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Existen numerosas evidencias de los beneficios de la intervención logopédica en pacientes con afasia; no obstante, aún se continúa investigando qué factores aumentan la eficacia de un tratamiento sobre otro. Revisando la bibliografía existente, se ha constatado que uno de los métodos por los que la comunidad científica se está interesando recientemente es la terapia intensiva, que se basa en aumentar considerablemente las horas dedicadas a la intervención logopédica. El objetivo de este Trabajo de Fin de Grado ha sido actualizar los conceptos y evidencias sobre la intervención logopédica intensiva en pacientes con afasia. Para ello, se ha realizado una revisión bibliográfica de ensayos clínicos y otras publicaciones relacionadas.En primer lugar, se ha comprobado que existe un número considerable de investigaciones referentes a esta temática que persiguen objetivos diversos, conformando un complejo y controvertido entramado de evidencias. Los ensayos clínicos revisados, en su mayoría, encuentran eficaces las terapias intensivas; sin embargo, se está investigando acerca de la optimización de los resultados y de los factores que influyen en éxito de la terapia.Por un lado, uno de los temas centrales de investigación es la determinación de la dosis óptima de intervención; es decir, el número de horas (semanales, mensuales y totales) suficientes para alcanzar unos resultados considerablemente más beneficiosos que un régimen regular. Determinar esta dosis es importante teniendo en cuenta que la elevada intensidad del tratamiento conlleva ciertas desventajas como el coste económico o el cansancio de los pacientes. Aunque continúa investigándose, recientes estudios indican que un régimen de entre 4 y 7 horas semanales prolongado durante más de dos semanas podría ser la dosis óptima, sin conseguir mejoras sustanciales aplicando una dosis aún más intensiva de 15 o 20 horas semanales.(AU)
Subject(s)
Humans , Male , Female , Aphasia/therapy , Language Disorders , Language Therapy/methods , Brain Injuries, Diffuse , Speech, Language and Hearing Sciences , AudiologyABSTRACT
OBJECTIVES: This study aimed to systematically evaluate the effects of constraint-induced aphasia therapy (CIAT) for aphasic patients reported by randomized controlled trials. METHODS: Relevant randomized controlled trials were retrieved from 11 electronic databases. A methodological quality assessment was conducted in accordance with the Cochrane Handbook, and meta-analyses were performed by using RevMan 5.2. A descriptive analysis was conducted when the included trials were not suitable for a meta-analysis. RESULTS: A total of 12 trials were included. A statistically significant group difference was shown from the meta-analysis in the results measured by the Western Aphasia Battery (random-effects model, MD = 1.23, 95% CI = 0.31 to 2.14, P < 0.01). However, there were no statistically significant differences shown in the results of the Boston Naming Test (fixed-effects model, MD = -1.79, 95% CI = -11.19 to 7.62, P > 0.05) and Aachen Aphasia Test (fixed-effects model, MD = -1.11, 95% CI = -4.49 to 2.27, P > 0.05). The descriptive analysis showed positive results in language performances of naming, repetition, and comprehension. CONCLUSION: This systematic review indicated that CIAT was efficient for improving language performance with regard to naming, comprehension, repetition, written language, and oral language based on the current evidence. And this review provides some meaningful guides for clinical practice: expand the therapy duration to 2 or 3 h per day, focus on naming, and choose the best assessment tool. It also indicates a need for more rigorous, large-scale, and high-quality trials in the future.
ABSTRACT
Constraint-induced aphasia therapy (CIAT) is becoming increasingly popular worldwide. It is based on the theory of CI therapy, which is supported by considerable evidence as being useful for rehabilitation after stroke. The CIAT-II protocol (Johnson et al., 2015) was modified to a Japanese version, consisting of intensive training using five expressive language exercises, with shaping and a transfer package for 3 hr/day for 15 consecutive weekdays. We assessed outcomes using the Standard Language Test of Aphasia (SLTA) and Verbal Activity Log (VAL) before and after therapy. We confirmed some improvements in language function using the SLTA and remarkable improvement in VAL amount-of-use scores. Language function and communication skills can be improved using CIAT in patients with chronic aphasia, based on their language function evaluation. The present findings suggest that CIAT might be effective as speech therapy for Japanese patients with chronic aphasia.
ABSTRACT
Constraint-induced aphasia therapy (CIAT) is becoming increasingly popular worldwide. It is based on the theory of CI therapy, which is supported by considerable evidence as being useful for rehabilitation after stroke. The CIAT-II protocol (Johnson et al., 2015) was modified to a Japanese version, consisting of intensive training using five expressive language exercises, with shaping and a transfer package for 3 hr/day for 15 consecutive weekdays. We assessed outcomes using the Standard Language Test of Aphasia (SLTA) and Verbal Activity Log (VAL) before and after therapy. We confirmed some improvements in language function using the SLTA and remarkable improvement in VAL amount-of-use scores. Language function and communication skills can be improved using CIAT in patients with chronic aphasia, based on their language function evaluation. The present findings suggest that CIAT might be effective as speech therapy for Japanese patients with chronic aphasia.
ABSTRACT
Ohjective To explore the impact of constraint-induced aphasia therapy (CIAT) on language function and neural activity in patients with chronic Broca's aphasia.Methods Two chronic aphasics whose use of language was recovering after standard language therapy were selected to receive 1.5 h of CIAT twice daily for two weeks (30 hours in total).Before and after the CIAT they were tested using a block-designed picture-naming task,fMRIs were taken and their use of language was examined.Results The language function assessments showed relatively large improvements in the subjects' use of language after 4 weeks of conventional language training,but not much further change after 8 and 12 weeks.After the two weeks of CIAT,their language function improved further to a certain extent.fMRI showed increased activation in the left inferior frontal gyrus with or without enhanced activation in the left hemisphere,and reduced activation in the right inferior frontal gyrus.Conclusions Functional reorganization induced in the brain by CIAT was associated with up-regulation of the left inferior frontal gyrus or down-regulation of the right inferior frontal gyrus.Even the whole language network may have been modified.
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A range of methods in clinical research aim to assess treatment-induced progress in aphasia therapy. Here, we used a crossover randomized controlled design to compare the suitability of utterance-centered and dialogue-sensitive outcome measures in speech-language testing. Fourteen individuals with post-stroke chronic non-fluent aphasia each received two types of intensive training in counterbalanced order: conventional confrontation naming, and communicative-pragmatic speech-language therapy (Intensive Language-Action Therapy, an expanded version of Constraint-Induced Aphasia Therapy). Motivated by linguistic-pragmatic theory and neuroscience data, our dependent variables included a newly created diagnostic instrument, the Action Communication Test (ACT). This diagnostic instrument requires patients to produce target words in two conditions: (i) utterance-centered object naming, and (ii) communicative-pragmatic social interaction based on verbal requests. In addition, we administered a standardized aphasia test battery, the Aachen Aphasia Test (AAT). Composite scores on the ACT and the AAT revealed similar patterns of changes in language performance over time, irrespective of the treatment applied. Changes in language performance were relatively consistent with the AAT results also when considering both ACT subscales separately from each other. However, only the ACT subscale evaluating verbal requests proved to be successful in distinguishing between different types of training in our patient sample. Critically, testing duration was substantially shorter for the entire ACT (10-20 min) than for the AAT (60-90 min). Taken together, the current findings suggest that communicative-pragmatic methods in speech-language testing provide a sensitive and time-effective measure to determine the outcome of aphasia therapy.
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INTRODUCTION: Clinical research highlights the importance of massed practice in the rehabilitation of chronic post-stroke aphasia. However, while necessary, massed practice may not be sufficient for ensuring progress in speech-language therapy. Motivated by recent advances in neuroscience, it has been claimed that using language as a tool for communication and social interaction leads to synergistic effects in left perisylvian eloquent areas. Here, we conducted a crossover randomized controlled trial to determine the influence of communicative language function on the outcome of intensive aphasia therapy. METHODS: Eighteen individuals with left-hemisphere lesions and chronic non-fluent aphasia each received two types of training in counterbalanced order: (i) Intensive Language-Action Therapy (ILAT, an extended form of Constraint-Induced Aphasia Therapy) embedding verbal utterances in the context of communication and social interaction, and (ii) Naming Therapy focusing on speech production per se. Both types of training were delivered with the same high intensity (3.5 h per session) and duration (six consecutive working days), with therapy materials and number of utterances matched between treatment groups. RESULTS: A standardized aphasia test battery revealed significantly improved language performance with ILAT, independent of when this method was administered. In contrast, Naming Therapy tended to benefit language performance only when given at the onset of the treatment, but not when applied after previous intensive training. CONCLUSIONS: The current results challenge the notion that massed practice alone promotes recovery from chronic post-stroke aphasia. Instead, our results demonstrate that using language for communication and social interaction increases the efficacy of intensive aphasia therapy.
Subject(s)
Aphasia/rehabilitation , Interpersonal Relations , Speech Therapy , Speech/physiology , Adult , Aged , Communication , Female , Humans , Language , Male , Middle Aged , Speech Therapy/methods , Stroke/physiopathology , Stroke Rehabilitation/methods , Treatment OutcomeABSTRACT
BACKGROUND: Constraint Induced Aphasia Therapy (CIAT) has been shown to be effective in the treatment of aphasia, but clinicians have expressed concern regarding how far CIAT is practical to implement in clinical practice. OBJECTIVE: To determine whether CIAT delivered in a less-intense, lower dose, reduced constraint and volunteer-led format could produce positive outcomes in people with chronic aphasia. METHODS: Two groups were run, each with two people with chronic aphasia. Treatment involved a standard CIAT card-exchange game, supplemented by a home activity. Spoken language was required for responses but alternative modalities of communication were also permitted. Each group was led by a trained volunteer, lasted 90 minutes and was delivered twice a week for four weeks. RESULTS: Three of the four participants showed significant improvements in target word retrieval following treatment. No significant improvements were observed for untreated stimuli or language tasks. Two participants showed increases in the elaboration of their responses, and the same two showed an increase in the frequency with which they engaged in communication activities. CONCLUSIONS: Clear gains in performance were observed for the majority of people with aphasia who participated in a less intense format, considerably lower dose and less constrained form of CIAT led by trained volunteers. This suggests that this 'clinically realistic' service delivery model for CIAT could be added to the clinical repertoire of speech pathologists.
Subject(s)
Aphasia/psychology , Aphasia/therapy , Language Therapy/methods , Volunteers/psychology , Adult , Aged , Aphasia/diagnosis , Female , Humans , Language Tests , Male , Middle Aged , Neuropsychological Tests , Pattern Recognition, Visual/physiology , Random Allocation , Treatment OutcomeABSTRACT
Changes in ERP (P100 and N400) and root mean square (RMS) were obtained during a silent reading task in 28 patients with chronic post-stroke aphasia in a randomized, double-blind, placebo-controlled trial of both memantine and constraint-induced aphasia therapy (CIAT). Participants received memantine/placebo alone (weeks 0-16), followed by drug treatment combined with CIAT (weeks 16-18), and then memantine/placebo alone (weeks 18-20). ERP/RMS values (week 16) decreased more in the memantine group than in the placebo group. During CIAT application (weeks 16-18), improvements in aphasia severity and ERP/RMS values were amplified by memantine and changes remained stable thereafter (weeks 18-20). Changes in ERP/RMS occurred in left and right hemispheres and correlated with gains in language performance. No changes in ERP/RMS were found in a healthy group in two separated evaluations. Our results show that aphasia recovery induced by both memantine alone and in combination with CIAT is indexed by bilateral cortical potentials.
Subject(s)
Aphasia/therapy , Brain/physiology , Evoked Potentials/physiology , Language Therapy/methods , Memantine/therapeutic use , Stroke/therapy , Adult , Aged , Aphasia/etiology , Aphasia/physiopathology , Brain/drug effects , Double-Blind Method , Evoked Potentials/drug effects , Female , Functional Laterality/drug effects , Functional Laterality/physiology , Humans , Male , Memantine/pharmacology , Middle Aged , Photic Stimulation/methods , Reading , Stroke/complications , Stroke/physiopathologyABSTRACT
The role of the two hemispheres in the neurorehabilitation of language is still under dispute. This study explored the changes in language-evoked brain activation over a 2-week treatment interval with intensive constraint induced aphasia therapy (CIAT), which is also called intensive language action therapy (ILAT). Functional magnetic resonance imaging (fMRI) was used to assess brain activation in perilesional left hemispheric and in homotopic right hemispheric areas during passive listening to high and low-ambiguity sentences and non-speech control stimuli in chronic non-fluent aphasia patients. All patients demonstrated significant clinical improvements of language functions after therapy. In an event-related fMRI experiment, a significant increase of BOLD signal was manifest in right inferior frontal and temporal areas. This activation increase was stronger for highly ambiguous sentences than for unambiguous ones. These results suggest that the known language improvements brought about by intensive constraint-induced language action therapy at least in part relies on circuits within the right-hemispheric homologs of left-perisylvian language areas, which are most strongly activated in the processing of semantically complex language.
ABSTRACT
Aphasia is prevalent in people following stroke, which can have a significant impact on the quality of life of the patients with stroke. One of the new methods for treatment of patients with aphasia is constraint-induced aphasia therapy (CIAT). The aim of this study was to investigate the efficacy of CIAT on naming deficits in individuals with chronic aphasia. This study had a prospective, single-subject study with A-B-A design. The CIAT was administered to two patients with chronic aphasia. Participants were a 57-year-old male and a 45-year-old female and had a stroke 60 and 36 months ago, respectively. In this study, the naming test was used as the outcome measure. The naming test was administered in three baseline sessions with 1 week interval between tests (phase A). Patients received CIAT for four consecutive weeks (3 days/week). Four measurements were taken during the treatment phase (phase B). In follow-up phase (phase A) two other measurements were performed. Visual analysis consisting of level, regression line, and variability were used to determine the effects of CIAT on naming. Both participants increased scores on naming test after phase A and B. The mean of the naming score improved from the baseline to the intervention phase in both participants. There was a positive trend in naming scores during the treatment phase compared with the trend in the baseline demonstrated by both participants. The results of this study showed that the CIAT can be effective in improving the naming deficit in patients with chronic post-stroke aphasia.
