From the Guidelines
The standard treatment for a patient with a history of cerebrovascular accident (CVA) and residual mild expressive aphasia centers on speech-language therapy (SLT) combined with medical management, as recommended by the most recent guidelines 1.
Key Components of Treatment
- Speech therapy should be initiated as soon as possible after the stroke and typically involves 2-3 sessions per week for at least 3-6 months, focusing on word-finding exercises, sentence formation, and communication strategies.
- Medical management includes antiplatelet therapy with aspirin (81-325 mg daily), clopidogrel (75 mg daily), or a combination of aspirin and extended-release dipyridamole (25/200 mg twice daily) for secondary stroke prevention.
- Blood pressure control is essential, targeting levels below 140/90 mmHg using medications such as ACE inhibitors (like lisinopril 10-40 mg daily) or ARBs.
- Cholesterol management with statins (atorvastatin 40-80 mg daily or rosuvastatin 20-40 mg daily) is recommended regardless of baseline cholesterol levels.
Additional Considerations
- Lifestyle modifications including a Mediterranean or DASH diet, regular physical activity (150 minutes weekly of moderate exercise), smoking cessation, and limiting alcohol consumption are crucial components.
- Regular monitoring for depression is important as it commonly occurs post-stroke and can impede recovery; if present, SSRIs like escitalopram (10-20 mg daily) may be beneficial as they can potentially aid neuroplasticity.
- Communication partner training is effective in improving communication activities or the participation of the communication partner, and may be considered as part of the treatment plan 1.
- Computerized treatment may be considered to supplement treatment provided by a speech-language pathologist, and group treatment may be useful across the continuum of care, including the use of community-based aphasia groups 1.
From the Research
Standard Treatment Care for CVA with Residual Mild Expressive Aphasia
The standard treatment care for a patient with a history of Cerebrovascular Accident (CVA) and residual mild expressive aphasia typically involves speech and language therapy (SLT) 2.
- Speech and Language Therapy (SLT): SLT is the mainstay treatment for aphasia, aiming to improve language and communication abilities, activity, and participation 2.
- Intensity and Duration of SLT: Research suggests that therapy at high intensity, high dose, or over a longer period may be beneficial for improving functional communication, reading, writing, and expressive language 2.
- Combination Therapies: Combining transcranial direct current stimulation (tDCS) with SLT may also improve language performance in persons with aphasia 3.
- Pharmacological Agents: Certain pharmacological agents, such as piracetam, dopamine agonists, and cholinergic agents (e.g., donepezil), have shown promise in treating aphasia, although more research is needed to confirm their effectiveness 4, 5.
Classification and Treatment of Aphasia
Aphasia can be classified into different types, including nonfluent aphasias (e.g., Broca's, transcortical motor) and fluent aphasias (e.g., anomic, conduction, Wernicke's) 6.
- Nonfluent Aphasias: Treatment for nonfluent aphasias, such as Broca's aphasia, may involve intensive language therapy and pharmacological agents like bromocriptine 5.
- Fluent Aphasias: Treatment for fluent aphasias, such as Wernicke's aphasia, may involve a combination of language therapy and pharmacological agents like donepezil 5.
Recovery and Prognosis
Recovery from aphasia is possible, even in severe cases, and spontaneous recovery often occurs within the first three months after stroke onset 6.
- Spontaneous Recovery: Spontaneous recovery is most remarkable in the first three months after stroke onset, with earlier and more intensive recovery occurring in ischemic stroke patients 6.
- Prognosis: The prognosis for aphasia depends on the type and severity of the aphasia, as well as the individual's overall health and response to treatment 6, 5.