Objectives: Aphasia is an acquired language disorder that is a common sequelae of stroke and
poses tremendous levels of handicap for the victim as well as burden for caregivers. While
the efficacy of aphasia rehabilitation has been found to be statistically significant in its
effect (Wertz et al., 1986; Robey, 1994), its clinical significance has been often
disappointing (Siegel, 1987). A promising avenue for rehabilitation of chronic aphasia based
on the approach and principles of Constraint Induced Movement Therapy (CIMT) has recently
been described (Pulvermuller et al., 2001). These investigators reported that individuals
with chronic, stable aphasia benefited (statistically as well as clinically) from language
therapy designed to include attributes of CIMT (forced-use delivered in high doses over a
relatively short period of time). In a limitation of the study, the conditions of
constraint-induced language treatment (CILT) and traditional treatment were confounded by
differences in treatment intensity. A pilot study funded by the VA Rehabilitation Research &
Development (RR&D) to begin to control for confounding variables and treatment intensity is
currently underway in a collaboration between the Houston VAMC Center of Excellence in
Healthy Aging with Disabilities and the Brain Rehabilitation Research Center of Excellence in
Gainesville, FL. While data collection is ongoing, preliminary results suggest that
individuals with chronic aphasia made substantial, measurable change on a language battery
following intensive CILT.
The purpose of this study is to expand on the pilot work we have done and to identify the
functional and qualitative impact of these interventions on communication in naturalistic
settings and on caregivers. Specifically, we will compare the relative impact of therapy type
(constrained, forced speech TX vs. multi-modal PACE TX) and dose intensity (massed practice
or distributed) on rehabilitation of chronic aphasia.
Research Plan: Using between group comparisons and multiple-baseline single subject
comparisons, we will examine the impact of CILT in a larger group of individuals with
aphasia, controlling for the confounding variables of massed practice, forced use and
relevant context. In addition, we will investigate the functional and qualitative impact of
these interventions on communication in naturalistic settings.
Methods: A total of 48 subjects collected at three sites (Houston, Gainesville and Tampa
VAMCs) will be randomly assigned across four experimental conditions: 1) intensive CILT; 2)
intensive PACE therapy; 3) distributed CILT and 4) distributed PACE therapy. Pre and post
treatment language assessments, discourse samples, daily probe measures and qualitative
interviews will be used to measure TX effects. In addition, these measures will be
recollected one month following TX to assess the stability of the TX effects.