Intensive Language Action Therapy Research Articles

Donepezil alone and combined with intensive language-action therapy on depression and apathy in chronic post-stroke aphasia: A feasibility study

This study explored the feasibility and effectiveness of a short-term (10-week) intervention trial using Donepezil administered alone and combined with intensive language action therapy (ILAT) for the treatment of apathy and depression in ten people with chronic post-stroke aphasia. Outcome measures were the Western Aphasia Battery and the Stroke Aphasia Depression Questionnaire-21. Structural magnetic resonance imaging and 18fluorodeoxyglucose positron emission tomography were acquired at baseline and after two endpoints (Donepezil alone and Donepezil-ILAT). The intervention was found to be feasible to implement. Large treatment effects were found. Donepezil alone and combined with ILAT reduced aphasia severity, while apathy and depression only improved with Donepezil-ILAT. Structural and functional neuroimaging data did not show conclusive results but provide hints for future research. Given these overall positive findings on feasibility, language and behavioral benefits, further studies in larger sample sizes and including a placebo-control group are indicated.

Long-Term Stability of Short-Term Intensive Language–Action Therapy in Chronic Aphasia: A 1–2 year Follow-Up Study

Background. Intensive aphasia therapy can improve language functions in chronic aphasia over a short therapy interval of 2–4 weeks. For one intensive method, intensive language–action therapy, beneficial effects are well documented by a range of randomized controlled trials. However, it is unclear to date whether therapy-related improvements are maintained over years. Objective. The current study aimed at investigating long-term stability of ILAT treatment effects over circa 1–2 years (8–30 months). Methods. 38 patients with chronic aphasia participated in ILAT and were re-assessed at a follow-up assessment 8–30 months after treatment, which had been delivered 6–12.5 hours per week for 2–4 weeks. Results. A standardized clinical aphasia battery, the Aachen Aphasia Test, revealed significant improvements with ILAT that were maintained for up to 2.5 years. Improvements were relatively better preserved in comparatively young patients (<60 years). Measures of communicative efficacy confirmed improvements during intensive therapy but showed inconsistent long-term stability effects. Conclusions. The present data indicate that gains resulting from intensive speech–language therapy with ILAT are maintained up to 2.5 years after the end of treatment. We discuss this novel finding in light of a possible move from sparse to intensive therapy regimes in clinical practice.

Современные зарубежные нейрокогнитивные подходы к использованию музыкообогащенной среды в реабилитации афазических расстройств и деменций альцгеймеровского типа

This paper presents an analysis of current foreign trends in neurocognitive rehabilitation of cognitive disorders in Alzheimer's dementia (AD) and neuropsychological rehabilitation of the most common form of vascular cognitive disorders (VCD) - aphasia. Two approaches to the restoration of higher mental functions (HMF), based on a different understanding of the neuroplasticity mechanisms, are described. The description presents non-invasive and functional methods of direct stimulation of HMF. Various methods of transcranial brain stimulation and Intensive Language-Action Therapy (ILAT) are reviewed and analyzed. The data of experimental studies present the application of these methods to the restoration of Broca's aphasia. The paper also considers an approach to neurorehabilitation based on the methodology of "workaround" recovery of HMF using sensory-enriched environment. The article describes and analyzes the theoretical foundations of Music Intonation Therapy (MIT), Thérapie mélodique est rythmée) (TMR), palliative MIT, Music Therapy (MT). The paper carries out an analytical review of the implementation of abovementioned methods in aphasics. Also, programs and neurocognitive correction methods in mild cognitive impairment (MCI) are considered. The paper describes the possibilities of using active and passive MT, STAM-DEM Therapy, and Multimodal Cognitive Enhancement Therapy (MCET) in AD. The study presents the data of systematic and meta-analytical reviews on their use in MCI. The paper describes the methodology of "musical" neuropsychological diagnostics in dementia.

Culturally Appropriate Stimuli for Cognitive Neuropsychology-Based Treatment "Intensive Language Action Therapy (ILAT)".

Context:A standardized set of picture stimuli for neuro-language disorder has been long overdue.Aims:To develop a standardized set of 303 pictures for use in experiments of Intensive Language Action Therapy (ILAT).Methods and Material:Several sources with standardized picture stimuli having culturally unbiased features were studied. Among those studies two prime sources (1) Snodgrass & Vanderwart (1980), 127 (89+37) items and (2) Neininger & Pulvermuller (2002), 147 (89+56) items were used extensively. Out of 303 stimuli, 89 items were common to both principle sources. An Indian study by George & Mathuranath (2007) has also been taken as an additional source. Line drawing stimuli were standardized on four variables of central relevance to memory and cognitive processing: name agreement, image agreement, familiarity, and visual complexity.Statistical analysis used:All measures related to 303 concepts i.e. % correct, H statistics, familiarity, image agreement and visual complexity were analysed descriptively.Results:Low mean and positive skew on H statistics and visual complexity show that many concepts had a high name agreement (13 concepts have H values of .0, and 55 have H values of 0.68 or below, where 0.68 represents consensus among all but few of the subjects on a picture's name) and were visually simple line drawings. The intercorrelations among the four measures were low, suggesting that they are indices of different attributes of the pictures.Conclusions:Usage of appropriate items/stimuli has immense potential to influence aphasia therapy outcome. This set of pictures and its normative variable has enhanced the ILAT outcome. It could be generalised for other aphasia therapy too to understand its efficacy.

Intensive aphasia therapy improves low mood in fluent post-stroke aphasia: Evidence from a case-controlled study

ABSTRACT Introduction: Depressive symptoms are a major drawback of aphasia, negatively impacting on functional outcomes. In a previous study, Intensive Language-Action Therapy (ILAT) was effective in improving depression and low mood in persons with chronic non-fluent aphasia. We present a proof-of-concept case–control study that evaluates language and mood outcomes amongst persons with fluent post-stroke aphasia. Participants: Thirteen Spanish speaking persons with fluent aphasia due to chronic stroke lesions in the left hemisphere participated in the study. Intervention: Five participants (intervention group) received ILAT for 3 h/day during two consecutive weeks, for an overall of 30 h, and 8 participants (control group) entered a waiting-list no-treatment arm. Results: The main finding was that participants receiving active treatment showed significant improvements on depression and aphasia severity scores, whereas no significant changes were found in the control group. Conclusions: The implementation of ILAT was efficient in improving clinical language deficits in people with fluent aphasia and contributes to improvement in mood after therapy. Trial registration: EUDRACT (2008-008481-12)

Increased Recruitment of Domain-General Neural Networks in Language Processing Following Intensive Language-Action Therapy: fMRI Evidence From People With Chronic Aphasia.

PurposeThis study aimed to provide novel insights into the neural correlates of language improvement following intensive language-action therapy (ILAT; also known as constraint-induced aphasia therapy).MethodSixteen people with chronic aphasia underwent clinical aphasia assessment (Aachen Aphasia Test [AAT]), as well as functional magnetic resonance imaging (fMRI), both administered before (T1) and after ILAT (T2). The fMRI task included passive reading of single written words, with hashmark strings as visual baseline.ResultsBehavioral results indicated significant improvements of AAT scores across therapy, and fMRI results showed T2−T1 blood oxygenation-level-dependent (BOLD) signal change in the left precuneus to be modulated by the degree of AAT score increase. Subsequent region-of-interest analysis of this precuneus cluster confirmed a positive correlation of T2−T1 BOLD signal change and improvement on the clinical aphasia test. Similarly, the entire default mode network revealed a positive correlation between T2−T1 BOLD signal change and clinical language improvement.ConclusionThese results are consistent with a more efficient recruitment of domain-general neural networks in language processing, including those involved in attentional control, following aphasia therapy with ILAT.

Language as a Threat: Multimodal Evaluation and Interventions for Overwhelming Linguistic Anxiety in Severe Aphasia.

Linguistic anxiety (LA) is an abnormal stress response induced by situations that require the use of verbal behavior, and it is accentuated during language testing in persons with aphasia (PWA). The presence of LA in PWA may jeopardize the interpretation of cognitive evaluations, leading to biased conclusions about the severity of the language alteration and the effectiveness of the treatments. In the present study, we report the case of a woman (Mrs. A) with severe chronic mixed transcortical aphasia due to left frontal and parietal hemorrhages that partially spared the perisylvian area. Mrs. A was treated with the dopamine agonist Rotigotine alone and combined with Intensive Language-Action Therapy (ILAT). Complementary evaluations included autonomic reactivity during the performance of different language tasks, resting state functional magnetic resonance imaging (rs-fMRI) and [18F]-fluorodeoxyglucose positron emission tomography (18F-FDG-PET). We found that formal language testing in a clinical setting triggered a dramatic increase of automatic echolalia, perseverations and frustration, making the task completion difficult. The treatment improved aphasia, but gains were more robust when evaluation was performed by Mrs. A’s husband at home than by clinicians. Autonomic evaluation under Rotigotine revealed higher reactivity during tasks tapping an impaired function in comparison with a task evaluating a preserved function (verbal repetition). Baseline 18F-FDG-PET analysis showed decreased metabolic activity in left limbic-paralimbic areas, whereas rs-fMRI revealed compensatory activity in the right hemisphere. We also analyzed the different factors (e.g., premorbid personality traits, task difficulty) that may have contributed to LA in Mrs. A during language testing. Our findings emphasize the usefulness of implicating adequately trained laypersons in the evaluation and treatment of PWA showing LA. Further studies using multidimensional evaluations are needed to disentangle the interplay between anxiety and abnormal language as well as the neural mechanisms underpinning LA in PWA.

Good results with intensive language-action therapy

Good results with intensive language-action therapy

Efficacy of intensive aphasia therapy in patients with chronic stroke: a randomised controlled trial

ObjectiveRecent evidence has fuelled the debate on the role of massed practice in the rehabilitation of chronic post-stroke aphasia. Here, we further determined the optimal daily dosage and total duration...

Intensive Communicative Therapy Reduces Symptoms of Depression in Chronic Nonfluent Aphasia

Background. Patients with brain lesions and resultant chronic aphasia frequently suffer from depression. However, no effective interventions are available to target neuropsychiatric symptoms in patients with aphasia who have severe language and communication deficits. Objective. The present study aimed to investigate the efficacy of 2 different methods of speech and language therapy in reducing symptoms of depression in aphasia on the Beck Depression Inventory (BDI) using secondary analysis (BILAT-1 trial). Methods. In a crossover randomized controlled trial, 18 participants with chronic nonfluent aphasia following left-hemispheric brain lesions were assigned to 2 consecutive treatments: (1) intensive language-action therapy (ILAT), emphasizing communicative language use in social interaction, and (2) intensive naming therapy (INT), an utterance-centered standard method. Patients were randomly assigned to 2 groups, receiving both treatments in counterbalanced order. Both interventions were applied for 3.5 hours daily over a period of 6 consecutive working days. Outcome measures included depression scores on the BDI and a clinical language test (Aachen Aphasia Test). Results. Patients showed a significant decrease in symptoms of depression after ILAT but not after INT, which paralleled changes on clinical language tests. Treatment-induced decreases in depression scores persisted when controlling for individual changes in language performance. Conclusions. Intensive training of behaviorally relevant verbal communication in social interaction might help reduce symptoms of depression in patients with chronic nonfluent aphasia.

FV 13 Electrophysiological correlates of language recovery – an MEG study of neuroplasticity in chronic post stroke aphasia

Background Previous studies have demonstrated that efficient language and communication therapy in chronic post stroke aphasia leads to significant clinical language improvements ( Pulvermuller et al., 2001 ) and promotes neuroplasticity. Brain areas frequently associated with functional restitution of language comprise perilesional sites in the left hemisphere ( MacGregor et al., 2015 ) as well as right-hemispheric regions, homotopic to those lesioned in the left ( Mohr et al., 2014 ). To date, however, the neuronal mechanisms underlying therapy-induced language changes and functional restitution are still largely unclear. In the present study, hemispheric contributions to neuroplasticity and neurophysiological changes were investigated in chronic aphasia patients by using magnetoencephalography. Methods Patients underwent intensive language action therapy for three hours per day on 10 consecutive week-days. Before and immediately after treatment, language and communication skills were assessed and patients’ brain responses were recorded during automatic language processing, employing a lexical magnetic mismatch negativity (MMNm) paradigm, in which words and meaningless pseudowords were presented auditorily. Results After the two-week therapy interval, patients showed significant clinical improvements of language skills, as assessed by the Boston Diagnostic Aphasia Examination. Spatio-temporal dynamics of neuronal changes revealed a significant increase in word-specific neuro-magnetic MMNm activation around 200 ms after stimulus identification points. This neuromagnetic enhancement of the MMNm brain response occurred specifically for words and was most prominent over perilesional areas in the left hemisphere. Importantly, therapy-induced changes in neuromagnetic activation to words significantly correlated with clinical test performance. Discussion and conclusion The results suggest that language recovery in chronic post stroke aphasia is associated with neuroplastic changes in both cerebral hemispheres. During automatic language processing, particularly perilesional regions in the left-hemisphere seem to contribute to functional restitution in patients with chronic aphasia.

Communicative-Pragmatic Assessment Is Sensitive and Time-Effective in Measuring the Outcome of Aphasia Therapy.

A range of methods in clinical research aim to assess treatment-induced progress in aphasia therapy. Here, we used a crossover randomized controlled design to compare the suitability of utterance-centered and dialogue-sensitive outcome measures in speech-language testing. Fourteen individuals with post-stroke chronic non-fluent aphasia each received two types of intensive training in counterbalanced order: conventional confrontation naming, and communicative-pragmatic speech-language therapy (Intensive Language-Action Therapy, an expanded version of Constraint-Induced Aphasia Therapy). Motivated by linguistic-pragmatic theory and neuroscience data, our dependent variables included a newly created diagnostic instrument, the Action Communication Test (ACT). This diagnostic instrument requires patients to produce target words in two conditions: (i) utterance-centered object naming, and (ii) communicative-pragmatic social interaction based on verbal requests. In addition, we administered a standardized aphasia test battery, the Aachen Aphasia Test (AAT). Composite scores on the ACT and the AAT revealed similar patterns of changes in language performance over time, irrespective of the treatment applied. Changes in language performance were relatively consistent with the AAT results also when considering both ACT subscales separately from each other. However, only the ACT subscale evaluating verbal requests proved to be successful in distinguishing between different types of training in our patient sample. Critically, testing duration was substantially shorter for the entire ACT (10–20 min) than for the AAT (60–90 min). Taken together, the current findings suggest that communicative-pragmatic methods in speech-language testing provide a sensitive and time-effective measure to determine the outcome of aphasia therapy.

Investigating the Effects of Intensive Oral Reading Therapy and Intensive Language Action Therapy for Chronic Mild Aphasia and Alexia

Investigating the Effects of Intensive Oral Reading Therapy and Intensive Language Action Therapy for Chronic Mild Aphasia and Alexia

Intensive Language Action Therapy in Chronic Aphasia: A Randomized Clinical Trial Examining Guidance by Constraint

Intensive language action therapy (ILAT) can be effective in overcoming learned nonuse in chronic aphasia. It is suggested that all three guiding principles (constraint, communication embedding, massed practice) are essential to ILAT's success. We examined whether one of these, guidance by constraint, is critical. Twenty-four participants with aphasia (PWAs) were assigned to ILAT or a modified version of promoting aphasic communicative effectiveness (PACE) in a randomized block, single-blind, parallel-group treatment study. Blocking was by severity (mild/moderate, moderate to severe, severe). Both groups received intensive treatment in the context of therapeutic language action games. Whereas the ILAT group was guided toward spoken responses, the PACE group could choose any response modality. All participants, whether assigned to ILAT or PACE groups, improved on the primary outcome measure, picture naming. There was a Severity × Treatment interaction, with the largest effects estimated for PWAs with mild/moderate and moderate to severe aphasia. Regardless of severity, the ILAT group outperformed the PACE group on untrained pictures, suggesting some benefit of ILAT to generalization. However, this difference was not statistically significant. Although the groups differed in subtle ways, including better generalization to untrained pictures for ILAT, the study was inconclusive on the influence of guidance by constraint.

Using language for social interaction: Communication mechanisms promote recovery from chronic non-fluent aphasia

IntroductionClinical research highlights the importance of massed practice in the rehabilitation of chronic post-stroke aphasia. However, while necessary, massed practice may not be sufficient for ensuring progress in speech-language therapy. Motivated by recent advances in neuroscience, it has been claimed that using language as a tool for communication and social interaction leads to synergistic effects in left perisylvian eloquent areas. Here, we conducted a crossover randomized controlled trial to determine the influence of communicative language function on the outcome of intensive aphasia therapy. MethodsEighteen individuals with left-hemisphere lesions and chronic non-fluent aphasia each received two types of training in counterbalanced order: (i) Intensive Language-Action Therapy (ILAT, an extended form of Constraint-Induced Aphasia Therapy) embedding verbal utterances in the context of communication and social interaction, and (ii) Naming Therapy focusing on speech production per se. Both types of training were delivered with the same high intensity (3.5 h per session) and duration (six consecutive working days), with therapy materials and number of utterances matched between treatment groups. ResultsA standardized aphasia test battery revealed significantly improved language performance with ILAT, independent of when this method was administered. In contrast, Naming Therapy tended to benefit language performance only when given at the onset of the treatment, but not when applied after previous intensive training. ConclusionsThe current results challenge the notion that massed practice alone promotes recovery from chronic post-stroke aphasia. Instead, our results demonstrate that using language for communication and social interaction increases the efficacy of intensive aphasia therapy.

Collaborative participation in aphasic conversation before and after intensive language-action therapy

ABSTRACTThis study applies conversation analysis to compare everyday conversation samples between a person with aphasia (PWA) and a familiar communication partner (CP) before and after intensive language-action therapy (ILAT). Our analysis concentrated on collaborative repair sequences with the assumption that impairment-focused therapy would translate into a change in the nature of trouble sources, which engender collaborative repair action typical of aphasic conversation. The most frequent repair initiation technique used by the CP was candidate understandings. The function of candidate understandings changed from addressing specific trouble sources pre-ILAT to concluding longer stretches of the PWA’s talk post-ILAT. Alongside with these findings, we documented a clinically significant increase in the Western Aphasia Battery’s aphasia quotient post-ILAT. Our results suggest that instead of mere frequency count of conversational behaviours, examining the type and function of repair actions might provide insight into therapy-related changes in conversation following impairment-focused therapy.

Hemispheric contributions to language reorganisation: An MEG study of neuroplasticity in chronic post stroke aphasia

Previous studies have demonstrated that efficient neurorehabilitation in post stroke aphasia leads to clinical language improvements and promotes neuroplasticity. Brain areas frequently implicated in functional restitution of language after stroke comprise perilesional sites in the left hemisphere and homotopic regions in the right hemisphere. However, the neuronal mechanisms underlying therapy-induced language restitution are still largely unclear. In this study, magnetoencephalography was used to investigate neurophysiological changes in a group of chronic aphasia patients who underwent intensive language action therapy (ILAT), also known as constraint-induced aphasia therapy (CIAT). Before and immediately after ILAT, patients’ language and communication skills were assessed and their brain responses were recorded during a lexical magnetic mismatch negativity (MMNm) paradigm, presenting familiar spoken words and meaningless pseudowords. After the two-week therapy interval, patients showed significant clinical improvements of language and communication skills. Spatio-temporal dynamics of neuronal changes revealed a significant increase in word-specific neuro-magnetic MMNm activation around 200ms after stimulus identification points. This enhanced brain response occurred specifically for words and was most pronounced over perilesional areas in the left hemisphere. Therapy-related changes in neuromagnetic activation for words in both hemispheres significantly correlated with performance on a clinical language test. The findings indicate that functional recovery of language in chronic post stroke aphasia is associated with neuroplastic changes in both cerebral hemispheres, with stronger left-hemispheric contribution during automatic stages of language processing.

Ultra-rapid access to words in chronic aphasia: the effects of intensive language action therapy (ILAT).

Effects of intensive language action therapy (ILAT) on automatic language processing were assessed using Magnetoencephalography (MEG). Auditory magnetic mismatch negativity (MMNm) responses to words and pseudowords were recorded in twelve patients with chronic aphasia before and immediately after two weeks of ILAT. Following therapy, Patients showed significant clinical improvements of auditory comprehension as measured by the Token Test and in word retrieval and naming as measured by the Boston Naming Test. Neuromagnetic responses dissociated between meaningful words and meaningless word-like stimuli ultra-rapidly, approximately 50 ms after acoustic information first allowed for stimulus identification. Over treatment, there was a significant increase in the left-lateralisation of this early word-elicited activation, observed in perilesional fronto-temporal regions. No comparable change was seen for pseudowords. The results may reflect successful, therapy-induced, language restitution in the left hemisphere.

Changes of right-hemispheric activation after constraint-induced, intensive language action therapy in chronic aphasia: fMRI evidence from auditory semantic processing.

The role of the two hemispheres in the neurorehabilitation of language is still under dispute. This study explored the changes in language-evoked brain activation over a 2-week treatment interval with intensive constraint induced aphasia therapy (CIAT), which is also called intensive language action therapy (ILAT). Functional magnetic resonance imaging (fMRI) was used to assess brain activation in perilesional left hemispheric and in homotopic right hemispheric areas during passive listening to high and low-ambiguity sentences and non-speech control stimuli in chronic non-fluent aphasia patients. All patients demonstrated significant clinical improvements of language functions after therapy. In an event-related fMRI experiment, a significant increase of BOLD signal was manifest in right inferior frontal and temporal areas. This activation increase was stronger for highly ambiguous sentences than for unambiguous ones. These results suggest that the known language improvements brought about by intensive constraint-induced language action therapy at least in part relies on circuits within the right-hemispheric homologs of left-perisylvian language areas, which are most strongly activated in the processing of semantically complex language.

Intensive language-action therapy (ILAT): The methods

Background: Brain and language theories suggest the application of general neuroscientific and linguistic principles in the neurorehabilitation of language. The interwoven nature of language and action has long been emphasised in linguistic pragmatics, and recent neuroscience research has indeed demonstrated tight functional interactions between language and action mechanisms of the human brain. This provides important arguments in favour of practising language in communicative settings, rather than with the sole purpose of producing linguistic structures. Intensive language-action therapy (ILAT), including its most popular form called constraint-induced aphasia therapy (CIAT), realises language-action embedding in synergy with the use of intensive training and guidance by modelling, shaping, and explicit rules. ILAT leads to significant improvement of language performance in chronic post-stroke aphasia within a short period of time. A comprehensive description of its methods has thus far been missing. Aims: We describe the methods of ILAT, illustrate its use, and outline methods for linguistic-pragmatic evaluation of its effects. Main Contribution: We explain the general principles and practical features of ILAT methods and of language-action games (LAGs) constituting this method. The structure of and materials for two LAGs, the REQUEST and PLANNING games, are highlighted by discussing in detail their respective action-structure, materials, and rules. These LAGs are employed to encourage the use of language in communicative contexts through interactive requests and the planning of joint activities. A main linguistic focus is on object nouns in the REQUEST game and on action verbs in the PLANNING game. Focusing and tailoring of LAGs to patients' communicative needs by means of modelling, shaping, and explicitly introduced communication rules are also explained. Finally the assessment of communicative success is illustrated based on clinical measures, performance within LAGs, and the Communicative Aphasia Log (CAL). Conclusions: Different linguistic-pragmatic and social-interactive forms of communication can be translated into specific therapeutic LAGs in the context of ILAT to target specific speech acts and parts of speech. Apart from clinical tests, methods for evaluating communication performance are available for assessment of therapy success.