The National Center for Evidence-Based Practice
in Communication Disorders
Home      Aphasia-Treatment-Constraint-Induced-Language-Therapy

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)
 
 
 
 
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)
 
 
 
 
 
Evidence-Based Systematic Reviews
Therapeutic Interventions for Aphasia Initiated More Than Six Months Post Stroke: A Review of the Evidence
Allen, L., Mehta, S., et al. (2012).
Topics in Stroke Rehabilitation, 19(6), 523-535.

This review meets the criteria for a high-quality evidence-based systematic review.
Added: May 2013

Description
This is a review of randomized controlled trials examining the efficacy of aphasia treatments provided to individuals with 6 months post onset of stroke-induced aphasia.

Conclusions

  • Evidence was found in support of a number of treatments for individuals with chronic aphasia. These included:

    • computer-based aphasia treatments

    • constraint-induced language aphasia therapy

    • delivery of intensive aphasia therapy

    • conversation partner training

  • Given the heterogeneity of patients included and wide range of interventions included, further research is warranted.

» See full summary and quality ratings



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). 
 
 
 
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
 
 
 
 
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.  
 
 
 
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
 
 
 

Clinical Expertise/Expert Opinion

 
Consensus Guidelines  
No consensus guidelines were found. 
 
 
 
 

Client/Patient/Caregiver Perspectives

 
Constraint Induced Language Therapy in Early Aphasia Rehabilitation

Kirmess, M., & Maher, L. M. (2010).
Aphasiology, 24(6-8), 725-736
.
Added: May 2012
 
Description
This is a pre/post study of three individuals with acute stroke-induced aphasia examining the impact of constraint-induced language treatment (CILT) on expressive language outcomes. Patient satisfaction outcomes were also reported
 
Conclusions
  • "Qualitative evaluation of participation in CILT using the self-report questionnaire revealed mostly positive experiences" (p 731).
  • Mixed findings were reported regarding intensity of treatment; two participants preferred a less intensive intervention and one preferred a more intensive treatment
 
 

 
Use the image below to navigate to other sections of the Aphasia evidence map.