Constraint-induced aphasia therapy in post-stroke aphasia rehabilitation: A systematic review and meta-analysis of randomized controlled trials

Abstract

BackgroundConstraint-induced aphasia therapy (CIAT) has been widely used in post-stroke aphasia rehabilitation. An increasing number of clinical controlled trials have investigated the efficacy of the CIAT for the post-stroke aphasia.PurposeTo systematically review the randomized controlled trials (RCTs) concerning the effect of the CIAT in post-stroke patients with aphasia, and to identify the useful components of CIAT in post-stroke aphasia rehabilitation.MethodsA computerized database search was performed through five databases (Pubmed, EMbase, Medline, ScienceDirect and Cochrane library). Cochrane handbook domains were used to evaluate the methodological quality of the included RCTs.ResultsEight RCTs qualified in the inclusion criteria. Inconsistent results were found in comparing the CIAT with conventional therapies without any component from the CIAT based on the results of three RCTs. Five RCTs showed that the CIAT performed equally well as other intensive aphasia therapies, in terms of improving language performance. One RCT showed that therapies embedded with social interaction were likely to enhance the efficacy of the CIAT.ConclusionCIAT may be useful for improving chronic post-stroke aphasia, however, limited evidence to support its superiority to other aphasia therapies. Massed practice is likely to be a useful component of CIAT, while the role of “constraint” is needed to be further explored. CIAT embedded with social interaction may gain more benefits.

Playing a team game improves word production in poststroke aphasia

“…Our approach is not the first attempt to deliver aphasia therapy in the context of a game. CIAT/CILT are popular protocols which adopt a game approach and show benefits (e.g., Zhang et al, 2017). Our intervention, however, has novel aspects.…”

“…Structured linguistic intervention (following a defined protocol) may work better, especially for patients with moderate-to-severe impairments who may find conversation too difficult (see also Lanyon et al, 2013). Structured interventions, however, are mostly delivered one-to-one with the important exception of Constraint-Induced Protocols (CIP), which involve small groups of participants (known as CIAT, CILT, or ILAT-Intensive Language Action Therapy; see Pulvermüller et al, 2001;Difrancesco, Pulvermüller, & Mohr, 2012; for a review, see Balardin & Miotto, 2009;Meinzer, Rodriguez, & Rothi, 2012;Zhang et al, 2017). These protocols share the following defining characteristics: (1) Treatment is delivered in small groups (up to three patients); (2) practice is strictly focused on a verbal, spoken output with other forms of communication either not practiced or actively discouraged (constrained); (3) treatment is intensive where intensity refers to the therapy being delivered both with a high-dose and in a compact way (massed rather than distributed practice); (4) treatment is focused on word production (picture naming); (5) treatment involves shaping, where word production is practiced repeatedly, with different carrier sentences, and different degrees of facilitation; (6) naming is promoted in the context of social requests as part of a card game (Go Fish) where participants ask other participants for matching cards.…”

“…These protocols share the following defining characteristics: (1) Treatment is delivered in small groups (up to three patients); (2) practice is strictly focused on a verbal, spoken output with other forms of communication either not practiced or actively discouraged (constrained); (3) treatment is intensive where intensity refers to the therapy being delivered both with a high-dose and in a compact way (massed rather than distributed practice); (4) treatment is focused on word production (picture naming); (5) treatment involves shaping, where word production is practiced repeatedly, with different carrier sentences, and different degrees of facilitation; (6) naming is promoted in the context of social requests as part of a card game (Go Fish) where participants ask other participants for matching cards. CIP have received a lot of attention because studies have shown benefits for treated words and, occasionally, improvements on standardized tasks (e.g., Carpenter & Cherney, 2016;Pulvermüller et al, 2001; for a review, see Zhang et al, 2017; but also see for negative results-Attard, Rose, & Lanyon, 2012;Hameister, Nickels, Ca, & Croot, 2017;Kurland, Stanek, Stokes, Li, & Andrianopoulos, 2016;Nickels & Osborne, 2016). Which elements are responsible for the success of CIP, however, remain unclear.…”

“…If anything, the opposite may be true (Cepeda, Pashler, Vul, Wixted, & Rohrer, 2006;Dignam, Rodriguez, & Copland, 2016;Mozeiko, Coelho, & Myers, 2016). Therefore, given that many word retrieval treatments are effective (see Boo & Rose, 2011;Boyle, 2004;Coelho, McHugh, & Boyle, 2000;Howard, 2000;Maddy, Capilouto, & McComas, 2014;Rider et al, 2008) and to a similar degree as CIP (see Zhang et al, 2017), one can ask what makes CIP a desirable form of therapy.…”

Changing Trends from Traditional to Technology Based Approach: Speech Language Pathologist’s Preferences for Computer Mediated Aphasia Therapy (CMAT) in Pakistan

“…A variety of traditional speech rehabilitation options are available for speech language pathologists (henceforth called as SLPs), e.g., The Copy and Recall Therapy (Thiel, Sage & Conroy, 2015), the Visual Image Communication (VIC) therapy (Wertz, de Riesthal, Irwin & Ross, 2009), the Function Communication Therapy , the Promoting Aphasic's Communicative Effectiveness (Raglio et al, 2016), the Stimulation Response method and the Melodic Intonation Therapy (Bhogal, Teasell & Speechley, 2003;Manasco, 2017). Other traditional methods are linguistic-oriented learning approach, prompting approach, response elaboration training (Manasco, 2017), constraintinduced aphasia therapy (Raymer, 2009;Segismundo, 2017;Zhang et al, 2017) and drawing methods (Parrish, 2014).…”