Increases in hours of treatment for the top FCMs (Functional Communication Measures) addressed resulted in more patients making progress.
ASHA NOMS Outpatient Data 2011 (pp. 11-14, 20-23, 29-30, 36-39). This is data gathered by speech therapists and reports to the ASHA (the American Speech-Language Hearing Association), which is the governing body that licenses and acredits speech pathologists.
Research Abstract:
The present study provides a meta-analysis of cognitive rehabilitation literature (K = 115, N = 2,014) that was originally reviewed by K. D. Cicerone et al. (2000, 2005) for the purpose of providing evidence-based practice guidelines for persons with acquired brain injury. The analysis yielded a small treatment effect size (ES = .30, d+ statistic) directly attributable to cognitive rehabilitation. A larger treatment effect (ES = .71) was found for single-group pretest to posttest outcomes; however, modest improvement was observed for non-treatment control groups as well (ES = .41). Correction for this effect, which was not attributable to cognitive treatments, resulted in the small, but significant, overall estimate. Treatment effects were moderated by cognitiveAte domain treated, time post-injury, type of brain injury, and age. The meta-analysis revealed sufficient evidence for the effectiveness of attention training after traumatic brain injury and of language and visuospatial training for aphasia and neglect syndromes after stroke. Results provide important quantitative documentation of effective treatments, complementing recent systematic reviews. Findings also highlight gaps in the scientific evidence supporting cognitive rehabilitation, thereby indicating future research directions. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Neuropsychology, Vol 23(1), Jan 2009, 20-39. doi: 10.1037/a0013659
(Same source)
Conclusions:
There is substantial evidence to support interventions for attention, memory, social communication skills, executive function, and for comprehensive-holistic neuropsychologic rehabilitation after TBI. Evidence supports visuospatial rehabilitation after right hemisphere stroke, and interventions for aphasia and apraxia after left hemisphere stroke. Together with our prior reviews, we have evaluated a total of 370 interventions, including 65 class I or Ia studies. There is now sufficient information to support evidence-based protocols and implement empirically-supported treatments for cognitive disability after TBI and stroke.
Objective: To update our clinical recommendations for cognitive rehabilitation of people with traumatic brain injury (TBI) and stroke, based on a systematic review of the literature from 2003 through 2008.
Data Sources: PubMed and Infotrieve literature searches were conducted using the terms attention, awareness, cognitive, communication, executive, language, memory, perception, problem solving, and/or reasoning combined with each of the following terms: rehabilitation, remediation, and training for articles published between 2003 and 2008. The task force initially identified citations for 198 published articles.
Study Selection: One hundred forty-one articles were selected for inclusion after our initial screening. Twenty-nine studies were excluded after further detailed review. Excluded articles included 4 descriptive studies without data, 6 nontreatment studies, 7 experimental manipulations, 6 reviews, 1 single case study not related to TBI or stroke, 2 articles where the intervention was provided to caretakers, 1 article redacted by the journal, and 2 reanalyses of prior publications. We fully reviewed and evaluated 112 studies.
Data Extraction: Articles were assigned to 1 of 6 categories reflecting the primary area of intervention: attention; vision and visuospatial functioning; language and communication skills; memory; executive functioning, problem solving and awareness; and comprehensive-holistic cognitive rehabilitation. Articles were abstracted and levels of evidence determined using specific criteria.
Data Synthesis: Of the 112 studies, 14 were rated as class I, 5 as class Ia, 11 as class II, and 82 as class III. Evidence within each area of intervention was synthesized and recommendations for Practice Standards, Practice Guidelines, and Practice Options were made.
Research Source:ANNA BASSO. Aphasiology, 1992, 6(4), 337-348.
Abstract
This paper reviews the literature on prognostic factors related to recovery from aphasia. These can be regrouped under two headings: anagraphicaland neurological factors. Age, sex and handedness are the anagraphical factors considered. Aetiology, site and extent of lesion, and seventy and type of aphasia are the neurological ones. The effects of aphasia therapy are considered separately in more detail. Finally, the literature on patterns of recovery in groups of patients and in individual patients is reviewed. It is concluded that personal factors (age, sex, handedness) play a minor role in recovery from aphasia. Initial severity of aphasia and rehabilitation are the most important factors.
Conclusion: Although modest evidence exists for more intensive treatment and CILT for individuals with stroke-induced aphasia, the results of this review should be considered preliminary and, when making treatment decisions, should be used in conjunction with clinical expertise and the client’s individual values.
Evidence-Based Systematic Review: Effects of Intensity of Treatment and Constraint-Induced Language Therapy for Individuals With Stroke-Induced Aphasia
Leora R. Cherney, Janet P. Patterson, Anastasia Raymer, Tobi Frymark, and Tracy Schooling
Journal of Speech, Language, and Hearing Research, October 2008, Vol. 51, 1282-1299. doi:10.1044/1092-4388(2008/07-0206)
Purpose: This systematic review summarizes evidence for intensity of treatment and constraint-induced language therapy (CILT) on measures of language impairment and communication activity/participation in individuals with stroke-induced aphasia.
Method: A systematic search of the aphasia literature using 15 electronic databases (e.g., PubMed, CINAHL) identified 10 studies meeting inclusion/exclusion criteria. A review panel evaluated studies for methodological quality. Studies were characterized by research stage (i.e., discovery, efficacy, effectiveness, cost–benefit/public policy research), and effect sizes (ESs) were calculated wherever possible.
Results: In chronic aphasia, studies provided modest evidence for more intensive treatment and the positive effects of CILT. In acute aphasia, 1 study evaluated high-intensity treatment positively; no studies examined CILT. Four studies reported discovery research, with quality scores ranging from 3 to 6 of 8 possible markers. Five treatment efficacy studies had quality scores ranging from 5 to 7 of 9 possible markers. One study of treatment effectiveness received a score of 4 of 8 possible markers.
Constraint-induced aphasia therapy stimulates language recovery in patients with chronic aphasia after ischemic stroke
Med Sci Monit. 2008 May; 14(5): CR243–CR250.
Research Conclusions:
It appears that the CIAT protocol used in this study is a useful tool in post stroke language restoration. (Editors note: CIAT defined in the paper as: systematic constraint of verbal and nonverbal communication modalities with massed practice of targeted language skill. This is the same approach used in Bungalow Software's PC Software and webapp, MoreSpeech.com
The present study further explained the philosophic model for CIAT and expanded on previous protocols for the CIAT clinical procedures. Given that the duration of treatment in this study was only 1 week, the linguistic improvements in post stroke aphasia participants were encouraging. Pre and posttest out-comes using story retell task were more sensitive to change than formal expressive language subtests. Future studies that expand on discourse analysis as a functional outcome measure are needed. In addition, the mini-CAL did not demonstrate participant perception of improvement with four communicative situations, but it could be further adapted to facilitate aphasic reading comprehension.