Two prominent aphasiologists – Julius Fridriksson from University of South Carolina and Argye Elizabeth Hillis from Johns Hopkins University – have published an evaluative review of rehabilitation advances over the last five years for persons with aphasia (PWA). The authors first discuss research focused on traditional behavioral speech-language therapies and studied in large-group, randomized, scientifically controlled trials; from there, they move to discussion of other rehabilitation approaches that combine traditional speech-language approaches with other elements of interest, such as advanced technologies or pharmacological agents. These latter, combined approaches are of more recent provenance and consequently in earlier stages of clinical validation and characterization. Consequently, the authors employ multiple evaluative methodologies – including scrutiny of rigorously designed controlled studies, review of meta-analyses covering multiple studies, and judicious incorporation of expert opinion – to discuss therapy advances for PWA over the past half decade.

The authors note that behavioral speech-language therapies (SLT) have served as the standard approach to aphasia interventions for over a century and a half – since modern aphasiology began the latter half of the 19th century. Clinicians’ rehabilitative focus may vary: some practitioners emphasize reducing clients’ impairments, while others focus on improving functional communication in the daily lives of those they serve. Studies have documented treatment efficacy of behavioral SLT, but only within limits and with considerable individual variability; SLT recipients improve but they are not cured. Still elusive are prognoses of types and magnitudes of improvements that are delivered. In the authors’ view, most PWA could benefit from more therapy than is typically available to them, and here they expand their focus to encompass more recent initiatives. They point, for example, to promise in telerehabilitation, as distance therapies have been shown efficacious in delivering therapeutic benefits. They also note more recent programs that provide opportunities for cost-free engagement in chronic aphasia, such as the Life Participation Approach to Aphasia (LPAA), in their words a ‘very promising approach to managing aphasia’. Here also fits Virtual Connections, an on-line meeting place co-hosted by the Aphasia Recovery Connection and Lingraphica, that incorporates distance communication technologies. Regarding the use of pharmacologic agents and/or non-invasive brain stimulation – such as transcranial direct current stimulation or repetitive transcranial magnetic stimulation – the authors note that while they show promise, research into their use and benefits is still in an early stage.

For further reading: J. Fridriksson, A. E. Hillis, 2021

Current approaches to the treatment of post-stroke aphasia. Journal of Stroke, 23(2): 183–201

https://doi.org/10.5853/jos.2020.05015

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