Severity of aphasia and recovery after treatment in patients with stroke

Background: Aphasia due to stroke is often very severe immediately after onset. However, knowledge about the impact of severity on therapeutic potential in the first months is scarce. The optimal therapeutic approach for patients with severe aphasia is still subject to debate.Aims: To explore the recovery pattern of verbal communication in stroke patients with aphasia of varying degrees of severity receiving language therapy during the first 6 months poststroke.Methods & Procedures: We used data from our previous trial in which 80 patients with aphasia due to stroke were randomised within the first 3 weeks postonset for either cognitive-linguistic therapy (CLT) or communicative therapy. All patients were tested at baseline and at 3 and 6 months postaphasia onset. We formed three severity groups, based on baseline Amsterdam-Nijmegen Everyday Language Test scores. We used repeated measures ANOVA to compare test scores at baseline and at 3 and 6 months poststroke onset for each of the three severity groups, stratified for the two treatments.Outcomes & Results: Patients with severe or very severe aphasia improved substantially during follow-up, especially during the first 3 months poststroke. Improvement was less pronounced in the moderate to mild group. Although improvement did not differ significantly between the two treatment arms of the trial during the first 6 months poststroke, the very severe group seemed to benefit particularly from CLT (mean difference between treatments was 4.1 points; 95% CI: -4.0 to 12.2).Conclusions: Even in very severely aphasic patients, considerable improvement of functional communication is possible. These patients might benefit more from early initiated CLT therapy than generally assumed. Hence, speech and language therapists should not refrain from applying CLT in the acute phase of rehabilitation of severe aphasia.

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