SciELO - Scientific Electronic Library Online

vol.6 issue4Systematic review of the literature on vitamin A and memoryApathy, cognitive function and motor function in Alzheimer's disease author indexsubject indexarticles search
Home Pagealphabetic serial listing  

Services on Demand




Related links


Dementia & Neuropsychologia

Print version ISSN 1980-5764

Dement. neuropsychol. vol.6 no.4 São Paulo Oct./Dec. 2012 

Artigos Originais

Rehabilitation of language in expressive aphasias: a literature review

Reabilitação da linguagem nas afasias expressivas: uma revisão da literatura

Denise Ren da Fontoura1 

Jaqueline de Carvalho Rodrigues2 

Luciana Behs de Sá Carneiro3 

Ana Maria Monção4 

Jerusa Fumagalli de Salles5 

1Fonoaudióloga, Doutora em Ciências da Linguagem/Psicolinguística pela Universidade Nova de Lisboa (UNL), Mestre em Ciências da Saúde/Neurociências pela Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Especialista em Reabilitação Fonoaudiológica/ Voz pelo Instituto Metodista IPA e Pós Graduada em Neuropsicologia/ Linguagem pela PUCRS.

2Psicóloga Clínica, Mestranda em Psicologia no Programa de Pós-Graduação em Psicologia, Universidade Federal do Rio Grande do Sul - UFRGS.

3Fonoaudióloga Clínica.

4Professora Auxiliar do Departamento de Linguística da Universidade Nova de Lisboa, Doutora em Psicolinguística, Licenciada em Psicoterapia e Mestre em Neuropsicologia e Demências.

5Fonoaudióloga, Doutora em Psicologia, Professora Adjunta do Departamento de Psicologia do Desenvolvimento e da Personalidade, Instituto de Psicologia, Programa de Pós-Graduação em Psicologia, Universidade Federal do Rio Grande do Sul - UFRGS, Coordenadora do Núcleo de estudos em Neuropsicologia Cognitiva - NEUROCOG.



This paper reviews the methodological characteristics of studies on rehabilitation of expressive aphasia, describing the techniques of rehabilitation used.


The databases Medline, Science Direct and PubMed were searched for relevant articles (January 1999 to December 2011) using the keywords Expressive / Broca / Nonfluent Aphasia, combined with Language or Speech Rehabilitation / Therapy / Intervention.


A total of 56 articles were retrieved describing rehabilitation techniques, including 22 with a focus on lexical processing, 18 on syntax stimulation, seven with the aim of developing speech and nine with multiple foci.


A variety of techniques and theoretical approaches are available, highlighting the heterogeneity of research in this area. This diversity can be justified by the uniqueness of patients' language deficits, making it difficult to generalize. In addition, there is a need to combine the formal measures of tests with measures of pragmatic and social skills of communication to determine the effect of rehabilitation on the patient's daily life.

Key words: rehabilitation; language disorders; review; aphasia



Revisar as características metodológicas dos estudos sobre a reabilitação da afasia expressiva, descrevendo as técnicas de reabilitação utilizadas.


Foram pesquisados artigos nas bases de dados Medline, Science Direct e PubMed (Janeiro de 1999 a Dezembro de 2011), utilizando as palavras-chave Expressive / Broca / Nonfluent Aphasia, combinado com Language or Speech Rehabilitation / Therapy / Intervention.


Foram encontrados 56 artigos descrevendo técnicas de reabilitação, incluindo 22 com foco no processamento lexical, 18 na estimulação da sintaxe, sete com objetivo de desenvolver a fala e nove com múltiplos focos.


Há variedade de técnicas e abordagens teóricas, destacando a heterogeneidade da investigação nesta área, que pode justificar-se pela singularidade dos déficits linguísticos dos pacientes, tornando-se difícil a generalização. Existe também necessidade de combinar as medidas formais de testes com medidas de habilidades pragmáticas e sociais da comunicação, para determinar o efeito da reabilitação na vida diária do paciente.

Palavras-chave: reabilitação; transtornos da linguagem; revisão; afasia

Texto completo disponível apenas em PDF.

Full text available only in PDF format.


Goodglass H, Kaplan E, Barresi B. The Assessment of Aphasia and Related Disorders. 3nd ed. Philadelphia: Lippincott Williams & Wilkins; 2001:85. [ Links ]

Helm-Estabrooks N, Albert ML. Manual of Aphasia and Aphasia Therapy. Austin: Pro-Ed.;2003:281. [ Links ]

World Health Organization (2001). World Health Report 2001. Mental Health: New Understanding, New Hope.Geneva: World Health Organization. [ Links ]

Schwartz MF, Fink RB. Rehabilitation of aphasia. In: Feinberg TE, Farah MJ (Editors), Behavioral Neurology and Neuropsychology, 2nd ed. United States of America: McGraw-Hill Professional; 2003:179-195. [ Links ]

Basso A. The efficacy oh the impairment-based treatment. In: Halligan PW, Wade DT (Editors.), Effectiveness of rehabilitation for cognitive deficits. United States: Oxford University Press; 2005:185-194. [ Links ]

Code C. Multifactorial processes in recovery from aphasia: Developing the foundations for a multileveled framework. Brain Lang 2001;77: 25-44. [ Links ]

Céspedes JMM, Ustárroz JT. Rehabilitación neuropsicológica. Madrid: Editorial Sínteses S. A.; 2008:01-238. [ Links ]

Haase VG, Lacerda SS. Neuroplasticidade, variação interindividual e recuperação funcional em neuropsicologia. Temas em Psicologia da SBP 2004;12:28- 42. [ Links ]

Mateer CA. Fundamentals of cognitive rehabilitation. In: Halligan PW, Wade DT (Editors.), Effectiveness of rehabilitation for cognitive deficits . United States: Oxford University Press ; 2005: 21-29. [ Links ]

Cappa SF, Benke T, Clarke S, Rossi B, Stemmer B, van Heugten CM. EFNS guidelines on cognitive rehabilitation: report of an EFNS task force. Eur J Neurol 2003;10:11-23. [ Links ]

Cicerone KD, Dahlberg C, Malec JF, et al. Evidence-based cognitive rehabilitation: Updated review of the literature from 1998 through 2002. Arch Phys Med Rehab 2005;86:1681-1692. [ Links ]

Cicerone KD, Langenbahn DM, Braden C, et al. Evidence-based cognitive rehabilitation: Updated review of the literature from 2003 through 2008. Arch Phys Med Rehab 2011;92:519-530. [ Links ]

Murray LL, Ray AH. A comparison of relaxation training and syntax stimulation for chronic nonfluent aphasia. J Commun Disord 2001;34: 87-113. [ Links ]

Faroqi-Shah Y. A comparison of two theoretically driven treatments for verb inflection deficits in aphasia. Neuropsychologia 2008;46:3088-3100. [ Links ]

Cherney LR, Halper AS, Holland AL, Cole R. Computerized script training for aphasia: Preliminary results. Am J Speech Lang Pathol 2008;17: 19-34. [ Links ]

Cherney LR, Halper AS. Novel technology for treating individuals with aphasia and concomitant cognitive deficits. Top Stroke Rehabil 2008; 15:542-554. [ Links ]

Cherney LR. Oral reading for language in aphasia: Impact of aphasia severity on cross-modal outcomes in chronic nonfluent aphasia. Semin Speech Lang 2010a;31:42-51. [ Links ]

Kendall DL, Rosenbek JC, Heilman KM, et al. Phoneme-based rehabilitation of anomia in aphasia. Brain Lang 2008;105:1-17. [ Links ]

Biedermann B, Nickels L. The representation of homophones: More evidence from the remediation of anomia. Cortex 2008;44:276-293. [ Links ]

Lorenz A, Ziegler W. Semantic vs. word-form specific techniques in anomia treatment: A multiple single-case study. J Neuroling 2009;22: 515-537. [ Links ]

Ballard KJ, Thompson CK. Treatment and generalization of complex sentence production in agrammatism. J Speech Lang Hear Res 1999;42:690-707. [ Links ]

Thompson CK, Shapiro LP, Kiran S, Sobecks J. The role of syntactic complexity in treatment of sentence deficits in agrammatic aphasia: The complexity account of treatment efficacy (CATE). J Speech Lang Hear Res 2003;46:591-607. [ Links ]

Cappa SF. Spontaneous Recovery in Aphasia. In: B. Stemmer & H. A. Whitaker (Editors), Handbook of Neurolinguistics. San Diego: Academic Press;1998:536-545. [ Links ]

Blomert L. Recovery from language disorders: Interaction between brain and rehabilitation. In: B. Stemmer , H. A. Whitaker (Editors), Handbook of Neurolinguistics . San Diego: Academic Press ; 1998:548-557. [ Links ]

Carlomago S, Pandolfi M, Labruna L, Colombo A, Razzano C. Recovery from moderate aphasia in the first year poststroke: Effect of type of therapy. Arch Phys Med Rehab il 2001;82:1073-1080. [ Links ]

Wilson BA. Evidence for the effectiveness of neuropsychological rehabilitation. In: Wilson BA, Gracey F, Evans JJ, Bateman A (Editors), Neuropsychological Rehabilitation: Theory, Models, Therapy and Outcome. Cambridge: Cambridge University Press; 2009: 22-36. [ Links ]

Marcotte K, Ansaldo AI. The neural correlates of semantic feature analysis in chronic aphasia: Discordant patterns according to the etiology. Semin Speech Lang 2010;31: 52-63. [ Links ]

Kiran S. Typicality of inanimate category exemplars in aphasia treatment: Further evidence for semantic complexity. J Speech Lang Hear Res 2008;51:1550-1568. [ Links ]

LaFrance C, Garcia LJ, Labreche J. The effect of a therapy dog on the communication skills of an adult with aphasia. J Commun Disords 2007;40:215-224. [ Links ]

Breier JI, Randle S, Maher LM, Papanicolaou AC. Changes in maps of language activity activation following melodic intonation therapy using magnetoencephalography: Two case studies. J Clin Exp Neuropsychol 2010;32:309-314. [ Links ]

Cherney LR, Small SL. Task-dependent changes in brain activation following therapy for nonfluent aphasia: Discussion of two individual cases. J Int Neuropsychol Soc 2006;12: 828-842. [ Links ]

Schlaug G, Marchina S, Norton A. Evidence for plasticity in white-matter tracts of patients with chronic Broca's aphasia undergoing intense intonation-based speech therapy. Ann N Y Acad Sci 2009;1169:385-394. [ Links ]

Grady CL, Kapur S. The use of neuroimaging in neurorehabilitative research. In Stuss DT, Winocur G, Robertson IH (Editors), Cognitive Neurorehabilitation. Cambridge: Cambridge University Press ; 1999: 47-48. [ Links ]

Adrián JA, González M, Buiza JJ, Sage K. Extending the use of Spanish Computer-assisted Anomia Rehabilitation Program (CARP -2) in people with aphasia. J Commun Disord 2011;44:666-677. [ Links ]

Best W, Schröder A, Herbert R. An investigation of a relative impairment in naming non-living items: Theoretical and methodological implications. J Neuroling 2006;19: 96-123. [ Links ]

Crosson B, Moore AB, Gopinath K, et al. Role of the right and left hemispheres in recovery of function during treatment of intention in aphasia. J Cogn Neurosc 2005; 17: 392-406. [ Links ]

Crosson B, Fabrizio KS, Singletary F, et al. Treatment of naming in nonfluent aphasia through manipulation of intention and attention: A phase 1 comparison of two novel treatments. J Int Neuropsychol Soc 2007;13:582-594. [ Links ]

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

Fridriksson J, Moser D, Bonilha L, et al. Neural correlates of phonological and semantic-based anomia treatment in aphasia. Neuropsychologia 2007;45:1812-1822. [ Links ]

Fridriksson J, Baker JM, Whiteside J, et al. Treating visual speech perception to improve speech production in nonfluent aphasia. Stroke 2009;40:853-858. [ Links ]

Léger A, Démonet JF, Ruff S, et al. Neural substrates of spoken language rehabilitation in an aphasic patient: An fMRI study. Neuroimage 2002;17(1):174-183. [ Links ]

Vitali P, Abutalebi J, Tettamanti M, et al. Training-induced brain remapping in chronic aphasia: A pilot study. Neurorehabil Neural Repair 2007;21:152-160. [ Links ]

McCann C, Doleman J. Verb retrieval in nonfluent aphasia: A replication of Edwards & Tucker, 2006. J Neuroling 2011;24:237-248. [ Links ]

Marangolo P, Bonifazi S, Tomaiuolo F, et al. Improving language without words: First evidence from aphasia. Neuropsychologia 2010;48: 3824-3833. [ Links ]

Martin N, Fink RB, Renvall K, Laine M. Effectiveness of contextual repetition priming treatments for anomia depends on intact access to semantics. J Int Neuropsychol Soc 2006;12: 853-866. [ Links ]

Parkinson BR, Raymer A, Chang YL, Fitzgerald DB, Crosson B. Lesion characteristics related to treatment improvement in object and action naming for patients with chronic aphasia. Brain Lang 2009;110:61-70. [ Links ]

Richards K, Singletary F, Rothi LJG, Koehler S, Crosson B. Activation of intentional mechanisms through utilization of nonsymbolic movements in aphasia rehabilitation. J Rehabil Res Dev 2002;39:445-454. [ Links ]

Rider JD, Wright HH, Marshall RC, Page JL. Using semantic feature analysis to improve contextual discourse in adults with aphasia. Am J Speech Lang Pathol 2008;17:161-172. [ Links ]

Hashimoto N, Frome A. The use of a modified semant ic features analysis approach in aphasia. J Commun Disord 2011;44:459-469. [ Links ]

Rochon E, Leonard C, Burianova H, et al. Neural changes after phonological treatment for anomia: An fMRI study. Brain Lang 2010;114: 164-179. [ Links ]

Cherney L. Oral reading for language in aphasia: Evaluating the efficacy of computer-delivered therapy in chronic nonfluent aphasia. Top Stroke Rehabil 2010b;17:423-431. [ Links ]

Dickey MW, Thompson CK. The resolution and recovery of filler-gap dependencies in aphasia: Evidence from on-line anomaly detection. Brain Lang 2004;88:108-127. [ Links ]

Jacobs BJ. Social validity of changes in informativeness and efficiency of aphasic discourse following Linguistic Specific Treatment (LST). Brain Lang 2001;78:115-127. [ Links ]

Thompson CK, den Ouden D, Bonakdarpour B, Garibaldi K, Parrish TB. Neural plasticity and treatment-induced recovery of sentence processing in agrammatism. Neuropsychologia 2010;48:3211-3227. [ Links ]

Koul R, Corwin M, Hayes S. Production of graphic symbol sentences by individuals with aphasia: Efficacy of a computer-based augmentative and alternative communication intervention. Brain Lang 2005;92:58-77. [ Links ]

Linebarger MC, Schwartz MF, Romania JR, Kohn SE, Stephens DL. Grammatical encoding in aphasia: Evidence from a "processing prosthesis". Brain Lang 2000;75:416-427. [ Links ]

Rochon E, Laird L, Bose A, Scofield J. Mapping therapy for sentence production impairments in nonfluent aphasia. Neuropsychol Rehabil 2005;15:1-36. [ Links ]

Ruiter MB, Kolk HJK, Rietveld TCM. Speaking in ellipses: The effect of a compensatory style of speech on functional communication in chronic agrammatism. Neuropsychol Rehabil 2010;20:423-458. [ Links ]

Stadie N, Schorder A, Postler J, et al. Unambiguous generalization effects after treatment of non-cationical sentence production in German agrammatism. Brain Lang 2008;104:211-229. [ Links ]

Straube T, Schulz A, Geipel K, Mentzel HJ, Miltner WH. Dissociation between singing and speaking in expressive aphasia: The role of song familiarity. Neuropsychologia 2008;46:1505-1512. [ Links ]

Weinrich M, Boser KI, McCall D. Representation of linguistic rules in the brain: Evidence from training an aphasic patient to produce past tense verb morphology. Brain Lang 1999;70:144-158. [ Links ]

Weinrich M, Boser KI, McCall D, Bishop V Training agrammatic subjects on passive sentences: Implications for syntactic deficit theories. Brain Lang 2001;76:45-61. [ Links ]

Cherney LR, Halper AS, Holland AL, Lee JB, Babbitt E, Cole R. Improving conversational script production in aphasia with virtual therapist computer treatment software. Brain Lang 2007;103:246-247. [ Links ]

Cherney LR, Halper AS, Kaye RC. Computer-based script training for aphasia: Emerging themes from post-treatment interviews. J Commun Disord 2011;44:493-501. [ Links ]

Beek S, Maxim J, Best W, Cooper F. Redesigning therapy for agrammatism: Initial findings from the ongoing evaluation of a conversation-based intervention study. J Neuroling 2011;24: 222-236. [ Links ]

Johnson RK, Hough MS, King KA, Vos P, Jeffs T. Functional communication in individuals with chronic severe aphasia using augmentative communication. Augment Altern Commun 2008;24:269-280. [ Links ]

Linebarger M, McCall D, Virata T, Berndt RS. Widening the temporal window: Processing support in the treatment of aphasic language production. Brain Lang 2007;100: 53-68. [ Links ]

Bakheit AMO, Shaw S, Carrington S, Griffiths S. The rate and extent of improvement with therapy from the different types of aphasia in the first year after stroke. Clin Rehabil 2007;21:941-949. [ Links ]

Basso A, Caporali A. Targeted intervention for multiple language disorders: A case study. J Neuroling 2004;17:383-401. [ Links ]

Breier JI, Juranek J, Maher LM, Schmadeke S, Men D, Papanicolaou AC. Behavioral and neurophysiologic response to therapy for chronic aphasia. Arch Phys Med Rehab il 2009;90: 2026-2033. [ Links ]

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. [ Links ]

Kim M, Tomaino CM. Protocol evaluation for effective music therapy for persons with nonfluent aphasia. Top Stroke Rehabil 2008;15):555-569. [ Links ]

Pinhasi-Vittorio L. The role of written language in the rehabilitation process of brain injury and aphasia: The memory of the movement in the reacquisition of language. Top Stroke Rehabil 2007;14:115-122. [ Links ]

Received: May 31, 2012; Accepted: August 13, 2012

Denise R. Fontoura. Instituto de Psicologia - Rua Ramiro Barcelos, 2600 / sala 114 - 90035-003 Porto Alegre RS - Brazil. E-mail: /

Disclosure: The authors report no conflicts of interest.

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