Department of Neurology, Medical Faculty, RWTH Aachen University, Pauwelsstrasse 30, 52074, Aachen, Germany.
Institute of Cognitive Neurology and Dementia Research, Otto-Von-Guericke-University, Magdeburg, Germany.
J Neurol. 2024 Nov;271(11):7169-7183. doi: 10.1007/s00415-024-12429-7. Epub 2024 May 20.
Aphasia is a devastating consequence after stroke, affecting millions of patients each year. Studies have shown that intensive speech and language therapy (SLT) is effective in the chronic phase of aphasia. Leveraging a large single-center cohort of persons with aphasia (PWA) including patients also in the subacute phase, we assessed treatment effects of intensive aphasia therapy in a real-world setting.
Data were collected at the Aachen aphasia ward in Germany between 2003 and 2020. Immediate treatment responses across different language domains were assessed with the Aachen Aphasia Test (AAT) using single-case psychometrics, conducted before and after 6-7 weeks of intensive SLT (10 h per week, median (IQR) dosage = 68 (61-76)). We adjusted for spontaneous recovery in subacute patients. Differential treatment effects between subgroups of chronicity and predictors of therapy response were investigated.
A total of 448 PWA were included (29% female, median (IQR) age = 54 (46-62) years, median (IQR) time post-onset = 11 (6-20) months) with 12% in the early subacute, 15% in the late subacute and 74% in the chronic phase of aphasia. The immediate responder rate was 59%. Significant improvements in all AAT subtests und subscales were observed hinting at broad effectiveness across language domains. The degree of therapy-induced improvement did not differ between the chronicity groups. Time post-onset, dosage of therapy and aphasia severity at the beginning of treatment were predictors of immediate treatment response.
Intensive therapy protocols for aphasia after stroke are yielding substantial responder rates in a routine clinical setting including a wide range of patients.
失语症是中风后的一种毁灭性后果，每年影响数以百万计的患者。研究表明，强化言语和语言治疗（SLT）对失语症的慢性期有效。利用包括亚急性期患者在内的大型单中心失语症患者队列，我们在真实环境中评估了强化失语症治疗的治疗效果。
数据收集于德国亚琛失语症病房，时间为 2003 年至 2020 年。使用单病例心理测量学，通过 Aachen Aphasia Test（AAT）评估不同语言领域的即时治疗反应，在 6-7 周的强化 SLT（每周 10 小时，中位数（IQR）剂量=68（61-76））前后进行。我们对亚急性期患者的自发恢复进行了调整。研究了慢性和治疗反应预测因素之间的亚组差异治疗效果。
共纳入 448 例失语症患者（29%为女性，中位（IQR）年龄=54（46-62）岁，中位（IQR）发病后时间=11（6-20）个月），其中 12%为早期亚急性期，15%为晚期亚急性期，74%为慢性失语症期。即时反应率为 59%。所有 AAT 子测试和子量表均观察到显著改善，暗示了跨语言领域的广泛有效性。治疗引起的改善程度在慢性组之间没有差异。发病后时间、治疗剂量和治疗开始时的失语症严重程度是即时治疗反应的预测因素。
在常规临床环境中，包括广泛的患者群体，强化言语和语言治疗方案对中风后失语症的治疗效果显著。
