Increasing aphasia treatment intensity in an acute inpatient rehabilitation programme: a feasibility study

Abstract

Background: Intensity of therapy is a critical factor influencing outcomes in aphasia. However, there are many barriers to increasing treatment intensity for those with acute/subacute aphasia including the demands of the inpatient medical facilities and the endurance of the participants. Nevertheless, with some modifications to its original procedures, evidence suggests that Constraint-Induced Language Therapy (CILT) may yield positive outcomes when given in the early stages of recovery.

Aims: To investigate the feasibility of increasing the amount of therapy provided to individuals with aphasia on an inpatient rehabilitation unit by adding CILT at a modified intensity, and to assess whether those receiving 2 weeks of the additional CILT show more improvement than control participants who did not receive the additional treatment.

Methods & Procedures: A case-series single-subject design study was conducted. All participants received usual care of approximately an hour of speech and language treatment, 5–6 days a week. Participants in the experimental condition received an additional hour-long CILT session, 5 days per week, for 2 weeks. Trained, untrained, and generalisation probes comprising naming of pictured items and oral reading of sentences were taken at baseline, during treatment, and at posttreatment. All participants were probed equally. Probe performance was scored and effect sizes (ESs) were calculated and compared. Performance gains from pretreatment to posttreatment on subtests of the Boston Diagnostic Aphasia Examination were also compared.

Outcomes & Results: Thirteen individuals with aphasia onset ranging from 7 to 68 days were recruited, with six allocated to the experimental Usual Care + CILT condition and seven allocated to the control Usual Care condition. Increasing the amount of speech and language treatment by adding an hour of daily CILT was feasible. Individual performance varied within and across conditions with large gains noted in some, but not all participants. As a group, there was a small to medium ES of the Usual Care + CILT condition over Usual Care alone for trained and untrained oral reading probes and untrained naming probes.

Conclusions: It is feasible to increase the amount of treatment provided to participants with aphasia on an acute inpatient rehabilitation unit. Preliminary results suggest that there may be better outcomes for those who receive more treatment. Further research using larger numbers of homogeneous participants and controlling for content of therapy as well as amount of therapy is warranted.

KEYWORDS:

• aphasia
• acute
• rehabilitation
• intensity
• constraint therapy

Acknowledgement

The authors extend their thanks to Rosalind Hurwitz, Mara Nussbaum, and Laura Pitts who assisted with reliability measures.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This study was supported by the Rehabilitation Institute of Chicago’s James Brown IV Fellowship (awarded to JC). Preparation of the manuscript was supported by the National Institute on Deafness and Other Communication Disorders, Award No. 1R01 DC011754 (to LRC) and by the U.S. Department of Education, NIDRR Grant # H133G120123 (to LRC). The content is solely the responsibility of the authors and does not necessarily represent the official views of the funding organisations. Endorsement by the Federal Government should not be assumed.