Communication makes intensive language therapy more efficient: a randomized controlled trial in chronic post-stroke aphasia.

Speech-language therapy is effective in chronic post-stroke aphasia if it is delivered in an intensive fashion. The study investigated whether intensive communicative therapy by practicing everyday language use (e.g. requesting objects and proposing actions) leads to better outcomes than equally intensive conventional treatment (e.g. picture naming). A randomized controlled trial compared intensive conventional speech-language therapy to a social-communicative treatment, called Intensive Language Action Therapy, a further development of Constraint-Induced Aphasia Therapy. Forty-four chronic post-stroke aphasia patients randomized to one of these treatments received 2 weeks, 5 days/week, for 2.5 h/day of therapy. Primary outcome measure was an established clinical language battery. To address any changes in mood, patients' depressive symptoms were assessed using Beck's Depression Inventory. A significant interaction [F(1,42) = 7.42; P = 0.009] revealed stronger language improvements across Intensive Language Action Therapy as compared to conventional therapy [t(22) = 3.93, P < 0.001 versus t(20) < 1.5, non-significant]. Likewise, depression scores after Intensive Language Action Therapy were significantly reduced. These results show that different types of intensive speech-language therapy can improve language skills of chronic post-stroke aphasia patients to different degrees. Intensive Language Action Therapy led to significantly stronger improvements on a clinical language test battery than equally intensive conventional therapy. Furthermore, our data suggest that patients' symptoms of depression improved to different degrees depending on the type of therapy delivered.