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

Abstract

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.

Keywords:

• aphasia
• efficacy
• rehabilitation
• stroke
• therapy
• timing

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Key issues

• Although it is often advocated that speech and language treatment should start as soon as possible after a stroke, evidence supporting this notion is weak.

• Animal studies have shown that there is a limited critical treatment window during which the brain is optimally responsive to rehabilitation training.

• Cohort studies have shown that there is a relationship between an early start of rehabilitation and better recovery, but in the absence of evidence from RCTs it is unclear whether this relationship might merely reflect that stroke survivors who can tolerate early intensive training have a better potential for recovery anyway.

• Animal and human studies have shown that too early initiated and too intensive motor training might be detrimental.

• More solid evidence is needed to determine the relationship between timing of speech and language treatment and its efficacy in patients with aphasia due to stroke.