regular speech therapy in global aphasia: a controlled study. Aphasiol. 1996; 10: 385–394.[CrossRef]
10. Bayley MT, Hurdowar A, Teasell R, Wood-Dauphinee S, Korner-Bitensky N, Richards CL, Harrison M, Jutai JW. Priorities for stroke rehabilitation and research: results of a 2003 Canadian Stroke Network consensus conference. Arch Phys Med Rehabil. 2007; 88 (4): 526–8.[CrossRef][Medline] [Order article via Infotrieve]
Related Article:
Stroke 2008 39: e48.
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