From the Guidelines
Treatment for post-stroke aphasia should prioritize early and intensive speech-language therapy, starting within the first 4 weeks post-stroke, to maximize language recovery. This approach is supported by the most recent and highest quality study, which emphasizes the importance of early intervention in improving functional communication, reading comprehension, and expressive language 1.
Key Components of Therapy
- Early aphasia therapy, starting within the first 4 weeks post-stroke
- Intensive aphasia therapy, with at least 45 minutes of direct language therapy for five days a week, in the first few months after stroke
- Language therapy sessions, ranging between 30-45 minutes, two-three days per week, from stroke onset to week 6 post-stroke
- Speech and language therapy to improve functional communication, reading comprehension, general expressive language, and written language
Additional Considerations
- Communication partner training is recommended to support individuals with aphasia 1
- Computerized treatment may be considered to supplement traditional therapy 1
- Group treatment, including community-based aphasia groups, may be useful across the continuum of care 1
- Pharmacotherapy, such as methylphenidate or donepezil, may be considered on a case-by-case basis to enhance attention and cognition, particularly if there are coexisting cognitive deficits 1
Technology-Based Interventions
- Speech apps and computer programs can supplement traditional therapy and provide additional practice opportunities for individuals with aphasia
Family Involvement
- Family members should be involved in practice outside formal therapy sessions and taught communication strategies to support their loved one with aphasia
Recovery and Progress
- Recovery varies widely among individuals, with most improvement occurring in the first 3-6 months post-stroke, though progress can continue for years with ongoing therapy and practice 1
From the Research
Treatment Approaches for Post-Stroke Aphasia
- Behavioral speech and language therapy is the mainstay of treatment for post-stroke aphasia, as supported by evidence from Phase III trials and large meta-analyses 2
- Computer-delivered language therapies have also been introduced to augment the effects of behavioral therapy 2
- Noninvasive brain stimulation techniques, such as transcranial brain stimulation, have shown promise in boosting aphasia therapy outcomes, with emerging evidence from Phase II trials 2, 3
- Pharmacotherapy options are also being explored to augment the effectiveness of behavioral therapy 3
Individualized Treatment Plans
- Aphasia diagnosis has evolved beyond traditional syndrome-based classification, focusing on individualized patient profiles 3
- Treatment plans should be tailored to each patient's specific needs and deficits, with a focus on direct therapy of language deficits, counseling, or both 2
- Patients with nonfluent aphasia may benefit from alternative approaches, such as melodic intonation therapy (MIT), which has shown significant improvements in speech output 4
Timing and Duration of Treatment
- The optimal timing of speech and language therapy for aphasia after stroke is still unclear, with some evidence suggesting that early initiation of treatment may not always be the most effective approach 5
- Intensive treatment may be more effective when patients are in a more stable condition, but further research is needed to determine the optimal window of time for language therapy 5
- Treatment duration and intensity can also impact outcomes, with some studies suggesting that longer periods of intensive therapy may be necessary to achieve significant improvements 4, 6