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Int J Lang Commun Disord ; 49(2): 149-61, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-24588906

RESUMO

BACKGROUND: Very early aphasia rehabilitation studies have shown mixed results. Differences in therapy intensity and therapy type contribute significantly to the equivocal results. AIMS: To compare a standardized, prescribed very early aphasia therapy regimen with a historical usual care control group at therapy completion (4-5 weeks post-stroke) and again at follow-up (6 months). METHODS & PROCEDURES: This study compared two cohorts from successive studies conducted in four Australian acute/sub-acute hospitals. The studies had near identical recruitment, blinded assessment and data-collection protocols. The Very Early Rehabilitation (VER) cohort (N = 20) had mild-severe aphasia and received up to 20 1-h sessions of impairment-based aphasia therapy, up to 5 weeks. The control cohort (n = 27) also had mild-severe aphasia and received usual care (UC) therapy for up to 4 weeks post-stroke. The primary outcome measure was the Aphasia Quotient (AQ) and a measure of communicative efficiency (DA) at therapy completion. Outcomes were measured at baseline, therapy completion and 6 months post-stroke and were compared using Generalised Estimating Equations (GEE) models. OUTCOMES & RESULTS: After controlling for initial aphasia and stroke disability, the GEE models demonstrated that at the primary end-point participants receiving VER achieved 18% greater recovery on the AQ and 1.5% higher DA scores than those in the control cohort. At 6 months, the VER participants maintained a 16% advantage in recovery on the AQ and 0.6% more on DA scores over the control cohort participants. CONCLUSIONS & IMPLICATIONS: A prescribed, impairment-based aphasia therapy regimen, provided daily in very early post-stroke recovery, resulted in significantly greater communication gains in people with mild-severe aphasia at completion of therapy and at 6 months, when compared with a historical control cohort. Further research is required to demonstrate large-scale and long-term efficacy.


Assuntos
Afasia/reabilitação , Terapia da Linguagem/métodos , Fonoterapia/métodos , Reabilitação do Acidente Vascular Cerebral , Idoso , Idoso de 80 Anos ou mais , Afasia/terapia , Isquemia Encefálica/reabilitação , Isquemia Encefálica/terapia , Hemorragia Cerebral/reabilitação , Hemorragia Cerebral/terapia , Estudos de Coortes , Avaliação da Deficiência , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Acidente Vascular Cerebral/terapia , Tempo para o Tratamento , Resultado do Tratamento
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