Intensive therapy is not necessarily best when it comes to treating the loss of language and communication in early recovery after a stroke, according to research from Edith Cowan University.
Published recently in the International Journal of Stroke, the research suggests that unlike physical and motor skill rehabilitation, recovering lost language caused by aphasia after stroke is a marathon, not a sprint. In addition, early intervention is crucial.
The findings have important implications for the treatment of aphasia because they mean service delivery options are likely to change, according to Erin Godecke, associate professor in ECU’s School of Medical and Health Sciences and the study’s lead author, in a media release.
“Previously, people with aphasia got the majority of their therapy in the first 6-8 weeks after stroke. Our research shows that there is no benefit to this. It is likely that the same therapy could be spread over a longer period to enhance recovery, rather than getting a burst at the start and very little over the next months or years.”
— Erin Godecke
Early Care is Vital, But Not Intensity
According to Godecke, aphasia therapy and early intervention are vitally important for recovery outcomes after stroke. However, increasing the intensity of the treatment doesn’t equate to better results.
“We found that when we provided early aphasia therapy people had a massive increase in their ability to communicate at 12 and 26 weeks after their stroke. They could talk better and had less difficulty finding and using the right words. Importantly, though, we also found that if we provided around 10 hours of therapy per week versus nearly 23 hours a week, the results weren’t any different. We didn’t see any harm, but we didn’t see any benefit.”
— Erin Godecke
Language Recovery is Different from Motor Recovery
Godecke adds that the way people recover motor skills after a stroke is different to how they regain language.
“We tend to believe that more intensive is always better. However, we’re beginning to see data emerge to show us that language recovery might behave a little differently to motor recovery functions such as walking, moving your arm or sitting up. We don’t need quite as intensive a regimen for language as we do for walking recovery. We might need the same amount of treatment, just spread over a longer period.”
— Erin Godecke
The difficulty level, or intensity, of the aphasia therapy needs to be tailored to what the person can tolerate, she continues.
“Because language is a higher order function and it involves more thinking time and cognitive skill, having breaks between sessions may help consolidate learning. It’s akin to running on a treadmill — you can only run on the treadmill if you can walk. There’s no benefit having someone run at full speed when you can have them run at a moderate pace, get the learning they need, retain it for longer and build on it.”
— Erin Godecke
VERSE Study
The Very Early Rehabilitation for Speech (VERSE) study at ECU aimed to determine whether intensive aphasia therapy, beginning within 14 days after stroke, improved communication recovery compared to usual care.
Researchers recruited 246 participants with aphasia after stroke from 17 acute care hospitals across Australia and New Zealand. Participants either received the usual level of aphasia therapy, or one of two higher-intensity regimens.
The ECU study suggests that early intensive aphasia therapy did not improve communication recovery within 12 weeks post stroke compared to usual care.
[Source(s): Edith Cowan University, Science Daily]
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