This is a plain English summary of an original research article. The views expressed are those of the author(s) and reviewer(s) at the time of publication.
Speech and language therapy helps people with language problems (aphasia) after a stroke. A large international analysis showed that this therapy is most effective when it is delivered early (within 28 days of the start of aphasia), frequently and in high doses. The greatest improvements in recovery were seen when people practiced tasks at home.
Aphasia is commonly caused by a stroke and can result in difficulty speaking, understanding speech, reading or writing. To date, there has been a lack of evidence about the how much therapy people with aphasia after a stroke need to support their recovery.
Researchers analysed 174 studies of speech and language therapy for aphasia after stroke. They found that the best recovery was linked to 20 – 50 hours in total of speech and language therapy. The best improvements in general language were linked to 2 – 4 hours of therapy, given over 4 to 5 days per week.
Optimal recovery for younger adults, men and people with milder aphasia was linked to more speech and language therapy. People under 55 years were likely to improve the most. However, the research showed that older people (75+ years) still improved with therapy.
The timing of therapy was important. Starting therapy within a month of experiencing aphasia was linked to the greatest improvements. People who had had aphasia for more than 3 months needed more therapy. However, people whose stroke occurred more than 6 months earlier could still improve with therapy.
Therapy could be effectively delivered in-person or via video. Family members who had received training from a speech and language therapist could support the delivery of a therapy programme to their loved one.
These findings have informed national and international guidelines. They are relevant to professionals who design and deliver programmes of speech and language therapy. People with aphasia after a stroke, and their carers, will also be interested.
For more information about aphasia, visit the NHS website.
What’s the issue?
More than 3.5 million people around the world have a stroke that affects their speech and understanding of speech, reading and writing (aphasia). Stroke patients with aphasia can struggle more with daily activities, and have poorer recovery and wellbeing than those who did not develop aphasia. Speech and language therapy improves people’s recovery, but therapists lack information on how to optimise the delivery of therapy for each individual.
This review brought together data from previous studies. Researchers assessed the impact of various types of treatment, delivered with greater or less intensity, and over different lengths of time.
What’s new?
The review included 174 studies from 28 countries (including 47 randomised controlled trials). Together, these studies included individual information on almost 6000 people.
Overall, the review concluded that for people with aphasia after stroke, their best recovery is associated with:
- therapy started within 28 days of the onset of aphasia
- 20 – 50 hours of speech and language therapy in total
- 2 – 4 hours of therapy a week, delivered over 4 – 5 days, for general language improvement
- tasks that are practiced at home.
Starting therapy early was important. People who had had aphasia for more than 3 months needed extra therapy to make their best recovery. However, those who had a stroke more than 6 months previously could still improve with therapy.
Younger adults (under 55) were likely to improve the most, though people over 75 still made gains with therapy. Men and people with milder aphasia were likely to need more therapy than others, the study found.
The intensity of therapy necessary varied according to the problem being addressed. The greatest improvements in overall language abilities and functional communication (the ability to communicate in real settings) were associated with 2 – 4 hours of therapy per week. But improvements in understanding speech were only evident when there were 9+ hours of therapy per week.
Neither the delivery method (in-person versus video, for example), nor who (professional therapist versus a family member who had received training from a professional therapist) delivered the speech and language therapy programme, made a meaningful difference.
Why is this important?
Overall, the greatest gains were linked to therapy that was delivered early (within 28 days of the start of aphasia), frequently and in high doses. Home practice and therapy tailored to the individual’s needs (and the level of their language difficulty) was linked with the greatest improvements.
Some of the studies in the review were small. The researchers noted variation in how data was collected and reported, including information about the people who took part, their aphasia (such as reading and writing problems) and the therapy delivered. Some of the findings therefore need to be interpreted with caution. Further research could explore groups of people unrepresented in the data, examine in more detail the link between dose of therapy and recovery, and develop more tailored speech and language therapies.
What’s next?
The findings have been included in the UK and Ireland National Clinical Guideline for Stroke and in Australian and New Zealand Clinical Guidelines. They are being considered by the National Institute for Health and Care Excellence (NICE) for its forthcoming update to guidelines on stroke rehabilitation in adults, and by the European Stroke Organisation Guidelines on Aphasia Rehabilitation after Stroke.
You may be interested to read
This Alert is based on: Brady MC, and others. Complex speech-language therapy interventions for stroke-related aphasia: the RELEASE study incorporating a systematic review and individual participant data network meta-analysis. Health and Social Care Delivery Research 2022; 10 (28).
Information about aphasia after stroke from the Stroke Association.
Conflict of interest: One of the authors has received fees from pharmaceutical companies outside of this research. Full disclosures can be found in the original research paper.
Funding: This research was funded by the NIHR Health and Social Care Delivery Research programme and the Tavistock Trust for Aphasia, UK.
Disclaimer: NIHR Alerts are not a substitute for professional medical advice. They provide information about research which is funded or supported by the NIHR. Please note that views expressed in NIHR Alerts are those of the author(s) and reviewer(s) at the time of publication. They do not necessarily reflect the views of the NHS, the NIHR or the Department of Health and Social Care.
