Limits...
Constraint-Induced Aphasia Therapy for Treatment of Chronic Post-Stroke Aphasia: A Randomized, Blinded, Controlled Pilot Trial.

Szaflarski JP, Ball AL, Vannest J, Dietz AR, Allendorfer JB, Martin AN, Hart K, Lindsell CJ - Med. Sci. Monit. (2015)

Bottom Line: Clinicians treating patients (CIAT group) did not communicate with other team members to maintain blinding and the testing team members were blinded to treatment group assignment.Other measures trended towards better performance in the CIAT group.In this pilot RCT intensive language therapy led to an improvement in subjective language abilities.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA.

ABSTRACT

Background: To provide a preliminary estimate of efficacy of constraint-induced aphasia therapy (CIAT) when compared to no-intervention in patients with chronic (>1 year) post-stroke aphasia in order to plan an appropriately powered randomized controlled trial (RCT).

Material and methods: We conducted a pilot single-blinded RCT. 24 patients were randomized: 14 to CIAT and 10 to no-intervention. CIAT groups received up to 4 hours/day of intervention for 10 consecutive business days (40 hours or therapy). Outcomes were assessed within 1 week of intervention and at 1 and 12 weeks after intervention and included several linguistic measures and a measure of overall subjective communication abilities (mini-Communicative Abilities Log (mini-CAL)). Clinicians treating patients (CIAT group) did not communicate with other team members to maintain blinding and the testing team members were blinded to treatment group assignment.

Results: Overall, the results of this pilot RCT support the results of previous observational studies that CIAT may lead to improvements in linguistic abilities. At 12 weeks, the treatment group reported better subjective communication abilities (mini-CAL) than the no-intervention group (p=0.019). Other measures trended towards better performance in the CIAT group.

Conclusions: In this pilot RCT intensive language therapy led to an improvement in subjective language abilities. The effects demonstrated allow the design of a definitive trial of CIAT in patients with a variety of post-stroke aphasia types. In addition, our experiences have identified important considerations for designing subsequent trial(s) of CIAT or other interventions for post-stroke aphasia.

No MeSH data available.


Related in: MedlinePlus

Diagram of the CIAT study and associated testing (LMCA – left middle cerebral artery; TT – Token Test; NAT – Neuropsychological aphasia testing; CIAT – constraint-induced aphasia treatment).
© Copyright Policy
Related In: Results  -  Collection


getmorefigures.php?uid=PMC4588672&req=5

f1-medscimonit-21-2861: Diagram of the CIAT study and associated testing (LMCA – left middle cerebral artery; TT – Token Test; NAT – Neuropsychological aphasia testing; CIAT – constraint-induced aphasia treatment).

Mentions: Subjects were recruited into this Institutional Review Board-approved study by word of mouth from among the stroke and aphasia clinics at the University of Cincinnati and University of Alabama at Birmingham, and from local aphasia support groups. We also listed the study on www.clinicaltrials.gov (registered NCT00843427; PI: Szaflarski), and several contacts were received directly from patients. After providing consent for screening, 32 individuals were interviewed. The inclusion criteria were chronic aphasia related to a single ischemic stroke in the left middle cerebral artery (LMCA) distribution (i.e., diagnosis of a single LMCA stroke was confirmed by medical record review including admission notes for the incident stroke and the results of brain imaging obtained prior to enrollment), Token Test in an impaired range (score ≤40), and pre-stroke fluency in English. The exclusion criteria were history of degenerative (e.g., dementia or Parkinson’s disease) or metabolic disorder (e.g., encephalopathy) or supervening illness (e.g., brain tumor or other cancer), history of severe depression or other mental illness, and positive pregnancy test in women of childbearing age. Patients with more than 1 stroke were not eligible. Five potential participants were excluded after interview. The format and the goals of the CIAT program were explained to all participants at the time of obtaining the informed consent. All patients indicated their understanding of the goals of the program prior to signing the informed consent; they also understood that they may be randomized to a no-intervention group, and that the follow-up testing will need to be performed. Of the 27 who were offered participation, 3 were excluded before randomization: 2 had a normal Token Test and 1 was hospitalized for reasons unrelated to the study. Fourteen subjects were randomized to receive CIAT (3–4 participants per group; 4 groups were assembled) and 10 to receive no-intervention (Figure 1). Demographic and clinical data of the participants are provided in Table 1.


Constraint-Induced Aphasia Therapy for Treatment of Chronic Post-Stroke Aphasia: A Randomized, Blinded, Controlled Pilot Trial.

Szaflarski JP, Ball AL, Vannest J, Dietz AR, Allendorfer JB, Martin AN, Hart K, Lindsell CJ - Med. Sci. Monit. (2015)

Diagram of the CIAT study and associated testing (LMCA – left middle cerebral artery; TT – Token Test; NAT – Neuropsychological aphasia testing; CIAT – constraint-induced aphasia treatment).
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4588672&req=5

f1-medscimonit-21-2861: Diagram of the CIAT study and associated testing (LMCA – left middle cerebral artery; TT – Token Test; NAT – Neuropsychological aphasia testing; CIAT – constraint-induced aphasia treatment).
Mentions: Subjects were recruited into this Institutional Review Board-approved study by word of mouth from among the stroke and aphasia clinics at the University of Cincinnati and University of Alabama at Birmingham, and from local aphasia support groups. We also listed the study on www.clinicaltrials.gov (registered NCT00843427; PI: Szaflarski), and several contacts were received directly from patients. After providing consent for screening, 32 individuals were interviewed. The inclusion criteria were chronic aphasia related to a single ischemic stroke in the left middle cerebral artery (LMCA) distribution (i.e., diagnosis of a single LMCA stroke was confirmed by medical record review including admission notes for the incident stroke and the results of brain imaging obtained prior to enrollment), Token Test in an impaired range (score ≤40), and pre-stroke fluency in English. The exclusion criteria were history of degenerative (e.g., dementia or Parkinson’s disease) or metabolic disorder (e.g., encephalopathy) or supervening illness (e.g., brain tumor or other cancer), history of severe depression or other mental illness, and positive pregnancy test in women of childbearing age. Patients with more than 1 stroke were not eligible. Five potential participants were excluded after interview. The format and the goals of the CIAT program were explained to all participants at the time of obtaining the informed consent. All patients indicated their understanding of the goals of the program prior to signing the informed consent; they also understood that they may be randomized to a no-intervention group, and that the follow-up testing will need to be performed. Of the 27 who were offered participation, 3 were excluded before randomization: 2 had a normal Token Test and 1 was hospitalized for reasons unrelated to the study. Fourteen subjects were randomized to receive CIAT (3–4 participants per group; 4 groups were assembled) and 10 to receive no-intervention (Figure 1). Demographic and clinical data of the participants are provided in Table 1.

Bottom Line: Clinicians treating patients (CIAT group) did not communicate with other team members to maintain blinding and the testing team members were blinded to treatment group assignment.Other measures trended towards better performance in the CIAT group.In this pilot RCT intensive language therapy led to an improvement in subjective language abilities.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA.

ABSTRACT

Background: To provide a preliminary estimate of efficacy of constraint-induced aphasia therapy (CIAT) when compared to no-intervention in patients with chronic (>1 year) post-stroke aphasia in order to plan an appropriately powered randomized controlled trial (RCT).

Material and methods: We conducted a pilot single-blinded RCT. 24 patients were randomized: 14 to CIAT and 10 to no-intervention. CIAT groups received up to 4 hours/day of intervention for 10 consecutive business days (40 hours or therapy). Outcomes were assessed within 1 week of intervention and at 1 and 12 weeks after intervention and included several linguistic measures and a measure of overall subjective communication abilities (mini-Communicative Abilities Log (mini-CAL)). Clinicians treating patients (CIAT group) did not communicate with other team members to maintain blinding and the testing team members were blinded to treatment group assignment.

Results: Overall, the results of this pilot RCT support the results of previous observational studies that CIAT may lead to improvements in linguistic abilities. At 12 weeks, the treatment group reported better subjective communication abilities (mini-CAL) than the no-intervention group (p=0.019). Other measures trended towards better performance in the CIAT group.

Conclusions: In this pilot RCT intensive language therapy led to an improvement in subjective language abilities. The effects demonstrated allow the design of a definitive trial of CIAT in patients with a variety of post-stroke aphasia types. In addition, our experiences have identified important considerations for designing subsequent trial(s) of CIAT or other interventions for post-stroke aphasia.

No MeSH data available.


Related in: MedlinePlus