The effects of a stroke can be extremely severe and can include difficulties in motor skills, paralysis, fatigue, memory loss, dementia, and aphasia. Aphasia is the damage of the portion of the brain that is associated with communication and language. Namely, Broca's area or Wernicke's area are damaged. Aphasia is largely caused by stroke because when the stroke occurs blood cannot get to the brain tissue and it will die. Aphasia, however can be reduced and the function and ability to speak effectively can be regained through aphasia therapy. Many stroke patients will undergo aphasia therapy, which includes two different categories of treatment style. One is called impairment-based and the other is called communication-based. Impairment-based treatment generally aims to improve skills like listening, speaking, and reading/writing. Communication-based focuses on actual interpersonal interactions and situations where communicating is essential.
The AHA/ASA published an article that looked at the correlation between the intensity of the aphasia treatment and the improvement from the treatment. Essentially, this was a literature search where the researchers found several clinical trials of various treatment lengths and their results and compared them. The values for how well a patient improved was compared by the Porch Index of Communicative Ability (PICA) test and the Functional Communication Profile (FCP). These are ways of evaluating a persons speaking and communication abilities. The study found that the length of the therapy per week (in hours) and total hours of therapy was directly correlated to improvement on the PICA. This shows that a higher intensity therapy program yields much better results for the patients. They found that an average of about 8-9 hours of therapy per week yielded significantly improved results to that of 2 hours of therapy per week.
It's interesting to me that there are such great differences in therapy lengths for aphasia treatment instead of a standard range of therapy lengths and intensities. The issues with creating a standard treatment, like for example saying that a patient with aphasia will be put on a treatment program of 8 hours a week for 12 weeks, would be the same that physical therapy has. There are differences in patient motivation and commitment that stop something like this from becoming a reality. It would be beneficial because of the clear improvement, but actual enforcement of it would be difficult due to that fact that not everyone is as motivated to get better as maybe they should be. Being the type of person that I am, I would definitely be opting for the longer, more intensive treatments because communication skills are essential in everyday life and being deficient in them would be very frustrating to deal with.
SOURCES
Bhogal, S. K.. "Intensity of Aphasia Therapy, Impact on Recovery * Aphasia Therapy Works!." Stroke 34.4 (2003): 987-993. Stroke. Web. 12 Oct. 2014. https://stroke.ahajournals.org/content/34/4/987.full.pdf+html
http://www.aphasia.org/content/aphasia-therapy-guide
Another barrier to having intensive treatments be the standard for aphasia is the associated cost. My experience with physical therapy has been that you get treatments in-house that you can't replicate yourself at home, and the cost of doing more appointments than your insurance covers is very high. I would venture to guess that working with speech pathologists or other specialists involved in aphasia treatment is also rather expensive. Communication-based therapy would likely be particularly hard to work on without someone trained to give feedback and help the process.
ReplyDeleteI think that most insurance companies only cover a certain amount of days and hours. So even though most people would probably benefit from more intensive therapy it is just not plausible. My grandma had a stroke and suffered from aphasia. Oddly, she lost the ability to speak English, which was her second language, but could speak her native language much better. We had a speech pathologist come in and I believe it was geared more towards "impairment based" as you described above.
ReplyDelete