Very Early Poststroke Aphasia Therapy: A Pilot Randomized Controlled Efficacy Trial
Abstract
Background and purpose: Early stroke rehabilitation has shown benefits over spontaneous recovery. Insufficient evidence exists to determine the benefits of early aphasia intervention. We hypothesized that daily aphasia therapy would show better communication outcomes than usual care (UC) in early poststroke recovery. Method: This prospective, randomized, single-blinded, controlled trial was conducted in three acute-care hospitals in Perth, Australia, each with over 200 stroke admissions annually. Patients with acute stroke causing moderate to severe aphasia were recruited at a median of three-days (range: 0–10 days) to receive daily aphasia therapy or usual care therapy. Individually tailored, impairment-based intervention was provided for the acute hospital stay or intervention phase (median: 19 days; range: 5–76). Primary outcome measures were the aphasia quotient and functional communication profile at acute hospital discharge or four-weeks poststroke, whichever came first. A random-number generator and sealed envelopes were used to randomize participants. Assessments were completed by a blinded assessor. Results: Fifty-nine participants were recruited, with six withdrawals (10%) and seven deaths (12%) at six-months. Ninety percent had ischemic strokes, with 56·5% experiencing a total anterior circulation stroke. The group mean (±SD) age was 69·1 (±13·9) years. Six participants (18·75%) in the daily aphasia therapy group did not complete the minimum (150 min) therapy required for this study. The daily aphasia therapy intervention phase mean therapy session time was 45 min (range: 30–80) and the total mean amount of therapy for the daily aphasia therapy participants was 331 min (range: 30–1415). Four (15%) participants in the usual care group received therapy. The collective total therapy provided to these participants was 295 min over seven sessions. Usual care participants received an average of 10·5 min of therapy per week during the intervention phase. At the primary end point, a generalized estimating equations model demonstrated that after controlling for initial aphasia severity, participants receiving daily aphasia therapy scored 15·1 more points ( P = 0·010) on the aphasia quotient and 11·3 more points ( P = 0·004) on the functional communication profile than those receiving usual care therapy. Conclusions: Daily aphasia therapy in very early stroke recovery improved communication outcomes in people with moderate to severe aphasia.
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Rehabilitation for people with aphasia provided by speech-language pathologists has shown improved outcomes.
“Rehabilitation for people with aphasia provided by speech-language pathologists (SLPs) has shown improved outcomes [6,7].”
VERSE provides compelling evidence to challenge the intensive mindset in early stroke language and communication recovery.
“Together, these trials3–6 provide compelling evidence to challenge the ‘intensive’ mindset in early stroke language and communication recovery.”
From A randomized control trial of intensive aphasia therapy after acute stroke: The Very Early Rehabilitation for SpEech (VERSE) study (2021) · cites this paper as [5]
The Phase I pilot study indicated a statistical and clinical benefit from daily intensive therapy targeted at spoken language.
“Our Phase I pilot study 5 (N = 59) indicated a statistical and clinical benefit from daily intensive therapy targeted at spoken language.”
From A randomized control trial of intensive aphasia therapy after acute stroke: The Very Early Rehabilitation for SpEech (VERSE) study (2021) · cites this paper as [5]
The intensity level for the high intensity groups was chosen in line with available evidence (≥5 h per week) and demonstrated tolerability.
“The intensity level for these groups was chosen in-line with available evidence (≥5 h per week 19 ) and demonstrated tolerability.5,18”
From A randomized control trial of intensive aphasia therapy after acute stroke: The Very Early Rehabilitation for SpEech (VERSE) study (2021) · cites this paper as [5]
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- Authors
- Godecke, E., Hird, K., Lalor, E. E., Rai, T., & Phillips, M. R.
- Affiliations
- Edith Cowan University (AU)
- The University of Western Australia (AU)
- National Stroke Foundation (AU)
- Corresponding author
- Godecke, Erin
- Venue
- International Journal of Stroke
- Publisher
- SAGE Publications
- Published
- 2011-10-06
- Volume
- 7
- Issue
- 8
- Pages
- 635-644
- ISSN
- 1747-4930 (ISSN-L)
- 1747-4949
- OpenAlex
- W2002631337
- Cited by
- 126
- References
- 31
- Citations by year
- 2026: 4 · 2025: 3 · 2024: 1 · 2023: 5 · 2022: 6 · 2021: 17 · 2020: 14 · 2019: 7 · 2018: 8 · 2017: 10 · 2016: 15 · 2015: 12 · 2014: 10 · 2013: 10 · 2012: 3
- FWCI
- 7.78
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- International Journal of Stroke (publishedVersion)
- PubMed (publishedVersion)
- UWA Profiles and Research Repository (UWA) (submittedVersion)
- ResearchOnline@ND (The University of Notre Dame) (submittedVersion)
- Research Online (Edith Cowan University) (submittedVersion)
- UTS ePRESS (University of Technology Sydney) (submittedVersion)
- Topics
- Health Sciences › Medicine › Rehabilitation › Stroke Rehabilitation and Recovery
- Life Sciences › Neuroscience › Cognitive Neuroscience › Neurobiology of Language and Bilingualism
- Health Sciences › Health Professions › Speech and Hearing › Dysphagia Assessment and Management
- Keywords
- aphasia, stroke rehabilitation, acute stroke, aphasia rehabilitation, functional communication, aphasia quotient, communication outcomes, ischemic stroke, anterior circulation stroke, hospital discharge outcomes, medication adherence, aphasia severity
- MeSH terms
- Stroke Rehabilitation, Aged, Aphasia, Female, Humans, Language Therapy, Male, Neuropsychological Tests, Patient Compliance, Pilot Projects, Prospective Studies, Western Australia, Single-Blind Method, Treatment Outcome, Secondary Prevention
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