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Cognitive neurology
Research paper
Efficacy of intensive aphasia therapy in patients with chronic stroke: a randomised controlled trial
  1. Benjamin Stahl1,2,3,4,
  2. Bettina Mohr5,
  3. Verena Büscher6,
  4. Felix R Dreyer6,
  5. Guglielmo Lucchese2,6,
  6. Friedemann Pulvermüller6,7
  1. 1 Department of Neurology, Charité Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany
  2. 2 Department of Neurology, Universitätsmedizin Greifswald, Greifswald, Germany
  3. 3 Department of Neurophysics, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
  4. 4 Psychologische Hochschule Berlin, Berlin, Germany
  5. 5 Department of Psychiatry, Charité Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany
  6. 6 Department of Philosophy and Humanities, Brain Language Laboratory, Freie Universität Berlin, Berlin, Germany
  7. 7 Berlin School of Mind and Brain, Humboldt-Universität zu Berlin, Berlin, Germany
  1. Correspondence to Dr Benjamin Stahl, Charité Universitätsmedizin Berlin, Department of Neurology, Charitéplatz 1, 10117 Berlin, Germany; benjamin.stahl{at}charite.de

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, η 2=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.

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/jnnp-2017-315962

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    Footnotes

    • Contributors Significant contributions include study concept and design (BS, BM, FP), treatment protocols and materials (BS, BM, FP), trial coordination and therapy sessions (BS, VB), structural MRI and lesion overlay maps (FD, GL), statistical analyses (BS), manuscript drafting and artwork (BS), and revisions (BS, BM, VB, FD, GL, FP).

    • Funding The current trial was supported by the Deutsche Forschungsgemeinschaft (Pu 97/15-1 to FP) and the Deutsche Akademische Austauschdienst (fellowship to GL).

    • Competing interests None declared.

    • Ethics approval The trial was approved by the ethics review board at the Charité University Hospital in Berlin, Germany, with written informed consent obtained from all patients.

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