Aphasia Treatment in StrokeImportnat Information About Aphasia Treatment After StrokeFrom Jose Vega M.D., Ph.D., former About.com Guide

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Aphasia treatment is an extremely important aspect of life after a stroke which has affected someone's ability to speak. In general terms, aphasia is a disturbance in the production, processing, or understanding of language due to brain damage, most commonly from stroke. Although multiple forms of treatment exist for the different types of aphasia, only a few of them have been studied rigorously enough to have proven efficacy. As a result, most forms of aphasia treatment are based on theoretical grounds which await further testing to prove their benefits. However, based on their experience with patients, most speech pathologists and physicians attest to the benefits of aphasia therapy.

General Principles

Several principles of therapy have been shown in small studies to improve the outcome of therapy.

Regardless of the type of therapy used, the outcome is better if the intensity of therapy is increased. In other words, a given number of hours of therapy will yield a much better outcome if they are given in a few sessions over a few days rather than in many sessions over many days.

The effectiveness of aphasia therapy increases when therapists use multiple forms of sensory stimuli. For instance, auditory stimuli in the form of music, and visual stimuli in the form of pictures, drawings, are routinely used during aphasia therapy sessions.

Gradual increases in the difficulty of language exercises practiced during a given therapy session improves the outcome.

Listed below are some well-known forms of aphasia treatments.

Cognitive Linguistic Therapy

This form of therapy emphasizes the emotional components of language. For example, some exercises require patients to interpret the characteristics of different emotional tones of voice. Others require them to describe the meaning of highly descriptive words or terms such as the word "happy." These exercises help patients practice comprehension skills while focusing on understanding the emotional components of language.

Programmed Simulation:

This type of therapy uses multiple sensory modalities, including pictures and music, introduced in a gradual progression from easy to difficult.

Stimulation-Fascilitation Therapy:

This form of aphasia therapy focuses mostly on the semantic and syntactic parts of language. The main stimulus used during therapy sessions is auditory stimulation. One of the main assumptions of this type of therapy is that improvements in language skills are best accomplished with repetition.

Group Therapy:

This type of therapy provides a social context for patients to practice the communication skills they have learned during individual therapy sessions, while getting important feedback from therapists and other aphasics. Family treatment strategies have a similar effect, while also facilitating the communications of aphasics with their loved ones.

PACE (Promoting Aphasic's Communicative Effectiveness):

This is one of the best-known forms of pragmatic therapy, a form of aphasia therapy that promotes improvements in communication by using conversation as a tool for learning. PACE therapy sessions typically involve an enacted conversation between the therapist and the patient. In order to stimulate spontaneous communication, this type of therapy uses drawings, pictures, and other visually-stimulating items which are used by the patient to generate ideas to be communicated during the conversation. The therapist and the patient take turns to convey their ideas.

The difficulty of the materials used to generate conversation is increased in a gradual fashion. Patients are encouraged to use any means of communication during the session, which allows the therapist to discover communication skills that should be reinforced in the patient. The therapist communicates with the patient by imitating the means of communication with which the patient feels most comfortable.

Pharmacotherapy:

This is one of the most appealing forms of aphasia therapy although its efficacy has yet to be proven. The list of medications tried so far include piracetam, bifenalade, piribedil, bromocriptine, idebenone and dextran 40, donezepil, amphetamines and several antidepressants.

Although the evidence is not very strong, it appears that at least donezepil, piribedil and amphetamines might have some degree of efficacy in aphasia treatment. The latter appears to be especially helpful at enhancing the benefits of traditional non-medication based therapy, as some studies have shown a better outcome of therapy when patients are given amphetamines before therapy sessions.

Transcranial Magnetic Stimulation (TMS):

Although this modality of treatment is seldom used, its efficacy is under intense investigation. TMS consists of aiming a magnet directly at a part of the brain which is thought to inhibit language recovery after stroke. By suppressing the function of that part of the brain, recovery is enhanced. The type of magnetic therapy that has been tried in aphasia rehabilitation is the "slow and repeated" version of TMS. A few small studies have had encouraging results, but a large, well-controlled study is still needed to ensure the efficacy of this form of treatment.

Sources: Jordan Lori and Hillis Argye; Disorders of speech and language: aphasia, apraxia and dysarthria; Current Opinion in Neurology 2006 19 (6): 580-585.

Cicerone et al., Evidence-based cognitive rehabilitation: Updated Review of the literature from 1998 to 2002 Archives of Physical Medicine and Rehabilitation 2005

Vol 86; 1681-1692.

Froma P Roth and Colleen K. Worthington treatment resource manual for speech and language pathology 2nd edition Delmar, Albany NY.