[Aphasia following apoplexy. Frequency, remission and effect of treatment]

About one fourth of the patients affected by apoplexy develop an aphasic speech defect. The greater proportion of recovery occurs within the first three months after the apoplectic insult. The remainder of the recovery usually occurs in the subsequent three months and this, as a rule, is limited. According to the majority of investigations, significant improvement in speech is relatively rare after six months. The severity of the aphasia is closely connected with the degree of severity of the apoplexy. Patients with severe apoplexy and severe aphasia have poorer prognoses than patients with mild apoplexy and mild aphasia. Patients with severe aphasia also recover more slowly than patients with mild aphasia. The tendency to recover is independent of sex. It is uncertain whether age plays a part in recovery. The greater proportion of recovery is spontaneous. It is uncertain whether speech therapy affects recovery at all. The two randomised investigations which have hitherto been published have contradictory results. Four randomised investigations in which speech therapy was compared with supportive non-speech therapy provided by a volunteer (eg an interested relative or friend with training in speech therapy) show unequivocally that recovery is independent of whether treatment is provided by a speech therapist or by volunteer. The therapeutic possibilities which are offered to victims of apoplexy at present are not satisfactory. New approaches and new developments are required in this field.