Socio-psychotherapeutic approach to the treatment of aphasic patients

Speech and language therapy for aphasia following stroke

BACKGROUND

Aphasia describes language impairment associated with a brain lesion.

OBJECTIVES

The objective of this review was to assess the effects of formal speech and language therapy and non-professional types of support from untrained providers for people with aphasia after stroke.

SEARCH STRATEGY

We searched the Cochrane Stroke Group Trials Register (last searched: March 1999), and reference lists of relevant articles to December 1998. We also contacted academic institutions and other researchers to identify further published and unpublished trials. We searched The International Journal of Disorders of Communication by hand (known by other names in the past), from 1969 to 1998. Date of most recent searches: January 1999.

SELECTION CRITERIA

Randomised controlled trials comparing: 1. Any type of formal speech and language therapy in any setting administered by trained speech and language therapists versus no treatment. 2. Any type of formal speech and language therapy in any setting administered by trained speech and language therapists versus any type of informal support for aphasia, given by speech and language therapists or volunteers, whether these were trained or untrained. 3. One type of speech and language therapy versus another type. Outcome measures included measures of any type of communication, other measures of functioning, numbers of drop-outs, and other non-clinical outcomes.

DATA COLLECTION AND ANALYSIS

The principal reviewer collected the data, and assessed the quality of the trials with independent data checking and methodological advice. If we could not perform a statistical combination of different studies, we sought missing data. Failing that we provided a description.

MAIN RESULTS

We considered sixty studies in detail, from which we identified twelve trials suitable for the review. Most of these trials were relatively old with poor or unassessable methodological quality. None of the trials was detailed enough for us to complete description and analysis. We could not determine whether formal speech and language therapy is more effective than informal support.

REVIEWER'S CONCLUSIONS

The main conclusion of this review is that speech and language therapy treatment for people with aphasia after a stroke has not been shown either to be clearly effective or clearly ineffective within a RCT. Decisions about the management of patients must therefore be based on other forms of evidence. Further research is required to find out if effectiveness of speech and language therapy for aphasic patients is effective. If researchers choose to do a trial, this must be large enough to have adequate statistical power, and be clearly reported.

The efficacy of group communication treatment in adults with chronic aphasia

We examined the effects of group communication treatment on linguistic and communicative performance in adults with chronic aphasia. Participants were randomly assigned to two treatment and two deferred treatment groups. Groups were balanced for age, education level, and initial aphasia severity. Twenty-four participants completed the 4-month treatment trial. While in the treatment condition, all participants received 5 hours of group communication treatment weekly, provided by a speech-language pathologist. The focus of treatment included increasing initiation of conversation and exchanging information using whatever communicative means possible. While awaiting group communication treatment, participants in the deferred treatment groups engaged in such activities as support, performance, or movement groups in order to control for the effects of social contact. Linguistic and communicative measures were administered to all participants at entry, after 2 and 4 months of treatment, and following 4 to 6 weeks of no treatment. In addition, participants in the deferred treatment groups received an additional administration of all measures just before their treatment trial. Results revealed that participants receiving group communication treatment had significantly higher scores on communicative and linguistic measures than participants not receiving treatment. In addition, significant increases were revealed after 2 months of treatment and after 4 months of treatment. No significant decline in performance occurred at time of follow-up.

Guidelines for treatment of chronic depression in the aphasic patient

This article defines the language disorder of aphasia and the motor speech disorders of apraxia of speech and the dysarthrias. Discussion includes depression and the five definable sets of behaviors related to the phenomenon: motor-expressive behaviors, affective, cognitive, motivational, and somatic, and the relationship of self-concept to both depression and visual and verbal thought. Detailed discussion of treatment of chronic depression inpatients with non-organic reactive factors is presented. These include positive reinforcement of desirable behaviors, avoidance of verbal punishment, labeling the disorder for the client and family, and time structuring or scheduling to assist in motivation. In addition, implementation of support from family, friends, and social relationships, tolerance of expressions of frustration and anger by the client, and environmental manipulation are considered therapeutic interventions.

Psychological effects of speech therapy

The study investigates the effect of speech therapy on the mood of aphasic stroke patients and their spouses. Patients were randomly allocated to receive speech therapy for 24 weeks starting at 10 weeks post stroke. Patient's mood was measured by means of simple rating scales and an adjective checklist. The mood of relatives was measured by The Goldberg General Health Questionnaire and The Wakefield Depression Inventory. Whereas depression and anxiety were surprisingly uncommon in aphasic patients, many spouses suffered depression and minor psychiatric disturbances. There were no significant differences between treated and untreated patients and their spouses on any measure. Speech therapy was not shown to have any psychological benefits.