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Language therapy in chronic post-stroke aphasia
In collaboration with colleagues abroad, MRC-CBU scientists have developed a new method for the therapy of aphasia in chronic stroke patients. The new method, which practices language in communication context in an intensive manner, is called Constraint-induced aphasia therapy, or CIAT 1.
Constraint-induced aphasia therapy is based on principles from brain science: Learning within the brain is best when we repeatedly practise the skills we want to learn. Learning is accomplished when nerve cells frequently fire together. The more frequently nerve cells fire together, the better we learn. For this reason, language training is performed in a very intensive manner, several hours per day (high therapy frequency).
We also know from neuroscience that the brain systems for language and action are heavily interwoven with each other 2. Hearing a word may automatically activate the motor system and performing actions may help us to understand words 3. Therefore, in the therapy, language is practised in the context of actions. Language is used in games where it is important to use and understand words, just as in everyday life.
Language therapy is administered three or more hours per day for two weeks, providing ample practise for participants. In so-called "language games" (often in form of card games), participants exercise basic and also more advanced language skills such as making a request, answering questions, describing an action etc. Specific exercises and level of practise are tailored to the patients' needs. In a group setting, participants help each other out while practising these language skills. Techniques and skills acquired in the therapy are intensively practised at home as well.
We could demonstrate in a randomised clinical trial that CIAT leads to language improvements, even in patients with chronic aphasia several years after their stroke 1. In a neuroimaging study, we recently showed changes in the brain's processes of language after Constraint induced aphasia therapy 4. Recent work done in collaboration with Prof. berthier's group at the University of Malaga showed that, together with drug therapy, the effect of Constrained-induced aphasia therapy is amplified 5.
1. Pulvermüller, F. et al. Constraint-induced therapy of chronic aphasia following stroke. Stroke 32, 1621-1626 (2001).
2. Pulvermüller, F. Brain mechanisms linking language and action. Nature Reviews Neuroscience 6, 576-582 (2005).
3. Pulvermüller, F., Hauk, O., Nikulin, V. V. & Ilmoniemi, R. J. Functional links between motor and language systems. European Journal of Neuroscience 21, 793-7 (2005).
4. Pulvermüller, F., Hauk, O., Zohsel, K., Neininger, B. & Mohr, B. Therapy-related reorganization of language in both hemispheres of patients with chronic aphasia. Neuroimage (2005).
5. Berthier, M. L. et al. Memantine and constraint-induced aphasia therapy in chronic post-stroke aphasia. Annals of Neurology in press (2009).