The efficacy of cognitive-linguistic treatment in stroke patients with chronic aphasia
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1
Erasmus University Medical Center, neurology, Netherlands
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2
Universidad Catolica de Chile, Facultad de Medicina, Chile
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3
Erasmus University Medical Center, epidemiology, Netherlands
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4
Rijndam Rehabilitation Center, Netherlands
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5
Speech Language Practice, Netherlands
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6
Erasmus University Medical Center, radiology, Netherlands
Introduction: A central issue in aphasia therapy is to improve word retrieval impairments with personalized cognitive-linguistic treatment (CLT), directed to phonological and/or semantic processing. Most studies on anomia treatment are based on the naming of pictures and have opted for a naming task as outcome measure1. It has been shown in a meta-analysis that therapy for anomia is efficacious with a higher gain for exposed words than unrelated words and in particular for patients after 1 year post onset2 . There is a lack of evidence of significant generalization from impairment-focused aphasia treatment to everyday communication3 . Our aim is to examine the influence of CLT (semantics and phonology) on verbal communication and impairment-based tests in patients with a chronic aphasia.
Subjects and Method: Patients with a chronic aphasia (> 1 y) were randomized for either CLT, 1 hour a day during 4 weeks, or no treatment, with a follow-up of 4 weeks without treatment for both groups. Intervention: verbal semantic (BOX) and/or phonological treatment (FIKS) without the use of pictures. Primary outcome measure: A(msterdam) N(ijmegen) E(veryday) L(anguage) T(est), Scale A: Understandability, a measure for verbal communication4. Secondary impairment-based and general outcome measures: see table 1. We used linear regression models with adjustment for baseline score on the test of interest to estimate the difference between treatment and control patients.
Times of observation: At baseline (T1), 4 weeks after randomization (T2), 4 weeks later (both groups no treatment) (T3).
Results: We included 36 patients, of whom 21 patients (mean age 57) received treatment and 15 patients (mean age 55) were controls. Mean amount of treatment in the experimental group was 32,7 hours, sd 9,1. There were small but significant differences in favor of the treatment group on the ANELT (beta =2.87, p < .03) and on PALPA Repetition of nonwords (beta = 2.51, p<.02) (see table 1) and also on T3 on the ANELT (beta = 3.46, p < .00), and on PALPA Rhyming (beta = 5.43, p <.03). There were no significant differences between the groups on any of the other secondary outcomes.
Interpretation and conclusion: Intensive CLT, directed to semantic and phonological processing with a variation of verbal exercises, appeared to be effective in chronic aphasia for the quality of normal daily verbal communication with a remaining effect during follow-up. The relevance of this finding lies in the relation between an impairment-based training and a functional outcome measure. However, the degree of improvement was not large, which makes the clinical relevance doubtful. Moreover, verbal communication requires the integration of different linguistic levels. Therefore, we expected to find a more coherent pattern in the results of the secondary and general linguistic measures, than only some progress in phonological processing. However, the supposition of Kendall et al (2008) remains a challenge for future research: the enhancement of phonological and semantic knowledge might enable aphasic patients to restore the same networks as used in language acquisition, and therefore might have the potential for a broad generalization effect5.
References
1 Best W, Grassly J, Greenwood A, Herbert R, Hickin J, Howard D. A controlled study of changes in conversation following aphasia therapy for anomia. Disability and Rehabilitation. 2011;33:229-242.
2Wisenburn B, Mahoney K. A meta-analysis of word-finding treatments for aphasia. Aphasiology. 2009;23:1338-1352.
3 Carragher M, Sage K, Conroy P. The effects of verb retrieval therapy for people with nonfluent aphasia: Evidence from assessment tasks and conversation. Neuropsychological rehabilitation: An international journal. 2014; 23: 846-887.
4 Blomert L, Kean M-L, Koster Ch, Schokker J. Amsterdam-Nijmegen Everyday Language Test: construction, reliability and validity. Aphasiology. 1994; 8: 318-407.
5 Kendall MS, Rosenbek JC, Heilman KM, Conway T, Klenberg K, Gonzalez Rothi LJ, Nadeau SE. Phoneme-based rehabilitation of anomia in aphasia. Brain and language. 2008; 105: 1-17.
Keywords:
phonological processing,
semantics,
treatment outcome,
Aphasia,
Communication
Conference:
54th Annual Academy of Aphasia Meeting, Llandudno, United Kingdom, 16 Oct - 18 Oct, 2016.
Presentation Type:
Platform Sessions
Topic:
Academy of Aphasia
Citation:
Visch-Brink
E,
Mendez Orellana
C,
Lingsma
H,
Nouwens
F,
De Jong-Hagelstein
M,
Koudstaal
P and
Smits
M
(2016). The efficacy of cognitive-linguistic treatment in stroke patients with chronic aphasia.
Front. Psychol.
Conference Abstract:
54th Annual Academy of Aphasia Meeting.
doi: 10.3389/conf.fpsyg.2016.68.00129
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Received:
01 May 2016;
Published Online:
15 Aug 2016.
*
Correspondence:
Dr. Evy Visch-Brink, Erasmus University Medical Center, neurology, Rotterdam, Netherlands, e.visch-brink@erasmusmc.nl