Study reveals best dose of speech therapy to maximise recovery for stroke patients with language problems

A world-first study led by Glasgow Caledonian University researcher Professor Marian Brady has revealed insights into the best dose of speech therapy to maximise recovery of stroke patients with language problems.

The international study ‘Dosage, Intensity, and Frequency of Language Therapy for Aphasia: A Systematic Review–Based, Individual Participant Data Network Meta-Analysis’, published in American Heart Association Stroke Journal, involved almost 1000 patients across 28 countries.

The findings will help revamp services for stroke survivors with language problems (aphasia) and inform national and international clinical guidelines.

Around a third of people suffer aphasia after a stroke and it is estimated that there are more than 350,000 people living with aphasia in the UK alone.

The study revealed the best dose for maximum language recovery in patients with aphasia after a stroke was between 20-50 hours in total of speech and language therapy.

Results showed that when rehabilitation was delivered at an intensity of 2-4 hours a week, the greatest gains were made in overall recovery of language and functional communication. However, nine or more hours were needed for improved understanding of the spoken language.

The study also highlighted that practicing rehabilitation tasks at home, outside of face-to-face time with the therapist, was very important and also linked to the best stroke recovery.

Professor Brady said that stroke rehabilitation services were always stretched, even more so now with a pandemic. The research highlighted that pre-pandemic levels of therapy were often insufficient to support optimal recovery. 

She stressed that in the current pandemic, people with aphasia after a stroke are at even greater risk of being short-changed with inadequate services.

Professor Brady hopes the recommendations in the study will be fed into the new UK stroke rehabilitation guidelines for speech and language therapy currently being revised because therapists experience huge limitations in access to resources and in turn the services offered to patients.

Professor Brady, Director of GCU’s NMAHP Research Unit’s Stroke Rehabilitation Research Programme, said: “The reason we carried out this study was to improve services for people with aphasia and to have more clarity about the level of therapy that should be delivered in order to maximise recovery across speaking and understanding of speech.

“The most recent UK guidelines were produced in 2016 and were somewhat vague in the amount of therapy recommended for people with aphasia. They recommend that people with aphasia should be seen by a speech and language therapist but they don’t say what kinds of therapy should be delivered, for how long or how often each week. This new research gives a clear indication of optimum therapy dosage/or prescription for the best language recovery for people with aphasia.”

The study was welcomed by stroke survivors and speech and language therapists Sandra Hewitt, from NHS Highland and Emma Coutts, from NHS Grampian, who said the findings gave the profession “clarity and context”.

Sandra said: “We really welcome this large-scale systematic review involving multi-national researchers. I think it is excellent and it really does help to add to the evidence base for speech and language therapy.

“It gives us clarity and context, and helpful comparisons of different types of treatment for post –stroke aphasia. What’s important about this research is that it allows us to think differently about how we can develop and deliver services creatively with the resources we have, looking at computer-based programmes, for example.”

Emma said: “It has long been recognised that there has been a real need for more high-quality research within aphasia practice. It’s good to get some data on the effectiveness of approaches to treat the impairment itself, but we also have to recognise that we aim to provide a holistic approach.”

Stroke survivors Brian Jackson, 74, and Lawson Hughes, 79, both from Edinburgh, felt strongly that the findings should be included in the new speech and language therapy guidelines.

They praised the therapists who helped them in hospital and at home but feel there needs to be more intense therapy and for longer for people with aphasia after a stroke.

Brian, a retired museum curator in mineralogy, had a stroke in 2014 and his speech has improved but the service could have been better. He turned to costly private speech therapy for help. He also attends the Speakability support group where he has given PowerPoint presentations and is now on the committee.

He said: “A one-size-fits-all approach does not work, aphasia sufferers are all different and need different strategies, more intense therapy would be better, not just one hour per week.”

Lawson, a retired construction manager, said the therapists who helped him after his stroke seven years ago were fantastic but that he didn’t get enough therapy sessions. He is hoping the research will improve services for hundreds of people like him.