Constraint-induced Language Therapy Research Articles

Effectiveness of Constraint-Induced Language Therapy for Aphasia: Evidence From Systematic Reviews and Meta-Analyses.

Constraint-induced language therapy (CILT) is an aphasia treatment that incorporates neuroplasticity principles of forced verbal use and high-intensity training to facilitate language recovery in individuals with stroke-induced aphasia (Pulvermüller et al., 2001). The burgeoning CILT literature has led to systematic reviews (SRs) that summarize treatment results. In this project, we appraised the quality and examined findings reported in several SRs to draw conclusions about the effectiveness of CILT. We searched multiple databases for SRs that summarized CILT research for poststroke aphasia. We identified six SRs, among which three summarized findings qualitatively and three included meta-analysis (MA) to quantify results. We rated each SR for methodologic quality using the A MeaSurement Tool to Assess Systematic Reviews (AMSTAR 2; Shea et al., 2017) and extracted findings across the six SRs. Two reviewers reliably applied the AMSTAR 2 to the six SRs. Although the six SRs generally were conducted with satisfactory rigor, each was lacking two or more critical domains. Descriptive summaries in SRs reported positive effects of CILT for language and communication measures. However, the three MAs showed that effects of CILT often did not surpass those of comparison treatments for naming, comprehension, and repetition measures. MA findings were positive in a review that included all research designs and evaluated treatment effects for trained naming items. Generalized CILT effects for standardized language measures were limited in two other MAs. CILT led to improvements in a variety of language and communication measures. When compared with intensive multimodality treatments, CILT effects were similar, suggesting that training intensity may be the potent factor in CILT outcomes. Future SRs should be implemented with increased rigor across quality rating scale domains to increase confidence in conclusions.

Constraint-Induced Language Therapy for Aphasia: Evidence from Systematic Reviews and Meta-Analyses

<h3>Objective(s)</h3> Constraint induced language therapy (CILT) is an aphasia treatment that incorporates use-dependent principles to facilitate language recovery in stroke-induced aphasia (Pulvermuller et al., 2001). Several systematic reviews (SR) have been conducted to summarize the growing CILT literature. The purpose of this project was to appraise the quality and examine the weight of treatment evidence reported in CILT SRs. <h3>Data Sources</h3> PsychInfo, PubMed, SpeechBite, ASHA Compendium of Systematic Reviews. <h3>Study Selection</h3> We identified six SRs that examined CILT for post-stroke aphasia in the English literature, three that included meta-analysis (MA). <h3>Data Extraction</h3> Two reviewers rated each SR for methodologic quality using the AMSTAR2 (Shea et al., 2017) and extracted findings across the six reviews. Coding reliability for the AMSTAR2 showed 94.8% agreement. <h3>Data Synthesis</h3> The quality of SRs varied on the AMSTAR2 scale (range 1.5-9.5, mean 7/16). Five SRs addressed more than half of the appraisal criteria. The number of original studies included in the SRs ranged from 5 to 24, as some reviews included only RCTs and others included all designs. CILT SRs that included all designs reported positive CILT outcomes, particularly for trained naming stimuli. Two MAs that analyzed RCTs reported limited positive outcomes for standardized language measures. <h3>Conclusions</h3> Conclusions varied as descriptive SR summaries reported positive effects of CILT studies, yet MA showed that effects often did not surpass comparison treatments for naming, comprehension, and repetition. Early enthusiasm has given way to measured caution in recent MAs that have summarized CILT outcomes relative to control treatments of similar intensity, suggesting that the intensity effect may be the more potent factor than verbal constraint in the reported CILT results. <h3>Author(s) Disclosures</h3> The authors have no conflicts of interest to report.

Through Thick and Thin: Baseline Cortical Volume and Thickness Predict Performance and Response to Transcranial Direct Current Stimulation in Primary Progressive Aphasia.

ObjectivesWe hypothesized that measures of cortical thickness and volume in language areas would correlate with response to treatment with high-definition transcranial direct current stimulation (HD-tDCS) in persons with primary progressive aphasia (PPA).Materials and MethodsIn a blinded, within-group crossover study, PPA patients (N = 12) underwent a 2-week intervention HD-tDCS paired with constraint-induced language therapy (CILT). Multi-level linear regression (backward-fitted models) were performed to assess cortical measures as predictors of tDCS-induced naming improvements, measured by the Western Aphasia Battery-naming subtest, from baseline to immediately after and 6 weeks post-intervention.ResultsGreater baseline thickness of the pars opercularis significantly predicted naming gains (p = 0.03) immediately following intervention, while greater thickness of the middle temporal gyrus (MTG) and lower thickness of the superior temporal gyrus (STG) significantly predicted 6-week naming gains (p’s < 0.02). Thickness did not predict naming gains in sham. Volume did not predict immediate gains for active stimulation. Greater volume of the pars triangularis and MTG, but lower STG volume significantly predicted 6-week naming gains in active stimulation. Greater pars orbitalis and MTG volume, and lower STG volume predicted immediate naming gains in sham (p’s < 0.05). Volume did not predict 6-week naming gains in sham.ConclusionCortical thickness and volume were predictive of tDCS-induced naming improvement in PPA patients. The finding that frontal thickness predicted immediate active tDCS-induced naming gains while temporal areas predicted naming changes at 6-week suggests that a broader network of regions may be important for long-term maintenance of treatment gains. The finding that volume predicted immediate naming performance in the sham condition may reflect the benefits of behavioral speech language therapy and neural correlates of its short-lived treatment gains. Collectively, thickness and volume were predictive of treatment gains in the active condition but not sham, suggesting that pairing HD-tDCS with CILT may be important for maintaining treatment effects.

Additional doses of Constraint Induced Language Therapy (CILT) can improve outcomes in aphasia

Q (1) Does Constraint Induced Language Therapy (CILT) improve verbal production of trained and untrained stimuli after one and two treatment periods (treatment period = 30 hrs over 2 weeks)?(2) Are...

Factors that influence Australian speech-language pathologists’ self-reported uptake of aphasia rehabilitation recommendations from clinical practice guidelines

ABSTRACTBackground: There are clinical practice guidelines for speech-language pathologists’ aphasia management practices. However, reported adherence to aphasia guideline recommendations is variable. The barriers and facilitators to meeting aphasia management recommendations are not well understood. In order to develop theory-informed strategies to improve implementation of aphasia management practices, a better understanding of these barriers and facilitators is required.Aims: This study aimed to describe barriers and facilitators to speech-language pathologists’ uptake and implementation of five prioritised recommended practices for aphasia management.Methods & Procedures: An online survey sought information from Australian speech-language pathologists working with clients with aphasia. The survey focused on five practices including goal setting, information provision, constraint-induced language therapy, timing, and intensity of intervention. The Theoretical Domains Framework was used to design the survey, with several statements generated about factors influencing practice for each domain.Outcomes & Results: Surveys were completed by 63 respondents. The theoretical domain “environmental context and resources” (e.g., “I have insufficient time to engage in…”) was the main perceived barrier for the majority of practices being investigated, whilst the theoretical domain “social/professional role and identity” (e.g., “It is part of my role with the multidisciplinary stroke team to engage in…”) was the main perceived implementation facilitator for all practices. The top three barriers and facilitators varied for each of the five recommended practices being investigated. Across clinical settings, there were commonalities and differences in the perceived barriers and facilitators to implementation. There was a significant correlation between self-reported uptake of all of the aphasia rehabilitation recommendations we investigated and participants’ total barrier scores. Total barrier scores were also significantly different between clinical settings in the area of goal setting, with acute settings having a higher number of reported barriers to goal setting than rehabilitation settings (p = 0.011).Conclusions: Implementation interventions that seek to overcome the barriers of environmental context and resources (time, competing priorities and resources) are likely to have the most effect on aphasia best practice uptake. Encouraging behaviour change in the “social professional role and identity” domain by emphasising the role of the speech-language pathologist in aphasia rehabilitation within the multidisciplinary stroke team should further improve uptake of recommended practices. At a local level, departments or individual speech pathologists need to identify their own barriers and facilitators and choose effective implementation interventions using the Behaviour Change Wheel. Both strategies should help close the evidence-practice gap in aphasia rehabilitation.

Combining Aerobic Exercise and Speech Language Treatment for Aphasia Rehabilitation: A Case Study

Combining Aerobic Exercise and Speech Language Treatment for Aphasia Rehabilitation: A Case Study

The feasibility of delivering constraint-induced language therapy via the Internet

ObjectiveThis study is designed to determine the feasibility of the provision of an evidenced-based aphasia therapy, constraint-induced language therapy, via telerehabilitation. It describes the computer software that was developed specifically for the delivery of constraint-induced language therapy in the online environment and presents two case studies.MethodsTwo participants with chronic aphasia were assessed before and after a two-week intensive treatment block of constraint-induced language therapy delivered via Web-based videoconferencing. The group-based, dual card request game utilized in face-to-face constraint-induced language therapy was transformed into an innovative and user-friendly Web-based game – Internet constraint-induced language therapy (iCILT). Participants accessed iCILT via the Internet from their own home every weekday for two weeks. Language and quality of life measures were administered pre- and post-therapy in order to detect treatment effects. Participant satisfaction information was also recorded.ResultsOnline delivery of iCILT was technically feasible and participant satisfaction was high with a number of benefits associated with telerehabilitation identified by participants. Post-treatment performance for language functioning and communication-related quality of life was variable for each participant, however improvements in naming were noted.ConclusionsConstraint-induced language therapy delivered via telerehabilitation may be a feasible alternative to traditional face-to-face therapy for people with chronic aphasia.

“Do you have mowing the lawn?” – improvements in word retrieval and grammar following constraint-induced language therapy in primary progressive aphasia

ABSTRACTBackground: Much recent progress has been made in developing speech–language therapy in primary progressive aphasia (PPA). Several treatment approaches that have shown significant effects with people with aphasia have been adapted and re-evaluated for PPA. Constraint-induced aphasia therapy (CIAT) is a well-evaluated method that has yielded significant language improvements in people with post-stroke aphasia but has not yet been evaluated with people with PPA. Nevertheless, the combination of CIAT features like massed practice and a motivating communicative setting seem likely to make it a suitable tool for improving the speech and language performance of individuals with PPA as well.Aims: This study investigates the effectiveness of a modified CIAT protocol on word retrieval, grammatical structure and connected speech in two individuals with non-fluent variant PPA (nfvPPA).Methods and procedures: Two participants with nfvPPA took part in a 9-day intensive CIAT-based group therapy with additional computer-based home training. Stimuli were 120 photos of people performing daily life activities, which could be described using a simple (e.g., “The man is mowing the lawn”) or reduced (e.g., “mowing the lawn”) sentence structure. During the treatment phase, the participants were required to request picture cards from other group members using spoken language only. The task difficulty was increased hierarchically (shaped) in accordance to each participant’s performance level.Outcomes and results: Directly after therapy, both participants achieved significant improvements in their noun and verb naming accuracy and their grammatical structure for trained items. Training effects were maintained 2 months after therapy. Moreover, generalisation to different pictures of the same item was found for both participants and one participant also showed improved grammatical structure when describing untrained pictures. No significant generalisation to untrained connected speech samples was observed for either participant.Conclusion: This study illustrates that CIAT can be effective in people with PPA. However, further modifications of CIAT should be considered to facilitate generalisation and in order to determine which aspects of the treatment are most important.

Meta-Analysis of Constraint-Induced Language Therapy in Aphasia

Constraint-Induced Language Therapy (CILT) 중재는 집중적인 일정 동안 구어를 극대화하여 사용할 수 있게 구조화한 실어증 중재방법이다. 여러 연구들이 CILT 중재의 효과를 검증하였지만 상이한 연구결과가 혼재하였다. 이에 본 연구에서는 메타 분석을 통해 실어증 환자 대상으로 CILT 중재의 효과성을 보고한 개별 연구들의...

The role of intensity in constraint-induced language therapy for people with chronic aphasia

Background: Studies of intensive aphasia treatments vary widely in terms of treatment focus, in patient population and, in particular, in definition of what is considered “intensive”. Variability makes it difficult to compare among studies and to definitively determine whether more treatment is actually better. Constraint-induced language therapy (CILT) is one treatment that has been successfully replicated at approximately the same dosage with generally positive results.Aims: The current study used a modified multiple baseline design across participants to investigate the administration of CILT at the standard intensive dosage of 30 hours over 2 weeks (CILT-I) compared to a more distributed dosage of 30 hours over 10 weeks (CILT-D).Methods & Procedures: Eight participants with chronic aphasia participated in either CILT-I or CILT-D. Standardised and discourse measures were taken pre- and post-treatment and also 4 weeks after the completion of treatment. Discourse probes were administered after every 6 hours of treatment to assess change in productivity and efficiency over time.Outcomes & Results: All of the participants who received CILT-I and CILT-D showed either an increased effect size on a discourse measure, a clinically significant change on a standardised battery or both. Gains were maintained in nearly all cases.Conclusions: CILT administered in both intensive and distributed dosages resulted in positive changes in aphasia severity and discourse. This study adds evidence to the still inconclusive role of intensity to CILT.

Increasing aphasia treatment intensity in an acute inpatient rehabilitation programme: a feasibility study

Background: Intensity of therapy is a critical factor influencing outcomes in aphasia. However, there are many barriers to increasing treatment intensity for those with acute/subacute aphasia including the demands of the inpatient medical facilities and the endurance of the participants. Nevertheless, with some modifications to its original procedures, evidence suggests that Constraint-Induced Language Therapy (CILT) may yield positive outcomes when given in the early stages of recovery.Aims: To investigate the feasibility of increasing the amount of therapy provided to individuals with aphasia on an inpatient rehabilitation unit by adding CILT at a modified intensity, and to assess whether those receiving 2 weeks of the additional CILT show more improvement than control participants who did not receive the additional treatment.Methods & Procedures: A case-series single-subject design study was conducted. All participants received usual care of approximately an hour of speech and language treatment, 5–6 days a week. Participants in the experimental condition received an additional hour-long CILT session, 5 days per week, for 2 weeks. Trained, untrained, and generalisation probes comprising naming of pictured items and oral reading of sentences were taken at baseline, during treatment, and at posttreatment. All participants were probed equally. Probe performance was scored and effect sizes (ESs) were calculated and compared. Performance gains from pretreatment to posttreatment on subtests of the Boston Diagnostic Aphasia Examination were also compared.Outcomes & Results: Thirteen individuals with aphasia onset ranging from 7 to 68 days were recruited, with six allocated to the experimental Usual Care + CILT condition and seven allocated to the control Usual Care condition. Increasing the amount of speech and language treatment by adding an hour of daily CILT was feasible. Individual performance varied within and across conditions with large gains noted in some, but not all participants. As a group, there was a small to medium ES of the Usual Care + CILT condition over Usual Care alone for trained and untrained oral reading probes and untrained naming probes.Conclusions: It is feasible to increase the amount of treatment provided to participants with aphasia on an acute inpatient rehabilitation unit. Preliminary results suggest that there may be better outcomes for those who receive more treatment. Further research using larger numbers of homogeneous participants and controlling for content of therapy as well as amount of therapy is warranted.

Speech Language Pathologists' Opinions of Constraint-Induced Language Therapy

AbstractBackground: Constraint-induced language therapy (CILT) has received recent attention as a possible intervention to improve expressive language in people with nonfluent aphasia. Difficulties have been reported with the practical implementation of constraint-induced movement therapy due to its intensive treatment parameters. It remains unknown whether similar challenges may exist with CILT. Objective: To determine the opinions of speech-language pathologists (SLPs) about CILT for people with nonfluent aphasia. Method and Procedures: One hundred sixty-seven SLPs completed an electronic survey assessing their opinions of various aspects of CILT. Outcomes and Results: Over 60% of participants felt that people with aphasia would be very unlikely or somewhat unlikely to adhere to CILT. The majority felt that people with aphasia would hold high or moderate concerns with the number of hours spent in therapy (high, 41.8%; moderate, 31.4%), the number of days spent in therapy (high, 44.4%; moderate, 24.8%), ...

Using informative verbal exchanges to promote verb retrieval in nonfluent aphasia.

The goal of this study was to determine whether positive treatment effects of a modified constraint-induced language therapy focused on verb production would generalize to unpracticed items and tasks. Four individuals participated in a single-subject treatment design protocol. The treatment involved intensive practice producing verbs in sentences in an informative communicative exchange. Direct treatment outcome was examined by measuring the accuracy of producing practiced verbs in an action description task, a task similar to those used in treatment. Generalization was assessed by measuring production of unpracticed verbs and sentence grammaticality in the action description task and by measuring verb production and sentence grammaticality in 2 relatively unstructured (unpracticed) language tasks. Two of the 4 participants showed a direct treatment effect, producing a greater number of practiced verbs in the action description task following treatment compared with before treatment. All participants improved sentence grammaticality following treatment, although grammaticality was not explicitly targeted in therapy. Generalization to unpracticed, less-structured tasks was variable across the participants. Patterns of generalization may depend on participants' specific language deficits and production characteristics, on the language tasks used, and on the measures used to detect change and assess generalization.

Speech Language Pathologists’ Opinions of Constraint-Induced Language Therapy

Background: Constraint-induced language therapy (CILT) has received recent attention as a possible intervention to improve expressive language in people with nonfluent aphasia. Difficulties have been reported with the practical implementation of constraint-induced movement therapy due to its intensive treatment parameters. It remains unknown whether similar challenges may exist with CILT. Objective: To determine the opinions of speech-language pathologists (SLPs) about CILT for people with nonfluent aphasia. Method and Procedures: One hundred sixty-seven SLPs completed an electronic survey assessing their opinions of various aspects of CILT. Outcomes and Results: Over 60% of participants felt that people with aphasia would be very unlikely or somewhat unlikely to adhere to CILT. The majority felt that people with aphasia would hold high or moderate concerns with the number of hours spent in therapy (high, 41.8%; moderate, 31.4%), the number of days spent in therapy (high, 44.4%; moderate, 24.8%), likelihood for managed care reimbursement (high, 74.8%; moderate, 15.2%), and other logistical issues (high, 39.2%; moderate, 30.7%). With respect to providing CILT, participants cited the number of hours of therapy (high, 37.3%; moderate, 21.6%) and the number of consecutive days of therapy (high, 29.4%; moderate, 20.3%) as concerns. There were 70.6% who indicated that their facilities lacked resources to provide CILT, and 90.9% felt that most facilitates do not have the resources to provide CILT. Conclusions: Some SLPs hold significant concerns with the administration of CILT, particularly related to its dosing and reimbursement parameters. Additional work is needed to investigate the issues that were identified in this survey using qualitative methods with SLPs and people with aphasia and to examine modified CILT protocols.

Recent advances in the treatment of post-stroke aphasia.

Aphasia is an impairment of language use following brain damage. There is no consensual definition of aphasia beyond this general description (Code and Petheram, 2011). In a more restricted definition, however, aphasia is an impairment of linguistic processing at the phonological, morphological, lexical semantic or syntactic level which is usually caused by lesions of the left cerebral hemisphere. This impairment can affect language reception and expression depending on the various aphasic syndromes (McNeil and Pratt, 2001). Aphasia results in restrictions in those activities of daily living which rely on communication. In terms of the International Classification of Functioning, Disability and Health (WHO, 2001), limitations in functional communication pose significant challenges to social participation (Davidson et al., 2008) and reduce the patients’ quality of life (Kauhanen et al., 1999; Shadden, 2005). Recent data on the incidence of aphasia following stroke range between 0.02 and 0.06 % with a prevalence between 0.1 and 0.4 % in the developed world (Code and Petheram, 2011). Spontaneous behavioral recovery usually occurs to some degree in the weeks to months after stroke and depends on many factors such as the infarct size and location and the severity of initial stroke deficits (Cramer, 2008). Traditionally, proposed mechanisms of the neurological intrinsic recovery are the resolution of edema surrounding the infarcted area (Katzman et al., 1977; Lo, 1986) and reperfusion of incompletely damaged, but highly vulnerable perilesional tissue (see Donnan et al., 2013). These local mechanisms are supposed to support early recovery (in days to weeks after stroke) and do not depend on behavioral experience but have been targeted by pharmacological treatments: of more than a thousand drugs tested in animal models, 114 have been studied in clinical trials (Perez de la Ossa and Davalos, 2007) and to date none of these potentially neuroprotective agents was found to be effective in humans. Only rapid reperfusion with recombinant tissue plasminogen activator (rTPA) does improve functional outcome after ischemic stroke, but its use is limited by a short therapeutic window (4.5 hours following stroke), the risk of hemorrhage and potential ischemia/reperfusion injury (Lakhan et al., 2009). In contrast, neuronal network reorganization, which also occurs spontaneously, has been related to later recovery and can be influenced by environmental and behavioral factors (Cramer, 2008; Nudo, 2011, 2013). On the molecular level, regulation of gene expression in the unaffected peri-infarct tissue seems to favour the synthesis of growth promoting and to suppress the synthesis of growth inhibiting proteins thus creating a permissive environment for axonal/dendritic sprouting and may thus offer a window of opportunity for behavioural interventions to be effective (Carmichael, 2006). Even after standard treatments provided by the health care systems, the majority of people with aphasia have a chronic communication disability. Speech and language therapy (SLT) is the current standard of care for aphasia treatment but supplemental therapeutic strategies are emerging. The aim of this short review is to give an overview of current advances in research on behavioural, pharmacological and electrophysiological treatments for post-stroke aphasia.

Transcranial Magnetic Stimulation and Aphasia Rehabilitation

Naeser MA, Martin PI, Ho M, Treglia E, Kaplan E, Bashir S, Pascual-Leone A. Transcranial magnetic stimulation and aphasia rehabilitation. Repetitive transcranial magnetic stimulation (rTMS) has been reported to improve naming in chronic stroke patients with nonfluent aphasia since 2005. In part 1, we review the rationale for applying slow, 1-Hz, rTMS to the undamaged right hemisphere in chronic nonfluent aphasia patients after a left hemisphere stroke; and we present a transcranial magnetic stimulation (TMS) protocol used with these patients that is associated with long-term, improved naming post-TMS. In part 2, we present results from a case study with chronic nonfluent aphasia where TMS treatments were followed immediately by speech therapy (constraint-induced language therapy). In part 3, some possible mechanisms associated with improvement after a series of TMS treatments in stroke patients with aphasia are discussed.

Spoken language production as outcome measurement following constraint induced language therapy

Background: Spoken language production reflects a more natural communication aspect of language than most standardised aphasia tests. Several methods for text analysis have been developed; however, clinical application in speech-language therapy has so far been limited. Further exploration of the generalisation effect of specific impairment-based treatment forms to spontaneous speech and everyday communication is warranted. Aims: The present study explores the relevance of spoken language production for measurement of aphasia treatment outcome with constraint induced language therapy (CILT). The study investigates if improvement on standardised tests generalises to spoken language production with a focus on vocabulary and content. Methods & Procedures: Analyses are based on the pre- and post-intervention transcriptions of dialogical interviews with three speakers with aphasia participating in a clinical CILT treatment study in early aphasia rehabilitation. The analyses include quantitative measurements of the speech production (number of words, number of utterances, and mean length of utterance), of the lexical production of nouns and verbs (proportion, variation, frequency, and specificity), and of the content (proportion of informative utterances and meta-communicative utterances). In addition, the analyses include a qualitative evaluation of the content. Outcomes & Results: Results indicate an overall increase in noun production for all three cases post-CILT with individual differences in improvement of noun diversity and specificity. There is a slight decrease in the amount of verbs produced post-intervention, but more specific verbs are produced after the treatment. Content evaluation and the quantitative measures of content demonstrate increased informativeness on the individual level. Conclusions: The applied measures provide a helpful structure for interpreting outcome changes in the use of nouns and verbs. Analysis of spoken language production supports a generalisation effect of increased word production to a more demanding speech context (connected speech production).

Changes in maps of language function and the integrity of the arcuate fasciculus after therapy for chronic aphasia

A patient with chronic aphasia secondary to unilateral stroke in the left hemisphere underwent language testing, diffusion tensor imaging (DTI), and functional imaging using magnetoencephalography (MEG) at four time points: 3 weeks prior to, immediately prior to, immediately after, and 3 months after Constraint Induced Language Therapy (CILT). Performance on language tests involving visual naming and repetition of spoken sentences improved between the immediately prior to and immediately after CILT testing sessions, but not between the pre-CILT sessions. MEG activation in putative pre-morbid language areas of the left hemisphere and homotopic areas of the right hemisphere increased immediately after therapy, as did integrity within the arcuate fasciculus bilaterally. These changes were not evident between the two pre-CILT sessions. While some of these functional, neurophysiological and structural changes had regressed 3 months after therapy, all remained at or above baseline levels. Results provide evidence for an association between improvement in functional status and the increased integrity within a white matter tract known to be involved in language function and its contralateral homologue, as well as increased neurophysiological activity in areas that have the potential to subserve language function bilaterally.

Treatment-induced neuroplasticity following intensive naming therapy in a case of chronic Wernicke's aphasia

Background: Renewed interest in the effects of intensity on treatment has led to development of short-term, intensive treatment protocols, such as Constraint-Induced Language Therapy (CILT), in which participants with chronic aphasia begin to show statistically significant language improvements in as little as 2 weeks. Given its relatively short treatment cycle, CILT is also a good choice of treatment methodology for studying brain/behaviour plasticity in post-stroke aphasia. Aims: This study aimed to examine differences between two short, intensive treatment protocols in a participant with chronic Wernicke's aphasia both in terms of treatment outcomes and changes in patterns of BOLD signal activation. Methods & Procedures: The participant (ACL) participated in language testing and an fMRI overt speech confrontation-naming paradigm pre and post 2 weeks of CILT, post 2 weeks of unconstrained language therapy (PACE), and 6 months post-CILT. He named 48 black/white line drawings from each of four conditions: treated (CILT or PACE), untreated, or consistently correctly named pictures. Outcomes & Results: Naming treated pictures improved, even in the scanner, while naming untreated pictures did not. About one third of PACE and three-fourths of CILT gains were maintained. Rather than a distinct pattern of activation distinguishing treated from untreated or CILT from PACE pictures, ACL recruited a frontal network during naming of all pictures that included left middle and inferior frontal cortex, SMA and pre-SMA, and that varied in spatial extent and degree of activation according to accuracy and performance expectation. In post-hoc analyses of accuracy, this frontal network was most active during incorrect trials. At 6 months post-CILT, compared to controls, incorrect naming recruited a large and significant bilateral network including right Wernicke's area homologue. Conclusions: Results suggest that short, intensive therapy can improve naming and jumpstart language recovery in chronic aphasia, whether responses are constrained to the speech modality or not. Modulation of a left frontal network was associated with accuracy in naming and may represent compensatory adaptation to improve response selection, self-monitoring, and/or inhibition.

What Can Neuroimaging Tell Us About Aphasia?

What Can Neuroimaging Tell Us About Aphasia?