Patterns of Recovery From Aphasia in the First 2 Weeks After Stroke

Abstract

Purpose Recovery from aphasia after stroke has a decelerating trajectory, with the greatest gains taking place early and the slope of change decreasing over time. Despite its importance, little is known regarding evolution of language function in the early postonset period. The goal of this study was to characterize the dynamics and nature of recovery of language function in the acute and early subacute phases of stroke. Method Twenty-one patients with aphasia were evaluated every 2–3 days for the first 15 days after onset of acute ischemic or hemorrhagic stroke. Language function was assessed at each time point with the Quick Aphasia Battery (Wilson, Eriksson, Schneck, & Lucanie, 2018), which yields an overall summary score and a multidimensional profile of 7 different language domains. Results On a 10-point scale, overall language function improved by a mean of 1.07 points per week, confidence interval [0.46, 1.71], with 19 of 21 patients showing positive changes. The trajectory of recovery was approximately linear over this time period. There was significant variability across patients, and patients with more impaired language function at Day 2 poststroke experienced greater improvements over the subsequent 2 weeks. Patterns of recovery differed across language domains, with consistent improvements in word finding, grammatical construction, repetition, and reading, but less consistent improvements in word comprehension and sentence comprehension. Conclusion Overall language function typically improves substantially and steadily during the first 2 weeks after stroke, driven mostly by recovery of expressive language. Information on the trajectory of early recovery will increase the accuracy of prognoses and establish baseline expectations against which to evaluate the efficacy of interventions. Supplemental Material https://doi.org/10.23641/asha.7811876

Predicting Early Post-stroke Aphasia Outcome From Initial Aphasia Severity

“…Recovery from aphasia peaks during the first weeks after onset (3, 4) but it is difficult to ensure that all changes in the abilities are constrained by time. We have reported here, as has also been recently reported elsewhere (20), that it is possible to capture this process with a sensitive and reliable assessment. As it is typical when quantifying these processes, patients with higher initial severities also show more recovery, due to a larger space for possible improvement.…”

“…Furthermore, another gap in the literature is the study of the spontaneous recovery, scarcely studied in the weeks after stroke onset (3,18,19), and impossible to analyze in longitudinal studies due to the effect of therapy and rehabilitation. Recently, Wilson and colleagues described the evolution of aphasia during the first 2 weeks after a stroke, and explored how language improves promptly in different modalities within the first week post-stroke (20). However, no measures were taken to assess the biomarkers that might predict this recovery.…”

“…This work could provide new information that can be used to improve the prediction of aphasia recovery and the planification of rehabilitation of patients in the long-term. Based on previous evidence (13,20), we hypothesized that initial severity will predict the early recovery, but only partially given that the dynamics of recovery are more unstable in this phase than in the phases more commonly reported in the literature (e.g., at 3, 6 months postonset). We also predicted that there is a relationship between the diffusion measures from the arcuate fasciculus (bilaterally), given its proven importance as a predictor for language abilities in other studies (30,34,37), and the early outcomes 2 weeks after onset.…”

The importance of thematic informativeness in narrative discourse recovery in acute post-stroke aphasia

“…All together, these results suggest that thematic informativeness might be more related to global communication rather than to specific language features. In a future study, the comparison of thematic informativeness with an overall language measure in the acute phase, as has been suggested by Wilson et al (2019), could prove the effectiveness of TUs and GIM as a general language assessment tool.…”

Tractography Alterations in the Arcuate and Uncinate Fasciculi in Post-Stroke Aphasia

“…Therefore, further studies that include a large group of patients and aim to examine effectiveness are needed. Tractography is a promising new tool for the evaluation of patients following ischemic stroke [ 51 , 52 ].…”