Carpenter Julia, Cherney Leora R
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Aphasiology. 2016 May 1;30(5):542-565. doi: 10.1080/02687038.2015.1023695. Epub 2015 Mar 19.
Intensity of therapy is a critical factor influencing outcomes in aphasia. However, there are many barriers to increasing treatment intensity for those with acute/subacute aphasia including the demands of the inpatient medical facilities and the endurance of the participants. Nevertheless, with some modifications to its original procedures, evidence suggests that Constraint Induced Language Therapy (CILT) may yield positive outcomes when given in the early stages of recovery.
To investigate the feasibility of increasing the amount of therapy provided to individuals with aphasia on an inpatient rehabilitation unit by adding CILT at a modified intensity, and to assess whether those receiving two weeks of the additional CILT show more improvement than control participants who did not receive the additional treatment.
A case-series single-subject design study was conducted. All participants received usual care of approximately an hour of speech and language treatment, five to six days a week. Participants in the experimental condition received an additional hour-long CILT session, five days per week, for two weeks. Trained, untrained, and generalization probes comprising naming of pictured items and oral reading of sentences were taken at baseline, during treatment, and at post-treatment. All participants were probed equally. Probe performance was scored and effect sizes were calculated and compared. Performance gains from pre- to post-treatment on subtests of the Boston Diagnostic Aphasia Examination were also compared.
Thirteen individuals with aphasia onset ranging from 7 to 68 days were recruited, with 6 allocated to the experimental Usual Care + CILT condition and 7 allocated to the control Usual Care condition. Increasing the amount of speech and language therapy by adding an hour of daily CILT was feasible. Individual performance varied within and across conditions with large gains noted in some, but not all participants. As a group, there was a small to medium effect size of the Usual Care + CILT condition over Usual Care alone for trained and untrained oral reading probes and untrained naming probes.
It is feasible to increase the amount of treatment provided to participants with aphasia on an acute inpatient rehabilitation unit. Preliminary results suggest that there may be better outcomes for those who receive more treatment. Further research using larger numbers of homogeneous participants and controlling for content of therapy as well as amount of therapy is warranted.
治疗强度是影响失语症治疗效果的关键因素。然而，对于急性/亚急性失语症患者而言，提高治疗强度存在诸多障碍，包括住院医疗设施的要求以及患者的耐受能力。尽管如此，有证据表明，对其原始程序进行一些调整后，强制性诱导语言治疗（CILT）在恢复早期进行时可能会产生积极效果。
通过以调整后的强度增加强制性诱导语言治疗（CILT），研究在住院康复单元增加失语症患者治疗量的可行性，并评估接受两周额外强制性诱导语言治疗（CILT）的患者是否比未接受额外治疗的对照组患者有更大改善。
进行了一项病例系列单受试者设计研究。所有参与者每周接受约一小时的言语和语言治疗，每周五到六天，作为常规护理。实验组的参与者在两周内每周额外接受五次为时一小时的强制性诱导语言治疗（CILT）。在基线、治疗期间和治疗后，对包括图片命名和句子朗读的训练、未训练及泛化性探测进行测试。所有参与者接受相同的测试。对探测表现进行评分，并计算和比较效应量。还比较了波士顿诊断失语症检查子测试中治疗前到治疗后的表现提升情况。
招募了13名失语症发病7至68天的患者，其中6名分配到实验组常规护理 + 强制性诱导语言治疗（CILT）组，7名分配到对照组常规护理组。通过每天增加一小时强制性诱导语言治疗（CILT）来增加言语和语言治疗量是可行的。个体表现因条件不同而有所差异，部分参与者有显著提升，但并非全部。作为一个整体，在训练和未训练的朗读探测以及未训练的命名探测方面，常规护理 + 强制性诱导语言治疗（CILT）组相对于单独常规护理组有小到中等的效应量。
在急性住院康复单元增加失语症患者的治疗量是可行的。初步结果表明，接受更多治疗的患者可能会有更好的治疗效果。有必要进行进一步研究，纳入更多同质性参与者，并控制治疗内容和治疗量。
