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 After 15 hours a week of therapy for three weeks, the study
participants could express themselves more effectively in daily
communications, such as changing a doctor’s appointment over the
phone.
“For a long time, it has been assumed that language recovery is
limited to the first months after the initial stroke,” said lead
author Caterina Breitenstein of the University of Muenster.
“During the past two decades, however, several clinical studies and
systematic reviews have challenged this dogma,” but they weren’t
considered high-quality studies, she told Reuters Health in an
email.
Chronic aphasia, the inability to understand or express speech well
due to brain damage from stroke, affects about 30 percent of stroke
survivors. One year after stroke, about half of them are still
struggling with aphasia. It interferes with day-to-day activities
and often leads to a lower quality of life and depression as well as
accounting for about 9 percent of stroke-related health care costs
during the first year after stroke, the study team writes in The
Lancet.
Breitenstein and colleagues enrolled 156 patients from 19 treatment
centers who had aphasia lasting more than six months after a stroke.
About half were randomly assigned to intensive speech therapy and
the other half were put on a waiting list for the therapy.
For three consecutive weeks, people in the treatment group had
speech therapy for 10 hours or more per week in one-on-one and group
sessions, as well as another five hours or more per week of
individual computer-based exercises. People in the waitlist group
also had about 1.5 hours of speech therapy a week as part of their
normal care.
Before and after the three-week intensive treatment program,
researchers measured the effectiveness of all the participants’
verbal communication in 10 everyday life situations, such as
rescheduling a doctor’s appointment or picking up clothes from a dry
cleaner. They also scored patients on specific aspects of
communication like how easy they were to understand and their
syntax.
Compared to the waitlist group, about 44 percent of patients in the
intensive therapy group significantly improved their communication
ability, and the benefits remained stable during the six-month
follow-up after the therapy sessions. The patients and their
partners rated quality of life higher as well.
“Until now, a lack in evidence has severely hampered stroke
survivors’ access to language rehabilitation services,” Breitenstein
said. “This demonstrates that intensive practice is the key.”
The study authors chose a three-week treatment because most German
health insurance companies limit aphasia rehabilitation to about
three weeks. A subgroup of 34 patients received five weeks of
therapy and showed additional improvement over the three-week group.
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“The most recent Cochrane review suggests that high-intensity
therapy leads to reduced aphasia and improvement in communication,”
said Linda Worrall of the University of Queensland in Brisbane,
Australia, who coauthored a commentary accompanying the study.
“Despite this, the intervention provided in clinical settings is far
from what would be considered intensive,” Worrall told Reuters
Health. “Confusion remains about the overall dose and intensity of
treatment required for meaningful change.”
The study focused on stroke survivors younger than 70 to limit any
age-related cognitive effects but otherwise found no differences in
the effectiveness of the treatment based on age, time since stroke
or severity of chronic aphasia. Patients with a milder stroke showed
larger gains in verbal communication compared to those with more
severe strokes, however.
In future research, Breitenstein's team wants to study what minimum
treatment intensity is required to improve speech skills and whether
multiple three-week sessions could help even more. In addition, they
want to investigate the general feasibility of implementing
intensive speech therapy since cost seems to be a barrier. During
the study, for example, 153 screened patients couldn’t participate
because their rehabilitation center had staff shortages and couldn’t
provide therapy.
“Aphasia therapy works,” Breitenstein said. “This calls for an
urgent change in the way rehabilitation resources are currently
used.”
SOURCE: http://bit.ly/2nfukXm and http://bit.ly/2m3pTyJ The Lancet,
online March 1, 2017 and February 28, 2017.
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