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One of the (few) strong points that we can get from the last one Cochrane Review of post-stroke aphasia (2016) is that speech therapy must be intensive. In short, many hours are better than a few and the more work, the better. However, even starting from this principle, it is not clear what is meant by intensive treatment and how many hours should actually be spent each week.

An intensive treatment, in fact, could consist of:


  • Many hours a week for a few weeks
  • More hours a day for a shorter period

According to Bhogal, Teasell and Speechley (2003) intensive treatment should require at least 8 hours a week for 2 or 3 months. Also in the same article it is specified that an intensive treatment "compressed" in a shorter period can bring more results than a treatment spread over a longer period.

Some authors have tried to use formulas to calculate the intensity of the treatment:

  • Cumulative Intervention Intensity (Warren et al., 2007): Dose1 x Dose frequency2 x Total intervention duration
  • Therapeutic Intensity Ratio (Babbitt et al., 2015): Number of hours of therapy in a treatment program divided by the total number of hours of potential treatment

Recent treatment protocols they already foresee the intervention doses to be administered. This is the case, for example, of the CIAT (Constraint-Induced Aphasia Therapy) or ILAT (Intensive Language Action Therapy), where treatments can take up to 3-4 hours a day for two weeks.

In general, going through all the literature, the only conclusion that can be drawn is that a high Dose Frequency2 is to be preferred at an early stage to get the most improvement; at a later stage, one can think of reducing the encounters to maintain these improvements.

1 Dose: Number of teaching episodes during the single session
2 Dose frequency: Number of times a dose is given in a unit of time (ex: every hour)

References

Babbitt EM, Worrall L, Cherney LR. Structure, Processes, and Retrospective Outcomes From an Intensive Comprehensive Aphasia Program. Am J Speech Lang Pathol. 2015 Nov; 24 (4): S854-63

Bhogal SK, Teasell R, Speechley M. Intensity of aphasia therapy, impact on recovery. Stroke. 2003 Apr; 34 (4): 987-93.

Brady MC, Kelly H, Godwin J, Enderby P, Campbell P. Speech and language therapy for aphasia following stroke. Cochrane Database of Systematic Reviews 2016, Issue 6. 

Warren SF, Fey ME, Yoder PJ. Differential treatment intensity research: a missing link to creating optimally effective communication interventions. Ment Retard Dev Disabil Res Rev. 2007; 13 (1): 70-7. 

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