title: A comparison of aphasia therapy outcomes before and after a Very Early Rehabilitation programme following stroke.
abstract: BACKGROUND
  Very early aphasia rehabilitation studies have shown mixed results. Differences in therapy intensity and therapy type contribute significantly to the equivocal results.
  
  
  OBJECTIVE
  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
  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.
  
  
  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
  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.
authors.affiliation: Faculty of Health, Engineering and Science, Edith Cowan University, Joondalup, WA, Australia; Clinical Centre of Research Excellence in Aphasia Rehabilitation, Brisbane, QLD, Australia.
authors.forename: Erin
authors.initials: E
authors.lastname: Godecke
authors.forename: Natalie A
authors.initials: NA
authors.lastname: Ciccone
authors.forename: Andrew S
authors.initials: AS
authors.lastname: Granger
authors.forename: Tapan
authors.initials: T
authors.lastname: Rai
authors.forename: Deborah
authors.initials: D
authors.lastname: West
authors.forename: Angela
authors.initials: A
authors.lastname: Cream
authors.forename: Jade
authors.initials: J
authors.lastname: Cartwright
authors.forename: Graeme J
authors.initials: GJ
authors.lastname: Hankey
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001037:Aphasia / Q000534:rehabilitation* / Q000628:therapy; D002545:Brain Ischemia / Q000534:rehabilitation / Q000628:therapy; D002543:Cerebral Hemorrhage / Q000534:rehabilitation / Q000628:therapy; D015331:Cohort Studies; D004185:Disability Evaluation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007808:Language Therapy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D013070:Speech Therapy / Q000379:methods*; D020521:Stroke / Q000628:therapy; D000071939:Stroke Rehabilitation; D061665:Time-to-Treatment; D016896:Treatment Outcome
keywords: Very Early Rehabilitation; aphasia; stroke