June 10, 2005
Intensive Therapy Helps Stroke Patients Speak
DALLAS -- Intensive therapy with people who suffered a stroke years earlier seems to improve their speaking ability, a small study suggests, offering hope to stroke victims and their families. Although the experiment needs to be duplicated with a larger, broader group, several experts praised the results.
"Anything that sort of tests our old thinking, which is that you can't get better after a year, I always think is exciting," said Dr. Marilyn Rymer, medical director of the Saint Luke's Mid America Brain and Stroke Institute in Kansas City, Mo., who was not involved in the study.
Researchers looked at 27 stroke survivors - 16 men and 11 women with an average age of 51 - who had suffered for about four years from varying degrees of aphasia, problems with speaking and comprehending words following a stroke.
About 700,000 people each year experience a new or recurrent stroke in the United States. Signs of a stroke include a sudden loss of vision in one or both eyes, sudden loss of strength or sensation on one side of the body and slurred speech or a change in language.
The patients in the study were given 30 hours of speech training - three hours a day over a period of 10 days. Before the training, the patients had trouble finding the right words or understanding what other people said. They improved right away after the training and that progress was maintained six months later.
Lead author of the study, Marcus Meinzer of the Unversitat Konstanz in Konstanz, Germany, said that about 38 percent of stroke survivors have aphasia after a stroke on the left side of the brain. While there is often spontaneous improvement in patients during the first six months after a stroke, as many as 60 percent still have problems speaking six months later.
For the study published Thursday in the American Heart Association journal Stroke, the therapists used games to encourage patients to speak rather than relying on gestures to communicate. Players had to ask for cards that matched the images on cards given to them.
"They play a card game with increasingly complex items and we require patients to increase complexity of utterances used," Meinzer wrote in an e-mail.
He said that they tested language functions like naming, repeating words and sentences, comprehension and written language.
Fifteen of the patients were also given additional therapy including reinforcement by family members at home and they were sent out into real-life situations with family members in which they had tasks such asking a tourist office for suggestions on sightseeing, Meinzer said.
Researchers found that language skills improved in 85 percent of the patients, and in the second group the improvements were even more pronounced. Patients and relatives in both groups saw an increase in quality of everyday communication following the training.
Dr. David C. Hess, chairman and professor of neurology at Medical College of Georgia in Augusta, noted that the median age of the group was quite young. "This is a younger group and younger brains recover better than older brains."
Dr. James C. Grotta, professor of neurology and director of the stroke program at the University of Texas Medical School at Houston, warned the results are preliminary and patients shouldn't expect miraculous recoveries. But he did say that the study offers hope.
"There is hope out there for recovery, even years after a stroke," Grotta said.
"To improve a person's language is dramatic four years after a stroke," Dr. Robert Felberg, director of the stroke program at the Ochsner Clinic Foundation in New Orleans.
American Stroke Association: http://www.strokeassociation.org/