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Constraint and multimodal approaches to therapy for chronic aphasia: A systematic review and meta-analysis

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posted on 18.01.2021, 00:05 by John Pierce, Maya Menahemi Falkov, Robyn O’Halloran, Leanne Togher, Miranda Rose
© 2017, © 2017 Informa UK Limited, trading as Taylor & Francis Group. Aphasia is a significant cause of disability and reduced quality of life. Two speech pathology treatment approaches appear efficacious: multimodal and constraint-induced aphasia therapies. In constraint-induced therapies, non-verbal actions (e.g., gesture, drawing) are believed to interfere with treatment and patients are therefore constrained to speech. In contrast, multimodal therapies employ non-verbal modalities to cue word retrieval. Given the clinical and theoretical implications, a comparison of these two divergent treatments was pursued. This systematic review investigated both approaches in chronic aphasia at the levels of impairment, participation and quality of life. After a systematic search, the level of evidence and methodological quality were rated. Meta-analysis was conducted on 14 single case experimental designs using Tau-U, while heterogeneity in the four group designs precluded meta-analysis. Results showed that high-quality research was limited; however, findings were broadly positive for both approaches with neither being judged as clearly superior. Most studies examined impairment-based outcomes without considering participation or quality of life. The application and definition of constraint varied significantly between studies. Both constraint and multimodal therapies are promising for chronic post-stroke aphasia, but there is a need for larger, more rigorously conducted studies. The interpretation of “constraint” also requires clearer reporting.

History

Publication Date

01/01/2019

Journal

Neuropsychological Rehabilitation

Volume

29

Issue

7

Pagination

37p. (p. 1005-1041)

Publisher

Taylor & Francis (Routledge)

ISSN

0960-2011

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