Aphasia
Treatment

Constraint-Induced Language Therapy (CILT)

External Scientific Evidence

Evidence-Based Practice Guidelines

Australian Government Department of Health and Ageing   Clinical Guidelines for Acute Stroke Management 2010 National Stroke Foundation (2010). Melbourne (Australia): National Stroke Foundation, 167 pages.  Added: May 2012

 

Description

This guideline provides recommendations for the assessment and management of stroke and transient ischemic attack (TIA) in adults. These guidelines are primarily intended to assist health care workers in improving quality and effectiveness of service. Of particular interest to speech-language pathologists is chapter six which focuses on rehabilitation management for aphasia, dysphagia, dysarthria, apraxia and cognitive-communication deficits. Recommendations are graded A, B, C, D or "Good Practice Point" based on the following criteria:  

• Grade A: Evidence can be trusted to guide practice.
• Grade B: Evidence can be used to guide practice in most situations.
• Grade C: Evidence provides some support, but care should be taken in application.
• Grade D: Evidence is weak and should be applied cautiously.
• Good Practice Point: Evidence based on clinical experience and expert opinion.  

Recommendations

The use of constraint-induced language therapy is recommended for individuals with aphasia (Grade B Evidence). 

 

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New Zealand Ministry of Health   New Zealand Clinical Guidelines for Stroke Management 2010 Stroke Foundation of New Zealand and New Zealand Guidelines Group (2010). Wellington (New Zealand): Stroke Foundation of New Zealand, 347 pages.  Added: May 2012

 

Description

This guideline provides recommendations for the management of individuals recovering from stroke and transient ischemic attacks. The target audience of the guideline is all healthcare professionals providing services to persons with stroke and their family in the New Zealand context. Of particular interest to speech-language pathologists are the sections discussing communication (aphasia, apraxia, dysarthria), cognition and swallowing disorders. Levels of evidence recommendations are graded as A, B, C, D or "Good Practice Points" and defined as follows:

• Level A: Body of evidence can be trusted to guide practice.
• Level B: Body of evidence can be trusted to guide practice in most situations.
• Level C: Body of evidence provides some support for recommendation(s) but care should be taken in its application.
• Level D: Body of evidence is weak and recommendation must be applied with caution.
• Good Practice Point: Recommended best practice based on clinical experience and expert opinion.  

Recommendations

The use of constraint-induced language therapy is recommended for individuals with aphasia (Level B Evidence). 

 

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Evidence-Based Systematic Reviews

Evidence-Based Review of Stroke Rehabilitation Teasell, R. W., Foley, N. C., et al. (2011). Retrieved from http://www.ebrsr.com.   This review meets the criteria for a high-quality evidence-based systematic review. Added: October 2012

 

Description

This is an update of the Teasell et al. (2009) evidence-based review investigating the effectiveness of pharmacological and non-pharmacological interventions for stroke rehabilitation. Of particular interest to speech-language pathologists are the modules specific to aphasia, dysphagia, perceptual disorders and cognitive disorders. The levels of evidence used to summarize the review findings are based on the United States Agency for Health Care Policy and Research (AHCPR) criteria:  

• Level 1a: Strong evidence supported by a meta-analysis or two or more randomized controlled trials (RCTs) with at least “fair” quality.
• Level 1b: Moderate evidence supported by at least one RCT of “fair” quality.
• Level 2: Limited evidence supported by at least one controlled trial with a minimum of 10 participants in each arm of the study.
• Level 3: Findings supported by expert consensus opinion in the absence of evidence.
• Level 4: Conflicting evidence based on disagreement between the findings of at least two RCTs. Where there are more than four RTCs, conclusions are based on the results of the majority of studies, unless conflicting results are reported in a higher quality study.

Conclusions

• Moderate evidence (Level 1b) suggests that contraint-induced language therapy (CILT) is beneficial for treating individuals with chronic aphasia and results in improved functional communication over a short period of time.
• Limited evidence (Level 2) suggests that "improvements in language function are similar following CIAT [constraint-induced aphasia therapy], CIATplus and PACE therapies" (Module 14; p. 40). 

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Rehabilitation of Aphasia: More Is Better Bhogal, S. K., Teasell, R. W., et al. (2003). Topics in Stroke Rehabilitation, 10(2), 66-76. Added: May 2012

 

Description

This is a review of studies investigating the effects of aphasia speech and language therapy on individuals post-stroke. 

 

Conclusions

Moderate evidence suggests that forced-use aphasia treatment is beneficial for improving speech and language outcomes in individuals with chronic aphasia. 

 

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Updated Evidence-Based Systematic Review: Effects of Intensity of Treatment and Constraint-Induced Language Therapy for Individuals with Stroke-Induced Aphasia Cherney, L. R., Patterson, J. P., et al. (2010). Rockville (MD): American Speech-Language-Hearing Association, 36 pages.   This review meets the criteria for a high-quality evidence-based systematic review.   Added: May 2012

 

Description

This is an update of the Cherney et al. 2008 review of peer-reviewed studies investigating the effects of constraint-induced language therapy (CILT) and intensity of treatment for individuals with stroke-induced aphasia. 

 

Conclusions

• This updated review identified 13 new studies pertaining to CILT, all contributing data to examine the effects of CILT on measures of language impairment. Six studies also examined the effects of CILT on measures of communication activity/participation and four examined treatment maintenance effects.
• Findings from two efficacy studies favored CILT on various measures of language impairment and communication activity/participation, while findings from exploratory studies were mixed. The conclusions from the updated review remains unchanged.
• Modest evidence supports the use of CILT for adults with stroke-induced aphasia. However given the small number of studies, range of methodological quality and range of participant characteristics and outcomes, these results are considered preliminary.  

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A Review of Constraint-Induced Therapy Applied to Aphasia Rehabilitation in Stroke Patients Balardin, J. B., & Miotto, E. C. (2009). Dementia & Neuropsychologia, 3(4), 275-282. Added: May 2012

 

Description

This is a review of research articles investigating constraint-induced language therapy (CILT) in individuals with stroke-induced aphasia. 

 

Conclusions

Preliminary results suggest that CILT improves language performance in individuals with aphasia. Based on the limited number of studies, further research is needed to investigate whether CILT offers greater communication outcomes compared to conventional aphasia treatment. 

 

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