Trying to find the right time to treat aphasia – early treatment is not necessarily better

July 2, 2018

Imagine wanting to say something, but your words just won’t come out or knowing someone is talking to you, but you can’t understand. These types of difficulties with speech production and language comprehension, known as aphasia, are common following a stroke. This condition is caused by an injury to the brain. Up to one-third of patients will experience some degree of aphasia after a stroke, and it can create significant challenges in a person’s ability to communicate.

A short introduction of aphasia of the National Aphasia Association

Speech and Language Therapy for aphasia is beneficial – but when?

Past studies have shown that Speech and Language Therapy (SLT) is helpful in aphasia treatment. However, little is known about the ideal time to begin this therapy following a stroke. Knowing that early intervention is beneficial in other areas of stroke recovery, researchers and therapists from the Netherlands wanted to look at whether an early period of intensive aphasia treatment could produce better results for patients when compared to treatment initiated 4-6 weeks after stroke.

Researchers in this study randomly divided a group of 152 stroke patients with aphasia into two groups. The first group worked for 4 weeks with speech-language pathologists to complete 1 hour of daily SLT. And they started early with the treatment, within 2 weeks of their stroke. The type of SLT used in this study was Cognitive Linguistic Treatment (CLT), which focuses on identifying communication impairments and working to correct or compensate for them. The second group in the study did not receive any SLT during the first 4 weeks following their strokes. After the initial 4 week study period all patients received standard aphasia treatment. Researchers tested the two groups on a variety of communication skills at the end of 4 weeks. They tested them again at the 3 months and 6 months following the study.

No need to rush

The researchers did not find any significant differences between the two groups’ everyday verbal communication skills at any point in the study. Although we may be anxious to begin intensive therapy as soon as possible, the results of this study tell us that it may not be necessary to jump into aphasia treatment immediately following a stroke. 

The first few weeks after a stroke are often full of tests, appointments with doctors, and managing other medical complications. This study is evidence that we do not need to rush into treating aphasia and can possibly remove an item from the priority list in those stressful early weeks.

Nevertheless, many caregivers will be eager to help their loved one with communication as soon as possible. Making an effort to communicate in simple and meaningful ways is a great first step in recovery. The video link in this article includes suggestions for helpful communication strategies. There are also many computer applications that target aphasia. This list is a great place to start to find apps that help with facilitating communication.

The lead author of this study was Femke Nouwens, Department of Neurology, Erasmus MC University Medical Centre, The Netherlands.

What you can do with this information

Editorial note:

Starting treatment for aphasia does not need to happen within the first weeks after a stroke. Researchers have found that starting a little later shows the same results.

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