Severity of aphasia and recovery after treatment in patients with stroke

Nouwens, Femke; Jong-Hagelstein, Marjolein; Lau, Lonneke M. L. de; Dippel, Diederik W.J.; Koudstaal, Peter J.; Sandt–Koenderman, W.M.E. van de; Visch-Brink, Evy

doi:10.1080/02687038.2014.907865

Cited by 11 publications

(6 citation statements)

References 36 publications

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“…10 Hence, in line with our previous trials, both in which we found that improvement on the ANELT-A was correlated with improvement at the impairment level, we used the ANELT-A as primary outcome measure. 16,25,26…”

Section: Discussionmentioning

confidence: 99%

“…10 In the early phase after stroke, impairment-based cognitive-linguistic treatment (CLT) is often preferred over other types of SLT, as it targets specific linguistic functions supposedly stimulating functional neural networks. [11][12][13] As most recovery occurs within the first 3 months after stroke, 5,[14][15][16] standard practice early after stroke often comprises CLT. 17 When linguistic performance reaches a plateau, SLT may be continued with compensatory treatment instead of CLT.…”

Section: Introductionmentioning

confidence: 99%

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Efficacy of early cognitive-linguistic treatment for aphasia due to stroke: A randomised controlled trial (Rotterdam Aphasia Therapy Study-3)

Nouwens

Lau

Visch-Brink

et al. 2017

European Stroke Journal

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IntroductionOne third of patients with acute stroke have aphasia. The majority receive speech and language therapy. There is evidence for a beneficial effect of speech and language therapy on restoring communication, but it is unknown whether and how efficacy of speech and language therapy is influenced by timing of treatment. We studied whether speech and language therapy early after stroke by way of intensive cognitive-linguistic treatment is more effective than no speech and language therapy in the Rotterdam Aphasia Therapy Study-3, a multicentre randomised single-blind trial.Methods and patientsStroke patients with first-ever aphasia were randomised within 2 weeks of onset to either 4 weeks of early intensive cognitive-linguistic treatment (1 h/day) or no language treatment. Hereafter, both groups received regular speech and language therapy. Primary outcome was the score on the Amsterdam-Nijmegen Everyday Language Test, measuring everyday verbal communication, 4 weeks after randomisation. Secondary outcomes were Amsterdam-Nijmegen Everyday Language Test at 3 and 6 months. The study was powered to detect a clinically relevant difference of four points on the Amsterdam-Nijmegen Everyday Language Test.ResultsOf the 152 included patients, 80 patients were allocated to intervention. Median treatment intensity in the intervention-group was 24.5 h. The adjusted difference between groups in mean Amsterdam-Nijmegen Everyday Language Test-scores 4 weeks after randomisation was 0.39, 95% confidence interval: [−2.70 to 3.47], p = 0.805. No statistically significant differences were found at 3 and 6 months after randomisation either.ConclusionFour weeks of intensive cognitive-linguistic treatment initiated within 2 weeks of stroke is not more effective than no language treatment for the recovery of post-stroke aphasia. Our results exclude a clinically relevant effect of very early cognitive-linguistic treatment on everyday language.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Efficacy of early cognitive-linguistic treatment for aphasia due to stroke: A randomised controlled trial (Rotterdam Aphasia Therapy Study-3)

Nouwens

Lau

Visch-Brink

et al. 2017

European Stroke Journal

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“…Dada la gran incidencia de la afasia, es muy importante contar con instrumentos de evaluación temprana que ayuden a generar un diagnóstico y orienten la intervención temprana (Flamand-Roze et al, 2011), maximizando así las ganancias de la rehabilitación (Salter et al, 2006). Considerando el reporte de Nouwens y colaboradores del año 2014, los pacientes se benefician de la terapia cognitiva lingüística durante los primeros 3 meses tras un ACV (Nouwens et al, 2014). Por ello caracterizar el perfil lingüístico y comunicativo de forma temprana es necesario para iniciar la terapia en la fase aguda.…”

Section: Introductionunclassified

Sensibilidad y especificidad del Test ScreeLing en usuarios afásicos en etapa aguda: un análisis preliminar

Mora-Castelletto

Hermosilla-Gotschlich

Márquez-Espinoza

et al. 2020

Rev. Chil. Fonoaudiol.

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En Chile, entre un 20% y un 38% de los usuarios que sufren un ataque cerebro-vascular (ACV) presentan afasia. Pese a su alta prevalencia no existen herramientas validadas que permitan realizar una caracterización lingüística temprana de la afasia. Por lo anterior, el objetivo del presente trabajo es analizar la sensibilidad y especificidad de la versión en español del ScreeLing en una muestra de usuarios afásicos después de producido un ACV. Se trata de un estudio transversal analítico en el cual se aplicó el test ScreeLing a 13 usuarios afásicos tras primer evento de ACV en etapa aguda (< 6 semanas tras ACV) y a 56 adultos neurológicamente sanos. Adicionalmente, se evaluó el nivel comprensivo y el lenguaje espontáneo de usuarios con afasia, con la versión abreviada del Token Test y Escala de Severidad de la Afasia (ASRS). Se construyeron modelos mediante regresiones logísticas, obteniendo sus respectivas áreas bajo la curva ROC. Los resultados muestran que el equilibrio entre sensibilidad y especificidad para el puntaje global del test ScreeLing se estableció en 67 puntos, obteniendo una sensibilidad del 94,6% y especificidad del 100%. El área bajo la curva ROC alcanzó 0,99 (IC 95%: 0,97-1,00). En las subpruebas sintáctica y fonológica se alcanzó un puntaje de corte de 21 puntos, mientras que en la subprueba semántica se lograron 22 puntos. Se concluye que el ScreeLing en español posee una alta sensibilidad y especificidad para la detección de déficits lingüísticos post ACV similar a los resultados encontrados en la versión original del test en holandés. Esfuerzos futuros deben concentrarse en ampliar la muestra de usuarios afásicos con distintos perfiles de severidad.

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“…Based on the fact that several studies indicate that the first 3 months, and specifically the first 6 weeks, after stroke are the most dynamic period in the recovery process, we suggest using acute phase for the first 3 months after stroke and chronic phase for the period after 3 months [25,26,[29][30][31]. Importantly, this does not imply that rehabilitation services should be limited after 3 months, nor that we expect further language treatment to be unsuccessful; recovery likely continues, albeit at a slower pace [30].…”

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confidence: 99%

Optimal timing of speech and language therapy for aphasia after stroke: more evidence needed

Nouwens

Sandt-Koenderman

et al. 2015

Expert Review of Neurotherapeutics

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Aphasia due to stroke affects communication and quality of life. Most stroke survivors with aphasia receive speech and language therapy. Although an early start of treatment is advocated in clinical practice, evidence for "The earlier, the better" in aphasia rehabilitation is weak. Hence, clinicians are faced with the dilemma of when to initiate intensive treatment: as early as possible, when most of the spontaneous recovery occurs but when patients are often ill, or later, when the patients' condition is more stabilized. Here we discuss whether aphasia outcome is affected by timing of treatment in relation to stroke onset and whether there is evidence for an optimal window of time during which language therapy should be provided. Findings from various rehabilitation research fields are discussed and combined to provide principles for future research.

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Severity of aphasia and recovery after treatment in patients with stroke

Cited by 11 publications

References 36 publications

Efficacy of early cognitive-linguistic treatment for aphasia due to stroke: A randomised controlled trial (Rotterdam Aphasia Therapy Study-3)

Efficacy of early cognitive-linguistic treatment for aphasia due to stroke: A randomised controlled trial (Rotterdam Aphasia Therapy Study-3)

Sensibilidad y especificidad del Test ScreeLing en usuarios afásicos en etapa aguda: un análisis preliminar

Optimal timing of speech and language therapy for aphasia after stroke: more evidence needed

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