Rehabilitation of post-stroke aphasia by a single protocol targeting phonological, lexical, and semantic deficits with speech output tasks: a randomized controlled trial.

Abstract

Background: The defective spoken output of persons with aphasia has anomia as a main clinical manifestation. Improving anomia is therefore a main goal of any language treatment.

Aim: This study assessed the effectiveness of a novel, 2-week, rehabilitation protocol (PHOLEXSEM), focused on PHonological, SEmantic, and LExical deficits, aiming at improving lexical retrieval, and, generally, spoken output.

Design: A prospective, randomized controlled trial.

Setting: In-patient and out-patient population of the Neurorehabilitation Unit of the Istituto Auxologico Italiano IRCCS, Milan, Italy.

Population: The sample comprised 44 adults with aphasia due to left brain damage; 22 of them were assigned to the experimental (PHOLEXSEM) group, whereas 22 were assigned to the control group that received the Promoting Aphasics Communicative Effectiveness (PACE) protocol.

Methods: All participants were treated 30-min daily for two weeks. The PHOLEXSEM training included 3 sets of exercises: 1) non-word, word, and phrase repetition; 2) semantic feature analysis by naming; 3) phonemic, semantic, and verb recall. Treatment effects were evaluated with tasks and items different from those used for training, to assess generalization effects.

Results: After the PHOLEXSEM treatment, repetition, naming, lexical retrieval and sentence comprehension improved more than in the control - PACE - group, with gains generalizing to non-trained items. These improvements were independent of aphasia chronicity and only marginally influenced by demographic factors.

Conclusions: The 2-week PHOLEXSEM training, by targeting spoken output, ameliorates different aspects of aphasia, ranging from speech production (i.e., phonology and lexical retrieval) to comprehension.

Clinical rehabilitation impact: The PHOLEXSEM training is a useful and easy-to-administer intervention to improve post-stroke language deficits in adults of different ages, levels of education, duration, type, and severity of aphasia.