A prospective, randomized, parallel group, controlled study of the effect of intensity of speech and language therapy on early recovery from poststroke aphasia

Objective: To examine whether the amount of speech and language therapy influences the recovery from poststroke aphasia. Setting: A hospital stroke unit and community. Design: A prospective, randomized controlled trial. Intervention: Aphasic stroke patients were randomly allocated to receive 5 hours (intensive therapy group, n = 51) or 2 hours (standard therapy group) of speech and language therapy per week for 12 consecutive weeks starting as soon as practicable after the stroke. Another 19 patients were recruited for 2 hours per week of therapy and were treated by National Health Service (NHS) staff (NHS group). Outcome measure and assessment: The Western Aphasia Battery. Assessments were made blind to randomization at baseline and 4, 8, 12 and 24 weeks after the start of therapy. Data were analysed by intention to treat. Results: The mean (SD) Western Aphasia Battery score at week 12 for the intensive, standard and NHS groups was 70.3 (26.9), 66.2 (26.2) and 58.1 (33.7), respectively. There was no treatment effect of intensive therapy (P> 0.05), but there was a statistically significant difference between the standard study and the NHS groups (P=0.002 at week 12 and 0.01 at week 24). Conclusions: Intensive speech and language therapy (as delivered in this study) did not improve the language impairment significantly more than the 'standard' therapy which averaged 1.6 hours/week. The improvement in aphasia was least in patients who were in the NHS group. These patients received 0.57 (0.49) hours of therapy per week.