From the Guidelines
Speech-language therapy (SLT) is the primary treatment for post-stroke (CVA) aphasia and should be initiated as early as possible after the stroke. This recommendation is based on the most recent and highest quality study, which suggests that SLT improves communication outcomes in people with aphasia after stroke, regardless of the time after onset 1. A comprehensive rehabilitation program typically includes individual therapy sessions 2-3 times per week for several months, focusing on language exercises tailored to the specific type of aphasia (expressive, receptive, or global).
Some key components of SLT for aphasia include:
- Communication partner training, which is recommended to support the patient's communication needs 1
- Computerized treatment, which may be considered to supplement treatment provided by a speech-language pathologist 1
- Group treatment, which may be useful across the continuum of care, including the use of community-based aphasia groups 1
- Intensive treatment, which is favored, but there is no consensus on the amount, distribution, and duration that is most beneficial 1
It is essential to note that while some studies suggest that medications like memantine or piracetam may provide modest benefits in certain cases, there is no specific pharmacotherapy regimen recommended for routine use in aphasia treatment 1. The recovery potential depends on stroke severity, aphasia type, and the patient's age, with most improvement occurring in the first 3-6 months but continuing at a slower pace for years with ongoing therapy.
Overall, the goal of treatment for post-stroke aphasia is to improve communication outcomes, reduce morbidity, and enhance the patient's quality of life. SLT, with its various components and approaches, remains the cornerstone of aphasia treatment, and its effectiveness is supported by the most recent and highest quality evidence 1.
From the Research
Treatment Options for Post-CVA Aphasia
- Intensive speech and language therapy has been shown to significantly improve verbal communication in people with chronic aphasia after stroke 2
- Pharmacological treatments, such as donepezil and memantine, have been found to improve the prognosis of post-stroke aphasia, with donepezil having a significant effect on improving auditory comprehension, naming, repetition, and oral expression 3
- Augmentative and alternative communication (AAC) can be used to empower people with aphasia to fully participate and engage in life activities with increased independence, and can also be used to drive intersystemic reorganization resulting in improved language performance 4
Behavioral Approaches to Aphasia Treatment
- Behavioral speech and language therapy is the mainstay of treatment for post-stroke aphasia 5, 6
- Computer-delivered language therapies have been introduced to augment the effects of behavioral therapy 6
- Noninvasive brain stimulation techniques, such as transcranial brain stimulation, have been found to be a promising method to boost aphasia therapy outcomes 6
Future Directions
- There is a need for more large-scale randomized, double-blind, placebo-controlled clinical trials of behavioral treatments, noninvasive brain stimulation, and medications to boost aphasia recovery 5
- Emerging evidence from Phase II trials suggests that transcranial brain stimulation is a promising method to boost aphasia therapy outcomes 6