What is the protocol that your doctor has for you that delivers intensive aphasia therapy? Yes, this is for chronic but your doctor will need to give you the protocol on this before you leave the hospital.
Long-Term Stability of Short-Term Intensive Language–Action Therapy in Chronic Aphasia: A 1–2 year Follow-Up Study
Abstract
Background.
Intensive aphasia therapy can improve language functions in chronic aphasia over a short therapy interval of 2–4 weeks. For one intensive method, intensive language–action therapy, beneficial effects are well documented by a range of randomized controlled trials. However, it is unclear to date whether therapy-related improvements are maintained over years.
Objective.
The current study aimed at investigating long-term stability of ILAT treatment effects over circa 1–2 years (8–30 months).
Methods.
38 patients with chronic aphasia participated in ILAT and were re-assessed at a follow-up assessment 8–30 months after treatment, which had been delivered 6–12.5 hours per week for 2–4 weeks. Results. A standardized clinical aphasia battery, the Aachen Aphasia Test, revealed significant improvements with ILAT that were maintained for up to 2.5 years. Improvements were relatively better preserved in comparatively young patients (<60 years). Measures of communicative efficacy confirmed improvements during intensive therapy but showed inconsistent long-term stability effects.
Conclusions.
The present data indicate that gains resulting from intensive speech–language therapy with ILAT are maintained up to 2.5 years after the end of treatment. We discuss this novel finding in light of a possible move from sparse to intensive therapy regimes in clinical practice.
Introduction
A growing body of evidence highlights the effectiveness of intensive speech and language therapy (SLT) in chronic aphasia.1-4 An intensity of 5–10 hours of training per week seems to be necessary to obtain significant improvements of language abilities in people with chronic aphasia (PWCA).5 Massed-practice protocols may represent an alternative and even more efficient treatment application compared to conventional non-intensive (<5 hours/week) regimes as the same amount of therapy has been reported to yield relatively better outcomes when given in an intensive (rather than sparse temporally spread-out) format, as compared with sparse delivery.3,6 However, short-term intensive regimes can only provide an advantage over non-intensive treatment if their effects persist over a subsequent therapy break of several months up to years. Although many studies so far demonstrated reliable improvements in language performance immediately after intensive SLT, only few examined whether any improvements obtained in chronic aphasia lasted for longer periods of time. For example, Breitenstein et al. reported improvements in functional communication of 158 PWCA (on average, 35 months post stroke) immediately after intensive therapy, which were maintained 6 months later.2 An earlier study by Meinzer et al. had previously shown stability of the effect of intensive constraint-induced aphasia therapy (CIAT) at a 6-month follow-up in 27 PWCA (on average, 47.9 months post stroke).7
When looking at treatment-related improvements and their stability, it is important to distinguish true intervention effects leading to generalization across linguistic materials from so-called “trivial” effects restricted to items directly trained in therapy. However, only very few studies reported explicitly that language materials trained in therapy were excluded from testing. Recent studies paying close attention to testing and treatment materials found that an intensive naming treatment (INT), given at least 10 hours per week for several weeks in 88 and 189 PWCA, led to maintenance of naming improvements for up to 8 months. However, maintenance effects were only present for practiced words, without any generalization to unpracticed words. Hence, at least for specific types of aphasia therapy, including naming treatment, general long-term therapy effects across practiced and not-practiced items seem difficult to achieve.10
In sum, it is unclear from most pre-existing work on stability of SLT effects in chronic aphasia whether generalized or item-specific therapy effects were measured. Generally, as outlined above, the majority of those few studies looking at maintenance effects2,7-9,11,12 showed, if any, maintenance of treatment gains for about half a year. However, in order to plan intensive therapy regimes with optimal efficacy and cost-effectiveness, it is important to examine effect stability across longer time windows of one or even 2 years. Such long-term stability would offer novel perspectives for intervention regimes by which short intensive treatment intervals could be separated by long therapy breaks.
Therefore, we examined whether improvements in language performance brought about by a short (2–4 weeks) intensive aphasia treatment would last over a long time span of 8–30 months in 38 PWCA. To exclude the possibility of documenting “trivial” training effects, we used different materials for therapy and for testing. As in previous work,7 we chose an established intensive SLT, intensive language–action therapy (ILAT), a communicative method extending an approach known as CIAT.3,13 Its effectiveness in chronic aphasia has been confirmed by a range of RCTs3,7,14-19 and, as mentioned, maintenance of its beneficial effects for 6 months has been reported before.7 Based on this pre-existing evidence, and given that ILAT is based on neuroscientific principles delivered with high treatment intensity which is necessary to induce long-lasting neural reorganization,20 we hypothesized that language improvements may even be maintained over a time window substantially exceeding 6 months, possibly up to 2.5 years. An additional aim of this work was to evaluate the impact of individual patient characteristics or clinical variables on long-term stability of language improvements.
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