Intensive Versus Distributed Aphasia Therapy

Abstract

T reatment intensity is an important consideration for the delivery of effective and efficient aphasia rehabilitation services. However, the optimal treatment intensity for aphasia rehabilitation is unknown.1 Neuroscience research suggests that intensive training is required to optimize neurological and functional recovery post stroke.2 Within the field of cognitive psychology, however, there is considerable evidence supporting the distributed practice effect, which suggests that optimal long-term learning in healthy humans is achieved with nonintensive or distributed training. 3Many meta-analyses and systematic reviews have been conducted in an attempt to synthesize the evidence for treatment intensity in aphasia rehabilitation. [4][5][6][7] Bhogal et al 8 found that studies that provided an increased dosage of therapy over a shorter duration (8.8 hours per week for 11.2 weeks) achieved positive therapeutic outcomes, whereas studies that provided a reduced dosage of therapy over a longer duration (2 hours per week for 22.9 weeks) did not. Consequently, this review provides support for the benefits of intensive therapy. However, a key limitation of this review is that the total dosage of aphasia therapy provided was not controlled. As such, it is difficult to differentiate between a dose-response relationship, whereby greater amounts of therapy result in greater therapeutic gains and the true effect of treatment intensity.Additional reviews have reported more equivocal results for the benefits of intensive treatment. Cherney et al 5 found no significant difference between the outcomes for intensive versus nonintensive treatment on impairment-based measures Background and Purpose-Most studies comparing different levels of aphasia treatment intensity have not controlled the dosage of therapy provided. Consequently, the true effect of treatment intensity in aphasia rehabilitation remains unknown. Aphasia Language Impairment and Functioning Therapy is an intensive, comprehensive aphasia program. We investigated the efficacy of a dosage-controlled trial of Aphasia Language Impairment and Functioning Therapy, when delivered in an intensive versus distributed therapy schedule, on communication outcomes in participants with chronic aphasia. Methods-Thirty-four adults with chronic, poststroke aphasia were recruited to participate in an intensive (n=16; 16 hours per week; 3 weeks) versus distributed (n=18; 6 hours per week; 8 weeks) therapy program. found that intensive aphasia therapy significantly reduced aphasia severity when compared with nonintensive aphasia therapy; however, significantly more individuals withdrew from intensive programs. As such, the evidence for intensive aphasia therapy remains mixed, and there is uncertainty as to whether intensive treatment is appropriate for all individuals with aphasia.A small number of studies have systematically compared different levels of treatment intensity while controlling the dosage of aphasia therapy provided.9-12 Consistent with the distributed practice effect, Raym...

Spontaneous and Therapeutic-Induced Mechanisms of Functional Recovery After Stroke

“…The relationship between treatment dosage and functional improvement is not straightforward. Restated, more does not always equate to better, and research in post-stroke motor [188] and language [189] function confirm this assertion. The VECTORS study randomized subjects with acute stroke to traditional upper-extremity therapy, dose-matched CIMT, or high-intensity CIMT [188].…”

Technology-Based Rehabilitation to Improve Communication after Acquired Brain Injury

“…The question of whether increasing the intensity of rehabilitation is beneficial to outcomes has been a focus of traditional rehabilitation studies. While it is logical to assume that more intensive treatment results in greater outcomes and has been demonstrated in chronic (Bhogal et al, 2003a , b ; Cherney et al, 2008 ) and in acute patients with aphasia (Godecke et al, 2014 ); other studies have questioned this premise (Bakheit et al, 2007 ; Dignam et al, 2015 ). For instance, a randomized controlled trial found that intensive treatment (up to 5 h/week) was no better than standard treatment (1–2 h/week) (Bakheit et al, 2007 ).…”

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

“…Some studies showed that CIAT with less constraint and less intensity still had the similar effect on post-stroke chronic aphasia [ 36 , 37 ]. A study comparing the intensive and distributed speech therapy gave a conclusion that intensive speech therapy may be not better than distributed speech therapy with the same dosage [ 38 ]. Thus, an increasing number of studies started to pay more attention to the difference between the CIAT with other speech therapy programs delivered in the same intensity, and tried to explain which component of the CIAT is useful.…”