Evidence-based approach to speech therapy introduced for stroke patients

Because physicians and surgeons rely on clinical trials to help determine how to treat their patients, a multidisciplinary team of researchers and speech therapists at Washington University School of Medicine in St. Louis and its affiliate, the Rehabilitation Institute of St. Louis, has developed a speech rehabilitation program for stroke patients that applies the same evidence-based approach.

Robert Fucetola

Many treatments used by Fucetola and colleagues are not the standard techniques used in rehabilitation programs elsewhere. For example, the team recently employed a new technique reported in the literature about one year ago. The approach is similar to constraint-induced movement therapy, which already has been shown to help stroke patients recover motor function. In that therapy, a patient is forced to use an affected limb, thereby improving and strengthening that limb’s ability to function. For example, an oven mitt may be securely placed on a patient’s strong arm during therapy to encourage use of the other, weakened arm.

Research published about a year ago indicated that a similar constraint-induced approach could improve recovery of speech. If, for example, a patient has trouble composing grammatically correct sentences, constraint-induced speech therapy would require him to do just that.

The technique is employed using a card game similar to “Go Fish”: A group of patients, each suffering from different speech problems, convenes several times a week to play the game . Each patient is given specific instructions on how to ask for cards from the other players, tapping into each patient’s specific verbal weakness.

“Normally, speech therapists teach patients to compensate for their problem, using gestures to communicate if they can’t do so with speech,” Fucetola explains. “In contrast, constraint-induced therapy slowly but persistently eases them into improving their specific speech impediment.”

The team plans to publish the decision trees soon so that others can use them to individualize speech rehabilitation for stroke patients on a more scientific basis.

Fucetola R, Tucker FT, Blank K, Corbetta M. An evidence-based aphasia clinic: A work in progress. 34th Annual Clinical Aphasiology Conference, 2004.

The full-time and volunteer faculty of Washington University School of Medicine are the physicians and surgeons of Barnes-Jewish and St. Louis Children’s hospitals. The School of Medicine is one of the leading medical research, teaching and patient care institutions in the nation, currently ranked second in the nation by U.S. News & World Report. Through its affiliations with Barnes-Jewish and St. Louis Children’s hospitals, the School of Medicine is linked to BJC HealthCare.