Constraint and multimodal approaches to therapy for chronic aphasia: A systematic review and meta-analysis

Abstract

Aphasia is a significant cause of disability and reduced quality of life. Two speech pathology treatment approaches appear efficacious: multimodal and constraint-induced aphasia therapies. In constraint-induced therapies, non-verbal actions (e.g., gesture, drawing) are believed to interfere with treatment and patients are therefore constrained to speech. In contrast, multimodal therapies employ non-verbal modalities to cue word retrieval. Given the clinical and theoretical implications, a comparison of these two divergent treatments was pursued. This systematic review investigated both approaches in chronic aphasia at the levels of impairment, participation and quality of life. After a systematic search, the level of evidence and methodological quality were rated. Meta-analysis was conducted on 14 single case experimental designs using Tau-U, while heterogeneity in the four group designs precluded meta-analysis. Results showed that high-quality research was limited; however, findings were broadly positive for both approaches with neither being judged as clearly superior. Most studies examined impairment-based outcomes without considering participation or quality of life. The application and definition of constraint varied significantly between studies. Both constraint and multimodal therapies are promising for chronic post-stroke aphasia, but there is a need for larger, more rigorously conducted studies. The interpretation of "constraint" also requires clearer reporting.

Novel Advances to Post-Stroke Aphasia Pharmacology and Rehabilitation

“…In this work, quality of life outcomes, impairment, and activity were assessed. A meta-analysis was impossible due to the methodological discrepancy and too few high-quality studies [41].…”

The Role of Gesture in Communication and Cognition: Implications for Understanding and Treating Neurogenic Communication Disorders

“…Many versions of CIAT have been tested by different research groups with an overall positive impact on expressive communication (see Rose, 2013, for a summary of outcomes of constraint-induced language interventions); however, it is unclear whether the active ingredients of its success are related to gesture suppression or other factors such as the high intensity of treatment, group participation, caregiver training, and transfer package. Indeed, these studies are highly variable in the extent to which they constrain gesture and often not well described (Pierce et al, 2017). Some studies prohibited gesture use (Pulvermüller et al, 2001) and even strictly enforced spoken language by asking patients to sit on their hands if necessary (Maher et al, 2006;Kirmess and Maher, 2010;Martin et al, 2014).…”

“…M-MAT and CIAT take different theoretical approaches to the potential interference or facilitation of gesture and other non-verbal modalities (see Rose, 2013 for a comparison of features of constraint vs. multi-modality interventions). However, functionally these two interventions share many common features that may help drive response to treatment ( Pierce et al, 2017 ). Both interventions use group-based language games, are highly intensive, and rely on shaping to approximate desired communicative behaviors.…”

“…Direct comparisons of these interventions in a two-participant single-case design pilot study found a marginal advantage of M-MAT for the primary outcome measure of confrontation naming ( Attard et al, 2013 ), but comparable effect sizes were found for both treatments in a group study of 11 PwA ( Rose et al, 2013a ). A systematic review of multi-modal and constraint-induced intervention approaches found limited empirical support for the superiority of either, although a meta-analysis of single-case experimental design studies favored multi-modal treatments ( Pierce et al, 2017 ). The authors called for a more rigorous, direct comparison of these two approaches with explicitly described protocol for use of constraints or the types of multi-modality cueing used.…”

Constraint-induced aphasia therapy for patients with aphasia: A systematic review

“…There is a huge amount of rehabilitation treatment approaches for aphasia in which speech and language therapy (SLT) is the most frequently used therapy, including intensive therapy [ 11 ], melodic intonation therapy [ 12 ], and constraint-induced aphasia therapy (CIAT) [ 13 ]. CIAT, as a noninvasive treatment approach, has attracted great interests in therapists [ 14 , 15 ] since it was first developed by Pulvermüller et al. [ 16 ] in 2001.…”