Speech and language therapy for aphasia following stroke

After stroke, speech and language therapy may improve functional communication, reading, writing, and expressive language compared with no therapy. Therapy at high intensity, high dose or over a longer period is probably beneficial.

Comment:The quality of evidence is downgraded by study quality (unclear allocation concealment, high drop-out rate) and inconsistency (heterogeneity in patients, interventions and outcomes).

Summary

A Cochrane review included 57 studies with a total of 3002 subjects. Twenty-seven randomised comparisons (n=1620) assessed speech and language therapy (SLT) vs. no SLT. The timing of SLT interventions after the onset of aphasia varied widely, from days to years. SLT resulted in clinically and statistically significant benefits to patients' functional communication (SMD 0.28, 95% CI 0.06 to 0.49; 10 trials, n=376), reading, writing, and expressive language, but benefits were not evident at follow-up. Nine randomised comparisons (n=447) assessed SLT with social support and stimulation; meta-analyses found no evidence of a difference in functional communication, but more participants withdrew from social support interventions than SLT. Thirty-eight randomised comparisons (n=1242) assessed two approaches to SLT. Functional communication was significantly better in people with aphasia that received therapy at a high intensity, high dose, or over a long duration compared to those that received therapy at a lower intensity, lower dose, or over a shorter period of time. The benefits of a high intensity or a high dose of SLT were confounded by a significantly higher dropout rate in these intervention groups.

Clinical comments

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Ədəbiyyat

1. Brady MC, Kelly H, Godwin J et al. Speech and language therapy for aphasia following stroke. Cochrane Database Syst Rev 2016;(6):CD000425.