Therapeutic Intervention In Aphasia Secondary To CVA

The existing scientific literature on aphasia rehabilitation shows its effectiveness being greater than no treatment. The Aphasia secondary to Cerebral Vascular Accident (AVC) has been, and is, the most widely studied

In the rehabilitation of aphasia caused by AVC several independent factors intervene that can exert an important influence on the results experienced by the patient. These are the severity and characteristics of aphasia, the physical state of the individual, comorbidity with emotional and psychosocial aspects, and the impact of aphasia on the patient’s quality of life (Berthier, 2005). It will also depend on the injured area, the size of the injury and the existence of previous strokes (Hamilton, 2011).

The benefits of therapy have not been tested yet in the acute stage ( 2 months), since it is very difficult to rule out effects such as spontaneous recovery, present up to 6 months of evolution. In chronic patients (> 6 months) the therapy appears effective if it is sufficiently intensive and/or prolonged. More intense therapy, in a shorter period of time results in significantly increased improvement and is critical for recovery, with a significant treatment effect for intensive therapy over a short period (8.8 hrs/week for 11.2 weeks), but not for less intensive therapy administered for a longer time (2 hrs/week for 22.9 weeks). The number of hours of therapy per week correlated with improvement in communication tests (PICA; p = 0.001) and the Token Test (p = 0.027) while the total duration of treatment showed an inverse correlation (no beneficial effect) with the change of the mean PICA score (p= 0.0001) (Bhogal, 2003; Hillis, 1998).

Within the framework of the findings previously stated, and based on the Constraint-Induced Movement Therapy (CIMT) (Taub et al, 2002) for the treatment of motor deficits secondary to AVC, in which all types of movements with the healthy limb are restricted to promote the use of the hemiparetic limb, the Constraint-Induced Aphasia Therapy (CIAT) (Pulvermüller et al., 2001). It is ecological language rehabilitation therapy based on real communication contexts. The objective of CIAT is to restrict gestures and promote the use of oral language in an intensive program (3 hours/day, 10 consecutive days). The CIAT is based on the neuroscientific principles of behavioral and communicative relevance, principle of intensive and focusing practice (CIMT).

The intensity and focus of the therapy result from a increased neuronal plasticity and the recruitment of neural networks with functional capacity for participation in the required verbal task. The REGIA (Intensive Group Rehabilitation of Aphasia) (Berthier, 2013) It is the Spanish adaptation of the CIAT to our language and cultural environment.

The Regia is a group game (2-4 participants and therapist and/or co-therapist) card exchange and pairing in which each participant is seated around a table. Each player is dealt 5 to 10 cards on which a drawn element, person or object appears. A copy of each of the cards is also dealt to another player.

The purpose of the game is get both copies of each card making verbal requests to the other participants, naming or describing the image, so that they can check if they have the identical card, until all the identical pairs present in the game are discarded. The request of one of the players is answered by another participant and may be accepted (he has the identical card), rejected (he does not have the identical card; the request is repeated to another player) or a clarification is required.

Any other attempt to use communication modalities alternative to oral communication (gestures, mime,…) is made difficult by separating panels arranged on the game table and must be deliberately discouraged by the therapist. The repetition keep goingof the target word and of grammatical structures present in daily life, facilitates the consolidation and generalization of the practice The difficulty of the game can be adapted to the patients’ deficits through the choice of the material to be worked on and through specific instructions, for example specific grammatical requirements.

The cards are divided into six categories taking into account the verbal content (nouns, minimal pairs, colors, numbers, adjectives and actions), each classified by frequency of use (high, medium and low frequency).

Depending on the therapeutic objectives, REGIA can be applied in two different modalities A first, addressed to the general language stimulation with the use of complete material, useful in working with people with moderate aphasia and when the objective is to master high frequency stimuli, to continue advancing towards stimuli of greater complexity, and in which the objective is for the patient to be able to construct phrases or make requests. A second modality, in which the patient is intended to be able to easily name a limited number of words For this option, the selection of a certain and restricted number of cards will be required. This modality is usually used with patients with mild aphasia who have problems naming low-frequency words, for which appropriate stimuli are selected.

The therapist in the REGIA has an important role Not only does he prepare and select the material to be worked on, but he also guides the practice of the game and informs the participants of the most appropriate strategies to use, decides the linguistic and communication rules that will be required, and distributes the turns allowing each participant access to the target word or the correct construction of the sentence. You must be aware of the appropriate aids to provide through, for example, semantic or phonetic instructions.

The therapist must be a professional (neuropsychologist, speech therapist or professional trained in the application of REGIA) language specialist, with knowledge of the patient’s deficits, the damaged process, its degree of deterioration and the influence of the variables being decisive for the correct application of the therapy. psycholinguistics (imaginability, frequency, concreteness,…), in addition to the preserved linguistic skills, which will serve as support in the recovery of the affected processes.

The benefit resulting from the application of REGIA is the relearning common objects of daily life, both in production and understanding. It also reduces the access time to naming and understanding nouns and verbs, increases fluency and informative content, in addition to optimizing prosody. It facilitates the use of numbers, colors and grammatical completion (Berthier et al., 2013).

To ensure the effectiveness of the therapy, the group should be as homogeneous as possible in terms of variables such as the degree of severity, the characteristics of aphasia and the time of evolution, since the benefits achieved, the experience of living with aphasia and adaptation to it may be different in the acute stage (Kirmess and Maher, 2010) and in the chronicle (Pulvermüller et al., 2001).

Aphasia represents a large social problem due to its high morbidity with other difficulties associated with the isolation in which those who suffer from it end up immersed. Communication difficulties, expressing and/or understanding, reach the family and social environment, creating a barrier between the person and those around them.

therapeutic care, the rehabilitation of communication difficulties, the adaptation and maximization of the resources of the environment and of the person themselves, result from vital importance to improve quality of life of people with aphasia and/or other cognitive deficits.

This article is merely informative, at PsychologyFor we do not have the power to make a diagnosis or recommend a treatment. We invite you to go to a psychologist to treat your particular case.

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