Management of Receptive Aphasia

Introduction to Receptive Aphasia

• Receptive aphasia is a language disorder characterized by difficulty with word-finding and speech production, telegraphic speech patterns with hesitations, and preserved comprehension relative to expression, with internal inconsistency in performance compared to lesion-based patterns 1

Intensive Speech and Language Therapy

• The American Heart Association recommends receptive aphasia be managed through early access to intensive speech and language therapy combined with communication therapy tailored to the patient's needs, goals, and impairment severity 2
• Intensive therapy should be provided as tolerated and feasible, with a recommended duration of at least 45 minutes daily, five days a week, according to the American Heart Association and the International Journal of Stroke 3, 4, 2
• For chronic aphasia (>6 months post-stroke), the American Stroke Association suggests implementing intensive therapy of at least 10 hours/week of therapist-led individual or group therapy for 3 weeks, plus 5+ hours/week of self-managed training 2
• Short-duration intensive therapy (3 weeks) has shown efficacy, while longer durations (12 weeks) may not always be feasible, as stated by the American Heart Association 3

Alternative Communication Strategies

• The International Journal of Stroke guidelines recommend implementing alternative communication strategies including gesture training, drawing techniques, writing strategies, augmentative and alternative communication (AAC) devices, and assistive technology 2
• Alternative communication methods, such as gesture training, drawing techniques, writing strategies, augmentative and alternative communication (AAC) devices, and assistive technology, should be considered and implemented when needed 2, 5, 6, 7

Supplemental Interventions

• Consider computerized treatment to supplement therapist-provided intervention, as recommended by the American Heart Association 2
• Computer-based therapy is beneficial as a supplement to therapist-provided intervention, and can also be used for home practice, as recommended by the American Heart Association 3
• Group therapy can improve specific linguistic processes with comparable outcomes to individual therapy, according to the American Heart Association 3
• Task-specific practice focused on improving functional communication is recommended for aphasia, based on guidelines from the American Stroke Association 3
• Promising medications, such as donepezil, memantine, and galantamine, may provide benefit when used in conjunction with speech-language therapy, according to the American Heart Association 3
• The following medications may be beneficial for language disorders:

Environmental Barriers and Community-Based Therapy

• Address environmental barriers through communication partner training, as recommended by the American Heart Association 2
• Communication partner training is effective for improving communication activities and participation, and should be implemented for family members, as stated by the American Heart Association and other guidelines 3, 1, 6, 2
• Consider community-based aphasia groups for continuing therapy following discharge, as suggested by the American Stroke Association 2
• Ensure discharge planning includes safe and comprehensive plans that are aphasia-friendly, and provide organized, interprofessional care with education for all healthcare providers about aphasia 2

Patient and Family Education

• Provide aphasia-friendly information formats, as recommended by the American Heart Association 2
• Explain the nature of the impairment to the patient, family/carers, and treating team, as suggested by the American Stroke Association 2
• Train family members and caregivers in supported conversation techniques, as suggested by the American Stroke Association 2
• Psychotherapy (cognitive-behavioral therapy) and mindfulness-based therapies for depression are also recommended, based on guidelines from the American College of Physicians 8

Assessment and Screening

• All stroke patients should be screened for communication disorders, including aphasia and dysarthria, by a certified speech-language pathologist, as recommended by the American Stroke Association 3
• Patients should also be screened for emotional disorders, such as depression and anxiety, given their high incidence after stroke, as recommended by the American Stroke Association 9
• A comprehensive assessment of communication abilities should be conducted across multiple domains, including comprehension, speaking, reading, writing, gesturing, use of technology, pragmatics, and conversation, to identify specific pragmatic deficits using validated tools 6, 2
• The following assessment tools can be used to evaluate communication abilities:

Follow-up and Rehabilitation

• Initial review with primary care provider should occur within 2-4 weeks following hospital discharge, according to the International Stroke Society 10
• Psychosocial interventions during transition to community are recommended, based on guidelines from the International Stroke Society 10
• Reassessing goals and treatment plans at appropriate intervals is crucial for ensuring effective rehabilitation, and providing sufficient intensity of intervention is essential for improving communication abilities and quality of life 2