A bit of background:
There are different recovery time points after stroke when different types of recovery occur. All recovery relies on neuroplasticity- the ability for the brain to adapt and change itself.
Spontaneous recovery is recovery that occurs without treatment. It involves a complex process of chemicals and mechanisms after a stroke (or other brain injury) that assists the brain to recover. Rehabilitation may enhance spontaneous recovery. Restitution refers to the return towards more normal patterns of behaviour or ‘true recovery’. Stroke usually leads to an area of cell death that cannot be recovered however rehabilitation can encourage adjacent brain areas to recover function. Other parts of the brain can compensate for the lost functions through learning a new way to achieve the goal and act as a substitute for the area of the brain that cannot recover.
How much and when?
The most up to date summary of evidence comes from The Stroke Foundation Living Clinical Guidelines for Stroke Management and RELEASE Collaborators.
General recovery points
The brain is able to adapt and change itself. Improvement is possible with aphasia therapy
Aphasia therapy should be provided in stroke recovery
Therapy should start within the first 4 weeks after stroke to maximize recovery
Some evidence suggests people with more severe aphasia require more therapy hours per week
Some evidence suggests older individuals (>65 years) may benefit from less intensive therapy
About 60% of people with aphasia immediately after stroke will have aphasia one year later
Early recovery (< 3 months)
The highest level evidence from a single trial focuses on stroke onset to six weeks post stroke. This suggests benefit of aphasia therapy for two to three days per week with sessions of 30-45minutes. More therapy at this time was not beneficial. Additional evidence from combined trial data indicates a similar picture of up to 2 hours per week. Therapy should focus on restitution of lost functions.
Late recovery (>3 months)
Evidence favours more intensive therapy (3-4 hours per week of therapist led therapy) and gains may be less pronounced. Therapy may involve consideration of compensatory techniques.
How will The Speech Rehab Centre help?
We will take into consideration the timepoint of recovery that you are in.
After a thorough assessment we will transparently discuss the recommended dose of therapy and the recovery that you can expect for your timepoint.
Funding for therapy within Australia is frequently limited and does not allow for the recommended dose particularly in the chronic stage of recovery. We will be creative coordinating with other therapists, home programs and support groups to optimise the dose that you receive.
Disclosure
Dr Emily Brogan gives expert input for the Stroke Foundation Living Guidelines for aphasia as a volunteer academic.
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