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The novel language-systematic aphasia screening SAPS: screening-based therapy in combination with computerised home training
Abstract
Background:
SAPS-'Sprachsystematisches Aphasiescreening'-is a novel language-systematic aphasia screening developed for the German language, which already had been positively evaluated. It offers a fast assessment of modality-specific psycholinguistic components at different levels of complexity and the derivation of impairment-based treatment foci from the individual performance profile. However, SAPS has not yet been evaluated in combination with the new SAPS-based treatment.
Aims:
To replicate the practicality of SAPS and to investigate the effectiveness of a SAPS-based face-to-face therapy combined with computerised home training in a feasibility study. To examine the soundness of the treatment design, to determine treatment-induced changes in patient performance as measured by SAPS, to assess parallel changes in communicative abilities, and to differentiate therapy effects achieved by face-to-face therapy versus add-on effects achieved by later home training.
Methods & procedures:
Sixteen participants with post-stroke aphasia (PWAs) were included into the study. They were administered the SAPS and communicative testing before and after the treatment regimen. Each PWA received one therapy session followed by home training per day, with the individual treatment foci being determined according to initial SAPS profile, and duration of treatment and possible change of focus dependent on performance assessed by continuous therapy monitoring.
Outcomes & results:
The combination of therapy and home training based on the SAPS was effective for all participants. We showed significant improvements for impairment-based SAPS performance and, with high inter-individual variability, in everyday communication. These two main targets of speech and language therapy were correlated and SAPS improvements after therapy were significantly higher than after home training.
Conclusions & implications:
SAPS offers the assessment of an individual performance profile in order to derive sufficiently diversified, well-founded and specific treatment foci and to follow up changes in performance. The appending treatment regimen has shown to be effective for our participants. Thus, the study revealed feasibility of our approach.
Background: There is an urgent need for treatment comparison studies for chronic aphasia. Two different treatments, Constraint-Induced Aphasia Therapy Plus (CIAT Plus) and Multi-Modality Aphasia Therapy (M-MAT) aim to improve spoken language production through intensive shaping of responses, and social-mediated repetitive practice. CIAT Plus constrains responses to the verbal modality, while M-MAT includes gesture, drawing, writing and reading-based cues to assist production. Aims: This Phase 1 study compared the efficacy of CIAT Plus and M-MAT. The study also aimed to investigate the relationship between treatment responsiveness and participant's aphasia severity and cognitive variables. Methods however, order effects are likely to have played a significant role. Treatment potency was demonstrated with generalisation to noun (8 participants) and verb production (1 participant) in discourse. Overall , CIAT Plus and M-MAT were equally efficacious for these 11 individuals, although six participants expressed preference for M-MAT and three for CIAT Plus. Delayed treatment effects were present in some participants. Future large-scale studies are required to deal with order effects and a participant's variability.
Background:
Aphasia effects up to 38% of acute stroke patients. For many of these individuals, this condition persists far beyond the acute phase. The purpose of this review is to evaluate the effectiveness of therapeutic interventions for aphasia initiated more than 6 months post stroke.
Methods:
A literature search was conducted for articles in which aphasia treatments were initiated more than 6 months post stroke. Searches were conducted in multiple databases including MEDLINE, Scopus, CINAHL, and EMBASE.
Results:
A total of 21 randomized controlled trials (RCTs) met the inclusion criteria. There is good evidence to suggest that the use of computer-based treatments, constraint-induced therapy, intensity of therapy, group language therapies, and training conversation/communication partners are effective treatments for chronic aphasia. Repetitive transcranial magnetic stimulation, transcranial direct current stimulation, and the use of the drugs piracetam, donepezil, memantime, and galantamine have also demonstrated evidence that they are effective treatments of aphasia 6 months or more post stroke onset. Neither filmed language instruction nor the drug bromocriptine has been shown to be effective in treating chronic aphasia.
Conclusions:
There is evidence to support the use of a number of treatments for chronic aphasia post stroke. Further research is required to fully support the use of these interventions and to explore the effectiveness of other aphasia interventions in the chronic stage.
There is good evidence that aphasia therapy is effective if sufficiently prolonged or intensive and that chronic aphasic individuals can also benefit from therapy, but data on chronic aphasia are scanty.
The aim of this retrospective study was to investigate whether chronic aphasia benefits from a very intensive therapeutic regimen. We revised the files (January 2000 to December 2008) of the chronic subjects whom we suggested have periodic sessions in our Unit (generally once a week) and 2–3 hours daily of homework with the help of a family member, supervised and controlled by the speech-therapist. Treatment would go on as long as amelioration is evident. Results for 23 chronic aphasic subjects are reported. All subjects had undergone previous therapy and 10 had been dismissed because no further recovery was expected. Recovery was significant in oral and written nouns and actions naming, oral and written sentence production and Token Test scores. Only 4 subjects did not improve. Severity of the disorder did not predict success or failure. We conclude that recovery was due to the intense work done. Further, we believe such a regimen could be successful in a number of patients for whom a less intensive regimen would not be effective.
Numerous computer applications have been developed specifically for aphasia rehabilitation. In this paper, the role of these computer programs is discussed in relation to three complementary treatment approaches in aphasia rehabilitation: disorder-oriented treatment, functional treatment, and participation-oriented treatment. Most of the programs available focus on disorder-oriented treatment and several studies have reported a beneficial effect on language skills. Nowadays, in the context of disorder-oriented treatment, these applications are indispensible to achieve an adequate treatment frequency of at least 2 hours per week. Computer applications aiming at functional and social participation goals are less well-developed. Several studies show that high-technology AAC can be used to support off-line communication. Moreover, it is reported that the AAC training has a positive effect on overall communicative functioning. In the near future, computer applications for interactive communicative training may become an important tool in aphasia rehabilitation. Theoretically, the internet offers excellent opportunities to improve social participation for people with aphasia, but reading and writing problems limit their access to the internet. So far, only a few initiatives have been reported to support and increase their access.
Purpose
The aim of this study was to prove the efficacy of supervised self-training for individuals with aphasia. Linguistic and communicative performance in structured dialogues represented the main study parameters.
Method
In a cross-over design for randomized matched pairs, 18 individuals with chronic aphasia were examined during 12 weeks of supervised home training. Intensive language training, assisted by an electronic learning device (B.A.Bar), was compared with nonlinguistic training. Language performance, communicative abilities, and cognitive abilities were controlled before and after each intervention and at follow-up. The language training was designed to facilitate dialogue skills as required in everyday life.
Results
Robust and specific improvements in the participants' linguistic and communicative abilities were obtained using B.A.Bar dialogue training but not with nonlinguistic training. The transfer to general linguistic and communicative performance remained limited when the whole group was considered. For 30%–50% of the participants, individual analysis revealed significant improvements in spontaneous language and general communicative skills. Furthermore, individual participants demonstrated significant improvements regarding standardized aphasia assessment and proxy rating of communicative effectiveness.
Conclusion
Supervised home training works. This study has proven that it is an effective tool for bolstering linguistic and communicative skills of individuals with aphasia.
This study explores the psychometric qualities of the Scenario Test, a new test to assess daily-life communication in severe aphasia. The test is innovative in that it: (1) examines the effectiveness of verbal and non-verbal communication; and (2) assesses patients' communication in an interactive setting, with a supportive communication partner.
To determine the reliability, validity, and sensitivity to change of the Scenario Test and discuss its clinical value.
The Scenario Test was administered to 122 persons with aphasia after stroke and to 25 non-aphasic controls. Analyses were performed for the entire group of persons with aphasia, as well as for a subgroup of persons unable to communicate verbally (n = 43). Reliability (internal consistency, test-retest reliability, inter-judge, and intra-judge reliability) and validity (internal validity, convergent validity, known-groups validity) and sensitivity to change were examined using standard psychometric methods.
The Scenario Test showed high levels of reliability. Internal consistency (Cronbach's alpha = 0.96; item-rest correlations = 0.58-0.82) and test-retest reliability (ICC = 0.98) were high. Agreement between judges in total scores was good, as indicated by the high inter- and intra-judge reliability (ICC = 0.86-1.00). Agreement in scores on the individual items was also good (square-weighted kappa values 0.61-0.92). The test demonstrated good levels of validity. A principal component analysis for categorical data identified two dimensions, interpreted as general communication and communicative creativity. Correlations with three other instruments measuring communication in aphasia, that is, Spontaneous Speech interview from the Aachen Aphasia Test (AAT), Amsterdam-Nijmegen Everyday Language Test (ANELT), and Communicative Effectiveness Index (CETI), were moderate to strong (0.50-0.85) suggesting good convergent validity. Group differences were observed between persons with aphasia and non-aphasic controls, as well as between persons with aphasia unable to use speech to convey information and those able to communicate verbally; this indicates good known-groups validity. The test was sensitive to changes in performance, measured over a period of 6 months.
The data support the reliability and validity of the Scenario Test as an instrument for examining daily-life communication in aphasia. The test focuses on multimodal communication; its psychometric qualities enable future studies on the effect of Alternative and Augmentative Communication (AAC) training in aphasia.
Studies have yet to document that community-based aphasia treatment programs routinely produce results comparable or superior to published research protocols. We explore this issue here in an outcome study of individuals with aphasia enrolled in 2 community-based, comparably managed and equipped therapy programs, which use a specially designed computer-based tool that is employed therapeutically in adherence to an extensive, detailed, and formally trained patient care algorithm.
Patients (n=60) were assessed before and after treatment with standardized instruments at both the impairment and the disability levels. Pretreatment and posttreatment means were calculated and compared, with statistical significance of differences established with the use of 1-tailed matched t tests. One-way ANOVAs were used to analyze the comparability of patient performance changes among various subgroups, eg, patients in acute versus chronic stages of aphasia, patients by aphasia diagnostic type at start of care, patients by severity level at start of care, and patients by treatment location.
Analysis shows that patients spanned a wide range of aphasia diagnostic types, impairment severity levels at start of care, and times after onset. Patients' mean performance scores improved significantly in response to treatment in all measures assessed at both the impairment level and the functional communication level. Mean overall improvements ranged from 6.6% to 19.8%, with statistical significance ranging from P=0.0006 to P<0.0001. ANOVAs revealed no significant differences between improvements in patients in the acute versus chronic stages of aphasia, between those at different impairment severity levels at start of care, between those treated at different locations, or, at the functional level, between those with different diagnostic types of aphasia at start of care.
Measures of both language impairment and functional communication can be broadly, positively, and significantly influenced by therapy services that are delivered to persons with aphasia in these community-based programs. The significant improvements are shown to be available to individuals with chronic as well as acute aphasia and independent of diagnostic type of aphasia, impairment severity at start of care, or geographic program location.
To establish evidence-based recommendations for the clinical practice of cognitive rehabilitation, derived from a methodical review of the scientific literature concerning the effectiveness of cognitive rehabilitation for persons with traumatic brain injury (TBI) or stroke.
A MEDLINE literature search using combinations of these key words as search terms: attention, awareness, cognition, communication, executive, language, memory, perception, problem solving, reasoning, rehabilitation, remediation, and training. Reference lists from identified articles also were reviewed; a total bibliography of 655 published articles was compiled.
Studies were initially reviewed according to the following exclusion criteria: nonintervention studies; theoretical, descriptive, or review papers; papers without adequate specification of interventions; subjects other than persons with TBI or stroke; pediatric subjects; pharmacologic interventions; and non-English language papers. After screening, 232 articles were eligible for inclusion. After detailed review, 61 of these were excluded as single case reports without data, subjects other than TBI and stroke, and nontreatment studies. This screening yielded 171 articles to be evaluated.
Articles were assigned to 1 of 7 categories according to their primary area of intervention: attention, visual perception and constructional abilities, language and communication, memory, problem solving and executive functioning, multi-modal interventions, and comprehensive-holistic cognitive rehabilitation. All articles were independently reviewed by at least 2 committee members and abstracted according to specified criteria. The 171 studies that passed initial review were classified according to the strength of their methods. Class I studies were defined as prospective, randomized controlled trials. Class II studies were defined as prospective cohort studies, retrospective case-control studies, or clinical series with well-designed controls. Class III studies were defined as clinical series without concurrent controls, or studies with appropriate single-subject methodology.
Of the 171 studies evaluated, 29 were rated as Class I, 35 as Class II, and 107 as Class III. The overall evidence within each predefined area of intervention was then synthesized and recommendations were derived based on consideration of the relative strengths of the evidence. The resulting practice parameters were organized into 3 types of recommendations: Practice Standards, Practice Guidelines, and Practice Options.
Overall, support exists for the effectiveness of several forms of cognitive rehabilitation for persons with stroke and TBI. Specific recommendations can be made for remediation of language and perception after left and right hemisphere stroke, respectively, and for the remediation of attention, memory, functional communication, and executive functioning after TBI. These recommendations may help to establish parameters of effective treatment, which should be of assistance to practicing clinicians.
Background:
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.
Methods:
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.
Findings:
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.
Interpretation:
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.
Funding:
German Federal Ministry of Education and Research and the German Society for Aphasia Research and Treatment.
Self-delivered speech therapy provides an opportunity for individualised dosage as a complement to the speech-therapy regime in the long-term rehabilitation pathway. Few apps for speech therapy have been subject to clinical trials, especially on a self-delivered platform. In a crossover design study, the Comprehensive Aphasia Test (CAT) and Cookie Theft Picture Description (CTPD) were used to measure untrained improvement in a group of chronic expressive aphasic patients after using a speech therapy app. A pilot study (n = 3) and crossover design (n = 7) comparing the therapy app with a non-language mind-game were conducted. Patients self-selected their training on the app, with a recommended use of 20 minutes per day. There was significant post-therapy improvement on the CAT and CTPD but no significant improvement after the mind-game intervention, suggesting there were language-specific effects following use of the therapy app. Improvements on the CTPD, a functional measurement of speech, suggest that a therapy app can produce practical, important changes in speech. The improvements post-therapy were not due to type of language category trained or amount of training on the app, but an inverse relationship with severity at baseline and post-therapy improvement was shown. This study suggests that self-delivered therapy via an app is beneficial for chronic expressive aphasia.
There is wide agreement in the literature that significant improvements in aphasia therapy can only be obtained with high frequency of treatment. Self-training of patients at home is a reasonable completion of outpatient treatment to enhance frequency, the efficacy of home training in aphasia has not been studied empirically under strict research criteria. The aim of the present single case study was to investigate efficacy of a supervised home training that makes use of the speech generating barcode reader B.A.Bar. Results show significant improvements in word activation by B.A.Bar home training evert in conditions of severe global aphasia.
This chapter begins with a discussion of psychometric aspects of neuropsychological tests. It then discusses the classical test theory model, criterion-referenced testing, probabilistic test models, individual case classification, psychometric single-case analysis, and comparison of a single case to a small control or normative sample.
Our experience with aphasia therapy has developed in the Neurology Department of the Technical University in Aachen under the direction of Klaus Poeck. Aphasia therapy is provided for both in- and outpatients. Inpatients stay either on acute wards, including intensive care, or on a special aphasia ward. Outpatients are seen either for extensive neurolinguistic and neuropsychological diagnosis at the neurological clinic or for aphasia therapy administered at the school of logopedics. The aphasia therapists cooperate with an interdisciplinary group of researchers including linguists, psychologists, and neurologists. Research on therapy has developed from clinical, diagnostic, and theoretical interests. In the past, we have made several attempts to combine different approaches to a comprehensive treatment regimen (cf. Huber, 1988; Huber, 1991, 1992; Huber, Poeck, & Springer, 1991; Huber & Springer, 1989; Poeck, 1982; Poeck, Huber, Stachowiak, & Weniger, 1977; Springer, 1986; Springer & Weniger, 1980; Weniger,Huber, Stachowiak, & Poeck, 1980; Weniger & Springer, 1989). Furthermore, we have been concerned with methodological issues of therapy research using either single case or group designs (Willmes, 1985, 1990).
Background: Speech pathologists face the clinical obstacle of providing an intensive service for individuals with aphasia. Computer therapy potentially offers a solution to the dilemma of increasing therapy frequency while maintaining or reducing the load on therapists’ resources.
Das sprachsystematische Aphasiescreening (SAPS) ist ein neu entwickeltes diagnostisches Instrument, mit dem die Verarbeitungsebenen Phonetik/Phonologie, Lexikon/Semantik und Morphologie/Syntax nach ansteigendem Schwierigkeitsgrad rezeptiv und expressiv gepruft werden, um darauf aufbauend storungsspezifische Behandlungen ableiten und evaluieren zu konnen. Ziel der vorliegenden Pilotstudie war eine erste Erprobung und Evaluation des SAPS bei 31 Patienten mit Aphasie vor und nach stationarer Intensivtherapie. Die Konstruktionseigenschaften des Screenings konnten grostenteils empirisch abgesichert werden. Die Leistungen der Patienten und signifikante Veranderungen im Verlauf wurden zuverlassig dargestellt, und es konnten Therapieschwerpunkte aus dem Storungsprofil abgeleitet werden. Nicht ausreichend nach Schwierigkeit abgestufte Aufgabenstellungen wurden bereits modifiziert. Insgesamt hat sich das SAPS in der praktischen Anwendung fur die Neurorehabilitation bewahrt. Die sprachsystematische Ausrichtung eigne...
This paper provides an overview of the computerized assessment and rehabilitation of patients with cognitive disorders caused by focal brain damage. The characteristics of computer-based rehabilitation systems are discussed in general and questions as to their efficacy addressed. Diagnostic but in particular rehabilitation systems for the following areas are examined more closely: attention disorders, visual-perceptual disorders, memory and language disorders. The development of hard and software is followed back to its beginnings. Typical examples of modern systems are given. The focus is on systems evaluated in the course of a European Concerted Research Action.Supported by the European Commission, Project No. MR4*-0231-D).
The Amsterdam—Nijmegen Everyday Language Test (ANELT) is designed to measure, first, the level of verbal communicative abilities of aphasic patients and, second, changes in these abilities over time. The level of communicative effectiveness is determined by the adequacy of bringing a message across. Verbal communication is operationally defined as a function of the understandability of the message and the intelligibility of the utterance. Test items are constructed as scenarios of familiar daily life situations. Two parallel versions have been constructed, each consisting of 10 items; responses for every item are scored on two five-point scales. The psychometric analysis shows perfect parallelism for both test versions. Each scale for judging verbal communication is unidimensional in nature and measures only the construct it purports to measure. Criterion-related, as well as construct validity, measures show ANELT to be a sensitive instrument for measuring verbal communication in a language-disturbed population. The test is well suited for individual diagnostic and therapy evaluation procedures as well as for more fundamental research.
The rehabilitation of communicative effectiveness has developed into one of the main concerns in aphasia treatment. Development of effective intervention programmes is dependent on rehabilitation evaluation. Standard assessment of neurolinguistic deficits does not account for communicative effectiveness. Improved scores on standard aphasia tests therefore have limited relevance to improved functional communication. Assessment of functional impairments can contribute to aphasia therapy by developing reliable and valid instruments for the evaluation of communicative adequacy. A recently developed instrument for measuring verbal communicative adequacy in terms of the comprehensibility of the message to the listener is presented. An analysis of the assessed communicative abilities of aphasic patients should expand our knowledge about the nature of and processes involved in communicative effectiveness. It is therefore argued that functional assessment can contribute to the search for adequate means and realistic goals in the treatment of aphasic patients. The results of a qualitative analysis of verbal communicative behaviour of aphasic patients is presented, which illustrates the effectiveness of aphasic communication despite their language deficits. It could be shown that even if the informational content of the messages is rather poor, aphasic patients bring across at least the most central elements of the message.
The focus of research on aphasia has been directed toward the assessment of the aphasic person's linguistic impairments. In contrast, there has been little attention given to the question of how aphasic speakers get intended messages across in verbal interactions. This issue is of both theoretical and pragmatic importance. In this paper we report results of a study designed to determine the verbal communicative competence of aphasic persons in ordinary daily life situations. The test involves role-playing in 15 everday life situations such as going to the bank. Each scenario elicits highly consistent responses from non-neurologically impaired adults. These responses have two components: (a) necessary elements, e.g. asking a bank teller for change and noting when the incorrect change is given; and (b) socially conventional elements which are elaborative but non-essential. The consistency of normal subjects' verbal responses in these scenarios allows for the establishment of an objective scoring procedure and to make meaningful comparisons among aphasic and normal subjects' responses. In this study Broca's and Wernicke's aphasic subjects were found to be successful in verbally communicating necessary information, even in the face of severe linguistic (notably, syntactic) limitations. Conversely, both aphasic populations showed a significant reduction in their use of informationally inessential but socially conventional elements.
Background: The goals of people with aphasia should guide service delivery. Services are increasingly influenced by the International Classification of Functioning, Disability and Health (ICF) (WHO, 200145.
World Health Organisation (WHO) . 2001. International classification of functioning, disability and health (ICF), Geneva, Switzerland: World Health Organisation. View all references), but little is yet known about whether the goals of people with aphasia span the full spectrum of the ICF. Aims: The purpose of this study was to describe the goals of people with aphasia and to code the goals according to the ICF. Methods & Procedures: A qualitative descriptive research approach was used involving semi-structured in-depth interviews with 50 participants with aphasia post-stroke. Interviews were videotaped and transcribed verbatim and then analysed using qualitative content analysis. The goals of a 30% consecutive subsample were then coded using the ICF. Outcomes & Results: Nine broad categories of goals were identified. Participants with aphasia wanted to return to their pre-stroke life and to communicate not only their basic needs but also their opinions. They also wanted information about aphasia, stroke, and available services; more speech therapy; greater autonomy; and dignity and respect. They identified the importance of engagement in social, leisure, and work activities as well as regaining their physical health. Interestingly, their goals included wanting to help others. Goals could be linked to all ICF components within the ICF, with the majority linked to Activities and Participation, followed by Environmental Factors, Body Functions and Structures, and Personal Factors. Conclusions: People with aphasia in this study were able to articulate a wide range of goals post-stroke that encompassed all of the ICF components but had a particular focus on the Activity and Participation components.
focus of this chapter has been on one potential source of information regarding such behavioral changes, namely, patients' own subjective perceptions of their difficulties / to examine the potential utility of this data source, we have described the development of the Patient Assessment of Own Functioning Inventory (PAF), a standardized method of obtaining patients' ratings regarding ability deficits experienced in their everyday functioning (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Aphasien sind erworbene Störungen in der zentralen Sprachverarbeitung bedingt durch temporäre, bleibende oder fortschreitende
Schädigungen der perisylvischen Region in der sprachdominanten, meist linken Hirnhälfte. Die häufigste Ursache sind Durchblutungsstörungen.
Man unterscheidet 4 Stan dardsyndrome, die in der Spontansprache prototy pische Leitsymptome zeigen:
–
Sprachautomatismen bei globaler Aphasie,
–
Paragrammatismus und Paraphasien bei Wernicke-Aphasie,
–
Agrammatismus bei Broca-Aphasie,
–
Wortfindungsstörungen bei amnestischer Aphasie.
Herausragend gutes bzw. schlechtes Nachsprechen charakterisiert die Sonderformen der transkortikalen Aphasien und der Leitungsaphasie.
Zusätzlich zur Aphasie können Störungen der Sprechmotorik vorliegen. Eine spontane Rückbildung der Aphasie findet bei ca.
30% der Patienten in der Akutphase (4–6 Wochen nach dem Ereignis) statt. Besserungen über die spontane Rückbildung hinaus
sind durch eine gezielte logopädische Behandlung zu erreichen. Es lassen sich 3 unterschiedliche Mechanismen der Rückbildung
differenzieren: Restitution, Substitution und Kompensation.
Background:
Aphasia is an acquired language impairment following brain damage which affects some or all language modalities: expression and understanding of speech, reading and writing. Approximately one-third of people who have a stroke experience aphasia.
Objectives:
To assess the effectiveness of speech and language therapy (SLT) for aphasia following stroke.
Search strategy:
We searched the Cochrane Stroke Group Trials Register (last searched April 2009), MEDLINE (1966 to April 2009) and CINAHL (1982 to April 2009). In an effort to identify further published, unpublished and ongoing trials we handsearched the International Journal of Language and Communication Disorders, searched reference lists of relevant articles and contacted other researchers and authors.
Selection criteria:
Randomised controlled trials comparing SLT versus no SLT, SLT versus social support or stimulation, and one SLT intervention versus another SLT intervention. SLT refers to a formal speech and language therapy intervention that aims to improve language and communication abilities and in turn levels of communicative activity and participation. Social support and stimulation refers to an intervention which provides social support or communication stimulation but does not include targeted therapeutic interventions. Direct comparisons of different SLT interventions refers to SLT interventions that differ in terms of duration, intensity, frequency or method of intervention or in the theoretical basis for the SLT approach.
Data collection and analysis:
Two review authors independently extracted the data and assessed the quality of included trials. We sought missing data from study investigators if necessary.
Main results:
We included 30 trials (41 paired comparisons) in the review: 14 subcomparisons (1064 participants) compared SLT with no SLT; six subcomparisons (279 participants) compared SLT with social support and stimulation; and 21 subcomparisons (732 participants) compared two approaches to SLT. In general, the trials randomised small numbers of participants across a range of characteristics (age, time since stroke and severity profiles), interventions and outcomes. Suitable statistical data were unavailable for several measures.
Authors' conclusions:
This review shows some indication of the effectiveness of SLT for people with aphasia following stroke. We also observed a consistency in the direction of results which favoured intensive SLT over conventional SLT, though significantly more people withdrew from intensive SLT than conventional SLT. SLT facilitated by a therapist-trained and supervised volunteer appears to be as effective as the provision of SLT by a professional. There was insufficient evidence to draw any conclusions in relation to the effectiveness of one SLT approach over another.
It has been speculated that the conflicting results demonstrated across poststroke aphasia therapy studies might be related to differences in intensity of therapy provided across studies. The aim of this study is to investigate the relationship between intensity of aphasia therapy and aphasia recovery.
A MEDLINE literature search was conducted to retrieve clinical trials investigating aphasia therapy after stroke. Changes in mean scores from each study were recorded. Intensity of therapy was recorded in terms of length of therapy, hours of therapy provided per week, and total hours of therapy provided. Pearson correlation was used to assess the relationship between changes in mean scores of outcome measures and intensity of therapy.
Studies that demonstrated a significant treatment effect provided 8.8 hours of therapy per week for 11.2 weeks versus the negative studies that only provided approximately 2 hours per week for 22.9 weeks. On average, positive studies provided a total of 98.4 hours of therapy, whereas negative studies provided 43.6 hours of therapy. Total length of therapy time was found to be inversely correlated with hours of therapy provided per week (P=0.003) and total hours of therapy provided (P=0.001). Total length of therapy was significantly inversely correlated with mean change in Porch Index of Communicative Abilities (PICA) scores (P=0.0001). The number of hours of therapy provided in a week was significantly correlated to greater improvement on the PICA (P=0.001) and the Token Test (P=0.027). Total number of hours of therapy was significantly correlated with greater improvement on the PICA (P<0.001) and the Token Test (P<0.001).
Intense therapy over a short amount of time can improve outcomes of speech and language therapy for stroke patients with aphasia.
Although the most effective means of treating aphasia post stroke has not been determined, several areas of aphasia therapy have proven to be more effective than others. A recent study had determined that intense aphasia therapy over a short period of time has greater impact on recovery than less intense therapy over a longer period of time. Building upon the idea that more is better, this article examines other spects of aphasia therapy that may be combined to facilitate recovery.
Funktionelle Aphasiediagnostik mit dem Amsterdam–Nijmegen Everyday Language Test (ANELT)—Deutsche Fassung. [Functional aphasia diagnostic with the Amsterdam–Nijmegen Everyday Language Test (ANELT)—German version]
- Blomert L.
BLOMERT, L. and BUSLACH, D., 1994, Funktionelle Aphasiediagnostik mit dem Amsterdam-Nijmegen Everyday Language Test
(ANELT)-Deutsche Fassung. [Functional aphasia diagnostic with the Amsterdam-Nijmegen Everyday Language Test
(ANELT)-German version]. Forum Logopädie, 2, 3-6.
- Brown
The Handbook of Adult Language Disorders
- A E Hillis
HILLIS, A. E., ed., 2015, The Handbook of Adult Language Disorders,
2nd edn (New York, NY: Psychology Press).
The Neurocognition of Language
- C. M. Brown
- P. Hagoort
Die Evaluation der sprachpragmatischen Fähigkeiten mit dem ANELT—Eine empirische Studie zur Wirksamkeit der Therapie auf der Aachener Aphasiestation
- M. Kawalla
Sprachsystematisches Aphasiescreening (SAPS) [Language-Systematic Aphasia Screening (SAPS)]
- S. Abel
- W. Huber
- F. Longoni
- K.-J. Schlenck
- K. Willmes
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
- C. Breitenstein
- T. Grewe
- A. Flöel
- W. Ziegler
- L. Springer
- P. Martus
- W. Huber
- K. Willmes
- E. B. Ringelstein
- K. G. Hausler
- S. Abel
- R. Glindemann
- F. Domahs
- F. Regenbrecht
- K.-J. Schlenck
- M. Thomas
- H. Obrig
- E. De Langen
- R. Rocker
- F. Wigbers
Handbook of the Neuroscience of Language
- L. Springer
Klinische Neuropsychologie
- D. Weniger
- L. Springer
Evidence-based cognitive rehabilitation: Recommendations for clinical practice
- K D Cicerone
- D M Langenbahn
- C Dahlberg
- K Kalmar
- J F Malec
- T F Bergquist
- T Fleicetti
- J T Giacina
- J P Harley
- D E Harrington
- J Herzog
- S Kneipp
- L Laasch
- P Morse
CICERONE, K. D., LANGENBAHN, D. M., DAHLBERG, C., KALMAR,
K., MALEC, J. F., BERGQUIST, T. F., FLEICETTI, T., GIACINA, J.
T., HARLEY, J. P., HARRINGTON, D. E., HERZOG, J., KNEIPP,
S., LAASCH, L. and MORSE, P., 2000, Evidence-based cognitive rehabilitation: Recommendations for clinical practice.
Archives of Physical Medicine and Rehabilitation, 81, 1596-1615.
- W Huber
- K Poeck
- D Weniger
- K Willmes
HUBER, W., POECK, K., WENIGER, D. and WILLMES, K., 1983, Der
Aachener Aphasie Test (Göttingen: Hogrefe).
Computer-based aphasia therapy with the Lingware/STACH system
- F J Stachowiak
STACHOWIAK, F. J., 1993, Computer-based aphasia therapy with
the Lingware/STACH system. In F. J. Stachowiak, R. D.
Bleser, G. Deloche, R. Kaschel, H. Kremin and P. North
(eds), Developments in the Assessment and Rehabilitation of
Brain-Damaged Patients (Tübingen: Gunther Narr).
- I Van Der Meulen
- J Van Gelder-Houthuizen
- J Wiegers
- S Wielaert
- M W E Van De Sandt-Koenderman
VAN DER MEULEN, I., VAN GELDER-HOUTHUIZEN, J., WIEGERS, J.,
WIELAERT, S. and VAN DE SANDT-KOENDERMAN, M. W. E.,
2008, Scenario Test (Houten: Bohn Stafleu van Loghum).
Intensive speech and language therapy in patients with chronic aphasia after stroke: a randomised, open-label, blinded-endpoint
- C Breitenstein
- T Grewe
- A Flöel
- W Ziegler
- L Springer
- P Martus
- W Huber
- K Willmes
- E B Ringelstein
- K G Hausler
- S Abel
- R Glindemann
- F Domahs
- F Regenbrecht
- K.-J Schlenck
- M Thomas
- H Obrig
- E De Langen
- R Rocker
- F Wigbers
- C Rühmkorf
- I Hempen
- J List
- A Baumgaertner
- Group
BREITENSTEIN, C., GREWE, T., FLÖEL, A., ZIEGLER, W., SPRINGER,
L., MARTUS, P., HUBER, W., WILLMES, K., RINGELSTEIN, E.
B., HAUSLER, K. G., ABEL, S., GLINDEMANN, R., DOMAHS,
F., REGENBRECHT, F., SCHLENCK, K.-J., THOMAS, M., OBRIG,
H., DE LANGEN, E., ROCKER, R., WIGBERS, F., RÜHMKORF,
C., HEMPEN, I., LIST, J., BAUMGAERTNER, A. and THE
FCET2EC STUDY GROUP, 2017, 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. Lancet, 389, 1528-1538.
Die Evaluation der sprachpragmatischen Fähigkeiten mit dem ANELT-Eine empirische Studie zur Wirksamkeit der Therapie auf der Aachener Aphasiestation [Evaluation of Pragmatic Abilities with the ANELT-An Empirical Study of the Efficacy of Therapy on the Aachen Aphasia Ward
- M Kawalla
KAWALLA, M., 2011, Die Evaluation der sprachpragmatischen
Fähigkeiten mit dem ANELT-Eine empirische Studie zur
Wirksamkeit der Therapie auf der Aachener Aphasiestation
[Evaluation of Pragmatic Abilities with the ANELT-An
Empirical Study of the Efficacy of Therapy on the Aachen
Aphasia Ward]. Aachen: Rheinisch-Westfälische Technische
Hochschule.
Therapie von Aphasien
- D Weniger
- L Springer
WENIGER, D. and SPRINGER, L., 2006, Therapie von Aphasien.
In W. Hartje and K. Poeck (eds), Klinische Neuropsychologie,
6th edn (Stuttgart: Thieme).
- Brown C. M.
- Hillis A. E.