Abstract
BackgroundAphasia is a severely disabling condition occurring in 20 to 25% of stroke patients. Most patients with aphasia due to stroke receive speech and language therapy. Methodologically sound randomised controlled trials investigating the effect of specific interventions for patients with aphasia following stroke are scarce. The currently available evidence suggests that intensive speech and language therapy is beneficial for restoration of communication, but the optimal timing of treatment is as yet unclear.In the Rotterdam Aphasia Therapy Study-3 we aim to test the hypothesis that patients with aphasia due to stroke benefit more from early intensive cognitive-linguistic therapy than from deferred regular language therapy.Methods/designIn a single blinded, multicentre, randomised controlled trial, 150 patients with first ever aphasia due to stroke will be randomised within two weeks after stroke to either early intensive cognitive-linguistic therapy (Group A) or deferred regular therapy (Group B). Group A will start as soon as possible, at the latest two weeks after stroke, with a four week period of one hour a day treatment with cognitive-linguistic therapy. In Group B professional speech and language therapy is deferred for four weeks. After this period, patients will follow the conventional procedure of speech and language therapy. Participants will be tested with an extensive linguistic test battery at four weeks, three months and six months after inclusion. Primary outcome measure is the difference in score between the two treatment groups on the Amsterdam-Nijmegen Everyday Language Test, a measure of everyday verbal communication, four weeks after randomisation.Trial registrationThis trial is registered in the Dutch Trial Register (http://www.trialregister.nl), NTR3271.
Highlights
Aphasia is a severely disabling condition occurring in 20 to 25% of stroke patients
The authors conclude that there is some evidence that speech and language therapy (SLT) is more effective than no SLT for recovery of communication after stroke and that efficacy of SLT seems to be influenced by intensity of therapy
They emphasise that these results should be interpreted cautiously, as many studies lack proper methodology and comparison across studies is hampered by a large degree of heterogeneity regarding characteristics of the study population, applied treatment methods, timing and duration of therapy, and outcome assessments
Summary
About one fifth to a quarter of all stroke patients suffer from aphasia [1]. Aphasia after stroke is a major health problem with dramatic consequences for the quality of life of affected individuals. In a review article that was not restricted to randomised trials and included studies with other designs, the authors conclude that SLT in the acute stages of aphasia following stroke is almost twice as effective as natural recovery alone [10] This assumes the presence of a “critical period” after stroke during which the brain is more susceptible to rehabilitation. The number of drop-outs or deaths reported in the intervention group with daily therapy was not higher than in the control group with usual care therapy Another trial, in which 123 aphasic patients were randomised for intensive SLT (three weeks of daily SLT for 45 minutes on workdays, starting within two days after stroke) or control condition (no SLT for three weeks) in the acute stage of aphasia, showed no significant differences between groups on the primary outcome measure ANELT-A [7,19]. This regime will be studied in the Rotterdam Aphasia Therapy Study (RATS) – 3
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