ABSTRACT
Aphasia is a significant cause of disability and reduced quality of life. Two speech pathology treatment approaches appear efficacious: multimodal and constraint-induced aphasia therapies. In constraint-induced therapies, non-verbal actions (e.g., gesture, drawing) are believed to interfere with treatment and patients are therefore constrained to speech. In contrast, multimodal therapies employ non-verbal modalities to cue word retrieval. Given the clinical and theoretical implications, a comparison of these two divergent treatments was pursued. This systematic review investigated both approaches in chronic aphasia at the levels of impairment, participation and quality of life. After a systematic search, the level of evidence and methodological quality were rated. Meta-analysis was conducted on 14 single case experimental designs using Tau-U, while heterogeneity in the four group designs precluded meta-analysis. Results showed that high-quality research was limited; however, findings were broadly positive for both approaches with neither being judged as clearly superior. Most studies examined impairment-based outcomes without considering participation or quality of life. The application and definition of constraint varied significantly between studies. Both constraint and multimodal therapies are promising for chronic post-stroke aphasia, but there is a need for larger, more rigorously conducted studies. The interpretation of “constraint” also requires clearer reporting.
Disclosure statement
No potential conflict of interest was reported by the authors.
ORCID
John E. Pierce http://orcid.org/0000-0001-5164-5106
Robyn O’Halloran http://orcid.org/0000-0002-2772-2164
Leanne Togher http://orcid.org/0000-0002-4518-6748
Miranda L. Rose http://orcid.org/0000-0002-8892-0965