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Popescu T, Stahl B, Wiernik BM, Haiduk F, Zemanek M, Helm H, Matzinger T, Beisteiner R, Fitch WT. Melodic Intonation Therapy for aphasia: A multi-level meta-analysis of randomized controlled trials and individual participant data. Ann N Y Acad Sci 2022; 1516:76-84. [PMID: 35918503 PMCID: PMC9804200 DOI: 10.1111/nyas.14848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Melodic Intonation Therapy (MIT) is a prominent rehabilitation program for individuals with post-stroke aphasia. Our meta-analysis investigated the efficacy of MIT while considering quality of outcomes, experimental design, influence of spontaneous recovery, MIT protocol variant, and level of generalization. Extensive literature search identified 606 studies in major databases and trial registers; of those, 22 studies-overall 129 participants-met all eligibility criteria. Multi-level mixed- and random-effects models served to separately meta-analyze randomized controlled trial (RCT) and non-RCT data. RCT evidence on validated outcomes revealed a small-to-moderate standardized effect in noncommunicative language expression for MIT-with substantial uncertainty. Unvalidated outcomes attenuated MIT's effect size compared to validated tests. MIT's effect size was 5.7 times larger for non-RCT data compared to RCT data (g̅case report = 2.01 vs. g̅RCT = 0.35 for validated Non-Communicative Language Expression measures). Effect size for non-RCT data decreased with number of months post-stroke, suggesting confound through spontaneous recovery. Deviation from the original MIT protocol did not systematically alter benefit from treatment. Progress on validated tests arose mainly from gains in repetition tasks rather than other domains of verbal expression, such as everyday communication ability. Our results confirm the promising role of MIT in improving trained and untrained performance on unvalidated outcomes, alongside validated repetition tasks, and highlight possible limitations in promoting everyday communication ability.
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Affiliation(s)
- Tudor Popescu
- Department of Behavioural and Cognitive BiologyUniversity of ViennaViennaAustria
- Department of NeurologyMedical University of ViennaViennaAustria
- Centre for Mind and Brain SciencesUniversity of TrentoRoveretoItaly
| | - Benjamin Stahl
- Faculty of ScienceMedical School BerlinBerlinGermany
- Department of NeurologyCharité UniversitätsmedizinBerlinGermany
- Department of NeurophysicsMax Planck Institute for Human Cognitive and Brain SciencesLeipzigGermany
- Department of NeurologyUniversitätsmedizin GreifswaldGreifswaldGermany
| | | | - Felix Haiduk
- Department of Behavioural and Cognitive BiologyUniversity of ViennaViennaAustria
| | | | - Hannah Helm
- Faculty of ScienceMedical School BerlinBerlinGermany
| | - Theresa Matzinger
- Department of Behavioural and Cognitive BiologyUniversity of ViennaViennaAustria
- Department of EnglishUniversity of ViennaViennaAustria
- Centre of Language Evolution StudiesNicolaus Copernicus University ToruńToruńPoland
| | | | - W. Tecumseh Fitch
- Department of Behavioural and Cognitive BiologyUniversity of ViennaViennaAustria
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Doppelbauer L, Mohr B, Dreyer FR, Stahl B, Büscher V, Pulvermüller F. Long-Term Stability of Short-Term Intensive Language-Action Therapy in Chronic Aphasia: A 1-2 year Follow-Up Study. Neurorehabil Neural Repair 2021; 35:861-870. [PMID: 34232091 DOI: 10.1177/15459683211029235] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background. Intensive aphasia therapy can improve language functions in chronic aphasia over a short therapy interval of 2-4 weeks. For one intensive method, intensive language-action therapy, beneficial effects are well documented by a range of randomized controlled trials. However, it is unclear to date whether therapy-related improvements are maintained over years. Objective. The current study aimed at investigating long-term stability of ILAT treatment effects over circa 1-2 years (8-30 months). Methods. 38 patients with chronic aphasia participated in ILAT and were re-assessed at a follow-up assessment 8-30 months after treatment, which had been delivered 6-12.5 hours per week for 2-4 weeks. Results. A standardized clinical aphasia battery, the Aachen Aphasia Test, revealed significant improvements with ILAT that were maintained for up to 2.5 years. Improvements were relatively better preserved in comparatively young patients (<60 years). Measures of communicative efficacy confirmed improvements during intensive therapy but showed inconsistent long-term stability effects. Conclusions. The present data indicate that gains resulting from intensive speech-language therapy with ILAT are maintained up to 2.5 years after the end of treatment. We discuss this novel finding in light of a possible move from sparse to intensive therapy regimes in clinical practice.
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Affiliation(s)
- Lea Doppelbauer
- Brain Language Laboratory, 9166Freie Universität Berlin, Berlin, Germany
- Einstein Center for Neurosciences, Berlin, Germany
- Berlin School of Mind and Brain, Humboldt Universität zu Berlin, Berlin, Germany
| | - Bettina Mohr
- Department of Psychiatry, Charité Universitätsmedizin, Berlin, Germany
- ZeNIS - Centre for Neuropsychology and Intensive Language Therapy, Berlin, Germany
| | - Felix R Dreyer
- Brain Language Laboratory, 9166Freie Universität Berlin, Berlin, Germany
- Cluster of Excellence 'Matters of Activity', Humboldt Universität zu Berlin, Berlin, Germany
| | - Benjamin Stahl
- Department of Neurology, Charité Universitätsmedizin, Berlin, Germany
- Department of Neurology, 60634Universitätsmedizin Greifswald, Greifswald, Germany
- Department of Neurophysics, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
- Psychologische Hochschule Berlin, Berlin, Germany
| | - Verena Büscher
- Brain Language Laboratory, 9166Freie Universität Berlin, Berlin, Germany
| | - Friedemann Pulvermüller
- Brain Language Laboratory, 9166Freie Universität Berlin, Berlin, Germany
- Einstein Center for Neurosciences, Berlin, Germany
- Berlin School of Mind and Brain, Humboldt Universität zu Berlin, Berlin, Germany
- Cluster of Excellence 'Matters of Activity', Humboldt Universität zu Berlin, Berlin, Germany
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Pauranik A, George A, Sahu A, Nehra A, Paplikar A, Bhat C, Krishnan G, Kaur H, saini J, Suresh PA, Ojha P, Singh P, Sancheti P, Karanth P, Mathuranath PS, Goswami S, Chitnis S, Sundar N, Alladi S, Faroqi-Shah Y. Expert Group Meeting on Aphasia: A Report. Ann Indian Acad Neurol 2019; 22:137-146. [PMID: 31007423 PMCID: PMC6472241 DOI: 10.4103/aian.aian_330_18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
A multidisciplinary team of experts took stock of the current state of affairs about many aspects of aphasia in India, including community burden, diagnostic assessment, therapy, rehabilitation, research, education, and advocacy. The broad spectrum of aphasiology was matched by the types of participants ranging from neurologists, speech-language pathologists, clinical psychologists, linguists, to experts in neuroimaging and computer sciences. Threadbare discussion in 16 sessions over 3 days leads to the identification of pressing problems and possible solutions. Many action plans have been envisaged and recommendations made. A few examples with high priority are community-based and hospital-based study incidence and prevalence of aphasia, development of test batteries for the assessment of many components of speech and communication in Indian languages which are validated on rigorous psychometric, and linguistic criteria, national registry for aphasia, educational modules about aphasia for different target groups, resources for advocacy and its training, a bank of research questions and outlines of research protocols for young professionals to pursue. The expert group will continue to oversee execution of some of the actionable plans in short and long term.
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Affiliation(s)
- Apoorva Pauranik
- Professor, Deaprtment of Neurology, M.G.M. Medical College, Indore, Madhya Pradesh, India
| | | | - Aparna Sahu
- Scientist, Psyneuronics, Banglore, Karnataka, India
| | - Ashima Nehra
- Professor, Deapartment of Clinical Neuropsychology, AIIMS, New Delhi, India
| | | | - Chitralekha Bhat
- Scientist, TCS Research and Innovations, Mumbai, Maharashtra, India
| | - Gopee Krishnan
- Professor, Speech Language Pathology, School of Allied Health sciences, Manipal, Karnataka, India
| | - Harsimar Kaur
- Research Officer, Clinical Neuropsychology, AIIMS, New Delhi, India
| | - Jitendra saini
- Professor, Neuro-Radiology, NIMHANS, Banglore, Karnataka, India
| | - P. A. Suresh
- Professor, Neurologist, Director, ICCONS, Trichur, Kerala, India
| | - Pawan Ojha
- Consultant, Neurology, Fortis Hospital, Vashi, Mumbai, Maharashtra, India
| | - Pinky Singh
- Speech Language Pathology, AIIMS, Bhopal, Madhya Pradesh, India
| | | | - Prathibha Karanth
- Speech Language Pathologist, Director, Communication DEALL Trust, Banglore, Karnataka, India
| | | | - Satyapal Goswami
- Professor, Speech Language Pathology, AIISH, Mysore, Karnataka, India
| | - Sonal Chitnis
- Assistant Professor, Speech Language Pathology, Bharti Vidyapeeth, Pune, India
| | - N Sundar
- Scientist, Psyneuronics, Banglore, Karnataka, India
| | - Suvarna Alladi
- Professor, Neurology, NIMHANS, Banglore, Karnataka, India
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Stahl B, Mohr B, Büscher V, Dreyer FR, Lucchese G, Pulvermüller F. Efficacy of intensive aphasia therapy in patients with chronic stroke: a randomised controlled trial. J Neurol Neurosurg Psychiatry 2018; 89:586-592. [PMID: 29273692 PMCID: PMC6031278 DOI: 10.1136/jnnp-2017-315962] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 11/13/2017] [Accepted: 11/14/2017] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Recent evidence has fuelled the debate on the role of massed practice in the rehabilitation of chronic post-stroke aphasia. Here, we further determined the optimal daily dosage and total duration of intensive speech-language therapy. METHODS Individuals with chronic aphasia more than 1 year post-stroke received Intensive Language-Action Therapy in a randomised, parallel-group, blinded-assessment, controlled trial. Participants were randomly assigned to one of two outpatient groups who engaged in either highly-intensive practice (Group I: 4 hours daily) or moderately-intensive practice (Group II: 2 hours daily). Both groups went through an initial waiting period and two successive training intervals. Each phase lasted 2 weeks. Co-primary endpoints were defined after each training interval. RESULTS Thirty patients-15 per group-completed the study. A primary outcome measure (Aachen Aphasia Test) revealed no gains in language performance after the waiting period, but indicated significant progress after each training interval (gradual 2-week t-score change [CI]: 1.7 [±0.4]; 0.6 [±0.5]), independent of the intensity level applied (4-week change in Group I: 2.4 [±1.2]; in Group II: 2.2 [±0.8]). A secondary outcome measure (Action Communication Test) confirmed these findings in the waiting period and in the first training interval. In the second training interval, however, only patients with moderately-intensive practice continued to make progress (Time-by-Group interaction: P=0.009, η2=0.13). CONCLUSIONS Our results suggest no added value from more than 2 hours of daily speech-language therapy within 4 weeks. Instead, these results demonstrate that even a small 2-week increase in treatment duration contributes substantially to recovery from chronic post-stroke aphasia.
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Affiliation(s)
- Benjamin Stahl
- Department of Neurology, Charité Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany.,Department of Neurology, Universitätsmedizin Greifswald, Greifswald, Germany.,Department of Neurophysics, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany.,Psychologische Hochschule Berlin, Berlin, Germany
| | - Bettina Mohr
- Department of Psychiatry, Charité Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - Verena Büscher
- Department of Philosophy and Humanities, Brain Language Laboratory, Freie Universität Berlin, Berlin, Germany
| | - Felix R Dreyer
- Department of Philosophy and Humanities, Brain Language Laboratory, Freie Universität Berlin, Berlin, Germany
| | - Guglielmo Lucchese
- Department of Neurology, Universitätsmedizin Greifswald, Greifswald, Germany.,Department of Philosophy and Humanities, Brain Language Laboratory, Freie Universität Berlin, Berlin, Germany
| | - Friedemann Pulvermüller
- Department of Philosophy and Humanities, Brain Language Laboratory, Freie Universität Berlin, Berlin, Germany.,Berlin School of Mind and Brain, Humboldt-Universität zu Berlin, Berlin, Germany
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