Access to aphasia therapy

5.1 Speech and language therapy should be provided to people with aphasia – this can target functional communication, reading comprehension, auditory comprehension, general expressive language and/or written language.

Reference: Brady et al., 2016: Cochrane review; The RELEASE collaborators, 2022a: Meta-analysis of 25 RCTs (959 IPD)

NHMRC level of Evidence: I

Rationale: The results of a Cochrane review (Brady et al., 2016) and a meta-analysis (the RELEASE collaborators, 2022a) showed that aphasia therapy was more effective than no aphasia therapy for all language modalities and for generalisation into everyday communicative activities. See Treating different language modalities (statements 5.9 to 5.14) for detailed recommendations relating to different language and communication domains.

 References:

1. Brady, M.C., Kelly, H., Godwin, J., Enderby, P., & Campbell, P. (2016). Speech and language therapy for aphasia following stroke. The Cochrane Database of Systematic Reviews, 6(6). DOI: 10.1002/14651858.cd000425.pub4
2. The RELEASE collaborators. (2022a). Dosage, intensity and frequency of language therapy for aphasia: an individual participant data network meta-analysis. Stroke, 53(3). 956-967. DOI: 10.1161/STROKEAHA.121.035216

Effectiveness of language therapy post stroke:

In 2012, Brady and colleagues conducted a Cochrane review which included 39 randomised control trials (RCTs) with 2518 participants. The research questions were: 

1. Is speech and language therapy (SLT) more effective than no speech and language therapy?
2. Is speech and language therapy more effective than social supports?
3. Is one approach to therapy more effective than another? 

FINDINGS: The results showed that SLT was more effective than no SLT in the areas of functional communication, receptive language and expressive language. However, it was noted that some studies were reported poorly. There was no evidence of difference between social support interventions and SLT interventions on functional communication. However, a higher drop out rate was noted within the social support groups. In regards to specific treatment types the authors conclude that “there was insufficient evidence to draw any conclusions regarding the effectiveness of any one specific SLT approach over another ” (p2). 

NOTES: In general, the studies included small numbers of participants.