Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Hostname: page-component-586b7cd67f-dlnhk Total loading time: 0 Render date: 2024-11-26T14:28:09.849Z Has data issue: false hasContentIssue false

Chapter 24 - Language and Cognitive Rehabilitation after Stroke

from Part VI - Stroke Rehabilitation and Recovery

Published online by Cambridge University Press:  15 December 2020

By
Marian C. Brady  and
Jonathan J. Evans
Edited by
Jeffrey L. Saver  and
Graeme J. Hankey
Jeffrey L. Saver
Affiliation:
David Geffen School of Medicine, University of Ca
Graeme J. Hankey
Affiliation:
University of Western Australia, Perth
Get access

Summary

Language and cognitive impairments are common consequences of stroke. These difficulties persist with 60% of stroke survivors continuing to experience memory problems, 50% attention deficits and 61% communication problems long after the onset of the stroke-related impairments. Such deficits are ‘invisible’ – evident only through patient report, behavioural observation or formal assessment. The impacts of such deficits are considerable and can include prolonged hospital stays, poorer functional recovery and reduced quality of life. Effective and timely rehabilitation of language (auditory comprehension, expressive language, reading and writing) and cognitive abilities (memory, attention, spatial awareness, perception and executive function) are crucial to optimise recovery after stroke. In this chapter we review the current evidence base, relevant clinical guidelines relating to language and cognitive impairments and consider the implications for stroke rehabilitation practice and future research. Speech and language therapy offers benefit to people with aphasia after stroke; intensive intervention, if tolerated, likely augments the benefits. Interventions for deficits in all non-language cognitive domains exist, but need refining and evaluating more thoroughly with a wider range of methodologies.

Keywords

Aphasialanguage rehabilitationcognitive rehabilitationconstraint-induced aphasia therapymemoryexecutive functionvisual fieldshemispatial neglecttreatment
Type
Chapter
Information
Stroke Prevention and Treatment
An Evidence-based Approach
 , pp. 501 - 516
Publisher: Cambridge University Press
Print publication year: 2020

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Albert, ML, Sparks, RW, Helm, NA. (1973). Melodic intonation therapy for aphasia. Arch Neurol, 29(2)130–1.Google Scholar
Baddeley, AD, Wilson, BA. (1994). When implicit learning fails: amnesia and the problem of error elimination. Neuropsychologia, 32, 53–68.CrossRefGoogle ScholarPubMed
Barker-Collo, S, Feigin, VL, Lawes, CM, Parag, V, Senior, H, Rodgers, A. (2009). Reducing attention deficits after stroke using attention process training: a randomized controlled trial. Stroke, 40(10), 3293–8CrossRefGoogle ScholarPubMed
Barker-Collo, S, Feigin, VL, Parag, V, Lawes, CMM, Senior, H. (2010). Auckland Stroke Outcomes Study Part 2: Cognition and functional outcomes 5 years poststroke. Neurology, 75, 1608–18.Google Scholar
Black-Schaffer, RM, Osberg, JS. (1990). Return to work after stroke: development of a predictive model. Arch Phys Med Rehabil, 71(5), 285–90.Google Scholar
Bowen, A, Hazelton, C, Pollock, A, Lincoln, NB. (2013). Cognitive rehabilitation for spatial neglect following stroke. Cochrane Database Syst Rev, 7. CD003586. doi:10.1002/14651858.CD003586.pub3.Google Scholar
Bowen, A, Hesketh, A, Patchick, E, Young, A, Davies, L, Vail, A, et al. (2012). Clinical effectiveness, cost effectiveness and service users’ perceptions of early, well-resourced communication therapy following a stroke: a randomised controlled trial (the ACT NoW Study). Health Technol Assess, 16(26), 1–160.Google Scholar
Bowen, A, Knapp, P, Gillespie, D, Nicolson, DJ, Vail, A. (2011). Non-pharmacological interventions for perceptual disorders following stroke and other adult-acquired, non-progressive brain injury. Cochrane Database Syst Rev, 4. CD007039.Google Scholar
Brady MC, Ali M, VandenBerg K, Williams J, Williams LR, Abo M, et al. (2020). RELEASE: a protocol for a systematic review based, individual participant data, meta- and network meta-analysis, of complex speech-language therapy interventions for stroke-related aphasia.Aphasiology, 34, (2), 137–57.Google Scholar
Brady, MC, Godwin, J, Kelly, Enderby P, Elders, A, Campbell, P. (2018). Attention control comparisons with SLT for people with aphasia following stroke: methodological concerns raised following a systematic review. Clin Rehabil, 32(10), 1383–95. doi 0269215518780487.CrossRefGoogle ScholarPubMed
Brady, MC, Kelly, H, Godwin, J, Enderby, P, Campbell, P. (2016). Speech and language therapy for aphasia following stroke. Cochrane Database Syst Rev, 6. CD000425. doi:10.1002/14651858.CD000425.pub4.Google Scholar
Breitenstein, C, Grewe, T, Flöel, A, Ziegler, W, Springer, L, Martus, P, et al., for the FCET2EC study group. (2017). Intensive speech and language therapy in patients with chronic aphasia after stroke: a randomized, open-label, blinded-endpoint, controlled trial in a health-care setting. Lancet, 389(10078), 1528–38.CrossRefGoogle Scholar
Burgess, PW, Shallice, T. (1997). The Hayling and Brixton Tests. Bury St. Edmunds: Thames Valley Test Company.Google Scholar
Chung, CSY, Pollock, A, Campbell, T, Durward, BR, Hagen, S. (2013). Cognitive rehabilitation for executive dysfunction in adults with stroke or other adult non-progressive acquired brain damage. Cochrane Database Syst Rev, 4. CD008391. doi:10.1002/14651858.CD008391.pub2.CrossRefGoogle ScholarPubMed
Ciccone N, West D, Cream A, Cartwright J, Rai T, Granger A, et al. (2016) Constraint-induced aphasia therapy (CIAT): a randomised controlled trial in very early stroke rehabilitation. Aphasiology, 30(5), 566–84.CrossRefGoogle Scholar
Cicerone, KD, Langenbahn, DM, Braden, C, Malec, JF, Kalmar, K, Fraas, M, et al. (2011). Evidence-based cognitive rehabilitation: updated review of the literature from 2003 through 2008. Arch Phys Med Rehabil, 92, 519–30.CrossRefGoogle ScholarPubMed
das Nair, R, Cogger, H, Worthington, E, Lincoln, NB. (2016). Cognitive rehabilitation for memory deficits after stroke. Cochrane Database Syst Rev, 9. CD002293. doi:10.1002/14651858.CD002293.pub3.Google Scholar
das Nair, R, Lincoln, N. (2007). Cognitive rehabilitation for memory deficits following stroke. Cochrane Database Syst Rev, 3. CD002293. doi:10.1002/14651858.CD002293.pub2.Google Scholar
David, R, Enderby, P, Bainton, D. (1982). Treatment of acquired aphasia: speech therapists and volunteers compared. J Neurol Neurosurg Psychiatry, 45(11), 957–61.Google Scholar
Dickey, L, Kagan, A, Lindsay, MP, Fang, J, Rowland, A, Black, S. (2010). Incidence and profile of inpatient stroke-induced aphasia in Ontario, Canada. Arch Phys Med Rehabil, 91(2), 196–202.CrossRefGoogle ScholarPubMed
Engelter, ST, Gostynski, M, Papa, S, Frei, M, Born, C, Ajdacic-Gross, V, et al. (2006). Epidemiology of aphasia attributable to first ischemic stroke: incidence, severity, fluency, etiology, and thrombolysis. Stroke, 37(6), 1379–84.Google Scholar
Evans, JJ. (2003). Rehabilitation of executive deficits. In Wilson, BA, ed., Neuropsychological Rehabilitation. Abingdon: Swets and Zeitlinger.Google Scholar
Evans, JJ. (2009). The cognitive group, Part 2: Memory. In Wilson, BA, Gracey, F, Evans, JJ, Bateman, A, eds., Neuropsychological Rehabilitation: Theory, Therapy and Outcomes. Cambridge: Cambridge University Press.Google Scholar
Evans, JJ. (2013). Disorders of memory. In Goldstein, LH, McNeil, JE, eds., Clinical Neuropsychology: A Practical Guide to Assessment and Management for Clinicians. 2nd ed. Chichester: Wiley.Google Scholar
Evans, JJ, Needham, P, Wilson, BA, Brentnall, S. (2003). Which memory impaired people make good use of memory aids? Results of a survey of people with acquired brain injury. J Int Neuropsychol Soc, 9, 925–935.CrossRefGoogle ScholarPubMed
Fong, KNK, Chan, MKL, Ng, PPK, Tsang, MHN, Chow, KKY, Lau, CWL, et al. (2007). The effect of voluntary trunk rotation and half-field eye-patching for patients with unilateral neglect in stroke: a randomized controlled trial. Clin Rehabil, 21, 729–41.Google Scholar
Frassinetti, F, Angeli, V, Meneghello, F, Avanzi, S, Ladavas, E. (2002) Long-lasting amelioration of visuospatial neglect by prism adaptation. Brain, 125, 608–23.CrossRefGoogle ScholarPubMed
Gialanella, B. (2011) Aphasia assessment and functional outcome prediction in patients with aphasia after stroke. J Neurol, 258(2), 343–9.Google Scholar
Gialanella, B, Prometti, P. (2009). Rehabilitation length of stay in patients suffering from aphasia after stroke. Top Stroke Rehabil, 16(6):437–44.Google Scholar
Gillespie, DC, Bowen, A, Chung, CS. Cockburn, J, Knapp, P, Pollock, A. (2015) Rehabilitation for post-stroke cognitive impairment: an overview of recommendations arising from systematic reviews of current evidence. Clin Rehabil, 29(2), 120–8.Google Scholar
Godecke, E, Rai, T, Cadilhac, DA, Armstrong, E, Middleton, S, Ciccone, N, et al., (2018). Statistical analysis plan (SAP) for the Very Early Rehabilitation in Speech (VERSE) after stroke trial: an international 3-arm clinical trial to determine the effectiveness of early, intensive, prescribed, direct aphasia therapy. Int J Stroke, 13(8), 863–80.CrossRefGoogle Scholar
Hoffmann, T, Bennett, S, Koh, CL, McKenna, KT. (2010). Occupational therapy for cognitive impairment in stroke patients. Cochrane Database Syst Rev, 9. CD006430. doi:10.1002/14651858.CD006430.pub2.Google Scholar
Howard, D, Patterson, K, Franklin, S, Orchard-lisle, V, Morton, J. (1985). The facilitation of picture naming in aphasia. Cogn Neuropsychol, 2(1), 49–80.CrossRefGoogle Scholar
Hurkmans, J, de Bruijn, M, Boonstra, AM, Jonkers, R, Bastiaanse, R, Arendzen, H, et al. (2012). Music in the treatment of neurological language and speech disorders: A systematic review. Aphasiology, 26(1), 1–19.CrossRefGoogle Scholar
Intercollegiate Stroke Working Party. (2016). National Clinical Guideline for Stroke. 5th ed. Royal College of Physicians. Available at: https://www.rcplondon.ac.uk/guidelines-policy/stroke-guidelines. Accessed 24th January 2020.Google Scholar
Jokinen, H, Melkas, S, Ylikoski, R, Pohjasvaara, T, Kaste, M, Erkinjuntti, T, et al. (2015). Post-stroke cognitive impairment is common even after successful clinical recovery. Eur J Neurol, 22, 1288–94.Google Scholar
Krasny-Pacini, A, Chevignard, M, Evans, JJ. (2014). Goal management training for rehabilitation of executive functions: a systematic review of effectiveness in patients with acquired brain injury. Disabil Rehabil, 36, 105–16.Google Scholar
Levine, B, Robertson, IH, Clare, L, Carter, G, Hong, J, Wilson, BA, et al. (2000). Rehabilitation of executive functioning: an experimental-clinical validation of goal management training. J Int Neuropsychol Soc, 6, 299–312.Google Scholar
Loetscher, T, Lincoln, NB. (2013). Cognitive rehabilitation for attention deficits following stroke. Cochrane Database Syst Rev, 5. CD002842.Google ScholarPubMed
Luauté, J, Halligan, P, Rode, G, Rossetti, Y, Boisson, D. (2006). Visuo-spatial neglect: a systematic review of current interventions and their effectiveness. Neurosci Biobehav Rev, 30(7), 961–82.CrossRefGoogle ScholarPubMed
Middleton, LE, Lam, B, Fahmi, H, Black, SE, McIlroy, WE, Stuss, DT, et al. (2014). Frequency of domain-specific cognitive impairment in sub-acute and chronic stroke. Neurorehabilitation, 34(2), 305–12.Google Scholar
Mizuno, K, Tsuji, T, Takebayashi, T, Fujiwara, T, Hase, K, Liu, M. (2011). Prism adaptation therapy enhances rehabilitation of stroke patients with unilateral spatial neglect: a randomized, controlled trial. Neurorehabil Neural Repair, 25, 711–20.CrossRefGoogle ScholarPubMed
National Institute for Health and Care Excellence (NICE). (2013). Stroke rehabilitation: long-term rehabilitation after stroke. Retrieved from www.nice.org.uk/guidance/cg162.Google Scholar
Nouwens, F, de Lau, LM, Visch-Brink, EG, van de Sandt-Koenderman, WM, Lingsma, HF, Goosen, S, et al. (2017). Efficacy of early cognitive-linguistic treatment for aphasia due to stroke: a randomised controlled trial (Rotterdam Aphasia Therapy Study-3). Eur Stroke J, 2(2), 126–36.Google Scholar
Palmer R, Dimairo M, Cooper C, Enderby P, Brady M, Bowen A, Latimer N, Julious S, Cross E, Alshreef A , Harrison M, et al. (2019). Self-managed, computerised speech and language therapy for patients with chronic aphasia post-stroke compared with usual care or attention control (Big CACTUS) : a multicentre, single-blinded, randomised controlled trial. Lancet Neurol, 18(9), 821–33.Google Scholar
Paolucci, S, Matano, A, Bragoni, M, Coiro, P, De Angelis, D, Fusco, FR, et al. (2005). Rehabilitation of left brain-damaged ischemic stroke patients: the role of comprehension language deficits. Cerebrovasc Dis, 20(5), 400–06.Google Scholar
Pedersen, PM, Vinter, K, Olsen, TS. (2004). Aphasia after stroke: type, severity and prognosis. The Copenhagen Aphasia Study. Cerebrovasc Dis, 17(1), 35–43.Google Scholar
Pollock, A, Hazelton, C, Henderson, CA, Angilley, J, Dhillon, B, Langhorne, P, et al. (2011). Interventions for visual field defects in patients with stroke. Cochrane Database Syst Rev, 10. CD008388. doi:10.1002/14651858.CD008388.pub2.Google Scholar
Pollock, A, Hazelton, C, Rowe, FJ, Jonuscheit, S, Kernohan, A, Angilley, J, et al. (2019). Interventions for visual field defects in patients with stroke. Cochrane Database Syst Rev, 5. CD008388. doi:10.1002/14651858.CD008388.pub3.Google Scholar
Pulvermuller, F, Neininger, B, Elbert, T, Mohr, B, Rockstroh, B, Koebbel, P, Taub, E. (2001). Constraint-induced therapy of chronic aphasia after stroke. Stroke, 32(7): 1621–6.CrossRefGoogle ScholarPubMed
Robertson, IH, McMillan, TM, MacLeod, E, Edgeworth, J, Brock, D. (2002). Rehabilitation by limb activation training reduces left-sided motor impairment in unilateral neglect patients: a single-blind randomised control trial. Neuropsychol Rehabil, 12, 439–54.Google Scholar
Rowe, FJ, Wright, D, Brand, D, Jackson, C, Harrison, S, Maan, T, et al. (2013). A prospective profile of visual field loss following stroke: prevalence, type, rehabilitation, and outcome. Biomed Res Int, 2013, 719096.Google Scholar
Sackley, CM, Walker, MF, Burton, CR, Watkins, CL, Mant, J, Roalfe, AK, et al. (2015). An occupational therapy intervention for residents with stroke related disabilities in UK care homes (OTCH): cluster randomised controlled trial. BMJ, 350, h468.CrossRefGoogle ScholarPubMed
Sarno, MT. (1969). The Functional Communication Profile: Manual of Directions. Vol. 42. New York: Institute of Rehabilitation Medicine, New York University Medical Center.Google Scholar
Seghier, ML, Patel, E, Prejawa, S, Ramsden, S, Selmer, A, Li, L, et al. (2016). The PLORAS database: a data repository for predicting language outcome and recovery after stroke. Neuroimage, 124(Pt B), 1208–12.Google Scholar
Sickert, A, Anders, LC, Munte, TF, Sailer, M. (2014). Constraint-induced aphasia therapy following sub-acute stroke: a single-blind, randomised clinical trial of a modified therapy schedule. J Neurol Neurosurg Psychiatry, 85(1), 51–5.Google Scholar
SIGN. (2010). 118 Management of patients with stroke: rehabilitation, prevention and management of complications, and discharge planning. A national clinical guideline. Edinburgh: Scottish Intercollegiate Guidelines Network. ISBN 978 1 905813 63 6. www.sign.ac.uk/assets/sign118.pdfGoogle Scholar
Stahl, B, Mohr, B, Büscher, V, Dreyer, FR, Lucchese, G, Pulvermüller, F. (2017) Efficacy of intensive aphasia therapy in patients with chronic stroke: a randomised controlled trial. J Neurol Neurosurg Psychiatry, 89, 586–92.Google Scholar
Tate, RL, Perdices, M, McDonald, S, Togher, L, Rosenkoetter, U. (2014). The design, conduct and report of single-case research: resources to improve the quality of the neurorehabilitation literature. Neuropsychol Rehabil, 24, 315–31.Google Scholar
Tatemichi, TK, Desmond, DW, Stern, Y, Paik, M, Sano, M, Bagiella, E. (1994). Cognitive impairment after stroke – frequency, patterns, and relationship to functional abilities. J Neurol Neurosurg Psychiatry, 57, 202–07.Google Scholar
Tunnard, C, Wilson, BA. (2014). Comparison of neuropsychological rehabilitation techniques for unilateral neglect: an ABACADAEAF single-case experimental design. Neuropsychol Rehabil, 24, 382–99.Google Scholar
van der Meulen, I, van de Sandt-Koenderman, ME, Ribbers, GM. (2012). Melodic Intonation Therapy: present controversies and future opportunities. Arch Phys Med Rehabil, 93(1 Suppl), S46–52.CrossRefGoogle ScholarPubMed
van der Meulen, I, van de Sandt-Koenderman, WM, Heijenbrok-Kal, MH, Visch-Brink, EG, Ribbers, GM. (2014). The efficacy and timing of melodic intonation therapy in subacute aphasia. Neurorehabil Neural Repair, 28(6),36–44.Google Scholar
Vataja, R, Pohjasvaara, T, Mäntylä, R, Ylikoski, R, Leppävuori, A, Leskelä, M, et al. (2003). MRI correlates of executive dysfunction in patients with ischaemic stroke. Eur J Neurol, 10, 625–31.CrossRefGoogle ScholarPubMed
von Cramon, DY, von Cramon, GM, Mai, N. (1991). Problem-solving deficits in brain-injured patients: a therapeutic approach. Neuropsychol Rehabil, 1, 45–64.Google Scholar
Wallace, SJ, Worrall, L, Rose, T, Le Dorze, G, Breitenstein, C, Hilari, K, et al. (2019). A core outcome set for aphasia treatment research: the ROMA consensus statement. Int J Stroke, 14(2), 180–5. doi:1747493018806200.Google Scholar
Whitworth, A, Webster, J, Howard, D. (2005). A Cognitive Neuropsychological Approach to Assessment and Intervention in Aphasia: A Clinician’s Guide. Hove: Psychology Press.CrossRefGoogle Scholar
Wilson, BA. (2002). Towards a comprehensive model of cognitive rehabilitation. Neuropsychol Rehabil, 12, 97–110.Google Scholar
Wilson, BA, Alderman, N, Burgess, PW, Emslie, H, Evans, JJ. (1996). The Behavioural Assessment of Dysexecutive Syndrome. Flempton: Thames Valley Test Company.Google Scholar
Wilssens, I, Vandenborre, D, van Dun, K, Verhoeven, J, Visch-Brink, E, Marien, P. (2015). Constraint-induced aphasia therapy versus intensive semantic treatment in fluent aphasia. Am J Speech Lang Pathol, 24(2), 281–94.Google Scholar
Westerberg, H, Jacobaeus, H, Hirvikoski, T, Clevberger, P, Ostensson, ML, Bartfai, A, et al. (2007). Computerized working memory training after stroke – a pilot study. Brain Inj, 21(1), 21–9.Google Scholar

Save book to Kindle

To save this book to your Kindle, first ensure [email protected] is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×