Speech Language Pathologists’ Opinions of Constraint-Induced Language Therapy Stephen J. Page, PhD, MS, MOT, OTR/L, FAHA,1,2 and Sarah E. Wallace, PhD, CCC-SLP3 1
School of Health and Rehabilitation Sciences, 2B.R.A.I.N. (Better Rehabilitation and Assessment for Improved Neuro-recovery) Laboratory, The Ohio State University Wexner Medical Center, Columbus, Ohio; 3Department of Speech Language Pathology at Duquesne University, Pittsburgh, Pennsylvania Background: Constraint-induced language therapy (CILT) has received recent attention as a possible intervention to improve expressive language in people with nonfluent aphasia. Difficulties have been reported with the practical implementation of constraint-induced movement therapy due to its intensive treatment parameters. It remains unknown whether similar challenges may exist with CILT. Objective: To determine the opinions of speech-language pathologists (SLPs) about CILT for people with nonfluent aphasia. Method and Procedures: One hundred sixty-seven SLPs completed an electronic survey assessing their opinions of various aspects of CILT. Outcomes and Results: Over 60% of participants felt that people with aphasia would be very unlikely or somewhat unlikely to adhere to CILT. The majority felt that people with aphasia would hold high or moderate concerns with the number of hours spent in therapy (high, 41.8%; moderate, 31.4%), the number of days spent in therapy (high, 44.4%; moderate, 24.8%), likelihood for managed care reimbursement (high, 74.8%; moderate, 15.2%), and other logistical issues (high, 39.2%; moderate, 30.7%). With respect to providing CILT, participants cited the number of hours of therapy (high, 37.3%; moderate, 21.6%) and the number of consecutive days of therapy (high, 29.4%; moderate, 20.3%) as concerns. There were 70.6% who indicated that their facilities lacked resources to provide CILT, and 90.9% felt that most facilitates do not have the resources to provide CILT. Conclusions: Some SLPs hold significant concerns with the administration of CILT, particularly related to its dosing and reimbursement parameters. Additional work is needed to investigate the issues that were identified in this survey using qualitative methods with SLPs and people with aphasia and to examine modified CILT protocols. Key words: aphasia, constraint-induced language therapy, speech-language pathology, survey
phasia is primarily characterized by difficulty with expressive and receptive language. Nonfluent aphasia – which affects language production and expression – significantly compromises rehabilitation outcomes and quality of life for more than one million survivors of stroke.1-3 Several interventions have been examined to increase the communication and language abilities of people with nonfluent aphasia. One therapeutic approach that has received recent attention is constraint-induced language therapy (CILT). Derived from positive findings in the stroke motor rehabilitation literature,4,5 CILT increases language skills in people with nonfluent aphasia6-8 via cortical reorganization.9 The therapy as originally described primarily consists of daily, 3-hour, practice sessions provided over a 2-week period.8
During CILT sessions, people with nonfluent aphasia interact with each other through semistructured conversations (eg, discussion of current events) and games that encourage multitiered naming and description of items presented on cards (eg, “go fish”). During these structured exercises, participants are often permitted to use only verbal communication, whereas nonverbal modalities such as gesture or drawing are discouraged.8 Through these structured exercises, participants are engage in functional, contextually relevant, communication behaviors that are thought to re-habituate language production. Shaping (ie, progressively increasing the level of difficulty of required linguistic behaviors to more difficult, functional, and/or appropriate linguistic behaviors) is also used to iteratively progress patients toward their spoken language goals.
Corresponding author: Stephen J. Page, PhD, MS, MOT, OTR/L, FAHA, The Ohio State University Wexner Medical Center, 453 West Tenth Avenue, Suite 406, Columbus, OH 43210; phone: 614-292-5490; fax: 614-292-2101; e-mail: [email protected]
Top Stroke Rehabil 2014;21(4):332–338 2014;21(1):332–338 © 2014 Thomas Land Publishers, Inc. www.thomasland.com www.strokejournal.com
doi: 10.1310/tsr2104-332 10.1310/tscir2101-332