World Stroke Academy. Nouwens F. May 16, 2017; 183371
Ms. Femke Nouwens
Ms. Femke Nouwens
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Learning Objectives
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There is no urgency to start intensive cognitive-linguistic treatment for aphasia due to stroke as soon as possible after onset.
Intensive cognitive-linguistic treatment is not feasible in all stroke patients with aphasia very early after stroke.
Instead of focusing on impairment-based treatment, speech and language therapists might better put more emphasis on counselling and providing communication support, which are essential for coping with communication problems and prevention of social isolation. CLT may be more effective later in the course of this disabling condition.
Background: Aphasia occurs in 30% of stroke-patients and is often severely disabling. Most patients receive speech and language therapy (SLT), but much is unknown about factors influencing its efficacy, such as timing of treatment.
Objective: To study whether early after stroke patients with aphasia benefit more from intensive cognitive-linguistic treatment (CLT, a form of impairment-based SLT) than from no SLT.
Methods: This multicenter randomised controlled trial (PROBE-design) was carried out in over 85 institutions in the Netherlands. Stroke-patients with first-ever aphasia were randomised within two weeks after stroke to early intensive CLT (one hour/day) or no SLT, during the first four weeks after randomisation. Hereafter, both groups received regular SLT.
Outcome Measures: Patients were tested with a linguistic test-battery at baseline and at four weeks, three months and six months after randomisation. Primary outcome was the score on the Amsterdam-Nijmegen Everyday Language Test (ANELT; a measure for everyday verbal communication), four weeks after randomisation.
Results: 152 patients were included, and 80 were allocated to intervention. Median treatment intensity in the intervention-group was 24.5 hours. The adjusted difference between groups in mean ANELT-scores four weeks after randomisation was 0.39, 95%CI: [-2.70-3.47], p=0.805. No statistically significant differences were found at three and six months after randomisation either.
Conclusion: Four weeks of intensive CLT initiated within two weeks of stroke is not more effective than no early language treatment for the recovery of post-stroke aphasia. Our results exclude a clinically relevant effect of very early CLT on verbal communication.
Nouwens F, de Lau LML, Visch-Brink EG, van de Sandt-Koenderman WME, Lingsma HF, Goosen S, Blom DMJ, Koudstaal PJ, Dippel DWJ. Efficacy of early cognitive-linguistic treatment for aphasia due to stroke: A randomised controlled trial (Rotterdam Aphasia Therapy Study – 3). European Stroke Journal. March 10th 2017; DOI:10.1177/2396987317698327.
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