Abstract
Aphasia is one of the most common clinical features of functional impairment after a stroke. Approximately 21–40% of stroke patients sustain permanent aphasia, which progressively worsens one’s quality of life and rehabilitation outcomes. Post-stroke aphasia treatment strategies include speech language therapies, cognitive neurorehabilitation, telerehabilitation, computer-based management, experimental pharmacotherapy, and physical medicine. This review focuses on current evidence of the effectiveness of impairment-based aphasia therapies and communication-based therapies (as well as the timing and optimal treatment intensities for these interventions). Moreover, we present specific interventions, such as constraint-induced aphasia therapy (CIAT) and melodic intonation therapy (MIT). Accumulated data suggest that using transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS) is safe and can be used to modulate cortical excitability. Therefore, we review clinical studies that present TMS and tDCS as (possible) promising therapies in speech and language recovery, stimulating neuroplasticity. Several drugs have been used in aphasia pharmacotherapy, but evidence from clinical studies suggest that only nootropic agents, donepezil and memantine, may improve the prognosis of aphasia. This article is an overview on the current state of knowledge related to post-stroke aphasia pharmacology, rehabilitation, and future trends.
Highlights
Aphasia is one of the most common clinical features of functional impairment after a stroke, affecting 21–40% of post-stroke patients
It was shown that Melodic Intonation Therapy (MIT), compared to the control group, significantly improved functional communication, as well as repetition of practiced material, and a delay in therapy resulted in a reduction in the improvement of repetition of trained items [32]
This review provided a comprehensive overview of novel approaches to pharmacology and rehabilitation of aphasia in the early stage of post-stroke treatment, which may facilitate future decisions in patient therapy and trigger future innovative clinical studies
Summary
Aphasia is one of the most common clinical features of functional impairment after a stroke, affecting 21–40% of post-stroke patients. Aphasia is a language disorder with a broad clinical picture most often caused by damage to the dominant hemisphere of the brain [1]. Spontaneous improvement of linguistic functions, depending on the location, size of the infarction, severity of the initial neurological deficits, as well as individual characteristics of the patient (the degree of hemispherical laterality for language functions, age and level of education), occurs, to some extent, within weeks or months after an ischemic event [4]. In most cases of aphasia, the most effective method of recovery involves the assumption the functions by the preserved left-hemispheric structures, adjacent to the damaged region [5]. The most commonly used clinical terminology to describe the recovery phases after a stroke are: acute (stroke unit), subacute (neurorehabilitation unit—active rehabilitation), and chronic (compensation rather than functional restoration).
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