Aphasia Therapy - One Method Just Isn't Enough

Every year, aphasia treatment articles are published and presented in the world. Some of these treatments you will hear about, but most you won't. The treatments you hear about tend to become buzz words in therapy—constraint-induced, singing therapy, etc. As these therapy buzz words are spread around, clients will ask me if our facility does "X" therapy. They will insist that this is the therapy that they are looking for, as they have decided that that specific treatment is the best and should be done exclusively. My answer is this:

Our center offers many different types of evidence-based aphasia therapies, including "X". We use a variety of therapies with each client to obtain the best results, discarding those treatments that are not helpful. Our focus is on communication overall, as well as specific functional communication and improvement of speech, reading, writing, and comprehension in a therapeutic environment.

I think we can all agree that each person with aphasia is different. In a room full of people with Broca's aphasia, each person will have different abilities in speaking, reading, understanding, writing, gesturing, as well as severity of aphasia. I've heard many a frustrated caregiver tell me that their therapist just does the same treatment over and over without results. This is how you reach a "plateau"—a therapist has a limited repertoire of treatments and does the same thing for everyone. If you don't make progress in this system, you're out (but this is a different topic).

I truly appreciate it when a caregiver has some knowledge of different types of aphasia treatments. However, not every treatment will work for every person. Every person with aphasia is different. When the researcher publishes a treatment article, the study participants are typically a very limited set of people with aphasia. The study may show that the treatment worked to some extent for those people within that narrow range. I have conducted and published research, so I've spent many years in this environment. The point is that what helps one group may not help another. Treatments in research are supposed to be done over and over with more and different types of people before you can say what's effective and what isn't.

Constraint-Induced Language Therapy (CILT), for example, requires that you can speak a certain number of words in a sentence, are a moderate to milder aphasia and that you have a certain level of comprehension. This treatment significantly limits any type of communication except speech. You have to follow a very specific treatment pattern. Research has actually found that since CILT is done for several hours at a time that the INTENSITY of the treatment is the largest factor when it improves someone's speech. Does this improvement transfer to the real world?

Another treatment I am constantly asked about is Melodic Intonation Treatment, or "singing therapy". Many doctors seem to think that this is a miracle cure for any type of aphasia, and that's not true. While this therapy has been around for quite a while, I rarely use it. Again, it follows a very specific protocol for treatment. The client "sings" 1-3 word phrases while responding to a picture card. Even if you get good at remembering what to sing when you see the card, I've never seen it transfer to real life. While it may help "unlock" a few words, it's always related to the pictures. It has mixed reviews in the literature. This isn't to say that sometimes some clients benefit from this to an extent—I'm saying that as a whole, you can't put all your eggs into one treatment basket and expect great results. Yes, people with aphasia can often sing when they can't speak, and that's beautiful. Does it transfer to daily life as a significant treatment method? Not in my experience.

I've never had a client at the intensive program who started a specific type of treatment the way it's done in the research and wanted to do it after the first two times. It's very specific, very dry, and doesn't relate to real life. Research is great because it gives us the idea of treatment methods, but these methods then need to be modified to fit each individual with aphasia. Aphasia treatment is different for each individual. Some treatments are for people with fluent aphasia, some are for people with non-fluent aphasia. The beauty of having therapy for five hours a day in an intensive setting is that the aphasia therapists get to explore more possibilities in less time. If we see that a treatment isn't working right away, we can try another. We get to really fine-tune and deeply explore the aphasia strengths and deficits because we have time to do it. This translates into a variety of treatments used for maximum benefit. In an outpatient setting, it may take several weeks before we could tell if something was working or not for a variety of reasons, including time constraints.

The moral of the story is that unfortunately, there is not great cure-all treatment in aphasia. Please be open to a variety of evidence-based treatments and don't rely upon anecdotes. Determine first is your loved one is a candidate for a certain type of therapy. Every person with aphasia is different and has the potential to improve, but not necessarily by taking the same path.

About Dr. Bartels

Dr. Bartels is a published aphasia researcher, presenter, author, and founder of The Aphasia Center Intensive Aphasia Program. She is an aphasia diagnostic and treatment expert with over 11 years of daily experience. She helps families with aphasia all over the world plan their recovery and exceed their goals.

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