Speech and language therapy for aphasia following stroke

  • Review
  • Intervention

Authors


Abstract

Background

Aphasia describes language impairment associated with a brain lesion.

Objectives

To assess the effects of formal speech and language therapy and non-professional types of support from untrained providers for people with aphasia after stroke.

Search strategy

We searched the Cochrane Stroke Group Trials Register (last searched March 1999), and reference lists of relevant articles to December 1998. We also contacted academic institutions and other researchers to identify further published and unpublished trials. We handsearched the International Journal of Disorders of Communication from 1969 to 1998.

Selection criteria

Randomised controlled trials comparing: (1) any type of formal speech and language therapy in any setting administered by trained speech and language therapists versus no treatment; (2) any type of formal speech and language therapy in any setting administered by trained speech and language therapists versus any type of informal support for aphasia, given by speech and language therapists or volunteers, whether these were trained or untrained; (3) one type of speech and language therapy versus another type. Outcome measures included measures of any type of communication, other measures of functioning, numbers of drop-outs, and other non-clinical outcomes.

Data collection and analysis

The principal reviewer collected the data, and assessed the quality of the trials with independent data checking and methodological advice. If we could not perform a statistical combination of different studies, we sought missing data. Failing that we provided a description.

Main results

We considered 60 studies in detail, from which we identified 12 trials suitable for the review. Most of these trials were relatively old with poor or unassessable methodological quality. None of the trials was detailed enough for us to complete description and analysis. We could not determine whether formal speech and language therapy is more effective than informal support.

Authors' conclusions

The main conclusion of this review is that speech and language therapy treatment for people with aphasia after a stroke has not been shown either to be clearly effective or clearly ineffective within a RCT. Decisions about the management of patients must therefore be based on other forms of evidence. Further research is required to find out if effectiveness of speech and language therapy for aphasic patients is effective. If researchers choose to do a trial, this must be large enough to have adequate statistical power, and be clearly reported.

Plain language summary

Speech and language therapy for aphasia following stroke

Language impairment (aphasia) is apparent in the first week in about one quarter of survivors of a stroke. About half of all spontaneous recovery from disability occurs over the first month and can continue for six months. About 12% of survivors of are still aphasic at six months. Therapies are aimed at improving both communication and the functional and psychosocial aspects of having language impairment. Verbal expressive and receptive language, written language and overall functional communication can be affected. Speech and language therapy is delivered in a range of settings (hospital, rehabilitation centre, home), individually or in groups, with formally trained speech and language therapists or informal support from untrained providers including family and volunteers. The review identified 12 small controlled trials in adults; the most recent in 1993 (methodological quality of trials has improved a lot since then). The average age of participants ranged between 65 and 75 and therapy began at around three and a half months. No difference could be determined between formal therapy and informal support. In one study the volunteers felt they had made a significant difference in the quality of their patients' lives.

Ancillary