The aim of this study was to determine whether it was possible to predict therapy gain from participants' performance on background tests of language and cognitive ability. To do this, we amalgamated the assessment and therapy results from 33 people with aphasia following cerebral vascular accident (CVA), all of whom had received the same anomia therapy (based on progressive phonemic and orthographic cueing). Previous studies with smaller numbers of participants had found a possible relationship between anomia therapy performance and some language and cognitive assessments. Because this study had access to a larger data set than previous studies, we were able to replicate the previous findings and also to verify two overarching factors which were predictive of therapy gain: a cognitive factor and a phonological factor. The status of these two domains was able to predict both immediate and longer-term therapy gain. Pre-treatment naming ability also predicted gain after the anomia therapy. When combined, both cognitive and language (naming or phonological) skills were found to be independent predictors of therapy outcome.

The intensity of aphasia therapy has been a key clinical question. The aim of this case-series study was to compare the outcome of intensive and non-intensive therapy in the relearning of words for people with aphasia. Eight participants took part in a study comparing the intensity of delivery of the therapy. Participants received two courses of the same therapy (each lasting 10 sessions) delivered either intensively or non-intensively. Therapy consisted of confrontation naming with progressive phonemic and orthographic cues. Post-therapy assessments were carried out immediately after the study and one month later. Performance was also monitored during each therapy session. Immediately post-therapy, both types of therapy had improved naming accuracy considerably and there was no significant difference between the two interventions. One month later, seven out of eight participants showed a small yet significant difference in naming accuracy, favouring non-intensive over intense therapy. There were no differences in the learning patterns during the therapy sessions between the intensive and non-intensive therapies. For the majority of people with aphasia post-stroke, both intense and non-intense therapy for anomia leads to improved naming performance. Retention at one-month post therapy is relatively superior after non-intensive therapy.

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Background and Purpose: Optimizing speech and language therapy (SLT) regimens for maximal aphasia recovery is a clinical research priority. We examined associations between SLT intensity (hours/week), dosage (total hours), frequency (days/week), duration (weeks), delivery (face to face, computer supported, individual tailoring, and home practice), content, and language outcomes for people with aphasia. Methods: Databases including MEDLINE and Embase were searched (inception to September 2015). Published, unpublished, and emerging trials including SLT and ≥10 individual participant data on aphasia, language outcomes, and time post-onset were selected. Patient-level data on stroke, language, SLT, and trial risk of bias were independently extracted. Outcome measurement scores were standardized. A statistical inferencing, one-stage, random effects, network meta-analysis approach filtered individual participant data into an optimal model examining SLT regimen for overall language, auditory comprehension, naming, and functional communication pre-post intervention gains, adjusting for a priori–defined covariates (age, sex, time poststroke, and baseline aphasia severity), reporting estimates of mean change scores (95% CI). Results: Data from 959 individual participant data (25 trials) were included. Greatest gains in overall language and comprehension were associated with >20 to 50 hours SLT dosage (18.37 [10.58–26.16] Western Aphasia Battery–Aphasia Quotient; 5.23 [1.51–8.95] Aachen Aphasia Test–Token Test). Greatest clinical overall language, functional communication, and comprehension gains were associated with 2 to 4 and 9+ SLT hours/week. Greatest clinical gains were associated with frequent SLT for overall language, functional communication (3–5+ days/week), and comprehension (4–5 days/week). Evidence of comprehension gains was absent for SLT ≤20 hours, <3 hours/week, and ≤3 days/week. Mixed receptive-expressive therapy, functionally tailored, with prescribed home practice was associated with the greatest overall gains. Relative variance was <30%. Risk of trial bias was low to moderate; low for meta-biases. Conclusions: Greatest language recovery was associated with frequent, functionally tailored, receptive-expressive SLT, with prescribed home practice at a greater intensity and duration than reports of usual clinical services internationally. These exploratory findings suggest critical therapeutic ranges, informing hypothesis-testing trials and tailoring of clinical services. Registration: URL: https://www.crd.york.ac.uk/PROSPERO/ ; Unique identifier: CRD42018110947.

Background and Purpose: The factors associated with recovery of language domains after stroke remain uncertain. We described recovery of overall-language-ability, auditory comprehension, naming, and functional-communication across participants’ age, sex, and aphasia chronicity in a large, multilingual, international aphasia dataset. Methods: Individual participant data meta-analysis of systematically sourced aphasia datasets described overall-language ability using the Western Aphasia Battery Aphasia-Quotient; auditory comprehension by Aachen Aphasia Test (AAT) Token Test; naming by Boston Naming Test and functional-communication by AAT Spontaneous-Speech Communication subscale. Multivariable analyses regressed absolute score-changes from baseline across language domains onto covariates identified a priori in randomized controlled trials and all study types. Change-from-baseline scores were presented as estimates of means and 95% CIs. Heterogeneity was described using relative variance. Risk of bias was considered at dataset and meta-analysis level. Results: Assessments at baseline (median=43.6 weeks poststroke; interquartile range [4–165.1]) and first-follow-up (median=10 weeks from baseline; interquartile range [3–26]) were available for n=943 on overall-language ability, n=1056 on auditory comprehension, n=791 on naming and n=974 on functional-communication. Younger age (<55 years, +15.4 Western Aphasia Battery Aphasia-Quotient points [CI, 10.0–20.9], +6.1 correct on AAT Token Test [CI, 3.2–8.9]; +9.3 Boston Naming Test points [CI, 4.7–13.9]; +0.8 AAT Spontaneous-Speech Communication subscale points [CI, 0.5–1.0]) and enrollment <1 month post-onset (+19.1 Western Aphasia Battery Aphasia-Quotient points [CI, 13.9–24.4]; +5.3 correct on AAT Token Test [CI, 1.7–8.8]; +11.1 Boston Naming Test points [CI, 5.7–16.5]; and +1.1 AAT Spontaneous-Speech Communication subscale point [CI, 0.7–1.4]) conferred the greatest absolute change-from-baseline across each language domain. Improvements in language scores from baseline diminished with increasing age and aphasia chronicity. Data exhibited no significant statistical heterogeneity. Risk-of-bias was low to moderate-low. Conclusions: Earlier intervention for poststroke aphasia as crucial to maximize language recovery across a range of language domains, although recovery continued to be observed to a lesser extent beyond 6 months poststroke.