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

Abstract

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.

Results of the COMPARE trial of Constraint-induced or Multimodality Aphasia Therapy compared with usual care in chronic post-stroke aphasia

“…Most previous studies of Constraint and Multimodal aphasia therapies for chronic aphasia utilised non-randomised designs or were small phase I or II pilot trials subject to participant selection and other biases 8 9 11–13. These study limitations may account for the differences in findings between COMPARE and those of the preliminary trials that showed significant change in global aphasia severity.…”

“…CIAT-Plus and M-MAT are hypothesised to rely on different underlying neural recovery mechanisms and may be differentially effective based on aphasia severity 9 10. Systematic reviews of trials of CIAT-Plus and M-MAT reveal moderate-high effect sizes11–13 but studies are limited by small sample sizes (n<15), inadequate comparator groups, and recruitment and detection bias. Determining the most effective intervention for severity-based and other sub-groups of people with aphasia may lead to improved patient outcomes and reduced healthcare costs.…”

Effect of mobile application types on stroke rehabilitation: a systematic review

“…Aphasia is also a common consequence of stroke, affecting 35% of patients [ 61 ]. In a 2020 systematic review and meta-analysis, there was evidence supporting the use of face-to-face constraint-induced aphasia therapy which focuses on forcing patients to use verbal language with massed practice [ 62 ]. In this review, 6 quasi-experimental studies [ 34 , 36 , 40 , 44 – 46 ] explored the impact on aphasia using mobile apps built on similar principles to constraint-induced aphasia.…”

Intensive Comprehensive Aphasia Programmes: a systematic scoping review and analysis using the TIDieR checklist for reporting interventions

“…This mirrors research on higher intensity interventions from other areas of stroke, for example, for upper limb movement [6]. Evidence for intensive therapy comes largely from studies aiming to remediate language impairment [7][8][9][10][11].…”