The Efficacy of Early Cognitive-Linguistic Treatment and Communicative Treatment in Aphasia after Stroke - A Randomized Controlled Trial (RATS-2)

Marjolein de Jong-Hagelstein (1) , Mieke van de Sandt-Koenderman (2) , Niels Prins (1) , Diederik Dippel (1) , Peter Koudstaal (1) , Evy Visch-Brink (1)

1 Erasmus MC - Erasmus University Medical Center [Rotterdam]
2 Rijndam Rehabilitation center, Rotterdam

ABSTRACT Background: The two main approaches in aphasia treatment are cognitive-linguistic treatment (CLT), aimed at restoring the linguistic levels affected, semantics, phonology or syntax, and communicative treatment, aimed at optimizing information transfer by training compensatory strategies and use of residual language skills. We tested the hypothesis that CLT is more effective than communicative treatment in the early stages after stroke. Methods: In this multi-center, randomized, parallel group trial with blinded outcome assessment, 80 patients with aphasia after stroke were included within three weeks post-stroke. Patients received six months of CLT, comprising semantic and/or phonological training, or communicative treatment for at least two hours per week. They were assessed before treatment and at three and six months with the Amsterdam-Nijmegen Everyday Language Test (ANELT-A, primary outcome) and semantic and phonological tests (secondary outcomes). The intervention effect was evaluated by means of analysis of covariance, with adjustment for baseline scores. Results: There was no difference between the mean ANELT-A score of the CLT group (n=38) and the communicative treatment group (n=42), neither at three (adjusted difference: 1.5, 95% confidence interval: -2.6 to 5.6) nor at six months post-stroke (adjusted difference: 1.6, 95% confidence interval: -2.3 to 5.6). On two of six specific semantic and phonological tests the mean scores differed significantly, both in favor of CLT. Conclusion: This study does not confirm our hypothesis that patients with aphasia after stroke benefit more from CLT, aimed at activation of the underlying semantic and phonologic processes, than from general, nonspecific communicative treatment (ISRCTN67723958 Current Controlled Trials).

Mots clés: APHASIA; RANDOMISED TRIALS; SPEECH THERAPY; STROKE

Marjolein de Jong-Hagelstein, Mieke van de Sandt-Koenderman, Niels Prins, Diederik Dippel, Peter Koudstaal, et al.. The Efficacy of Early Cognitive-Linguistic Treatment and Communicative Treatment in Aphasia after Stroke - A Randomized Controlled Trial (RATS-2). Journal of Neurology, Neurosurgery and Psychiatry, 2010, 82 (4), pp.399. ⟨10.1136/jnnp.2010.210559⟩. ⟨hal-00584602⟩