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Aphasia due to stroke affects communication and quality of life. Most stroke survivors with aphasia receive speech and language therapy. Although an early start of treatment is advocated in clinical practice, evidence for "The earlier, the better" in aphasia rehabilitation is weak. Hence, clinicians are faced with the dilemma of when to initiate intensive treatment: as early as possible, when most of the spontaneous recovery occurs but when patients are often ill, or later, when the patients' condition is more stabilized. Here we discuss whether aphasia outcome is affected by timing of treatment in relation to stroke onset and whether there is evidence for an optimal window of time during which language therapy should be provided. Findings from various rehabilitation research fields are discussed and combined to provide principles for future research.

This article describes the state of the art of Melodic Intonation Therapy (MIT), a structured aphasia therapy program using the melodic aspects of language (intonation, rhythm, and stress) to improve language production. MIT was developed in the 1970s and is still used worldwide. Nevertheless, we argue that many questions crucial for the clinical application of MIT are still unanswered. First, a review of MIT effect studies is presented showing that evidence from well-designed group studies is still lacking. It is also unclear which aspects of MIT contribute most to its therapeutic effect and which underlying neural mechanisms are involved. Two cases are presented illustrating unsolved questions concerning MIT in clinical practice, such as candidacy and the best timing of this therapy., (Copyright © 2012 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.)

Background: There is an ongoing debate whether the effect of Melodic Intonation Therapy (MIT) in patients with severe non-fluent aphasia depends on recruitment of right hemisphere (RH) structures for language functioning or on re-recruitment of left hemisphere (LH) language structures. So far, neuroimaging studies have produced conflicting evidence. Aims: To investigate whether a shift in language lateralisation occurs after intensive treatment in subacute (<3 months post onset) and chronic (>1 year post onset) stroke patients with aphasia. Method & Procedures: In a multiple case pilot study with pre-post-design 5 subacute and 4 chronic stroke patients received intensive MIT (6 weeks, 30 sessions). Pre- and post-treatment they underwent functional MRI scanning with a passive listening task to determine language lateralisation indices (LIs). Outcomes & Results: No consistent shift of language activation was found either to the LH or to the RH. With one exception, subacute patients showed symmetrical or right-lateralised language activation pretreatment, which tended to become more right lateralised after treatment. Language activation in chronic patients was left lateralised in two of the four participants, with a tendency towards stronger left lateralised activation after treatment. Conclusions: Data for the subacute patients provide some support for the classical notion that MIT promotes recruitment of RH structures for language processing. However, the contrasting activation patterns in chronic participants before as well as after treatment suggest that reorganisation of language after MIT occurs in interaction with a dynamic recovery process after stroke. Time post onset should be addressed systematically in studies of treatment-induced language recovery. [ABSTRACT FROM AUTHOR]

Melodic Intonation Therapy (MIT) is a language production therapy for severely nonfluent aphasic patients using melodic intoning and rhythm to restore language. Although many studies have reported its beneficial effects on language production, randomized controlled trials (RCT) examining the efficacy of MIT are rare. In an earlier publication, we presented the results of an RCT on MIT in subacute aphasia and found that MIT was effective on trained and untrained items. Further, we observed a clear trend in improved functional language use after MIT: subacute aphasic patients receiving MIT improved considerably on language tasks measuring connected speech and daily life verbal communication. Here, we present the results of a pilot RCT on MIT in chronic aphasia and compare these to the results observed in subacute aphasia. We used a multicenter waiting-list RCT design. Patients with chronic (>1 year) post-stroke aphasia were randomly allocated to the experimental group (6 weeks MIT) or to the control group (6 weeks no intervention followed by 6 weeks MIT). Assessments were done at baseline (T1), after 6 weeks (T2), and 6 weeks later (T3). Efficacy was evaluated at T2 using univariable linear regression analyses. Outcome measures were chosen to examine several levels of therapy success: improvement on trained items, generalization to untrained items, and generalization to verbal communication. Of 17 included patients, 10 were allocated to the experimental condition and 7 to the control condition. MIT significantly improved repetition of trained items (β = 13.32, p = 0.02). This effect did not remain stable at follow-up assessment. In contrast to earlier studies, we found only a limited and temporary effect of MIT, without generalization to untrained material or to functional communication. The results further suggest that the effect of MIT in chronic aphasia is more restricted than its effect in earlier stages post stroke. This is in line with studies showing larger effects of aphasia therapy in earlier compared to later stages post stroke. The study was designed as an RCT, but was underpowered. The results therefore have to be interpreted cautiously and future larger studies are needed. [ABSTRACT FROM AUTHOR]

Purpose: The present article aimed to inform clinical practice on whether people with aphasia (PWA) deploy pantomime techniques similarly to participants without brain damage (PWBD) and if not, what factors influence these differences. Method: We compared 38 PWA to 20 PWBD in their use of 6 representation techniques (handling, enact, object, shape, deictic, and other ) when pantomiming objects, and determined whether PWA used the same defaults as PWBD. We assessed the influence of (non-)dominant arm use, ideomotor apraxia, semantic processing, aphasia severity, and oral naming. Results: PWA used various pantomime techniques. Enact, deictic, and other were used infrequently. No differences were found for the use of shape techniques, but PWA used fewer handling and object techniques than PWBD and they did not use these for the same objects as PWBD did. No influence was found for (non-)dominant arm use. All other variables correlated with the use of handling, object, and defaults. Conclusion: In our study, PWA were able to use various pantomime techniques. As a group, they used these techniques differently from PWBD and relied more heavily on the use of shape techniques. This was not influenced by a hemiparesis, but seemed dependent on semantic processing. Clinical implications are discussed. [ABSTRACT FROM AUTHOR]