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Efficacy of early cognitive–linguistic treatment and communicative treatment in aphasia after stroke: a randomised controlled trial (RATS-2)
  1. M de Jong-Hagelstein1,
  2. W M E van de Sandt-Koenderman2,
  3. N D Prins1,3,
  4. D W J Dippel1,
  5. P J Koudstaal1,
  6. E G Visch-Brink1
  1. 1Department of Neurology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
  2. 2Aphasia Team Rijndam Rehabilitation Centre, Rotterdam, The Netherlands
  3. 3Alzheimer Centre VUmc, Amsterdam, The Netherlands
  1. Correspondence to M de Jong-Hagelstein, Erasmus MC, Neurology, Room EE 2291, PO Box 2040, 3000 CA Rotterdam, The Netherlands; m.hagelstein{at}


Background The two main approaches in aphasia treatment are cognitive–linguistic treatment (CLT), aimed at restoring the linguistic levels affected, semantics, phonology or syntax, and communicative treatment, aimed at optimising information transfer by training compensatory strategies and use of residual language skills. The hypothesis that CLT is more effective than communicative treatment in the early stages after stroke was tested in this study.

Methods In this multicentre, randomised, parallel group trial with blinded outcome assessment, 80 patients with aphasia after stroke were included within 3 weeks post-stroke. Patients received 6 months of CLT, comprising semantic and/or phonological training, or communicative treatment for at least 2 h per week. They were assessed before treatment and at 3 and 6 months with the Amsterdam–Nijmegen Everyday Language Test (ANELT-A, primary outcome) and semantic and phonological tests (secondary outcomes). The intervention effect was evaluated by means of analysis of covariance, with adjustment for baseline scores.

Results There was no difference between the mean ANELT-A score of the CLT group (n=38) and the communicative treatment group (n=42), at 3 months (adjusted difference 1.5, 95% CI −2.6 to 5.6) or at 6 months (adjusted difference 1.6, 95% CI −2.3 to 5.6) post-stroke. On two of six specific semantic and phonological tests, the mean scores differed significantly, both in favour of CLT.

Conclusion This study does not confirm the hypothesis that patients with aphasia after stroke benefit more from CLT, aimed at activation of the underlying semantic and phonologic processes, than from general, non-specific communicative treatment (ISRCTN67723958 Current Controlled Trials).

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  • Funding This study was funded by the Stichting Nuts Ohra (T-07-71). Stichting Nuts Ohra had no involvement in the study design, data, report or publication.

  • Competing interests None.

  • Ethics approval This study was conducted with the approval of the ethics committee of Erasmus MC, Rotterdam, The Netherlands.

  • Provenance and peer review Not commissioned; externally peer reviewed.