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SLT needed ‘quickly, frequently and intensively’ for aphasia

Study reveals window for optimum gains for those whose stroke has led to communication difficulties



Speech and language therapy should be delivered quickly, frequently and in high doses to support a person recover from aphasia after stroke, new research has concluded. 

Aphasia is commonly caused by stroke and can result in difficulty speaking, understanding speech, reading or writing, and affects around 3.5million people globally. 

To date, there has been a lack of evidence about the how much therapy people with aphasia after stroke need to support their recovery.

Researchers analysed 174 studies of speech and language therapy for aphasia after stroke, and brought together more than 300 aphasia researchers from 41 countries through the Collaboration of Aphasia Trialists. 

The review’s findings, which have been included in the UK and Ireland National Clinical Guideline for Stroke, summarise that the best possible recovery is associated with: 

  • therapy started within 28 days of the onset of aphasia
  • 20 – 50 hours of speech and language therapy in total
  • 2 – 4 hours of therapy a week, delivered over 4 – 5 days, for general language improvement
  • tasks that are practiced at home.

The study discovered the best recovery was linked to 20 to 50 hours in total of speech and language therapy. The best improvements in general language, and the ability to display this in real world settings, were linked to between two and four hours of therapy, given over four to five days per week.

Optimal recovery for younger adults, men and people with milder aphasia was linked to more speech and language therapy. 

People under 55 years were likely to improve the most, although the research showed that older people (75+ years) still improved with therapy.

The timing of therapy was important, with those who started therapy within a month of experiencing aphasia linked to the greatest improvements. 

People who had lived with aphasia for more than three months needed more therapy, but people whose stroke occurred more than six months earlier could still improve with therapy.

Therapy could be effectively delivered in-person or via video, the research found. Family members who had received training from a speech and language therapist could support the delivery of a therapy programme to their loved one.

With so much of stroke rehabilitation based on communication between the healthcare team and stroke survivors, optimising aphasia recovery not only offers important benefits to the person with aphasia returning to their family, friendships and work, but it has the potential to improve the effectiveness of all aspects of stroke rehabilitation delivered,” said Dr Marian Brady, Professor of Stroke Care and Rehabilitation at Glasgow Caledonian University, and author of the study. 

“Our findings reflect the advances that can be made in our understanding of healthcare interventions through international, interdisciplinary research.” 

Richard Francis, Head of Research at The Stroke Association, said: “This new research indicates that receiving early, frequent, high-intensity speech and language therapy generally results in the biggest recovery of speaking and listening skills. Even people who experience a delay in starting therapy still show improvements in their language skills. 

“These findings could help to inform national guidelines and guide personalised care plans for individual stroke survivors.”

Nicola Holmes, Vice-Chair of the Association of Speech and Language Therapists in Independent Practice (ASLTIP), added: “We welcome these new findings. They will enable our members working in this field to be better informed with regard to the timing of therapy, dosage and possible outcomes for the individuals they support post-stroke.”