Intensive speech therapy helps months after stroke

(Reuters Health) - Even months after a stroke, survivors can make major strides in communication and quality of life with intensive speech therapy, a recent study in Germany suggests.

After 15 hours a week of therapy for three weeks, the study participants could express themselves more effectively in daily communications, such as changing a doctor’s appointment over the phone.

“For a long time, it has been assumed that language recovery is limited to the first months after the initial stroke,” said lead author Caterina Breitenstein of the University of Muenster.

“During the past two decades, however, several clinical studies and systematic reviews have challenged this dogma,” but they weren’t considered high-quality studies, she told Reuters Health in an email.

Chronic aphasia, the inability to understand or express speech well due to brain damage from stroke, affects about 30 percent of stroke survivors. One year after stroke, about half of them are still struggling with aphasia. It interferes with day-to-day activities and often leads to a lower quality of life and depression as well as accounting for about 9 percent of stroke-related health care costs during the first year after stroke, the study team writes in The Lancet.

Breitenstein and colleagues enrolled 156 patients from 19 treatment centers who had aphasia lasting more than six months after a stroke. About half were randomly assigned to intensive speech therapy and the other half were put on a waiting list for the therapy.

For three consecutive weeks, people in the treatment group had speech therapy for 10 hours or more per week in one-on-one and group sessions, as well as another five hours or more per week of individual computer-based exercises. People in the waitlist group also had about 1.5 hours of speech therapy a week as part of their normal care.

Before and after the three-week intensive treatment program, researchers measured the effectiveness of all the participants’ verbal communication in 10 everyday life situations, such as rescheduling a doctor’s appointment or picking up clothes from a dry cleaner. They also scored patients on specific aspects of communication like how easy they were to understand and their syntax.

Compared to the waitlist group, about 44 percent of patients in the intensive therapy group significantly improved their communication ability, and the benefits remained stable during the six-month follow-up after the therapy sessions. The patients and their partners rated quality of life higher as well.

“Until now, a lack in evidence has severely hampered stroke survivors’ access to language rehabilitation services,” Breitenstein said. “This demonstrates that intensive practice is the key.”

The study authors chose a three-week treatment because most German health insurance companies limit aphasia rehabilitation to about three weeks. A subgroup of 34 patients received five weeks of therapy and showed additional improvement over the three-week group.

“The most recent Cochrane review suggests that high-intensity therapy leads to reduced aphasia and improvement in communication,” said Linda Worrall of the University of Queensland in Brisbane, Australia, who coauthored a commentary accompanying the study.

“Despite this, the intervention provided in clinical settings is far from what would be considered intensive,” Worrall told Reuters Health. “Confusion remains about the overall dose and intensity of treatment required for meaningful change.”

The study focused on stroke survivors younger than 70 to limit any age-related cognitive effects but otherwise found no differences in the effectiveness of the treatment based on age, time since stroke or severity of chronic aphasia. Patients with a milder stroke showed larger gains in verbal communication compared to those with more severe strokes, however.

In future research, Breitenstein’s team wants to study what minimum treatment intensity is required to improve speech skills and whether multiple three-week sessions could help even more. In addition, they want to investigate the general feasibility of implementing intensive speech therapy since cost seems to be a barrier. During the study, for example, 153 screened patients couldn’t participate because their rehabilitation center had staff shortages and couldn’t provide therapy.

“Aphasia therapy works,” Breitenstein said. “This calls for an urgent change in the way rehabilitation resources are currently used.”

SOURCE: and The Lancet, online March 1, 2017 and February 28, 2017.