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Summary of Systematic Review

Speech and Language Therapy for Aphasia Following Stroke
Brady, M. C., Kelly, H., et al. (2012).
Cochrane Database of Systematic Reviews, 5, CD000425.

This review meets the criteria for a high-quality evidence-based systematic review.

Indicators of Review Quality:

The review states a clearly focused question or aim Yes
Criteria for inclusion of studies are provided Yes
Search strategy is described in sufficient detail for replication Yes
Included studies are assessed for study quality Yes
Quality assessments are reproducible Yes
Characteristics of the included studies are provided Yes

Description:
This is an update of an original systematic review by Greener et al. (1999) and subsequent review by Kelly et al. (2010) investigating the effects of speech language therapy intervention in adults with stroke-induced aphasia.

Question(s)/Aim(s) Addressed:

  1. Is speech and language treatment more effective than no speech and language treatment?

  2. Is speech and language treatment more effective than social support and stimulation?

  3. Is one speech and language treatment more effective than another speech and language treatment?

Population:
Adults with aphasia as a result of stroke.

Intervention/Assessment:
Speech language therapy (SLT) designed to impact communication.

Number of Studies Included:
39 studies; including nine additional trials since 2010 review.

Years Included:
Up to July 2011

Conclusions:

Aphasia Map

  • Treatment

    • General Findings

      • The authors found some evidence for the effectiveness of speech and language treatment to improve functional communication, as well as receptive and expressive language skills in individuals with stroke-induced aphasia. General findings are as follows:

        • Nineteen studies comparing a variety of speech and language therapy [SLT] treatments (e.g., conventional SLT, computer-based treatment) to no treatment were found. The majority of included trials favored the provision of speech and language intervention over no treatment with significant differences reported in measures of functional communication as well as receptive and expressive language skills.

        • Limited evidence from seven studies suggests that individuals with aphasia may benefit from stimulation or social support to improve receptive and expressive language skills. However, the authors indicated that most of the data came from one small trial limiting the utility of the findings. Further research is warranted.

        • While 25 trials were found comparing two different types of speech and language intervention, the small number of participants and variety of treatments included, makes it difficult to draw any firm conclusions regarding the effectiveness of one treatment over another. Further research is needed.

  • Service Delivery

    • Dosage

      • Six trials investigated intensive versus conventional speech and language treatment. Preliminary results from one trail favored intensive treatment over conventional treatment to improve functional communication and writing skills.

      • No evidence of difference was found in receptive language skills.

    • Format

      • At the time of the review, insufficient evidence exists regarding the effects of group versus one-on-one treatment. No differences were found in measures of expressive and receptive language skills in three studies comparing group and individual speech and language treatment. 

      • Additionally, little evidence of any difference was found between computer-facilitated speech and language treatment versus one-on-one speech and language treatment.

    • Provider

      • No evidence of a difference was found in functional communication or receptive and expressive language skills with intervention provided by a speech-language pathologist versus intervention facilitated by a volunteer. 

      • The authors reported the findings to be "unsurprising as the volunteers providing the SLT [speech and language therapy] interventions were trained...given access to the relevant therapy materials and the plan for therapeutic interventions was developed by (or under the direction of) the professional therapist" (p. 35).

Sponsoring Body:
The Cochrane Collaboration; Nursing, Midwifery and Alllied Health Professions Research Unit (UK); Queen Margaret University, Edinburgh (UK); Chief Scientist Office Scotland (UK)

Keywords:
Aphasia, Stroke

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