Long-term recovery in stroke accompanied by aphasia: a reconsideration

ABSTRACT

Background: This work focuses on the 26 individuals who provided data to AphasiaBank on at least two occasions, with initial testing between 6 months and 5.8 years post onset of aphasia. The data are archival in nature and were collected from the extensive database of aphasic discourse in AphasiaBank.

Aims: The aim is to furnish data on the nature of long-term changes in both the impairment of aphasia as measured by the Western Aphasia Battery-Revised (WAB-R) and its expression in spoken discourse.

Methods & Procedures: AphasiaBank’s demographic database was searched to discover all individuals who were tested twice at an interval of at least a year with either (a) the AphasiaBank protocol or (b) the AphasiaBank protocol at first testing, and the Famous People Protocol (FPP) at second testing. The FPP is a measure developed to assess the communication strategies of individuals whose spoken language limitations preclude full participation in the AphasiaBank protocol. The 26 people with aphasia (PWA) who were identified had completed formal speech therapy before being seen for AphasiaBank. However, all were participants in aphasia centres where at least 3 hr of planned activities were available, in most cases, twice weekly. WAB-R Aphasia Quotient scores (AQ) were examined, and in those cases where AQ scores improved, changes were assessed on a number of measures from the AphasiaBank discourse protocol.

Outcomes & Results: Sixteen individuals demonstrated improved WAB-R AQ scores, defined as positive AQ change scores greater than the WAB-R AQ standard error of the mean (WAB-SEM); seven maintained their original WAB quotients, defined as AQ change scores that were not greater than the WAB-SEM; and the final three showed negative WAB-R change scores, defined as a negative WAB-R AQ change score greater than the WAB-SEM. Concurrent changes on several AphasiaBank tasks were also found, suggesting that the WAB-R improvements were noted in more natural discourse as well.

Conclusions: These data are surprising since conventional wisdom suggests that spontaneous improvement in language is unlikely to occur beyond 1 year. Long-term improvement or maintenance of early test scores, such as that shown here, has seldom been demonstrated in the absence of formal treatment. Speculations about why these PWA improved, maintained, or declined in their scores are considered.

KEYWORDS:

• Aphasia
• language
• long-term recovery
• aphasia centres

Acknowledgements

This work was funded by NIH-NIDCD grant R01-DC008524 (2012-2017). The authors thank the persons with aphasia who generously agreed to participate in the extensive AphasiaBank protocol and to allow AphasiaBank researchers to video the process. All were members of one of the following aphasia programmes: Adler Aphasia Center, Maywood NJ; Aphasia Center of California, Oakland CA; Snyder Center for Aphasia Life Enhancement (SCALE), Baltimore MD; Stroke Comeback Center, Vienna VA; Aphasia Center of Tucson, Tucson, AZ. The authors also thank the staffs of these centres for allowing AphasiaBank researchers to seek participants from their programmes. Finally, the authors thank Nina Simmons-Mackie for her careful reading and critique of this manuscript, and the reviewers for their careful attention and comments.

Disclosure statement

No potential conflict of interest was reported by the author.

Notes

1. Or perhaps less ostentatiously, “luck”.

2. We report here only on the first and last AphasiaBank visits.

3. The WAB-SEM was calculated on the basis of data provided in the WAB-R manual for the second standardisation group of 215 PWA who received the AQ portion of the WAB-R. For 141 “aphasics with infarcts” (Kertesz, 2006, p. 97), the SEM is 2.52, the result of dividing the standard deviation (29.9) by the square root of the sample size (11.87, square root of 141).

Additional information

Funding

This work was supported by the National Institute on Deafness and Other Communication Disorders [R01-DC008524] (2012-2017).