CAT In patients with aphasia post stroke, does constraint induced aphasia therapy assist language production? NSW Adult Communication and Dysphagia Group

CIAT Application in Speech Pathology; Intensity: 30hr over 2weeks Shaping; language tasks of increasing complexity embedded in communicative language games within a group setting (max 2-3 people) Constraint: constraint of non-verbal or compensatory strategies. (Taub, et al 2002 cited in Meinzer et al 2006)

CAT Search produced two articles for appraisal. CAP#1:Pulvermueller et al (2001) Constraint induced therapy of chronic aphasia after stroke. Stroke. 32: CAP#2: Meinzer et al(2005). Long term stability of improved language functions in chronic aphasia after constrain induced aphasia therapy. Stroke. 37(6):1464 – 1466.

CAPS CAP#1CAP#2 Design Randomised Control TrialBasic pre and post test design Participants 17 participants. L MCA CVA and diagnosed aphasia 27 patients with chronic aphasia – classified as either mild, mod or severe. Experimental Gp 10 participants received CIAT. 2 diff exp gps: CIAT CIATplus: essentially in addition included family training and tasks for completion Control Gp 7 participants received “conventional therapy” Nil Results The Exp. Gp showed sig. Improvement The Control Gp did not show sig. Improvement. Both gps showed improvement. The CIATplus gp showed sig. improvement and showed greater improvements in everyday communication

CAP Cont’d CAP #1CAP#2 Strengths Authors acknowledged limitations of study RCT and attempted blind evaluation of assessment. Weakness: No family involvement. No info on “conventional therapy” No info on sustained gains Addressed limitations of CAP#1. Included families Did not distinguish the length post stroke Weakness: Non randomisation or control Poor description of therapy so which aspects of CIAT beneficial? No within gp comparisons i.e. classified as mild,mod, severe. Level of Evidence Level 2Level 3(111)

Clinical Bottom Line CAP#1 & #2 Massed-practice CIAT performed intensely over a short period of time with chronic aphasics resulted in improved language performance. It is difficult to determine whether CIAT was more effective than other conventional therapies.

Conventional Therapies Chronic aphasics usually receive the option of gp or individual therapy. Individual therapy 1hr/wk Offered in blocks –particularly if students placements available and if caseload permitting. Goal oriented therapy Gp therapy: 2hr a week/fortnight for a period of weeks. Total communication approach. Transport and staffing

Conventional Therapy Therapies used in individual and gp sessions include: Strategies Impairment Family Education Functional Therapy

Is CIAT an alternative model to service delivery for aphasia?

Participants Recruit 30 participants Confirmed diagnosis of stroke and aphasia Have functional comprehension at a single sentence level 12 mth post onset Outpatients

Methodology Blinding assessors Concealed and quasi-randomised Control gp 2 participants in the control or both treatment gps Therapy conducted 2hr/day for 2 weeks with carer education

Treatment Gp 1- CIAT Therapy tasks could include go-fish game, other barrier task games plus general conversation on current affairs topics.

Treatment Gp 2 – Functional Therapy Social communication tasks Total communication approach utilised Education to carers provided

Control Wait list gp Treatment not withheld

How? Big exercise At a smaller level Utilise clients as their own control while they are on the waiting list Compare CIAT with current functional therapy approach that focuses on total communication Increase intensity at sub acute level of rehab (inpatients)