Does communication make aphasia therapy more efficient?: Evidence from a cross-over randomized controlled trial

Traditional aphasia therapy focuses on language exercises such as object naming, repetition and sentence completion. These exercises are sometimes very different from the ‘language games’ relevant in conversation in everyday life, where words and constructions are tools for making requests, suggestions, or compliments. Therefore, a long-standing debate in aphasia research addresses the suitability of non-communicative exercises in aphasia therapy and the possibility to enhance therapy efficiency by use of language in communication similar to everyday conversation. The present cross-over RCT provided 18 patients with chronic post-stroke aphasia to an intensive therapy regime. In therapy interval A, each group received naming and word-to-picture-matching training for two weeks, three hours per day. In therapy interval B, the same pictures and linguistic forms were used in communicative language games, where patients were trained, with the same intensity, to make requests and to appropriately respond to requests, using methods known from constraint-induced aphasia therapy and intensive language action therapy (CIAT/ILAT). Participants were assigned randomly to groups; therapy order (A vs. B) was counterbalanced across groups. Results show consistent improvement only for ILAT/CIAT, with significant effects for the naming training only at therapy onset. A significant group x time interval interaction further confirmed the general efficiency of ILAT/CIAT, in contrast to the context-specificity of the effect of the non-communicative method. These results demonstrate that, in the therapy of chronic post-stroke aphasia, practicing language in request communications is more efficient than naming training, thus suggesting a beneficial influence of the embedding of language in communication. Implication of this new finding for brain language theory will be discussed.