Luise Springer’s research while affiliated with RWTH Aachen University and other places

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.

Die seit dem 1.2.2012 vom BMBF geforderte Aphasieversorgungsstudie FCET2EC (From con­trolled experimental trial to=2 everyday communication) ist international die erste multizentrische randomisierte kontrollierte Studie („randomized controlled trial“) zum Nachweis der Wirksamkeit intensiv durchgefuhrter Sprachtherapie bei Schlaganfallpatienten mit chronischer Aphasie (d. h. >6 Monate nach akutem Schlaganfall anhaltend). Ziel dieser Studie ist der statistische Nachweis auf einem hohen methodischen Niveau (Evidenzklasse 1), dass eine unter regularen klinischen Bedingungen durchgefuhrte intensive Sprach- und Kommunikationstherapie zu Verbesserungen der Alltagskommunikationsfahigkeit fuhrt. Eine sekundare Fragestellung ist die Nachhaltigkeit der erzielten sprachlichen Verbesserungen uber einen Zeitraum von 6 Monaten nach der Intensivtherapie. Die Studienergebnisse leisten einen unmittelbaren Beitrag bei der Entwicklung evidenzbasierter Leitlinien fur die Therapie chronischer Aphasien.

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

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...

Hintergrund: Kinder, die unter Sprechapraxie leiden, haben Probleme bei der Planung und Programmierung von sprechmotorischen Einheiten. Ätiologie, Definition und Diagnosekriterien dieses Störungsbildes werden kontrovers diskutiert. Kindliche Sprechapraxien (CAS) sind schwer abzugrenzen von kindlichen phonetisch-artikulatorischen Störungen sowie von ausgeprägten phonologischen Störungen (PhS), die ebenfalls zu den Aussprachestörungen zählen. Ziel der vorliegenden Studie war es, die Kernsymptomatik von kindlichen Sprechapraxien zu untersuchen und zu zeigen, inwiefern sich diese Merkmale von der Symptomatik phonologisch gestörter Kinder unterscheiden. Methode: Wir haben 8 sprechapraktische Kinder, 10 phonologisch gestörte Kinder und 10 Kontrollkinder im Alter von 4–7 Jahren während der Produktion von Wörtern, Pseudowörtern und Silben aufgenommen. Die in den Äußerungen enthaltenen Vokale wurden sowohl akustisch als auch perzeptiv analysiert. Die Konsonanten untersuchten wir ebenfalls perzeptiv. Ergebnisse: Beide Analyseformen ergeben hinsichtlich der auftretenden Vokal- und Konsonantenfehler deutliche Unterschiede zwischen allen 3 Untersuchungsgruppen, insbesondere, wenn es sich um Pseudowörter handelt.

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.

Supervised Home Training in Aphasia: Language Learning in Dialogues Highly intensive treatment is required to improve language and communication in aphasia. Supervised home training is a viable option to increase intensity of conventional, low-frequent treatment. The objective of the present study was to investigate the effi cacy of supervised home training by using B.A.Bar, a speech generating barcode reader. 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 by means of B.A.Bar was compared with non-linguistic training. The language training was designed to facilitate dialogue skills as required in everyday life. Robust and specifi c improvements in the participants' linguistic and communicative abilities were obtained using B.A.Bar home training. Furthermore, participants demonstrated signifi cant improvements in proxy rating of communicative effectiveness. In conclusion, this group study has proven that B.A.Bar home training is an effective tool for bolstering linguistic and communicative skills of individuals with aphasia.

According to recent effectivity studies on aphasia rehabilitation a high therapy frequency and a linguistically systematic repetitive exercising are decisive. This can be provided by a supplementary use of computerized training programs, in addition to the established face to face therapy. On that behalf, the internet based aphasia therapy program Fleppo was tested on two chronically aphasie patients in the context of a model based study of dysgraphia treatment. Dysgraphia is treated by both direct (segmental-phonographical) and indirect (holistic-lexical) methods. The results show a positive effect only for the direct approach. Partly contrasting results can be explained within individual contexts.