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.

Keywords: Aphasia - rehabilitation, Chronic Disease, Communication, Language Therapy - methods, Neuropsychological Tests, Pilot Projects, Research Design, Single-Blind Method, Stroke - rehabilitation, Time Factors