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CATIn patients with aphasia post
stroke, does constraint induced aphasia therapy assist language
production?
NSW Adult Communication and Dysphagia Group
CIAT Application in Speech Pathology;
Intensity: 30hr over 2weeks Shaping; language tasks of increasing
complexity embedded in communicative language games within a group setting (max 2-3 people)
Constraint: constraint of non-verbal or compensatory strategies.
(Taub, et al 2002 cited in Meinzer et al 2006)
CATSearch produced two articles for appraisal.
CAP#1:Pulvermueller et al (2001) Constraint induced therapy of chronic aphasia after stroke. Stroke. 32: 1621-1626
CAP#2: Meinzer et al(2005). Long term stability of improved language functions in chronic aphasia after constrain induced aphasia therapy. Stroke. 37(6):1464 –1466.
CAPS
CAP#1 CAP#2Design Randomised Control
TrialBasic pre and post test design
Participants 17 participants. L MCA CVA and diagnosed aphasia
27 patients with chronic aphasia –classified as either mild, mod or severe.
Experimental Gp
10 participants received CIAT.
2 diff exp gps:CIAT CIATplus: essentially in addition included family training and tasks for completion
Control Gp 7 participants received “conventional therapy”
Nil
Results The Exp. Gp showed sig. Improvement The Control Gp did not show sig. Improvement.
Both gps showed improvement.The CIATplus gp showed sig. improvement and showed greater improvements in everyday communication
CAP Cont’d
CAP #1 CAP#2
Strengths Authors acknowledged limitations of studyRCT and attempted blind evaluation of assessment.Weakness: No family involvement. No info on “conventional therapy”No info on sustained gains
Addressed limitations of CAP#1.Included familiesDid not distinguish the length post strokeWeakness:Non randomisation or controlPoor description of therapy so which aspects of CIAT beneficial? No within gp comparisons i.e. classified as mild,mod, severe.
Level of Evidence
Level 2 Level 3(111)
Clinical Bottom LineCAP#1 & #2
Massed-practice CIAT performed intensely over a short period of time with chronic aphasics resulted in improved language performance.
It is difficult to determine whether CIAT was more effective than other conventional therapies.
Conventional Therapies Chronic aphasics usually receive the option of
gp or individual therapy. Individual therapy 1hr/wk Offered in blocks –particularly if students
placements available and if caseload permitting.
Goal oriented therapy Gp therapy: 2hr a week/fortnight for a period
of 10-12 weeks. Total communication approach.
Transport and staffing
Conventional Therapy Therapies used in individual and gp
sessions include: Strategies Impairment Family Education Functional Therapy
Is CIAT an alternative model to service delivery
for aphasia?
Participants
Recruit 30 participants Confirmed diagnosis of stroke and
aphasia Have functional comprehension at a
single sentence level 12 mth post onset Outpatients
Methodology Blinding assessors Concealed and quasi-randomised Control gp 2 participants in the control or both
treatment gps Therapy conducted 2hr/day for 2
weeks with carer education
Treatment Gp 1- CIAT Therapy tasks could include go-fish
game, other barrier task games plus general conversation on current affairs topics.
Treatment Gp 2 – Functional Therapy
Social communication tasks Total communication approach
utilised Education to carers provided
Control
Wait list gp Treatment not withheld
How? Big exercise At a smaller level
Utilise clients as their own control while they are on the waiting list
Compare CIAT with current functional therapy approach that focuses on total communication
Increase intensity at sub acute level of rehab (inpatients)