A review of Constraint-Induced Therapy applied to aphasia rehabilitation in stroke patients

Balardin, Joana Bisol; Miotto, Eliane Correa

doi:10.1590/S1980-57642009DN30400003

Abstract

Constraint-induced aphasia therapy (CIAT) is an intensive therapy model based on the forced use of verbal oral language as the sole channel of communication, while any alternative communication mode such as writing, gesturing or pointing are prevented.

Objectives:

This critical review involved the analysis of studies examining CIAT applied to stroke patients.

Methods and Results:

Using keywords, the Medline database was searched for relevant studies published between 2001 and 2008 (Medline 2001-2008). The critical evaluation of the articles was based on the classifications described by the ASNS (Cicerone adaptation). Two studies were categorized as level Ia, two as level II and one study as level IV.

Conclusions:

These recommendations should be interpreted with caution, given the small number of studies involved, but serve as a guideline for future studies in aphasia therapy.

Key words:
aphasia; stroke; rehabilitation of speech and language disorders.

Resumo

A Terapia Induzida por Contenção aplicada à reabilitação da afasia é um modelo terapêutico intensivo que presume o treinamento da linguagem oral como exclusivo canal de comunicação verbal, enquanto métodos alternativos como a escrita, o desenho e os gestos não são permitidos.

Objetivos:

Revisar sistematicamente os estudos que examinaram a aplicabilidade da Terapia Induzida por Contenção em pacientes afásicos pós AVC.

Métodos e Resultados:

Os estudos relacionados ao tema foram selecionados na base de dados Medline, por meio de descritores, entre os anos de 2001 e 2008. A avaliação crítica dos artigos foi realizada de acordo com a classificação descrita pela ASNS (adaptado por Cicerone). Dois estudos foram categorizados como Ia, dois estudos receberam classificação II e um estudo foi categorizado no nível IV.

Conclusões:

Dado o limitado número de estudos existente, as recomendações sugeridas devem ser interpretadas com precaução, porém fornecem importantes diretrizes para futuros estudos sobre a terapia de afasia.

Palavras-chave:
afasia; acidente vascular cerebral; reabilitação dos transtornos da fala e da linguagem.

Texto completo disponível apenas em PDF.

Full text available only in PDF format.

References

¹
Gresham GE, Duncan PW, Stason WB, et al. Post-Stroke Rehabilitation: Clinical Practice Guidelines, No. 16. Rockville, MD: U.S. Department of Health and Human Services, Public Health Service, Agency for Health Care Policy and Research. AHCPR Publication No. 95- 0662. May 1995.
²
Pedersen PM, Jorgensen HS, Nakayama H, Raaschou HO, OlsenTS. Aphasia in acute stroke: Incidence, determinants, and recovery. Ann Neurol 1995;38:659-666.
³
Pedersen PM, Vinter K, Olsen TS. Aphasia after stroke: Type, severity and prognosis. The Copenhagen aphasia study. Cerebrovasc Dis 2004;17:35-43.
⁴
Benson F, Ardila A. What is Aphasia? In: Aphasia: a clinical perspective. New York, Oxford University Press; 1996:3-10.
⁵
Tonkonogy J, Goodglass H. Language function, foot of the third frontal gyrus, and Rolandic operculum. Arch Neurol 1981;38:486-490.
⁶
Chapey R. Project Leader Group (2000). Life participation approach to aphasia: A statement of values for the future. ASHA Leader, 02/15/2000, 5(3):4-6.
⁷
Hillis A. Aphasia: Progress in the last quarter of a century. Neurology 2007;69:200-213.
⁸
Albert M. Treatment of Aphasia. Arch Neurol. 1998;55:1417-1419.
⁹
Taub E, Uswatte G, Elbert T. New treatments in neurorehabilitation founded on basic research. Nat Rev Neurosci 2002;3: 228-236.
¹⁰
Taub E, Uswatte G, Mark VW, Morris DM. The learned nonuse phenomenon: implications for rehabilitation. Eura Medicophys 2006;42;241-255.
¹¹
Mark VW, Taub E. Constraint-induced movement therapy for chronic stroke hemiparesis and other disabilities. Restor Neurol Neurosci 2004;22:317-336.
¹²
Szaflarski JP, Page SJ, Kissela BM, et al. Cortical reorganization following modified constraint-induced movement therapy: a study of 4 patients with chronic stroke. Arch Phys Med Rehabil 2006;87:1052-1058.
¹³
Meinzer M, Elbert T, Djundja D, Taub E, Rockstroh B. Extending the Constraint-Induced Movement Therapy (CIMT) approach to cognitive functions: Constraint-Induced Aphasia Therapy (CIAT) of chronic aphasia. NeuroRehabilitation 2007a;22:311-318.
¹⁴
Pulvermüller F, Neininger B, Elbert T, et al. Constraint-induced therapy of chronic aphasia after stroke. Stroke 2001;32: 1621-1626.
¹⁵
Pulvermüller F, Roth VM. Communicative aphasia treatment as a further development of PACE therapy. Aphasiology 1991;5:39-50.
¹⁶
Maher LM, Kendall D, Swearengin JA, et al. A pilot study of use-dependent learning in the context of Constraint Induced Language Therapy. J Int Neuropsychol Soc 2006;12: 843-852.
¹⁷
Meinzer M, Djundja D, Barthel G, Elbert T, Rockstroh B. Long-term stability of improved language functions in chronic aphasia after constraint-induced aphasia therapy. Stroke 2005;36:1462-1466.
¹⁸
American Association of Neurologic Surgeons. Guidelines for the management of severe head injury. New York: Brain Trauma Foundation; 1995.
¹⁹
Cicerone KD, Dahlberg C, Kalmar K, et al. Evidence-based cognitive rehabilitation: recommendations for clinical practice. Arch Phys Med Rehabil 2000;81:1596-1615.
²⁰
Lillie R, Mateer CA. Constraint-based therapies as a proposed model for cognitive rehabilitation. J Head Trauma Rehabil. 2006;21:119-130.
21. Meinzer M, Streiftau S, Rockstroh B. Intensive language training in the rehabilitation of chronic aphasia: efficient training by laypersons. J Int Neuropsychol Soc 2007b;13:846-853.
²²
Szaflarski JP, Ball A, Grether S, et al. Constraint-induced aphasia therapy stimulates language recovery in patients with chronic aphasia after ischemic stroke. Med Sci Monit 2008;14:CR243-250.
²³
Meinzer M, Elbert T, Wienbruch C, Djundja D, Barthel G, Rockstroh B. Intensive language training enhances brain plasticity in chronic aphasia. BMC Biol 2004;2:20.
²⁴
Pulvermüller F, Hauk O, Zohsel K, Neininger B, Mohr B. Therapy-related reorganization of language in both hemispheres of patients with chronic aphasia. Neuroimage 2005;28:481-489.
²⁵
Meinzer M, Flaisch T, Obleser J, Assadollahi R, Djundja D, Barthel G, Rockstroh B. Brain regions essential for improved lexical access in an aged aphasic patient: a case report. BMC Neurol 2006;6:28.
²⁶
Breier JI, Maher LM, Schmadeke S, Hasan KM, Papanicolaou AC. Changes in language-specific brain activation after therapy for aphasia using magnetoencephalography: a case study. Neurocase 2007;13:169-177.
²⁷
Fridriksson J, Morrow-Odom L, Moser D, Fridriksson A, Baylis G. Neural recruitment associated with anomia treatment in aphasia. Neuroimage 2006;32:1403-1412.
²⁷
Meinzer M, Obleser J, Flaisch T, Eulitz C, Rockstroh B. Recovery from aphasia as a function of language therapy in an early bilingual patient demonstrated by fMRI. Neuropsychologia 2007c;45:1247-1256.
²⁸
Meinzer M, Flaisch T, Breitenstein C, Wienbruch C, Elbert T, Rockstroh B. Functional re-recruitment of dysfunctional brain areas predicts language recovery in chronic aphasia. Neuroimage 2008;39:2038-2046.
²⁹
Richter M, Miltner WH, Straube T. Association between therapy outcome and right-hemispheric activation in chronic aphasia. Brain 2008;131:1391-1401.
³⁰
Greener J, Enderby P, Whurr R. Speech and language therapy for aphasia following stroke. Cochrane Database Syst Rev. 2000;2:CD000425.
³¹
Pring T. Ask a silly question: two decades of troublesome trials. Int J Lang Commun Disord 2004;3:285-302.
³²
Bhogal SK, Teasell R, Speechley M. Intensity of aphasia therapy, impact on recovery. Stroke 2003;34:987-993.
³³
Liepert J, Miltner WH, Bauder H, et al. Motor cortex plasticity during constraint-induced movement therapy in stroke patients. Neurosci Lett 1998;250:5-8.

Publication Dates

Publication in this collection
Oct-Dec 2009

History

Received
15 Oct 2009
Accepted
13 Nov 2009

This is an open-access article distributed under the terms of the Creative Commons Attribution License

[1] ¹
Gresham GE, Duncan PW, Stason WB, et al. Post-Stroke Rehabilitation: Clinical Practice Guidelines, No. 16. Rockville, MD: U.S. Department of Health and Human Services, Public Health Service, Agency for Health Care Policy and Research. AHCPR Publication No. 95- 0662. May 1995.

[2] ²
Pedersen PM, Jorgensen HS, Nakayama H, Raaschou HO, OlsenTS. Aphasia in acute stroke: Incidence, determinants, and recovery. Ann Neurol 1995;38:659-666.

[3] ³
Pedersen PM, Vinter K, Olsen TS. Aphasia after stroke: Type, severity and prognosis. The Copenhagen aphasia study. Cerebrovasc Dis 2004;17:35-43.

[4] ⁴
Benson F, Ardila A. What is Aphasia? In: Aphasia: a clinical perspective. New York, Oxford University Press; 1996:3-10.

[5] ⁵
Tonkonogy J, Goodglass H. Language function, foot of the third frontal gyrus, and Rolandic operculum. Arch Neurol 1981;38:486-490.

[6] ⁶
Chapey R. Project Leader Group (2000). Life participation approach to aphasia: A statement of values for the future. ASHA Leader, 02/15/2000, 5(3):4-6.

[7] ⁷
Hillis A. Aphasia: Progress in the last quarter of a century. Neurology 2007;69:200-213.

[8] ⁸
Albert M. Treatment of Aphasia. Arch Neurol. 1998;55:1417-1419.

[9] ⁹
Taub E, Uswatte G, Elbert T. New treatments in neurorehabilitation founded on basic research. Nat Rev Neurosci 2002;3: 228-236.

[10] ¹⁰
Taub E, Uswatte G, Mark VW, Morris DM. The learned nonuse phenomenon: implications for rehabilitation. Eura Medicophys 2006;42;241-255.

[11] ¹¹
Mark VW, Taub E. Constraint-induced movement therapy for chronic stroke hemiparesis and other disabilities. Restor Neurol Neurosci 2004;22:317-336.

[12] ¹²
Szaflarski JP, Page SJ, Kissela BM, et al. Cortical reorganization following modified constraint-induced movement therapy: a study of 4 patients with chronic stroke. Arch Phys Med Rehabil 2006;87:1052-1058.

[13] ¹³
Meinzer M, Elbert T, Djundja D, Taub E, Rockstroh B. Extending the Constraint-Induced Movement Therapy (CIMT) approach to cognitive functions: Constraint-Induced Aphasia Therapy (CIAT) of chronic aphasia. NeuroRehabilitation 2007a;22:311-318.

[14] ¹⁴
Pulvermüller F, Neininger B, Elbert T, et al. Constraint-induced therapy of chronic aphasia after stroke. Stroke 2001;32: 1621-1626.

[15] ¹⁵
Pulvermüller F, Roth VM. Communicative aphasia treatment as a further development of PACE therapy. Aphasiology 1991;5:39-50.

[16] ¹⁶
Maher LM, Kendall D, Swearengin JA, et al. A pilot study of use-dependent learning in the context of Constraint Induced Language Therapy. J Int Neuropsychol Soc 2006;12: 843-852.

[17] ¹⁷
Meinzer M, Djundja D, Barthel G, Elbert T, Rockstroh B. Long-term stability of improved language functions in chronic aphasia after constraint-induced aphasia therapy. Stroke 2005;36:1462-1466.

[18] ¹⁸
American Association of Neurologic Surgeons. Guidelines for the management of severe head injury. New York: Brain Trauma Foundation; 1995.

[19] ¹⁹
Cicerone KD, Dahlberg C, Kalmar K, et al. Evidence-based cognitive rehabilitation: recommendations for clinical practice. Arch Phys Med Rehabil 2000;81:1596-1615.

[20] ²⁰
Lillie R, Mateer CA. Constraint-based therapies as a proposed model for cognitive rehabilitation. J Head Trauma Rehabil. 2006;21:119-130.

[21] 21. Meinzer M, Streiftau S, Rockstroh B. Intensive language training in the rehabilitation of chronic aphasia: efficient training by laypersons. J Int Neuropsychol Soc 2007b;13:846-853.

[22] ²²
Szaflarski JP, Ball A, Grether S, et al. Constraint-induced aphasia therapy stimulates language recovery in patients with chronic aphasia after ischemic stroke. Med Sci Monit 2008;14:CR243-250.

[23] ²³
Meinzer M, Elbert T, Wienbruch C, Djundja D, Barthel G, Rockstroh B. Intensive language training enhances brain plasticity in chronic aphasia. BMC Biol 2004;2:20.

[24] ²⁴
Pulvermüller F, Hauk O, Zohsel K, Neininger B, Mohr B. Therapy-related reorganization of language in both hemispheres of patients with chronic aphasia. Neuroimage 2005;28:481-489.

[25] ²⁵
Meinzer M, Flaisch T, Obleser J, Assadollahi R, Djundja D, Barthel G, Rockstroh B. Brain regions essential for improved lexical access in an aged aphasic patient: a case report. BMC Neurol 2006;6:28.

[26] ²⁶
Breier JI, Maher LM, Schmadeke S, Hasan KM, Papanicolaou AC. Changes in language-specific brain activation after therapy for aphasia using magnetoencephalography: a case study. Neurocase 2007;13:169-177.

[27] ²⁷
Fridriksson J, Morrow-Odom L, Moser D, Fridriksson A, Baylis G. Neural recruitment associated with anomia treatment in aphasia. Neuroimage 2006;32:1403-1412.

[28] ²⁷
Meinzer M, Obleser J, Flaisch T, Eulitz C, Rockstroh B. Recovery from aphasia as a function of language therapy in an early bilingual patient demonstrated by fMRI. Neuropsychologia 2007c;45:1247-1256.

[29] ²⁸
Meinzer M, Flaisch T, Breitenstein C, Wienbruch C, Elbert T, Rockstroh B. Functional re-recruitment of dysfunctional brain areas predicts language recovery in chronic aphasia. Neuroimage 2008;39:2038-2046.

[30] ²⁹
Richter M, Miltner WH, Straube T. Association between therapy outcome and right-hemispheric activation in chronic aphasia. Brain 2008;131:1391-1401.

[31] ³⁰
Greener J, Enderby P, Whurr R. Speech and language therapy for aphasia following stroke. Cochrane Database Syst Rev. 2000;2:CD000425.

[32] ³¹
Pring T. Ask a silly question: two decades of troublesome trials. Int J Lang Commun Disord 2004;3:285-302.

[33] ³²
Bhogal SK, Teasell R, Speechley M. Intensity of aphasia therapy, impact on recovery. Stroke 2003;34:987-993.

[34] ³³
Liepert J, Miltner WH, Bauder H, et al. Motor cortex plasticity during constraint-induced movement therapy in stroke patients. Neurosci Lett 1998;250:5-8.

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