Service delivery

In addition to individual therapy delivered by a speech pathologist aphasia rehabilitation may include:

	References	NHMRC level of evidence
Group therapy and conversation groups	Lanyon, Rose & Worrall., 2013	I
Computer-based treatments	Cherney, 2010; Katz & Wertz, 1997	II
Telerehabilitation	Cherney & van Vuuren, 2012; Dechene et al., 2011	IV
Trained volunteers	Brady et al., 2012	I

Rationale:

The evidence indicates that community and outpatient group participation can improve specific linguistic processes. There is also some evidence that group participation can benefit social networks and community access. However, there is limited evidence demonstrating improvement in functional communication as a consequence of group participation.

Computer-based treatments have the potential to increase the frequency and vary the nature of language treatments. Significant changes in language scores were shown following a computer-based language treatment. Promising results have been reported by one well-designed, multi-site RCT (Katz & Wertz, 1997), a one single site RCT (L. R. Cherney, 2010), which investigated a computer-provided language intervention.

Studies that compared volunteer-facilitated aphasia therapy compared to therapy from speech pathologists have shown little to no difference (Brady et al., 2012). Brady et al. (2012) report that this result is not surprising because volunteers were trained by a speech pathologist. The therapy plan was developed by the SLP and volunteers were given access to relevant therapy materials.

Group therapy

STUDY: “The efficacy of outpatient and community-based aphasia group interventions: A systematic review”. Lanyon, Rose & Worrall (2013)

DETAILS: This systematic review investigated the effectiveness of community-based and outpatient aphasia groups. A total of 29 studies were included in the review.
These studies examined the efficacy of highly structured group activities for improving specific linguistic processes. The review found that that group-based therapy can improve specific linguistic processes, such as picture naming, total speech utterances, and aphasia battery scores. Group participation also appears to improve social networks and community access. The effect of communication groups on activity and participation was unable to be calculated.

OVERALL CONCLUSION: “Overall, the results indicate that community and outpatient group participation can improve specific linguistic processes. There is also some evidence that group participation can benefit social networks and community access. However, there is limited evidence demonstrating improvement in functional communication as a consequence of group participation” (pp359).

Computer assisted delivery

STUDY:  “Computers in the treatment of chronic aphasia”. Katz (2010)

DETAILS: This non-systematic  review differentiates Computer Assisted Treatment (CAT) and Computer Only Treatment (COT). Additionally, it describes the real and practical applications of computer technology in treatment of adults with chronic aphasia. It identifies the highest level of evidence for Computer Only Treatment for Reading  (see Katz & Wertz, 1997).

NOTES: While computers can increase the intensity of treatment, provided to people with aphasia, they are only useful if the treatment is efficacious.

OVERALL  CONCLUSION:  Computer-based treatments have the potential to increase the frequency and vary the nature of language treatments. Promising results have been reported by one well-designed, multi-site RCTs.

RESOURCES:
Group therapy:

1. The Book Connection - Aphasia Centre of California. Use this resource and associated materials to start an aphasia book club. The Book Connection™ manual and curriculum materials provide “reading ramps” to help make books accessible to individuals with acquired reading impairments. 
    


 

2. Aphasia Community is a website and online forum designed to support individuals to build strong and sustainable aphasia groups. It includes details of aphasia group research, resources, and an up-to-date database of aphasia groups running across Australia. 

References:

1. Brady, M. C., Kelly, H., Godwin, J., & Enderby, P. (2012). Speech and language therapy for aphasia following stroke. The Cochrane database of systematic reviews, 5, CD000425. doi: 10.1002/14651858.CD000425.pub3
2. Cherney, L. R. (2010). Oral reading for language in aphasia (ORLA): evaluating the efficacy of computer-delivered therapy in chronic nonfluent aphasia. Topics in Stroke Rehabiliation, 17(6). doi: 10.1310/tsr1706-423
3. Cherney, L. R., & van Vuuren, S. (2012). Telerehabilitation, virtual therapists, and acquired neurologic speech and language disorders. Seminars in speech and language, 33(3). doi: 10.1055/s-0032-1320044
4. Dechêne, L., Tousignant, M., Boissy, P., Macoir, J., Héroux, S., Hamel, M., & Pagé, C. (2011). Simulated in-home teletreatment for anomia. International Journal of Telerehabilitation, 3(2). doi: 10.5195/ijt.2011.6075
5. Katz, R. C., & Wertz, R. T. (1997). The efficacy of computer-provided reading treatment for chronic aphasic adults. Journal of speech, language, and hearing research : JSLHR, 40(3), 493-507.
6. Lanyon, L. E., Rose, M. L., & Worrall, L. (2013). The efficacy of outpatient and community-based aphasia group interventions: a systematic review. International Journal of Speech Language Patholology, 15(4), 359-374. doi: 10.3109/17549507.2012.752865.