Better long-term speech outcomes in stroke survivors who received early clinical speech and language therapy: What’s driving recovery?

Figures & data

Figure 1. Factors that may affect the provision of speech therapy, and recovery and response to therapy.

Table 1. Patient characteristics.

		Severe		Moderate
		No Therapy	Therapy^▴	No Therapy	Therapy^▴
Group size		49	59	15	20
Early therapy amount (hours)	Mean (SD)	0	8 (6)	0	9 (8)
	Range	-	1–20	-	2–30
Later therapy amount (hours)	Mean (SD)	33 (29)	37 (35)	10.9 (12)	38 (41)
	Range	0–100	0–220	0–32	0–191
Sex	Male (%)	36 (73)	43 (73)	13 (87)	15 (75)
	Female (%)	13 (27)	16 (27)	2 (13)	5 (25)
Pre-stroke handedness	Right (%)	47 (96)	49 (83)	15 (100)	14 (70)
	Left (%)	2 (4)	6 (10)	0 (0)	2 (10)
	Ambidextrous (%)	0 (0)	4 (7)	0 (0)	4 (20)
Age at stroke (years)	Mean (SD)	56 (14)	57 (13)	61 (9)	57 (11)
	Range	33–85	30–82	45–73	37–70
Years post-stroke of CAT	Mean (SD)	4 (4)	4 (4)	4 (3)	4 (4)
	Range	0–23	1–17	1–9	1–17
Years post-stroke of PROM*	Mean (SD)	5 (4)	5.5 (5)	4 (3)	5 (5)
	Range^	1-16.5	0.9-24	1–9	1-16.5
Lesioned hemisphere	Left (%)	42 (86)	50 (85)	10 (66)	18 (90)
	Both (%)	7 (14)	9 (15)	5 (33)	2 (10)
Left hemisphere lesion size (cm^3)	Mean	70 (70)	73 (59)	32 (37)	43 (55)
	Range	3–355	1–235	2–119	1–194
One week understanding◊	None (%)	14 (29)	19 (32)	1 (7)	0 (0)
	Words (%)	14 (29)	10 (17)	4 (27)	8 (40)
	Sentences (%)	5 (10)	13 (22)	7 (47)	7 (35)
	Normal (%)	15 (31)	16 (27)	3 (20)	5 (25)

^▴ Early therapy data are self-reported retrospectively when patients enter the PLORAS study; see Table 2 for questions asked.

*Time post-stroke of PROM is missing for: 8 in the No Therapy-Severe group, 8 in the Therapy-Severe group, 6 in the No Therapy-Moderate group, and 4 in the Therapy-Moderate group.

^8 patients had not reached one-year post-stroke when the one-week and one-month data were collected. The time post-stroke data reflects the time the one-year data were collected.

◊One-week understanding scores are missing for: 1 in the No Therapy-Severe group and 1 in the Therapy-Severe group.

Table 2. Questions asked to participants about their speech and language therapy.

Have you received any speech and language therapy since your stroke? Yes/No If yes: When did therapy start When did therapy end? How often did you do therapy? (e.g., one hour every week) What sort of activities did you do in therapy?

Figure 2. Amount of early therapy (hours) reported by each patient, according to whether the initial severity of symptoms was Severe or Moderate.

Table 3. Outcomes in 143 patients who reported (i) whether they did versus did not receive early therapy and (ii) varying amounts of early therapy.

	Outcome measure	R^2	Model significance	Standardized Beta	P (2 tailed)
Binary analyses: Early therapy or none
1	Patient-reported improvement at one month	.203	.002	2.256	.045
2	Patient-reported improvement at one year	.186	.020	1.779	.213
3	Naming	.557	.000	.158	.013
4	Repetition	.462	.000	.109	.112
5	Spoken Picture Description	.499	.000	.043	.517
Continuous analyses: hours of early therapy
6	Patient-reported improvement at one month	.172	.008	1.018	.551
7	Patient-reported improvement at one year	.222	.005	1.117	.045
8	Naming	.540	.000	.074	.245
9	Repetition	.460	.000	.099	.147
10	Spoken Picture Description	.499	.000	.044	.500

Covariates of no interest: Initial severity (Severe or Moderate), handedness, age at stroke, left hemisphere lesion size, right hemisphere lesion size, (all models), amount of later therapy (all models except one month), semantic memory CAT scores, auditory word comprehension CAT scores, and time post-stroke of CAT (for Naming, Repetition and Spoken Picture Description).

Table 4. Outcomes in patients who reported (i) whether they did versus did not receive early therapy and (ii) varying amounts of early therapy, with outliers removed from analyses.

	Outcome measure	R^2	Model significance	Standardized Beta	P (2 tailed)
Binary analyses: Early therapy or none
1	Patient-reported improvement at one month	.216	.001	2.455	.030
2	Patient-reported improvement at one year	.183	.023	1.765	.220
3	Naming	.446	.000	.189	.009
4	Repetition	.414	.000	.120	.101
5	Spoken Picture Description	.502	.000	.048	.467
Continuous analyses: hours of early therapy
6	Patient-reported improvement at one month	.187	.004	1.039	.236
7	Patient-reported improvement at one year	.218	.006	1.117	.046
8	Naming	.419	.000	.074	.312
9	Repetition	.415	.000	.125	.087
10	Spoken Picture Description	.504	.000	.068	.303

Covariates of no interest: same as above.

Outliers: 1 outlier with 30 h of therapy removed from all models. 6 patients with outlying Naming scores removed from Naming analyses. 4 patients with outlying Repetition scores removed from Repetition analyses.

Figure 3. Degree of improvement from one week to one month, and one month to one year, according to five different patient-reported therapy amounts. The colour of the bar indicates the degree of improvement: Purple =  no change in score, green =  a change of one (e.g., Severe to Moderate, Moderate to Mild), orange =  a change of two (Severe to Mild, Moderate to Normal) and grey =  a change of three (Severe to Normal).

Figure 4. Degree of improvement for four patient groups with either Severe or Moderate initial severity, and who reported either no early therapy or more than 4 h of early Therapy.

Figure 5. Comparison of lesion sites across the four different groups. Lesion site results after assigning the 143 patients to four groups according to initial severity (Severe versus Moderate) and the provision of therapy (Yes versus No). Top row (A) shows the brain regions where damage was significantly greater in those with Severe versus Moderate initial severity. The sagittal, coronal and axial slices are at the co-ordinates of the most significant group difference (−48, −2, +24). Rows B to E show the lesion overlap maps (showing the frequency of damage) for the four groups at the same co-ordinates. From top to bottom, B) Patients with Severe initial severity who received Therapy (n = 59); C) Patients with Severe initial severity who did not receive therapy (n = 49); D) Patients with Moderate initial severity who received Therapy (n = 20); E) Patients with Moderate initial severity who did not receive therapy (n = 15). The colour scale indicates percentage of patients for each group.

Data availability

The data used in this study are stored in the PLORAS database (Seghier et al., 2016).