Effect of type of language therapy on expressive language skills in patients with post-stroke aphasia

Constraint-induced (language) aphasia therapy (CIAT), based on constraint usage of the language channel only, massed practice and shaping through therapeutic language games, has been suggested as a more efficient therapy approach than traditional aphasia therapies.

To examine the comparative efficacy of CIAT and a traditional therapy approach on expressive language ability, with the intensity of therapy controlled and matched, in the treatment of post-stroke aphasia.

Two successive 4-week blocks of intense (1 h, 5 days a week) of aphasia therapy programmes were delivered in a randomized within-subject crossover design: one therapy block consisted of stimulation aphasia therapy (SAT, a common traditional therapy approach), another of CIAT. Twenty consecutive patients, up to 1 year after stroke, were randomly assigned either to have SAT followed by CIAT (S1C2 group) or to have CIAT followed by SAT (C1S2 group). Measurements of naming (Boston Naming Test) and spontaneous sentence production (Cookie Theft Picture description task) were carried at the baseline, following the first therapy block, following the second therapy block and 4 weeks following the last therapy block.

Both groups of patients significantly improved in all variables of expressive language skills; the improvement was maintained 1 month post-treatment. However, patients who started with CIAT and continued with SAT (C1S2 group) tended to have higher final improvement than the patients who started with SAT and continued with CIAT (S1C2 group). This was particularly pronounced for naming. Moreover, when CIAT was the first therapy (the C1S2 group) the improvement achieved in naming following CIAT significantly exceeded the improvements achieved following SAT, not only in the same group (when SAT was the second) but also in the S1C2 group (when SAT was the first). In addition, the improvement in naming following CIAT in the C1S2 group exceeded the one in the S1C2 group, too. Similarly, the improvement in the total number of sentences produced following each therapy was quite clear and significant in the C1S2 group (when CIAT was the first), while in the S1C2 group it was much more modest and not significant.

Results suggest that the maximization of quantity and frequency of language therapy have a significant impact on the improvement of expressive language ability. Moreover, if practised early in aphasia therapy, the constrained usage of the language modality, as practised in CIAT, confers an additional benefit to massed practice, particularly on naming ability.