Long-term recovery in stroke accompanied by aphasia: a reconsideration

Background: This work focuses on the 26 individuals who provided data to AphasiaBank on at least two occasions, with initial testing between 6 months and 5.8 years post onset of aphasia. The data are archival in nature and were collected from the extensive database of aphasic discourse in AphasiaBank.

Aims: The aim is to furnish data on the nature of long-term changes in both the impairment of aphasia as measured by the Western Aphasia Battery-Revised (WAB-R) and its expression in spoken discourse.

Methods & Procedures: AphasiaBank’s demographic database was searched to discover all individuals who were tested twice at an interval of at least a year with either (a) the AphasiaBank protocol or (b) the AphasiaBank protocol at first testing, and the Famous People Protocol (FPP) at second testing. The FPP is a measure developed to assess the communication strategies of individuals whose spoken language limitations preclude full participation in the AphasiaBank protocol. The 26 people with aphasia (PWA) who were identified had completed formal speech therapy before being seen for AphasiaBank. However, all were participants in aphasia centres where at least 3 hr of planned activities were available, in most cases, twice weekly. WAB-R Aphasia Quotient scores (AQ) were examined, and in those cases where AQ scores improved, changes were assessed on a number of measures from the AphasiaBank discourse protocol.

Outcomes & Results: Sixteen individuals demonstrated improved WAB-R AQ scores, defined as positive AQ change scores greater than the WAB-R AQ standard error of the mean (WAB-SEM); seven maintained their original WAB quotients, defined as AQ change scores that were not greater than the WAB-SEM; and the final three showed negative WAB-R change scores, defined as a negative WAB-R AQ change score greater than the WAB-SEM. Concurrent changes on several AphasiaBank tasks were also found, suggesting that the WAB-R improvements were noted in more natural discourse as well.

Conclusions: These data are surprising since conventional wisdom suggests that spontaneous improvement in language is unlikely to occur beyond 1 year. Long-term improvement or maintenance of early test scores, such as that shown here, has seldom been demonstrated in the absence of formal treatment. Speculations about why these PWA improved, maintained, or declined in their scores are considered.