Intensive language action therapy and recovery in chronic aphasia

Intensive Language Action Therapy (ILAT) is a short-term aphasia therapy that emphasises massed-practise of language, where communication is framed through language action games that approximate everyday interactions. Despite increasing interest in ILAT, a comprehensive description of its methods has thus far been missing. Furthermore due to inconsistent results, further exploration of cortical reorganisation of language functions following ILAT is warranted. The underlying principles and practical features of ILAT methods and of language-action games are fully described, including the structure and materials for two specific games. 14 English speaking patients with chronic aphasia underwent two weeks of ILAT utilising the methods outlined. Pre and post measures of language performance were collected through standardised clinical assessments, along with functional Magnetic Resonance Imaging scans from a subset of 8 patients. Accuracy and response times for speech output and comprehension during language-action games were also recorded to measure success during the therapy interval. Data analysis showed significant improvements in clinical assessments of naming and comprehension, but not in auditory or syntactic processing tasks. Significant increases were also seen in patients’ self-ratings of quality of communication following therapy. Video and voice recordings during therapy sessions demonstrated significantly faster response times in production and comprehension of language, alongside an increase in the complexity of patients’ spoken output. Cortical activation was recorded whilst patients heard low-level noise, sentences containing ambiguous words and low-ambiguity sentences. Although the results showed no changes in cortical activation in the group of patients whilst processing low-level noise or low ambiguity sentences, increases in language-induced activation were seen in single-subject analyses in both the left and right hemispheres. Furthermore the group of patients recruited the right hemisphere significantly more than the left hemisphere following ILAT when processing complex sentences containing ambiguous words. iii Clinical assessments and measures of everyday communication showed undergoing two weeks of ILAT significantly improved speech output and comprehension in patients with chronic aphasia. Gains made in communicative performance during therapy highlight the importance of recording therapy sessions for additional assessment of therapy efficacy. Although conclusions regarding cortical reorganisation are not entirely clear, they indicate the important role of the right hemisphere in reorganisation of language after stroke.