Amsterdam-Nijmegen Everyday Language Test Research Articles

Validation of a Cantonese Version of the Amsterdam-Nijmegen Everyday Language Test (CANELT): A functional approach.

The current study aimed to validate the Cantonese version of the Amsterdam-Nijmegen Everyday Language Test (CANELT), a functional communication assessment tool for Cantonese speakers with aphasia. A quantitative scoring method was adopted to examine the pragmatics and informativeness of the production of people with aphasia (PWA). CANELT was translated from its English version with cultural adaptations. The performance on the 20-item CANELT collected from 56 PWA and 100 neurologically healthy Cantonese-speaking controls aged 30 to 79 years was orthographically transcribed. Scoring was based on the completeness of the main concepts produced in the preamble and subsequent elaborations, defined as Opening (O) and New Information (NI). Measures examining the validity and reliability were conducted. An age effect was found in neurologically healthy controls, and therefore z scores were used for subsequent comparisons between neurologically healthy controls and PWA. The test showed strong evidence for known-group validity in both O [χ2 (2) = 95.2, p < .001] and NI [χ2 (2) = 100.4, p < .001]. A moderate to strong correlation was found between CANELT and standardized aphasia assessment tools, suggesting satisfactory concurrent validity. Reliability measures were excellent in terms of internal consistency (Cronbach's α of .95 for both 'O' and 'NI'), test-retest reliability (ICC = .96; p < .001), intra-rater reliability (ICC = 1.00; p < .001), and inter-rater reliability for O (ICC = .99; p < .001) and NI (ICC = .99; p < .001). Sensitivity and specificity for O are 97% and 76.8%, respectively, while for NI, a sensitivity of 95% and specificity of 91.1% were obtained. Measures on validity and reliability yielded promising results, suggesting CANELT as a useful and reliable functional communication assessment for PWA. Its application in managing PWA and potential areas for development are discussed.

Protocol for the development of the international population registry for aphasia after stroke (I-PRAISE)

ABSTRACT Background We require high-quality information on the current burden, the types of therapy and resources available, methods of delivery, care pathways and long-term outcomes for people with aphasia. Aim To document and inform international delivery of post-stroke aphasia treatment, to optimise recovery and reintegration of people with aphasia. Methods & Procedures Multi-centre, prospective, non-randomised, open study, employing blinded outcome assessment, where appropriate, including people with post-stroke aphasia, able to attend for 30 minutes during the initial language assessment, at first contact with a speech and language therapist for assessment of aphasia at participating sites. There is no study-mandated intervention. Assessments will occur at baseline (first contact with a speech and language therapist for aphasia assessment), discharge from Speech and Language Therapy (SLT), 6 and 12-months post-stroke. Our primary outcome is changed from baseline in the Amsterdam Nijmegen Everyday Language Test (ANELT/Scenario Test for participants with severe verbal impairments) at 12-months post-stroke. Secondary outcomes at 6 and 12 months include the Therapy Outcome Measure (TOMS), Subjective Index of Physical and Social Outcome (SIPSO), Aphasia Severity Rating Scale (ASRS), Western Aphasia Battery Aphasia Quotient (WAB-AQ), stroke and aphasia quality of life scale (SAQoL-39), European Quality of Life Scale (EQ-5D), lesion description, General Health Questionnaire (GHQ-12), resource use, and satisfaction with therapy provision and success. We will collect demography, clinical data, and therapy content. Routine neuroimaging and medication administration records will be accessed where possible; imaging will be pseudonymised and transferred to a central reading centre. Data will be collected in a central registry. We will describe demography, stroke and aphasia profiles and therapies available. International individual participant data (IPD) meta-analyses will examine treatment responder rates based on minimal detectable change & clinically important changes from baseline for primary and secondary outcomes at 6 and 12 months. Multivariable meta-analyses will examine associations between demography, therapy, medication use and outcomes, considering service characteristics. Where feasible, costs associated with treatment will be reported. Where available, we will detail brain lesion size and site, and examine correlations with SLT and language outcome at 12 months. Conclusion International differences in care, resource utilisation and outcomes will highlight avenues for further aphasia research, promote knowledge sharing and optimise aphasia rehabilitation delivery. IPD meta-analyses will enhance and expand understanding, identifying cost-effective and promising approaches to optimise rehabilitation to benefit people with aphasia.

Investigating a new tablet-based telerehabilitation app in patients with aphasia: a randomised, controlled, evaluator-blinded, multicentre trial protocol

IntroductionAphasia is a common language disorder acquired after stroke that reduces the quality of life of affected patients. The impairment is frequently accompanied by a deficit in cognitive functions. The...

Effectiveness and safety of repetitive transcranial magnetic stimulation (rTMS) on aphasia in cerebrovascular accident patients: Protocol of a systematic review and meta-analysis.

Repetitive transcranial magnetic stimulation (rTMS), a non-invasive brain stimulation approach, might be a promising technique in the management of aphasia after cerebrovascular accidents (CVA). This protocol of systematic review (SR) aims to investigate the effectiveness and safety of rTMS in patients with aphasia after CVA. The following databases will be searched: PubMed, EMBASE, the Cochrane Central Register of Controlled Trials (CENTRAL), China National Knowledge infrastructure (CNKI), Technology Periodical Database (VIP), WanFang Data, and China Biology Medicine (CBM) from inception to August 2019. Randomized controlled trials (RCTs) investigating the effectiveness and safety of rTMS for aphasia patients after CVA will be included. Primary outcome will include Boston Diagnostic Aphasia Examination (BDAE). Secondary outcomes will include Aphasia Battery of Chinese (ABC), Aachen Aphasia Test (AAT), Aphasia Quotient (AQ), the Western Aphasia Battery (WAB), Standard Language Test of Aphasia (SLTA), Aphasia Severity Rating Scale (ASRS), Concise China Aphasia Test Scale (CCAT), Amsterdam-Nijmegen Everyday Language Test (ANELT), or other related outcomes. Adverse events such as headache, tinnitus, anxiety, fatigue, or epileptic seizure will be considered as safety measurement. Studies screening, data extraction, and methodological quality assessment will be performed independently by two reviewers. Meta-analysis will be conducted with Review Manager 5.3 software and R software 3.6.1. This study will provide a high-quality synthesis of RCTs on the effectiveness and safety of rTMS as an adjuvant therapy in the treatment of aphasia. The conclusion of this study will help clinicians and patients with aphasia after CVA to make decision. No privacy health information will be collected, thus formal ethics approval is not required. The findings of this SR will be submitted to a peer-reviewed journal. CRD42019144587.

Transcranial Direct Current Stimulation to Enhance Training Effectiveness in Chronic Post-Stroke Aphasia: A Randomized Controlled Trial Protocol.

Background: Intensive speech-language therapy (SLT) can promote recovery from chronic post-stroke aphasia, a major consequence of stroke. However, effect sizes of intensive SLT are moderate, potentially reflecting a physiological limit of training-induced progress. Transcranial direct current stimulation (tDCS) is an easy-to-use, well-tolerated and low-cost approach that may enhance effectiveness of intensive SLT. In a recent phase-II randomized controlled trial, 26 individuals with chronic post-stroke aphasia received intensive SLT combined with anodal-tDCS of the left primary motor cortex (M1), resulting in improved naming and proxy-rated communication ability, with medium-to-large effect sizes.Aims: The proposed protocol seeks to establish the incremental benefit from anodal-tDCS of M1 in a phase-III randomized controlled trial with adequate power, ecologically valid outcomes, and evidence-based SLT.Methods: The planned study is a prospective randomized placebo-controlled (using sham-tDCS), parallel-group, double-blind, multi-center, phase-III superiority trial. A sample of 130 individuals with aphasia at least 6 months post-stroke will be recruited in more than 18 in- and outpatient rehabilitation centers.Outcomes: The primary outcome focuses on communication ability in chronic post-stroke aphasia, as revealed by changes on the Amsterdam-Nijmegen Everyday Language Test (A-scale; primary endpoint: 6-month follow-up; secondary endpoints: immediately after treatment, and 12-month follow-up). Secondary outcomes include measures assessing linguistic-executive skills, attention, memory, emotional well-being, quality of life, health economic costs, and adverse events (endpoints: 6-month follow-up, immediately after treatment, and 12-month follow-up).Discussion: Positive results will increase the quality of life for persons with aphasia and their families while reducing societal costs. After trial completion, a workshop with relevant stakeholders will ensure transfer into best-practice guidelines and successful integration within clinical routine.Clinical Trial Registration: www.ClinicalTrials.gov, identifier: NCT03930121.

The Role of the BDNF Val66Met Polymorphism in Recovery of Aphasia After Stroke

Background. Brain-derived neurotrophic factor (BDNF) is assumed to play a role in mediating neuroplasticity after stroke. Carriers of the function-limiting Val66Met (rs6265) single nucleotide polymorphism (SNP) may have a downregulation in BDNF secretion, which may lead to a poorer prognosis after stroke compared to noncarriers in motor learning and motor function recovery. The present study investigates whether this polymorphism may also affect the recovery of poststroke aphasia (ie, language impairment). Objective. To study the influence of the BDNF Val66Met polymorphism on the recovery of poststroke aphasia. Methods. We included 53 patients with poststroke aphasia, all participating in an inpatient rehabilitation program with speech and language therapy. All patients were genotyped for the Val66Met SNP and subdivided into carriers (at least one Met allele) and noncarriers (no Met allele). Primary outcome measures included the improvement over rehabilitation time on the Amsterdam-Nijmegen Everyday Language Test (ANELT) and the Boston Naming Test (BNT). Results. The outcome measures showed a large variability in the improvement scores on both the ANELT and BNT. There was no significant difference between noncarriers and carriers in the primary outcome measures. Conclusion. This study investigated the effect of the BDNF Val66Met polymorphism on clinical recovery of poststroke aphasia. In contrast to earlier studies describing a reducing effect of this polymorphism on motor function recovery after stroke, the present study does not support a reduction in language recovery for carriers compared to noncarriers with poststroke aphasia.

Efficacy of early cognitive-linguistic treatment for aphasia due to stroke: A randomised controlled trial (Rotterdam Aphasia Therapy Study-3)

IntroductionOne third of patients with acute stroke have aphasia. The majority receive speech and language therapy. There is evidence for a beneficial effect of speech and language therapy on restoring communication, but it is unknown whether and how efficacy of speech and language therapy is influenced by timing of treatment. We studied whether speech and language therapy early after stroke by way of intensive cognitive-linguistic treatment is more effective than no speech and language therapy in the Rotterdam Aphasia Therapy Study-3, a multicentre randomised single-blind trial.Methods and patientsStroke patients with first-ever aphasia were randomised within 2 weeks of onset to either 4 weeks of early intensive cognitive-linguistic treatment (1 h/day) or no language treatment. Hereafter, both groups received regular speech and language therapy. Primary outcome was the score on the Amsterdam-Nijmegen Everyday Language Test, measuring everyday verbal communication, 4 weeks after randomisation. Secondary outcomes were Amsterdam-Nijmegen Everyday Language Test at 3 and 6 months. The study was powered to detect a clinically relevant difference of four points on the Amsterdam-Nijmegen Everyday Language Test.ResultsOf the 152 included patients, 80 patients were allocated to intervention. Median treatment intensity in the intervention-group was 24.5 h. The adjusted difference between groups in mean Amsterdam-Nijmegen Everyday Language Test-scores 4 weeks after randomisation was 0.39, 95% confidence interval: [−2.70 to 3.47], p = 0.805. No statistically significant differences were found at 3 and 6 months after randomisation either.ConclusionFour weeks of intensive cognitive-linguistic treatment initiated within 2 weeks of stroke is not more effective than no language treatment for the recovery of post-stroke aphasia. Our results exclude a clinically relevant effect of very early cognitive-linguistic treatment on everyday language.

Prediction of everyday verbal communicative ability of aphasic stroke patients after inpatient rehabilitation

ABSTRACTBackground: Early accurate prediction of verbal communicative ability at discharge from inpatient rehabilitation is essential for rehabilitation professionals to provide reliable prognostic information to the aphasic patient and family, and to make appropriate treatment decisions.Aims: To develop a prediction model for verbal communicative ability at discharge from inpatient rehabilitation in stroke patients with moderate-to-severe aphasia at rehabilitation admission.Methods & Procedures: Eighty-four stroke patients with moderate-to-severe aphasia were selected from a cohort of aphasic patients who enrolled in an inpatient rehabilitation programme from September 2010 to September 2013. From a group of eight candidate prognostic factors (demographic, neurological, and language variables, and the ictus-to-admission interval), those significantly associated with verbal communication (Amsterdam–Nijmegen Everyday Language Test scale A) at discharge were selected by means of multiple linear regression analyses.Outcomes & Results: A prognostic model of verbal communication was constructed, including verbal communicative ability and the phonology score at admission as independent predictors, which explained 64% of the adjusted variance. The ictus-to-admission interval was a marginally significant predictor. Age, sex, stroke type, activities of daily living dependency, and semantics did not make significant contributions to the prediction model.Conclusions: The results of this study represent a first step in the development of a prediction model for verbal communication outcome after inpatient rehabilitation in stroke patients with moderate-to-severe aphasia at admission. After the performance of the prognostic model has been externally validated, it can be used to inform patients with moderate-to-severe aphasia and their families about the expected recovery of verbal communicative ability after inpatient rehabilitation, and it may guide clinicians, patients, and their relatives in shared decisions on the most appropriate treatment approach to improve functional communication.

Intensive speech and language therapy in patients with chronic aphasia after stroke: a randomised, open-label, blinded-endpoint, controlled trial in a health-care setting

Treatment guidelines for aphasia recommend intensive speech and language therapy for chronic (≥6 months) aphasia after stroke, but large-scale, class 1 randomised controlled trials on treatment effectiveness are scarce. We aimed to examine whether 3 weeks of intensive speech and language therapy under routine clinical conditions improved verbal communication in daily-life situations in people with chronic aphasia after stroke. In this multicentre, parallel group, superiority, open-label, blinded-endpoint, randomised controlled trial, patients aged 70 years or younger with aphasia after stroke lasting for 6 months or more were recruited from 19 inpatient or outpatient rehabilitation centres in Germany. An external biostatistician used a computer-generated permuted block randomisation method, stratified by treatment centre, to randomly assign participants to either 3 weeks or more of intensive speech and language therapy (≥10 h per week) or 3 weeks deferral of intensive speech and language therapy. The primary endpoint was between-group difference in the change in verbal communication effectiveness in everyday life scenarios (Amsterdam-Nijmegen Everyday Language Test A-scale) from baseline to immediately after 3 weeks of treatment or treatment deferral. All analyses were done using the modified intention-to-treat population (those who received 1 day or more of intensive treatment or treatment deferral). This study is registered with ClinicalTrials.gov, number NCT01540383. We randomly assigned 158 patients between April 1, 2012, and May 31, 2014. The modified intention-to-treat population comprised 156 patients (78 per group). Verbal communication was significantly improved from baseline to after intensive speech and language treatment (mean difference 2·61 points [SD 4·94]; 95% CI 1·49 to 3·72), but not from baseline to after treatment deferral (-0·03 points [4·04]; -0·94 to 0·88; between-group difference Cohen's d 0·58; p=0·0004). Eight patients had adverse events during therapy or treatment deferral (one car accident [in the control group], two common cold [one patient per group], three gastrointestinal or cardiac symptoms [all intervention group], two recurrent stroke [one in intervention group before initiation of treatment, and one before group assignment had occurred]); all were unrelated to study participation. 3 weeks of intensive speech and language therapy significantly enhanced verbal communication in people aged 70 years or younger with chronic aphasia after stroke, providing an effective evidence-based treatment approach in this population. Future studies should examine the minimum treatment intensity required for meaningful treatment effects, and determine whether treatment effects cumulate over repeated intervention periods. German Federal Ministry of Education and Research and the German Society for Aphasia Research and Treatment.

A preliminary Cantonese version of the Amsterdam-Nijmegen Everyday Language Test (ANELT)

A preliminary Cantonese version of the Amsterdam-Nijmegen Everyday Language Test (ANELT)

FV 13. The combination of repetitive transcranial magnetic stimulation (rTMS) and language therapy enhances improvement of functional communication and linguistic skills in patients with subacute aphasia

Background and Objective Repetitive transcranial magnetic stimulation (rTMS) has shown encouraging effects on naming performance in the treatment of persons with chronic aphasia by means of inhibiting homologous language areas and reactivating perilesional tissue ( Naeser et al., 2005 ). However, there are heterogeneous results about the combined impact of speech and language therapy (SLT) and rTMS in the subacute stage of aphasia and its effect on linguistic performance in language assessments and functional communication ( Thiel et al., 2013 , Seniow et al., 2013 ). As few studies have dealt with the effect of rTMS on functional communication, the study aimed to determine to which extent rTMS combined with SLT improves functional communication and linguistic skills in patients with subacute aphasia. Methods Design and Participants: The randomized, blinded, sham-controlled study investigated the effect of a 10-day treatment period with inhibitory rTMS over the right inferior frontal gyrus versus sham stimulation in conjunction with SLT on language recovery in 30 participants with subacute aphasia after stroke. Intervention: During treatment period, half of the participants received 10 sessions of 20 min 1 Hz-rTMS over the right inferior frontal gyrus (BA 45) and the other half was subjected to sham stimulation. Directly thereafter all the participants underwent 45 min of SLT. SLT aimed at recruiting left hemisphere perilesional areas by using tasks and therapy methods which had been shown to activate predominantly left hemisphere structures in imaging studies ( Heim et al., 2008 ). Outcome Measures: Aachen Aphasia Test (AAT), Amsterdam-Nijmegen Everyday Language Test (ANELT), a naming screening and subscales of the Functional Independence Measure (FIM), all assessed the day before and the day after treatment period. Results The participants who received real rTMS significantly improved in all 10 measures of language skills and functional communication whereas sham treated participants significantly improved only regarding 6/10 measures (P Conclusion The results show for the first time that linguistic skills as well as functional communication are bolstered by combining rTMS and behavioral language therapy in patients with subacute aphasia.

Add-on Effects of Repetitive Transcranial Magnetic Stimulation on Subacute Aphasia Therapy: Enhanced Improvement of Functional Communication and Basic Linguistic Skills. A Randomized Controlled Study

ObjectiveTo determine to what extent repetitive transcranial magnetic stimulation (rTMS) combined with speech and language therapy improves functional communication and basic linguistic skills of individuals with subacute aphasia. DesignRandomized, blinded, and sham-controlled study. SettingNeurologic rehabilitation hospital. ParticipantsParticipants (N=30) with subacute aphasia after stroke. InterventionsDuring a 2-week treatment period, half of the participants received 10 sessions of 20-minute inhibitory 1-Hz rTMS over the right inferior frontal gyrus (Brodmann area 45), and the other half received sham stimulation. Directly thereafter, all the participants underwent 45 minutes of speech and language therapy. Main Outcome MeasuresAachen Aphasia Test, Amsterdam-Nijmegen Everyday Language Test (ANELT), a naming screening, and subscales of the FIM, all assessed the day before and the day after treatment period. ResultsThe participants who received real rTMS significantly improved with respect to all 10 measures of basic linguistic skills and functional communication, whereas sham-treated participants significantly improved in only 6 of 10 measures (paired t tests, P<.05). There was a significant difference in the gains made by the 2 groups on 5 of 10 measures including functional communication (ANELT) (repeated-measures analysis of variance, P≤.05). ConclusionsFor the first time, this study has demonstrated that basic linguistic skills as well as functional communication are bolstered by combining rTMS and behavioral language therapy in patients with subacute aphasia.

The effectiveness of Speech–Music Therapy for Aphasia (SMTA) in five speakers with Apraxia of Speech and aphasia

Background: Several studies using musical elements in the treatment of neurological language and speech disorders have reported improvement of speech production. One such programme, Speech–Music Therapy for Aphasia (SMTA), integrates speech therapy and music therapy (MT) to treat the individual with Apraxia of Speech (AoS) and aphasia. We have observed encouraging results in clinical practice, but there is still no empirical evidence of the effect of SMTA.Aims: The current study investigated the effectiveness of SMTA on verbal communication in daily life.Methods & Procedures: Five participants with AoS accompanied by aphasia were included in an efficacy study using a case series design with multiple measurements. All participants received 24 SMTA sessions including two 30-min sessions per week. Pretreatment and posttreatment (immediately and 3 months after treatment stopped), verbal communication (intelligibility and comprehensibility) were tested with the Amsterdam-Nijmegen Everyday Language Test. The Aachen Aphasia Test (AAT) and the Diagnostic Instrument for Apraxia of Speech (DIAS) were also administered. The participants were tested four times before the start of the treatment (baseline) with a related test for progress on articulation (Modified Diadochokinesis Test (MDT)) and once with an unrelated control test (Psycholinguistic Assessment in Language Processing of Aphasia 12; repetition of number series). During the treatment, both tests were administered weekly.Outcomes & Results: Intelligibility of verbal communication for all participating individuals, as well as comprehensibility in four out of five participants, improved after 24 SMTA treatment sessions. All measures of MDT and repetition of AAT showed significant improvement for all participants. Four participants also improved on the test for articulation of phonemes and the diadochokinesis test of the DIAS. Furthermore, two participants improved on the articulation of words (DIAS). The improvement remained stable after treatment ended (follow-up). For three out of the five participants, no improvement was found on the control tests. Two participants also showed improvement on almost all outcome measures, but also improved on the control tests. SMTA not only affected articulation but also positively influenced the severity of the aphasia in four out of five participants.Conclusions: SMTA seems an effective treatment programme for at least three of the five individuals that were treated in the current study. This treatment led not only to better articulation, but more importantly, also to improvement in communication in daily life.

Constraint-Induced Aphasia Therapy Versus Intensive Semantic Treatment in Fluent Aphasia

The authors compared the effectiveness of 2 intensive therapy methods: Constraint-Induced Aphasia Therapy (CIAT; Pulvermüller et al., 2001) and semantic therapy (BOX; Visch-Brink & Bajema, 2001). Nine patients with chronic fluent aphasia participated in a therapy program to establish behavioral treatment outcomes. Participants were randomly assigned to one of two groups (CIAT or BOX). Intensive therapy significantly improved verbal communication. However, BOX treatment showed a more pronounced improvement on two communication-namely, a standardized assessment for verbal communication, the Amsterdam Nijmegen Everyday Language Test (Blomert, Koster, & Kean, 1995), and a subjective rating scale, the Communicative Effectiveness Index (Lomas et al., 1989). All participants significantly improved on one (or more) subtests of the Aachen Aphasia Test (Graetz, de Bleser, & Willmes, 1992), an impairment-focused assessment. There was a treatment-specific effect. BOX treatment had a significant effect on language comprehension and semantics, whereas CIAT treatment affected language production and phonology. The findings indicate that in patients with fluent aphasia, (a) intensive treatment has a significant effect on language and verbal communication, (b) intensive therapy results in selective treatment effects, and (c) an intensive semantic treatment shows a more striking mean improvement on verbal communication in comparison with communication-based CIAT treatment.

P 126. Righthemispheric inhibitory rTMS in patients with letfsided brain infarcts: Effect on cerebral blood flow using PET and speech performance

Several small studies suggest that non-invasive repetitive transcranial magnetic stimulation (rTMS) of the non-dominant right Brodmann area might support recovery from aphasia in patients with leftsided stroke during conventional speech therapy.We evaluated the effect of this therapeutic regimen in patients with subacute stroke on cerebral blood flow (rCBF) and speech performance. 21 subjects have been included in this randomized, double blind, placebo controlled study. The intervention group was treated daily for 2 weeks with rTMS (1 Hz) for 20 min directly prior to speech therapy. The magnetic coil was placed over the right sided gyrus frontalis inferior, as indentified by T1 MRI. In the control group, the protocol was the same but the coil was placed over the vertex. Prior to the 2 weeks protocol, a PET (H 2 O 15 ) was performed during rest and during verb generation to calculate the rCBF change by this activation. The PET was repeated at the end of the protocol to identify a possible shift of cortical activation during verb generation. The Aachener Aphasia test (AAT) and the Amsterdam-Nijmegen Everyday Language Test (ANELT) were used for tests of the language performance. CBF measurement revaled a significant shift of activated language related cortex towards the left hemisphere in the group treated with rTMS compared to the control group. We calculated a significant difference in the pre-and posttreatment values of the global AAT scores between verum treated patients and control patients. The mean scores post treatment was significantly higher in the verum patients, predominantly in the subtest picture naming. rTMS with inhibitory effect on the rightsided homologous speech area plus speech therapy in patients with left sided brain infarcts and aphasia results in better recovery of language performance compared to patients who received speech therapy only.

Rotterdam Aphasia Therapy Study (RATS) – 3: “The efficacy of intensive cognitive-linguistic therapy in the acute stage of aphasia”; design of a randomised controlled trial

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.

FCET2EC (From controlled experimental trial to = 2 everyday communication): How effective is intensive integrative therapy for stroke-induced chronic aphasia under routine clinical conditions? A study protocol for a randomized controlled trial

BackgroundTherapy guidelines recommend speech and language therapy (SLT) as the “gold standard” for aphasia treatment. Treatment intensity (i.e., ≥5 hours of SLT per week) is a key predictor of SLT outcome. The scientific evidence to support the efficacy of SLT is unsatisfactory to date given the lack of randomized controlled trials (RCT), particularly with respect to chronic aphasia (lasting for >6 months after initial stroke). This randomized waiting list-controlled multi-centre trial examines whether intensive integrative language therapy provided in routine in- and outpatient clinical settings is effective in improving everyday communication in chronic post-stroke aphasia.Methods/DesignParticipants are men and women aged 18 to 70 years, at least 6 months post an ischemic or haemorrhagic stroke resulting in persisting language impairment (i.e., chronic aphasia); 220 patients will be screened for participation, with the goal of including at least 126 patients during the 26-month recruitment period. Basic language production and comprehension abilities need to be preserved (as assessed by the Aachen Aphasia Test).Therapy consists of language-systematic and communicative-pragmatic exercises for at least 2 hours/day and at least 10 hours/week, plus at least 1 hour self-administered training per day, for at least three weeks. Contents of therapy are adapted to patients’ individual impairment profiles.Prior to and immediately following the therapy/waiting period, patients’ individual language abilities are assessed via primary and secondary outcome measures. The primary (blinded) outcome measure is the A-scale (informational content, or 'understandability’, of the message) of the Amsterdam-Nijmegen Everyday Language Test (ANELT), a standardized measure of functional communication ability. Secondary (unblinded) outcome measures are language-systematic and communicative-pragmatic language screenings and questionnaires assessing life quality as viewed by the patient as well as a relative.The primary analysis tests for differences between the therapy group and an untreated (waiting list) control group with respect to pre- versus post 3-week-therapy (or waiting period, respectively) scores on the ANELT A-scale. Statistical between-group comparisons of primary and secondary outcome measures will be conducted in intention-to-treat analyses.Long-term stability of treatment effects will be assessed six months post intensive SLT (primary and secondary endpoints).Trial registrationRegistered in ClinicalTrials.gov with the Identifier NCT01540383

Expert Versus Proxy Rating of Verbal Communicative Ability of People with Aphasia after Stroke

In randomized clinical trials of aphasia treatment, a functional outcome measure like the Amsterdam-Nijmegen Everyday Language Test (ANELT), administered by speech-language therapists, is often used. However, the agreement between this expert rating and the judgment of the proxy about the quality of the daily life communication of the person with aphasia is largely unknown. We examined the association between ANELT scores by speech-language therapists and proxy judgments on the Partner Communication Questionnaire both at 3 and 6 months in 39 people with aphasia after stroke. We also determined which factors affected the level of agreement between expert and proxy judgment of the communicative ability at 6 months in 53 people with aphasia. We found moderate agreement (at 3 months r = .662; p = < .0001 and at 6 months r = .565; p = .0001), with proxies rating slightly higher than experts. Less severe aphasia, measured with the Aphasia Severity Rating Scale, was associated with better agreement. In conclusion, although proxies were slightly more positive than experts, we found moderate agreement between expert and proxy rating of verbal communicative ability of people with aphasia after stroke, especially in milder cases.

A Randomized Controlled Trial on Very Early Speech and Language Therapy in Acute Stroke Patients with Aphasia

Background: Aphasia affects one third of acute stroke patients. There is a considerable spontaneous recovery in aphasia, but impaired communication ability remains a great problem. Communication difficulties are an impediment to rehabilitation. Early treatment of the language deficits leading to increased communication ability would improve rehabilitation. The aim of this study is to elucidate the efficacy of very early speech and language therapy (SLT) in acute stroke patients with aphasia. Methods: A prospective, open, randomized, controlled trial was carried out with blinded endpoint evaluation of SLT, starting within 2 days of stroke onset and lasting for 21 days. 123 consecutive patients with acute, first-ever ischemic stroke and aphasia were randomized. The SLT treatment was Language Enrichment Therapy, and the aphasia tests used were the Norsk grunntest for afasi (NGA) and the Amsterdam-Nijmegen everyday language test (ANELT), both performed by speech pathologists, blinded for randomization. Results: The primary outcome, as measured by ANELT at day 21, was 1.3 in the actively treated patient group and 1.2 among controls. NGA led to similar results in both groups. Patients with a higher level of education (>12 years) improved more on ANELT by day 21 than those with <12 years of education (3.4 vs. 1.0, respectively). In 34 patients in the treatment group and 19 in the control group improvement was ≧1 on ANELT (p < 0.05). There was no difference in the degree of aphasia at baseline except for fluency, which was higher in the group responding to treatment. Conclusions: Very early intensive SLT with the Language Enrichment Therapy program over 21 days had no effect on the degree of aphasia in unselected acute aphasic stroke patients. In aphasic patients with more fluency, SLT resulted in a significant improvement as compared to controls. A higher educational level of >12 years was beneficial.

Towards a quantitative measure of verbal effectiveness and efficiency in the Amsterdam-Nijmegen Everyday Language Test (ANELT)

Background: A well-known test for measuring verbal adequacy (i.e., verbal effectiveness) in mildly impaired aphasic speakers is the Amsterdam-Nijmegen Everyday Language Test (ANELT; Blomert, Koster, & Kean, 1995). Aphasia therapy practitioners score verbal adequacy qualitatively when they administer the ANELT to their aphasic clients in clinical practice. Aims: The current study investigated whether the construct validity of the ANELT could be further improved by substituting the qualitative score by a quantitative one, which takes the number of essential information units into account. The new quantitative measure could have the following advantages: the ability to derive a quantitative score of verbal efficiency, as well as improved sensitivity to detect changes in functional communication over time. Methods & Procedures: The current study systematically compared a new quantitative measure of verbal effectiveness with the current ANELT Comprehensibility scale, which is based on qualitative judgements. A total of 30 speakers of Dutch participated: 20 non-aphasic speakers and 10 aphasic patients with predominantly expressive disturbances. Outcomes & Results: Although our findings need to be replicated in a larger group of aphasic speakers, the main results suggest that the new quantitative measure of verbal effectiveness is more sensitive to detect change in verbal effectiveness over time. What is more, it can be used to derive a measure of verbal efficiency. Conclusions: The fact that both verbal effectiveness and verbal efficiency can be reliably as well as validly measured in the ANELT is of relevance to clinicians. It allows them to obtain a more complete picture of aphasic speakers' functional communication skills.