Evidence is accumulating to support the efficacy of speech-language rehabilitation in chronic post-stroke aphasia. A recent German study (Stahl B, et al., J Neurol Neurosurg Psychiatry. 2018 Jun;89(6):586-592. doi: 10.1136/jnnp-2017-315962) has undertaken to determine the optimal daily amount and total duration of intensive speech-language therapy in stroke aphasia.
Individuals with chronic aphasia more than 1 year post-stroke received Intensive Language-Action Therapy in a randomised, blinded, parallel-group controlled trial. Participants were assigned to one of two outpatient groups: Group 1 received 4 hours daily of moderately-intensive practice, and Group II received 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.
Thirty patients, of 15 people each, 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).
Results demonstrate that even a small 2-week increase in treatment duration contributes substantially to recovery from chronic post-stroke aphasia. They also suggest no added value from more than 2 hours of daily speech-language therapy within 4 weeks.
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