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DOI: 10.1055/s-0033-1358369
Amount of Therapy Matters in Very Early Aphasia Rehabilitation after Stroke: A Clinical Prognostic Model
Publication History
Publication Date:
28 October 2013 (online)
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Abstract
Background and Aim The effects of very early aphasia therapy on recovery are equivocal. This article examines predictors of very early aphasia recovery through statistical modeling.
Methods This study involved a secondary analysis of merged data from two randomized, single-blind trials conducted in Australian acute and subacute hospitals. Study 1 (n = 59) compared daily therapy to usual ward care for up to 4 weeks poststroke in patients with moderate to severe aphasia. Study 2 (n = 20) compared daily group therapy to daily individual therapy for 20 1-hour sessions over 5 weeks, in patients with mild to severe aphasia. The primary outcome measure was the Western Aphasia Battery Aphasia Quotient (AQ) at therapy completion. This analysis used regression modeling to examine the effects of age, baseline AQ and baseline modified Rankin Scale (mRS), average therapy amount, therapy intensity, and number of therapy sessions on aphasia recovery.
Results Baseline AQ (p = 0.047), average therapy amount (p = 0.030), and baseline mRS (p = 0.043) were significant predictors in the final regression model, which explained 30% (p < 0.001) of variance in aphasia recovery.
Conclusion The amount of very early aphasia therapy could significantly affect communication outcomes at 4 to 5 weeks poststroke. Further studies should include amount of therapy provided to enhance reliability of prognostic modeling in aphasia recovery.
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References
- 1 Pedersen PM, Vinter K, Olsen TS. Aphasia after stroke: type, severity and prognosis. The Copenhagen aphasia study. Cerebrovasc Dis 2004; 17 (1) 35-43
- 2 El Hachioui H, Lingsma HF, van de Sandt-Koenderman MW, Dippel DW, Koudstaal PJ, Visch-Brink EG. Long-term prognosis of aphasia after stroke. J Neurol Neurosurg Psychiatry 2013; 84 (3) 310-315
- 3 Maas MB, Lev MH, Ay H , et al. The prognosis for aphasia in stroke. J Stroke Cerebrovasc Dis 2012; 21 (5) 350-357
- 4 Tsouli S, Kyritsis AP, Tsagalis G, Virvidaki E, Vemmos KN. Significance of aphasia after first-ever acute stroke: impact on early and late outcomes. Neuroepidemiology 2009; 33 (2) 96-102
- 5 Gialanella B, Prometti P. Rehabilitation length of stay in patients suffering from aphasia after stroke. Top Stroke Rehabil 2009; 16 (6) 437-444
- 6 Morris J, Franklin S, Menger F. Returning to work with aphasia: a case study. Aphasiology 2011; 25 (8) 890-907
- 7 Hilari K, Northcott S, Roy P , et al. Psychological distress after stroke and aphasia: the first six months. Clin Rehabil 2010; 24 (2) 181-190
- 8 Lazar RM, Antoniello D. Variability in recovery from aphasia. Curr Neurol Neurosci 2008; 8: 497-502
- 9 Pedersen PM, Jørgensen HS, Nakayama H, Raaschou HO, Olsen TS. Aphasia in acute stroke: incidence, determinants, and recovery. Ann Neurol 1995; 38 (4) 659-666
- 10 Lambon Ralph MA, Snell C, Fillingham JK, Conroy P, Sage K. Predicting the outcome of anomia therapy for people with aphasia post CVA: both language and cognitive status are key predictors. Neuropsychol Rehabil 2010; 20 (2) 289-305
- 11 Plowman E, Hentz B, Ellis Jr C. Post-stroke aphasia prognosis: a review of patient-related and stroke-related factors. J Eval Clin Pract 2012; 18 (3) 689-694
- 12 Brady MC, Kelly H, Godwin J, Enderby P. Speech and language therapy for aphasia following stroke. Cochrane Database Syst Rev 2012; (5) CD000425
- 13 Greenwood A, Grassly J, Hickin J, Best W. Phonological and orthographic cueing therapy: a case for generalized improvement. Aphasiology 2010; 24 (9) 991-1016
- 14 Kempler D, Goral M. A comparison of drill- and communication-based treatment for aphasia. Aphasiology 2011; 25 (11) 1327-1346
- 15 Kurland J, Baldwin K, Tauer C. Treatment-induced neuroplasticity following intensive naming therapy in a case of chronic Wernicke's aphasia. Aphasiology 2010; 24 (6–8) 737-751
- 16 Pulvermüller F, Neininger B, Elbert T , et al. Constraint-induced therapy of chronic aphasia after stroke. Stroke 2001; 32 (7) 1621-1626
- 17 Attard M, Rose M, Lanyon L. The comparative effects of multi-modality aphasia therapy and constraint induced aphasia therapy-plus for severe chronic Broca's aphasia: an in-depth pilot study. Aphasiology 2013; 27 (1) 80-111
- 18 Meinzer M, Elbert T, Djundja D, Taub E, Rockstroh B. Extending the Constraint-Induced Movement Therapy (CIMT) approach to cognitive functions: Constraint-Induced Aphasia Therapy (CIAT) of chronic aphasia. NeuroRehabilitation 2007; a; 22 (4) 311-318
- 19 Godecke E, Hird K, Lalor EE, Rai T, Phillips MR. Very early poststroke aphasia therapy: a pilot randomized controlled efficacy trial. Int J Stroke 2012; 7 (8) 635-644
- 20 Godecke E, Ciccone N, Granger AS, Rai T. A comparison of aphasia therapy outcomes before and after a Very Early Rehabilitation program following stroke. Int J Lang-Com . Accepted September 2013
- 21 National Stroke Foundation. Clinical Guidelines for Stroke Management. Melbourne, Australia: 2010
- 22 Royal College of Physicians. National Clinical Guideline for Stroke. Consultation Draft. London, England: Royal College of Physicians; 2012
- 23 Lindsay MP, Gubitz G, Bayley M , et al. Canadian Best Practice Recommendations for Stroke Care. On behalf of the Canadian Stroke Strategy Best Practices and Standards Writing Group. Ottawa, Ontario, Canada: Canadian Stroke Network; 2010
- 24 Code C, Petheram B. Delivering for aphasia. Int J Speech-Language Pathol 2011; 13 (1) 3-10
- 25 Bakheit AMO, Shaw S, Barrett L , et al. A prospective, randomized, parallel group, controlled study of the effect of intensity of speech and language therapy on early recovery from poststroke aphasia. Clin Rehabil 2007; 21 (10) 885-894
- 26 de Jong-Hagelstein M, van de Sandt-Koenderman WM, Prins ND, Dippel DW, Koudstaal PJ, Visch-Brink EG. Efficacy of early cognitive-linguistic treatment and communicative treatment in aphasia after stroke: a randomised controlled trial (RATS-2). J Neurol Neurosurg Psychiatry 2011; 82 (4) 399-404
- 27 Kertesz A. Western Aphasia Battery. New York, NY: Grune and Stratton; 1982
- 28 Visch-Brink EG. Bajema IM, van de Sandt-Koenderman WME. Clinical forum: lexical semantic therapy: BOX. Aphasiology 1997; 11 (11) 1057-1078
- 29 Schwartz MF, Saffran EM, Fink RB, Myers JL, Martin N. Mapping therapy: a treatment programme for agrammatism. Aphasiology 1994; 8 (1) 19-54
- 30 Boyle M, Coelho CA. Application of semantic feature analysis as a treatment for aphasic dysnomia. Am J Speech Lang Pathol 1995; 4 (4) 135-138
- 31 Pulvermüller F. Brain mechanisms linking language and action. Nat Rev Neurosci 2005; 6 (7) 576-582
- 32 Raymer AM, Thompson CK, Jacobs B, Le Grand HR. Phonological treatment of naming deficits in aphasia: model based generalisation analysis. Aphasiology 1993; 7 (1) 27-53
- 33 Leff AP, Howard D. Stroke: has speech and language therapy been shown not to work?. Nat Rev Neurol 2012; 8 (11) 600-601
- 34 Rankin J. Cerebral vascular accidents in patients over the age of 60. II. Prognosis. Scott Med J 1957; 2 (5) 200-215
- 35 Lazar RM, Minzer B, Antoniello D, Festa JR, Krakauer JW, Marshall RS. Improvement in aphasia scores after stroke is well predicted by initial severity. Stroke 2010; 41 (7) 1485-1488
- 36 Field A. Discovering Statistics Using SPSS, 3rd ed. London, England: Sage; 2009
- 37 Laska AC, Kahan T, Hellblom A, Murray V, von Arbin M. A randomized controlled trial on very early speech and language therapy in acute stroke patients with aphasia. Cerebrovasc Dis Extra 2011; 1 (1) 66-74
- 38 Meyer MJ, Megyesi J, Meythaler J , et al. Acute management of acquired brain injury part I: an evidence-based review of non-pharmacological interventions. Brain Inj 2010; 24 (5) 694-705
- 39 Bowen A, Hesketh A, Patchick E , et al. Effectiveness of enhanced communication therapy in the first four months after stroke for aphasia and dysarthria: a randomised controlled trial. BMJ 2012; 345: e4407
- 40 Ali M, Ashburn A, Bowen A , et al; VISTA-Rehab Investigators. VISTA-Rehab: a resource for stroke rehabilitation trials. Int J Stroke 2010; 5 (6) 447-452
- 41 Bamford J, Sandercock P, Dennis M, Burn J, Warlow C. Classification and natural history of clinically identifiable subtypes of cerebral infarction. Lancet 1991; 337 (8756) 1521-1526