Inclusion of people with communication impairment or aphasia in stroke rehabilitation trials
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Inclusion of People with Communication Impairment or Aphasia in Stroke Rehabilitation Trials
Prevalence and Impact of Aphasia Post-Stroke
Aphasia, a language impairment affecting speech, reading, and writing, occurs in approximately one-third of stroke survivors . This condition significantly impacts the quality of life and necessitates targeted rehabilitation interventions to improve communication abilities.
Effectiveness of Speech and Language Therapy (SLT)
Research consistently demonstrates the benefits of SLT for individuals with aphasia. SLT has been shown to improve functional communication, reading, writing, and expressive language compared to no therapy . High-intensity and high-dose SLT interventions may offer additional benefits, although they are associated with higher dropout rates . Intensive SLT, particularly in chronic aphasia cases, has been found to significantly enhance verbal communication in daily life.
Inclusion of People with Aphasia in Stroke Trials
Despite the clear benefits of SLT, people with aphasia (PwA) are often underrepresented in stroke rehabilitation trials. A systematic review found that only 1.5% of participants in stroke intervention trials had aphasia, with many trials excluding individuals with severe aphasia or requiring functional communication as an eligibility criterion. This underrepresentation can limit the external validity and applicability of trial findings to the broader population of stroke survivors with aphasia.
Strategies for Inclusion and Retention
To address the underrepresentation of PwA in stroke trials, researchers recommend several strategies. These include developing aphasia-specific inclusion criteria, providing communication support during the trial, and using augmentative and alternative communication (AAC) interventions alongside traditional SLT . AAC interventions have shown promise in improving communication effectiveness and quality of life for individuals with moderate to severe aphasia.
Precision Rehabilitation Approaches
Recent studies advocate for precision rehabilitation approaches tailored to individual characteristics such as age, sex, aphasia severity, and time since stroke. These approaches can optimize treatment responses and improve language outcomes by adjusting SLT frequency, intensity, and dosage based on specific patient subgroups. For example, younger patients and those with chronic aphasia may benefit more from high-intensity SLT, while older patients and those with severe aphasia may achieve better outcomes with lower-intensity interventions.
Conclusion
Inclusion of people with communication impairments or aphasia in stroke rehabilitation trials is crucial for developing effective, evidence-based interventions. While SLT has proven benefits, the underrepresentation of PwA in trials highlights the need for more inclusive research practices. Implementing tailored rehabilitation strategies and providing adequate support can enhance the participation and retention of PwA in clinical trials, ultimately leading to better rehabilitation outcomes for this population.
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