The effectiveness of early deployed cognitive-linguistic and communicative treatment for aphasia after a stroke: A randomized controlled trial (RATS-2)

Background: The two main approaches in aphasia treatment are cognitive-linguistic treatment (CLT), aimed at restoring the linguistic levels affected - semantics, phonology or syntax - and communicative treatment, aimed at optimizing information transfer by training compensatory strategies and use of residual language skills. We tested the hypothesis that CLT is more effective than communicative treatment in the early stages after stroke. Methods: In this multi-center, randomized, parallel group trial with blinded outcome assessment, 80 patients with aphasia after stroke were included within three weeks post onset. Patients received six months of aphasia therapy for at least two hours per week, either CLT, comprising semantic and/or phonological training, or communicative treatment. They were assessed before treatment and at three and sixmonths with the Amsterdam-Nijmegen Everyday Language Test (ANELT-A, primary outcome) and semantic and phonological tests (secondary outcomes). The intervention effect was evaluated by means of analysis of covariance, with adjustment for baseline scores. Results: There was no difference between the mean ANTELT-A score of the CLT group (n=38) and the communicative treatment group (n=42), neither at three months post onset (adjusted difference: 1.5, 95% confidence interval: -2.6 to 5.6) nor at six months (adjusted difference: 1.6, 95% confidence interval: -2.3 to 5.6). On two of six specific semantic and phonological tests the mean scores differed significantly, both in favor of CLT. Conclusion: This study does not confirm our hypothesis that patients with aphasia after stroke benefitmore from CLT, aimed at activation of the underlying semantic and phonological processes, than fromamore general communicative treatment.