The clinical management and rehabilitation of post stroke aphasia in Italy: evidences from the literature and clinical experience

Abstract

Aphasia is one of the most devastating symptoms in stroke survivors and severely affects patients’ communication, quality of life, and social interactions. Several factors are critical to the prediction of aphasia recovery, including acute stroke management and subsequent language rehabilitation. A comprehensive assessment of language skills with appropriate instruments in different phases of post stroke months and years is needed in patients, in order to monitor their language improvement and to guide speech therapies over time. Beyond spontaneous recovery, the effects of speech and language therapy in terms of time and dosage of administration during the course of post stroke aphasia are still under investigation. Data point to its efficacy either in the early or in the chronic (> 6 months) post stroke phase, with greater effects if intensive treatments are provided. Tailored interventions for single patients’ aphasia characteristics are recommended, with different levels of evidence for specific techniques. Ongoing trials and meta-analyses will be useful in order to change the allocation of rehabilitation resources for patients with aphasia.

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References

  1. 1.

    Basso A, Lecours AR, Moraschini S, Vanier M (1985) Anatomoclinical correlations of the aphasias as defined through computerized tomography: exceptions. Brain Lang 26(2):201–229

    Article  CAS  PubMed  Google Scholar 

  2. 2.

    Code C (2001) Multifactorial processes in recovery from aphasia: developing the foundations for a multileveled framework. Brain Lang 77:25–44

    Article  CAS  PubMed  Google Scholar 

  3. 3.

    Henseler I, Regenbrecht F, Obrig H (2014) Lesion correlates of patholinguistic profiles in chronic aphasia: comparisons of syndrome-, modality- and symptom-level assessment. Brain. 137(Pt 3):918–930. https://doi.org/10.1093/brain/awt374

    Article  PubMed  Google Scholar 

  4. 4.

    Beyot Y, Bailly H, Durier J, Giroud M (2016) Epidemiology of stroke in Europe and trends for the 21st century. Presse Med 45(12 Pt 2):e391–e398. https://doi.org/10.1016/j.lpm.2016.10.003

    Article  Google Scholar 

  5. 5.

    The Italian Longitudinal Study on Aging Working Group (1997) Prevalence of chronic diseases in older Italians: comparing self-reported and clinical diagnoses. Int J Epidemiol 26:995–1002

    Article  Google Scholar 

  6. 6.

    Feigin VL, Lawes CM, Bennett DA, Barker-Collo SL, Parag V (2009) Worldwide stroke incidence and early case fatality reported in 56 population based studies: a systematic review. Lancet Neurol 8:355–369

    Article  PubMed  Google Scholar 

  7. 7.

    Sacco S, Stracci F, Cerone D, Ricci S, Carolei A (2011) Epidemiology of stroke in Italy. Int J Stroke 6(3):219–227. https://doi.org/10.1111/j.1747-4949.2011.00594

    Article  PubMed  Google Scholar 

  8. 8.

    Engelter ST, Gostynski M, Papa A, Frei M, Born C, Ajdacic-Gross V et al (2006) Epidemiology of aphasia attributable to first ischemic stroke: incidence, severity, fluency, etiology, and thrombolysis. Stroke 37(6):1379–1384

    Article  PubMed  Google Scholar 

  9. 9.

    Pedersen PM, Jørgensen HS, Nakayama H, Raaschou HO, Olsen TS (1995t) Aphasia in acute stroke: incidence, determinants, and recovery. Ann Neurol 38(4):659–661995

    Article  CAS  PubMed  Google Scholar 

  10. 10.

    Basso A (2003) Aphasia and its therapy. Oxford University Press, New York

    Google Scholar 

  11. 11.

    Kertesz A (1997) Recovery of aphasia. In: Feinberg TE, Farah MJ (eds) Behavioral neurology and neuropsychology. McGraw Hill, New York, pp 167–182

    Google Scholar 

  12. 12.

    Ali M, Lyden P, Brady M, VISTA Collaboration (2015) Aphasia and dysarthria in acute stroke: recovery and functional outcome. Int J Stroke 10(3):400–406. https://doi.org/10.1111/ijs.12067

    Article  PubMed  Google Scholar 

  13. 13.

    Moss A, Nicholas M (2006) Language rehabilitation in chronic aphasia and time post-onset. A review of single-subject data. Stroke 37:3043–3051

    Article  PubMed  Google Scholar 

  14. 14.

    Smania N, Gandolfi M, Aglioti SM, Girardi P, Fiaschi A, Girardi F (2010) How long is the recovery of global aphasia? Twenty-five years of follow-up in a patient with left hemisphere stroke. Neurorehabil Neural Repair 24(9):871–875. https://doi.org/10.1177/1545968310368962

    Article  PubMed  Google Scholar 

  15. 15.

    Mimura M et al (1995) Prospective and retrospective studies of recovery in aphasia. Changes in cerebral blood flow and language functions. Brain 121:2083–2094

    Article  Google Scholar 

  16. 16.

    Hillis AE (2007) Aphasia: progress in the last quarter of a century. Neurology 60:200–213

    Article  Google Scholar 

  17. 17.

    Crinion JT, Leff AP (2015) Using functional imaging to understand therapeutic effects in poststroke aphasia. Curr Opin Neurol 28(4):331–337

    Article  CAS  Google Scholar 

  18. 18.

    Pickersgill MJ, Lincoln NB (1983) Prognostic indicators and the pattern of recovery of communication in aphasic stroke patients. J Neurol Neurosurg Psychiatry 46:130–139

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. 19.

    Kertesz A, Sheppard A (1981) The epidemiology of aphasic and cognitive impairment in stroke: age, sex, aphasia type and laterality differences. Brain 104:117–128

    Article  CAS  PubMed  Google Scholar 

  20. 20.

    Robey RR (1998) A meta-analysis of clinical outcomes in the treatment of aphasia. J Speech Lang Hear Res 41:172–187

    Article  CAS  PubMed  Google Scholar 

  21. 21.

    Code C, Herrmann M (2003) The relevance of emotional and psychological factors in aphasia to rehabilitation. Neuropsychol Rehab 13(1/2):109–132

    Article  Google Scholar 

  22. 22.

    Naeser MA, Helm-Estabrooks N, Haas G, Auerbach S, Srinivasan M (1987) Relationship between lesion extent in ‘Wernicke’s area’ on computed tomographic scan and predicting recovery of comprehension in Wernicke’s aphasia. Arch Neurol 44:73–82

    Article  CAS  PubMed  Google Scholar 

  23. 23.

    Bhogal SK, Teasell R, Speechley M (2003) Intensity of aphasia therapy, impact on recovery. Stroke 34(4):987–993

    Article  PubMed  Google Scholar 

  24. 24.

    Cicerone KD, Langenbahn DM, Braden C, Malec JF, Kalmar K, Fraas M, Ashman T (2011) Evidence-based cognitive rehabilitation: updated review of the literature from 2003 through 2008. Arch Phys Med Rehabil 92:519–530. https://doi.org/10.1016/j.apmr.2010.11.01

    Article  Google Scholar 

  25. 25.

    De Jong-Hagelstein M, Van De Sandt-Koenderman WM, Prins ND et al (2011) Efficacy of early cognitive-linguistic treatment and communicative treatment in aphasia after stroke: a randomised controlled trial (rats-2). J Neurol Neurosurg Psychiatry 82(4):399–404

    Article  PubMed  Google Scholar 

  26. 26.

    Pulvermuller F, Berthier ML (2008) Aphasia therapy on a neuroscience basis. Aphasiology 22(6):563–599

    Article  PubMed  PubMed Central  Google Scholar 

  27. 27.

    Kurland J, Baldwin K, Tauer C (2008) Treatment-induced neuroplasticity following intensive naming therapy in a case of chronic Wernicke’s aphasia. Aphasiology 24:737–751. https://doi.org/10.1080/02687030903524711Rose

    Article  Google Scholar 

  28. 28.

    Mattioli F, Ambrosi C, Mascaro L, Scarpazza C, Pasquali P, Frugoni M, Magoni M, Biagi L, Gasparotti R (2013) Early aphasia rehabilitation is associated with functional reactivation of the left inferior frontal gyrus. A pilot study. Stroke 45(2):545–552. https://doi.org/10.1161/STROKEAHA.113.003192

    Article  PubMed  Google Scholar 

  29. 29.

    Abel S, Weiller C, Huber W, Willmes K, Specht K (2015) Therapy-induced brain reorganization patterns in aphasia. Brain 138:1097–1112

    Article  PubMed  Google Scholar 

  30. 30.

    Brady MC, Kelly H, Godwin J, Enderby P, Campbell P (2016) Speech and language therapy for aphasia following stroke. Cochrane Rev Database Syst Rev 6:CD000425. https://doi.org/10.1002/14651858.cd000425.pub4

    Article  Google Scholar 

  31. 31.

    Hurkmans J, Madeleen de Bruijn M, Boonstra AM, Jonkers R, Bastiaanse R, Arendzen H, Reinders-Messelink HA (2012) Music in the treatment of neurological language and speech disorders: a systematic review. Aphasiology 26(1):1–19. https://doi.org/10.1080/02687038.2011.602514

    Article  Google Scholar 

  32. 32.

    Rohde A, Worrall L, Le Dorze G (2013) Systematic review of the quality of clinical guidelines for aphasia in stroke management. J Eval Clin Pract 19(6):994–1003

    Article  PubMed  Google Scholar 

  33. 33.

    Royal College of Physicians. National Clinical Guidelines for Stroke. Fifth Edition 2016 NICE Accredited

  34. 34.

    Breitstain C, Grewe T, Flowel A et al (2017) Intensive speech and language therapy in patients with chronic aphasia after stroke: a randomized open label blinded endpoint controlled trial in a health care setting. Lancet 389:1528–1538

    Article  Google Scholar 

  35. 35.

    Allibrio G, Gori MA, Signorini G, Luzzatti C (2009) Un esame del linguaggio per la diagnosi dei deficit afasici a letto del malato. Giornale di Psicologia 3(1):7–21 ISSN 1971-9558

    Google Scholar 

  36. 36.

    Capasso R and Miceli G. Esame neuropsicologico per l’afasia. Springer ISBN 978-88-470-0152

  37. 37.

    Belacchi, C., Scalisi, T.G., Cannoni, E.E. Cornoldi, C. (2008). Manuale CPM. Coloured progressive matrices. Standardizzazione italiana. Firenze: Giunti O.S. Organizzazioni Speciali

  38. 38.

    Magni E, Binetti G, Bianchetti A, Rozzini R, Trabucchi M (1996) Mini-mental state examination: a normative study in Italian elderly population. Eur J Neurol 3(3):198–202. https://doi.org/10.1111/j.1468-1331.1996.tb00423

    Article  CAS  PubMed  Google Scholar 

  39. 39.

    David RM, Skilbeck CE (1984) Raven IQ and language recovery following stroke. J Clin Neuropsychol 6(3):302–308

    Article  CAS  PubMed  Google Scholar 

  40. 40.

    Luzzatti C, Willmes K, De Bleser R (1996) Aachener Aphasie Test (AAT) Versione italiana, 2nd edn. Organizzazioni Speciali, Firenze, Italy

    Google Scholar 

  41. 41.

    De Renzi E, Vignolo LA (1962) The Token test: a sensitive test to detect receptive disturbances in aphasics. Brain 85:665–678

    Article  Google Scholar 

  42. 42.

    Miceli G, Laudanna A, Burani C, Capasso R. Batteria per l'analisi dei deficit afasici. B.A.D.A.1994 CEPSAG Roma Italia

  43. 43.

    Dell’acqua R, Lotto L, Remo J (2000) Naming times and standardized norms for the Italian PD/DPSS set of 266 pictures: direct comparisons with American, English, French, and Spanish published databases. Behav Res Methods Instrum Comput 32(4):588–615

    Article  PubMed  Google Scholar 

  44. 44.

    Laiacona M, Barbarotto R, Trivelli C, Capitani E (1993) Dissociazioni semantiche intercategoriali: descrizione di una batteria standardizzata e dati normativi [Category specific semantic defects: a standardised test with normative data]. Arch Psicol Neurol Psichiatr 54(2):209–248

    Google Scholar 

  45. 45.

    Gamboz N, Coluccia E, Iavarone A, Brandimonte MA (2009) Normative data for the pyramids and palm trees test in the elderly Italian population. Neurol Sci 30(6):453–458. https://doi.org/10.1007/s10072-009-0130-y

    Article  PubMed  Google Scholar 

  46. 46.

    Lomas J, Pickard L, Bester S, Elbard H, Finlayson A, Zoghaib C (1989) The Communicative Effectiveness Index: development and psychometric evaluation of a functional communication measure for adult aphasia. J Speech Hear Disord 54:113–124

    Article  CAS  PubMed  Google Scholar 

  47. 47.

    Hilari K, Byng S, Lamping DL, Smith SC (2003) Stroke and Aphasia Quality of Life Scale-39 (SAQOL-39). Stroke 34:1944–1950. https://doi.org/10.1161/01.STR.0000081987.46660.E

    Article  PubMed  Google Scholar 

  48. 48.

    Øra HP, Kirmess M, Brady M, Winsnes IE, Hansen SM, Becker F (2018) Telerehabilitation for aphasia—protocol of a pragmatic, exploratory, pilot randomized controlled trial. Trials 19(208):208. https://doi.org/10.1186/s13063-018-2588-5

    Article  PubMed  PubMed Central  Google Scholar 

  49. 49.

    Cicerone KD, Dahlberg C, Kalmar K, Langenbahn DM, Malec JF, Bergquist TF, Felicetti T, Giacino JT, Harley JP, Harrington DE, Herzog J, Kneipp S, Laatsch L, Morse PA (2000) Evidence-based cognitive rehabilitation: recommendations for clinical practice. Arch Phys Med Rehabil 81:1596–1615

    Article  CAS  PubMed  Google Scholar 

  50. 50.

    Royal College of Speech and Language Therapist (2005) Clinical guidelines. Speechmark Publishing Ltd, Bicester Oxon

    Google Scholar 

  51. 51.

    Marshall J (2005) Can speech and language therapy with aphasic people affect activity and partecipation levels? A review of the literature. In: Halligan PW, Wade DT (eds) Effectiveness of rehabilitation for cognitive deficits. Oxford University Press, Oxford, pp 195–207

    Google Scholar 

  52. 52.

    Marini A, Caltagirone C, Pasqualetti P, Carlomagno S (2007) Patterns of language in adults with non-chronic non-fluent aphasia after specific therapies. Aphasiology 21:164–186

    Article  Google Scholar 

  53. 53.

    Wilkinson K, Mitchell T (2014) Eye tracking research to answer questions about augmentative and alternative communication assessment and intervention. Augment Altern Commun 30(2):106–119. https://doi.org/10.3109/07434618.2014.904435

    Article  PubMed  PubMed Central  Google Scholar 

  54. 54.

    Kurland J, Liu A, Stokes P (2018) Effects of a tablet-based home practice program with telepractice on treatment outcomes in chronic aphasia. J Speech Lang Hear Res 61(5):1140–1156. https://doi.org/10.1044/2018_JSLHR-L-17-0277

    Article  PubMed  PubMed Central  Google Scholar 

  55. 55.

    Greener J, Enderby P, Whurr R (2006) Pharmacological treatment for aphasia following stroke. Cochrane Database of Sistematic Rev 4

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Acknowledgements

Thanks to speech therapist Ilaria Mega for her valuable help.

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Correspondence to Flavia Mattioli.

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Mattioli, F. The clinical management and rehabilitation of post stroke aphasia in Italy: evidences from the literature and clinical experience. Neurol Sci 40, 1329–1334 (2019). https://doi.org/10.1007/s10072-019-03844-0

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Keywords

  • Post stroke aphasia
  • Language therapy
  • Rehabilitation