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Journal of Speech, Language, and Hearing Research Vol.51 1282-1299 October 2008. doi:10.1044/1092-4388(2008/07-0206)
© American Speech-Language-Hearing Association
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Evidence-Based Systematic Review: Effects of Intensity of Treatment and Constraint-Induced Language Therapy for Individuals With Stroke-Induced Aphasia

Leora R. Cherney
Rehabilitation Institute of Chicago, IL

Janet P. Patterson
California State University, East Bay, Hayward, CA

Anastasia Raymer
Old Dominion University, Norfolk, VA

Tobi Frymark
Tracy Schooling
American Speech-Language-Hearing Association, Rockville, MD

Contact author: Tobi Frymark, National Center for Evidence-Based Practice in Communication Disorders, American Speech-Language-Hearing Association, 2200 Research Boulevard, Rockville, MD 20850. E-mail: tfrymark{at}asha.org.

Purpose: This systematic review summarizes evidence for intensity of treatment and constraint-induced language therapy (CILT) on measures of language impairment and communication activity/participation in individuals with stroke-induced aphasia.

Method: A systematic search of the aphasia literature using 15 electronic databases (e.g., PubMed, CINAHL) identified 10 studies meeting inclusion/exclusion criteria. A review panel evaluated studies for methodological quality. Studies were characterized by research stage (i.e., discovery, efficacy, effectiveness, cost–benefit/public policy research), and effect sizes (ESs) were calculated wherever possible.

Results: In chronic aphasia, studies provided modest evidence for more intensive treatment and the positive effects of CILT. In acute aphasia, 1 study evaluated high-intensity treatment positively; no studies examined CILT. Four studies reported discovery research, with quality scores ranging from 3 to 6 of 8 possible markers. Five treatment efficacy studies had quality scores ranging from 5 to 7 of 9 possible markers. One study of treatment effectiveness received a score of 4 of 8 possible markers.

Conclusion: Although modest evidence exists for more intensive treatment and CILT for individuals with stroke-induced aphasia, the results of this review should be considered preliminary and, when making treatment decisions, should be used in conjunction with clinical expertise and the client's individual values.

KEY WORDS: aphasia, intensity, constraint, rehabilitation


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