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Aphasia therapy early after stroke: behavioural and neurophysiological changes in the acute and post-acute phases

Annelies Aerts, Katja Batens, Patrick Santens UGent, Pieter van Mierlo UGent, Robert Hartsuiker UGent, Dimitri Hemelsoet, Wouter Duyck UGent, Dirk Van Roost UGent and Miet De Letter UGent (2015) APHASIOLOGY. 29(7). p.845-871
abstract
Background: There is reasonable evidence to suggest that speech and language therapy can be effective in the chronic stages of stroke recovery. However, the active ingredients remain unknown and several variables can influence therapy outcome, such as content, type, and amount of therapy. Neurophysiological measures, event-related brain potentials such as the N400 and P300, have shown to be sensitive markers of therapeutic effects. As a supplement to the usual behavioural evaluation methods, neurophysiological measures might help to further disentangle the effect of content, type, and/or amount of therapy. Aims: The present single case study aims to investigate the effect of language therapy by combining behavioural and neurophysiological outcome measures in a patient with aphasia during the acute and post-acute stage after stroke. By further subdividing the therapy period into different therapy blocks, possible influences of content, type, and/or amount of therapy are investigated. Methods & Procedures: RL is a 47-year-old man with a moderate non-fluent aphasia, who received three periods of therapy in the first fourmonths after his stroke. The initial evaluation moment occurred 10days post-stroke. First, he received an intensive language treatment of 30hr in 3weeks, which was followed by a conventional treatment of 30hr in 7weeks. Then, RL received a second, intensive language therapy of 30hr in 3weeks. This was followed by a period of 6months without any form of language treatment. Behavioural and neurophysiological measures were collected after every therapy and therapy-free period. The effect of therapy was examined by comparing the whole therapy period with the therapy-free period, without differentiating between the intensive and conventional treatment. In a second analysis, a comparison was made between the intensive therapy periods and the conventional therapy programme. Outcomes & Results: RL showed a general improvement on both behavioural and neurophysiological measures after the whole therapy period, which was preserved throughout the therapy-free period. Intensive treatment yielded better language outcomes as indicated by a behavioural and neurophysiological improvement in contrast with the behavioural deterioration of auditory discrimination of pseudowords and decline of the N400 neurophysiological marker, after the conventional therapy. Conclusions: The present study demonstrates the outcome of early language treatment after stroke in which intensity can play an important role. In addition, the use of neurophysiological outcome measures provides added value to the behavioural evaluations in the context of therapeutic follow-up.
Please use this url to cite or link to this publication:
author
organization
year
type
journalArticle (original)
publication status
published
subject
keyword
case study, neurophysiology, acute stroke, Intensity, aphasia therapy, RANDOMIZED CONTROLLED-TRIAL, EVENT-RELATED POTENTIALS, INDUCED LANGUAGE THERAPY, NONFLUENT APHASIA, ISCHEMIC-STROKE, SINGLE-SUBJECT, BRAIN-DAMAGE, RECOVERY, REHABILITATION, OUTCOMES
journal title
APHASIOLOGY
Aphasiology
volume
29
issue
7
pages
845 - 871
Web of Science type
Article
Web of Science id
000353117000005
JCR category
CLINICAL NEUROLOGY
JCR impact factor
1.139 (2015)
JCR rank
163/192 (2015)
JCR quartile
4 (2015)
ISSN
0268-7038
DOI
10.1080/02687038.2014.996520
project
The integrative neuroscience of behavioral control (Neuroscience)
language
English
UGent publication?
yes
classification
A1
copyright statement
I have transferred the copyright for this publication to the publisher
id
4192359
handle
http://hdl.handle.net/1854/LU-4192359
date created
2013-11-28 14:15:18
date last changed
2016-12-19 15:43:18
@article{4192359,
  abstract     = {Background: There is reasonable evidence to suggest that speech and language therapy can be effective in the chronic stages of stroke recovery. However, the active ingredients remain unknown and several variables can influence therapy outcome, such as content, type, and amount of therapy. Neurophysiological measures, event-related brain potentials such as the N400 and P300, have shown to be sensitive markers of therapeutic effects. As a supplement to the usual behavioural evaluation methods, neurophysiological measures might help to further disentangle the effect of content, type, and/or amount of therapy. 
Aims: The present single case study aims to investigate the effect of language therapy by combining behavioural and neurophysiological outcome measures in a patient with aphasia during the acute and post-acute stage after stroke. By further subdividing the therapy period into different therapy blocks, possible influences of content, type, and/or amount of therapy are investigated. 
Methods \& Procedures: RL is a 47-year-old man with a moderate non-fluent aphasia, who received three periods of therapy in the first fourmonths after his stroke. The initial evaluation moment occurred 10days post-stroke. First, he received an intensive language treatment of 30hr in 3weeks, which was followed by a conventional treatment of 30hr in 7weeks. Then, RL received a second, intensive language therapy of 30hr in 3weeks. This was followed by a period of 6months without any form of language treatment. Behavioural and neurophysiological measures were collected after every therapy and therapy-free period. The effect of therapy was examined by comparing the whole therapy period with the therapy-free period, without differentiating between the intensive and conventional treatment. In a second analysis, a comparison was made between the intensive therapy periods and the conventional therapy programme. 
Outcomes \& Results: RL showed a general improvement on both behavioural and neurophysiological measures after the whole therapy period, which was preserved throughout the therapy-free period. Intensive treatment yielded better language outcomes as indicated by a behavioural and neurophysiological improvement in contrast with the behavioural deterioration of auditory discrimination of pseudowords and decline of the N400 neurophysiological marker, after the conventional therapy. 
Conclusions: The present study demonstrates the outcome of early language treatment after stroke in which intensity can play an important role. In addition, the use of neurophysiological outcome measures provides added value to the behavioural evaluations in the context of therapeutic follow-up.},
  author       = {Aerts, Annelies and Batens, Katja and Santens, Patrick and van Mierlo, Pieter and Hartsuiker, Robert and Hemelsoet, Dimitri and Duyck, Wouter and Van Roost, Dirk and De Letter, Miet},
  issn         = {0268-7038},
  journal      = {APHASIOLOGY},
  keyword      = {case study,neurophysiology,acute stroke,Intensity,aphasia therapy,RANDOMIZED CONTROLLED-TRIAL,EVENT-RELATED POTENTIALS,INDUCED LANGUAGE THERAPY,NONFLUENT APHASIA,ISCHEMIC-STROKE,SINGLE-SUBJECT,BRAIN-DAMAGE,RECOVERY,REHABILITATION,OUTCOMES},
  language     = {eng},
  number       = {7},
  pages        = {845--871},
  title        = {Aphasia therapy early after stroke: behavioural and neurophysiological changes in the acute and post-acute phases},
  url          = {http://dx.doi.org/10.1080/02687038.2014.996520},
  volume       = {29},
  year         = {2015},
}

Chicago
Aerts, Annelies, KATJA BATENS, Patrick Santens, Pieter van Mierlo, Robert Hartsuiker, DIMITRI HEMELSOET, Wouter Duyck, Dirk Van Roost, and Miet De Letter. 2015. “Aphasia Therapy Early After Stroke: Behavioural and Neurophysiological Changes in the Acute and Post-acute Phases.” Aphasiology 29 (7): 845–871.
APA
Aerts, Annelies, BATENS, K., Santens, P., van Mierlo, P., Hartsuiker, R., HEMELSOET, D., Duyck, W., et al. (2015). Aphasia therapy early after stroke: behavioural and neurophysiological changes in the acute and post-acute phases. APHASIOLOGY, 29(7), 845–871.
Vancouver
1.
Aerts A, BATENS K, Santens P, van Mierlo P, Hartsuiker R, HEMELSOET D, et al. Aphasia therapy early after stroke: behavioural and neurophysiological changes in the acute and post-acute phases. APHASIOLOGY. 2015;29(7):845–71.
MLA
Aerts, Annelies, KATJA BATENS, Patrick Santens, et al. “Aphasia Therapy Early After Stroke: Behavioural and Neurophysiological Changes in the Acute and Post-acute Phases.” APHASIOLOGY 29.7 (2015): 845–871. Print.