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      Efficacy of intensive aphasia therapy in patients with chronic stroke: a randomised controlled trial

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          Abstract

          Objective

          Recent evidence has fuelled the debate on the role of massed practice in the rehabilitation of chronic post-stroke aphasia. Here, we further determined the optimal daily dosage and total duration of intensive speech-language therapy.

          Methods

          Individuals with chronic aphasia more than 1 year post-stroke received Intensive Language-Action Therapy in a randomised, parallel-group, blinded-assessment, controlled trial. Participants were randomly assigned to one of two outpatient groups who engaged in either highly-intensive practice (Group I: 4 hours daily) or moderately-intensive practice (Group II: 2 hours daily). Both groups went through an initial waiting period and two successive training intervals. Each phase lasted 2 weeks. Co-primary endpoints were defined after each training interval.

          Results

          Thirty patients—15 per group—completed the study. A primary outcome measure (Aachen Aphasia Test) revealed no gains in language performance after the waiting period, but indicated significant progress after each training interval (gradual 2-week t-score change [CI]: 1.7 [±0.4]; 0.6 [±0.5]), independent of the intensity level applied (4-week change in Group I: 2.4 [±1.2]; in Group II: 2.2 [±0.8]). A secondary outcome measure (Action Communication Test) confirmed these findings in the waiting period and in the first training interval. In the second training interval, however, only patients with moderately-intensive practice continued to make progress (Time-by-Group interaction: P=0.009, η 2=0.13).

          Conclusions

          Our results suggest no added value from more than 2 hours of daily speech-language therapy within 4 weeks. Instead, these results demonstrate that even a small 2-week increase in treatment duration contributes substantially to recovery from chronic post-stroke aphasia.

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          Most cited references 12

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          Using confidence intervals in within-subject designs.

          We argue that to best comprehend many data sets, plotting judiciously selected sample statistics with associated confidence intervals can usefully supplement, or even replace, standard hypothesis-testing procedures. We note that most social science statistics textbooks limit discussion of confidence intervals to their use in between-subject designs. Our central purpose in this article is to describe how to compute an analogous confidence interval that can be used in within-subject designs. This confidence interval rests on the reasoning that because between-subject variance typically plays no role in statistical analyses of within-subject designs, it can legitimately be ignored; hence, an appropriate confidence interval can be based on the standard within-subject error term-that is, on the variability due to the subject × condition interaction. Computation of such a confidence interval is simple and is embodied in Equation 2 on p. 482 of this article. This confidence interval has two useful properties. First, it is based on the same error term as is the corresponding analysis of variance, and hence leads to comparable conclusions. Second, it is related by a known factor (√2) to a confidence interval of the difference between sample means; accordingly, it can be used to infer the faith one can put in some pattern of sample means as a reflection of the underlying pattern of population means. These two properties correspond to analogous properties of the more widely used between-subject confidence interval.
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            Stereotaxic display of brain lesions.

            Traditionally lesion location has been reported using standard templates, text based descriptions or representative raw slices from the patient's CT or MRI scan. Each of these methods has drawbacks for the display of neuroanatomical data. One solution is to display MRI scans in the same stereotaxic space popular with researchers working in functional neuroimaging. Presenting brains in this format is useful as the slices correspond to the standard anatomical atlases used by neuroimagers. In addition, lesion position and volume are directly comparable across patients. This article describes freely available software for presenting stereotaxically aligned patient scans. This article focuses on MRI scans, but many of these tools are also applicable to other modalities (e.g. CT, PET and SPECT). We suggest that this technique of presenting lesions in terms of images normalized to standard stereotaxic space should become the standard for neuropsychological studies.
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              Speech and language therapy for aphasia following stroke.

              Aphasia is an acquired language impairment following brain damage that affects some or all language modalities: expression and understanding of speech, reading, and writing. Approximately one third of people who have a stroke experience aphasia.
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                Author and article information

                Journal
                J Neurol Neurosurg Psychiatry
                J. Neurol. Neurosurg. Psychiatry
                jnnp
                jnnp
                Journal of Neurology, Neurosurgery, and Psychiatry
                BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                0022-3050
                1468-330X
                June 2018
                22 December 2017
                : 89
                : 6
                : 586-592
                Affiliations
                [1 ] departmentDepartment of Neurology , Charité Universitätsmedizin Berlin, Campus Mitte , Berlin, Germany
                [2 ] departmentDepartment of Neurology , Universitätsmedizin Greifswald , Greifswald, Germany
                [3 ] departmentDepartment of Neurophysics , Max Planck Institute for Human Cognitive and Brain Sciences , Leipzig, Germany
                [4 ] Psychologische Hochschule Berlin , Berlin, Germany
                [5 ] departmentDepartment of Psychiatry , Charité Universitätsmedizin Berlin, Campus Benjamin Franklin , Berlin, Germany
                [6 ] departmentDepartment of Philosophy and Humanities , Brain Language Laboratory, Freie Universität Berlin , Berlin, Germany
                [7 ] departmentBerlin School of Mind and Brain , Humboldt-Universität zu Berlin , Berlin, Germany
                Author notes
                [Correspondence to ] Dr Benjamin Stahl, Charité Universitätsmedizin Berlin, Department of Neurology, Charitéplatz 1, 10117 Berlin, Germany; benjamin.stahl@ 123456charite.de
                Article
                jnnp-2017-315962
                10.1136/jnnp-2017-315962
                6031278
                29273692
                © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

                This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

                Product
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/501100001659, Deutsche Forschungsgemeinschaft;
                Categories
                Cognitive Neurology
                1506
                Research paper
                Custom metadata
                unlocked

                Surgery

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