Higher or lower weekly intensity for chronic aphasia? Video abstract
Channel: John E. Pierce
Date: 21/11/2020

Video abstract for my systematic review (see also aphasia friendly version)

Pierce, J. E., O'Halloran, R., Menahemi-Falkov, M., Togher, L., & Rose, M. L. (2020). Comparing higher and lower weekly treatment intensity for chronic aphasia: A systematic review and meta-analysis. Neuropsychological Rehabilitation, 34(2), 1–25. https://doi.org/10.1080/09602011.2020.1768127



The most recent systematic review of aphasia therapy demonstrated that it is effective overall, but there are many more questions to answer. One question that speech pathologists, clinicians, PWA and funding bodies want to know the answer to is: Is it better to have a given dose of therapy: 
- at a higher intensity 
- or lower intensity? 
This question is important to get the best outcome from patients’ time and effort, and for the best use of funding Higher intensity treatment is supported by principles of neuroplasticity - the brain should make stronger connections with high repetition in a short period, but this is based on movement and animal models, not aphasia. 
Lower intensity is supported by cognitive learning - repeating things over a more distributed period should improve long-term recall. We investigated this question by finding studies that compared the same amount of a therapy at a higher and lower intensity, in chronic aphasia. 
Overall, our analysis didn’t find a strong difference, although there were very few papers to look at. Importantly, all treatments were effective, from 3 to 15 hours of treatment per week This answer is not conclusive, and needs larger, higher quality studies that directly compare different schedules But... there are so many other factors in what makes treatment effective, so it may not be possible to have a black and white answer. Instead, the best schedule may depend on sophisticated algorithm that combines a person’s age, aphasia characteristics, and lesion properties.