Add-On Language Therapy May Improve Post-Stroke Aphasia Symptoms

Individuals with post-stroke aphasia who engage in computerized speech and language therapy (CSLT)—in addition to usual care—can experience significant improvement in personally relevant word finding, according to a new trial. However, CSLT does not appear to improve conversation.

To reach this conclusion, the researchers analyzed data on 278 patients aged 18 years or older from 21 speech and language therapy departments across the United Kingdom. To be included in the trial, the patients had to have been diagnosed with post-stroke aphasia at least 4 months before trial randomization.

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Using a computer-generated randomization system, participants were randomly assigned to 6 months of usual care (n = 101), daily self-managed CSLT plus usual care (n = 97), or attention control plus usual care (n = 80). Randomization was stratified by site and severity of word finding at baseline based on Comprehensive Aphasia Test (CAT) Naming Objects test scores.

A clinically meaningful change from baseline to 6 months was defined as (1) a 10.0% mean difference in change in the participant’s ability to retrieve personally relevant words in a picture-naming test; or (2) a 0.45 mean difference in change of Therapy Outcome Measures in functional communication ability, measured by masked ratings of video-recorded conversations.

In all, 86 participants in the usual care group, 83 participants in the CSLT group, and 71 in the attention control group were included in the modified intention-to-treat population—the population in which the primary analysis was based.

Mean word finding improvements were 1.1% in the usual care group, 16.4% in the CSLT group, and 2.4% in the attention control group. Mean changes in Therapy Outcome Measures were 0.05 in the usual care group, 0.04 in the CSLT group, and 0.10 in the attention control group.

Serious adverse events per year were rare, with those that occurred either unrelated or likely unrelated to the trial activity.

While CSLT plus usual care increased patients’ therapy practice amount and significantly improved patients’ ability to retrieve personally relevant words, it did not have an effect on conversation, self-perceived improvements in everyday communication, social participation, or quality of life.

“Further research should focus on therapy techniques to promote generalization of new words to functional, everyday communication contexts,” the researchers concluded.

—Colleen Murphy

Reference:

Palmer R, Dimairo M, Cooper C, et al. Self-managed, computerised speech and language therapy for patients with chronic aphasia post-stroke compared with usual care or attention control (Big CACTUS): a multicentre, single-blinded, randomised controlled trial. Lancet Neurol. 2019;18(9):821-833. doi:10.1016/S1474-4422(19)30192-9.