A. Evaluation of the Effectiveness of Constraint Induced Aphasia Therapy on Verbal Communication Disorders (Aphasia) in Meta-Analysis
Based on the meta-analysis process of ten articles, it was found that there are three distinct characteristics in demonstrating the effect of communication card therapy (CIAT) on aphasia in each article. These characteristics include interventions that involve and do not involve control groups, as well as interventions compared with other therapy interventions.
In the study by Kristinsson et al. 8, the effect of Constraint Induced Aphasia Therapy on 107 samples without involving a control group but comparing before and after the intervention was identified. The study's results, with one-hour intervention per day for 5 days a week over a period of 6 weeks, showed a significant improvement in naming performance using the PNT assessment instrument. The study by Mozeiko, Myers & Coelho (2018a) 9 also showed a significant improvement in the writing subtest after being given intervention over two periods with a total therapy duration of 30 hours.
Moreover, the study by Kanamori et al. 18 also showed significant results for three post-stroke aphasia patients with one week of intervention 5x3 hours for 3 weeks. The visible results were measured based on AS and AQ with an average increase of 4.5 points. AQ and AS are assessment instruments for the severity level of language disorders in aphasia.
The study by Rose et al. 10, which compared the Constraint Induced Aphasia Therapy intervention with Multi-Modality Aphasia Therapy and usual care (UC), also showed a significant improvement over usual care or the control group. With the WAB-R-AQ assessment, the comparison results between the intervention group and the control group were 1.05 points (p = 0.36). Meanwhile, the comparison results between Constraint Induced Aphasia Therapy and Multi-Modality Aphasia Therapy were not significantly different, with a score of 0.004 points (p = 1.00). This aligns with the research by Pierce et al. 16, which compared CIAT therapy and M-MAT. Through two methods, initiating with CIAT therapy followed by M-MAT and vice versa, showed more significant results if CIAT therapy was performed first.
The difference in measurement results between the intervention group and the control group was also shown in the study by Szaflarski et al. 13, indicating that with the intervention, there was a difference of 8 points with the mini-CAL research instrument and 9 points using the SFT instrument. Mini-CAL is an instrument to evaluate language ability in speaking, while SFT is an instrument to assess verbal fluency in semantics.
Additionally, the study by Woldag et al. 11 showed the effectiveness of Constraint Induced Aphasia Therapy in improving communication abilities compared with conventional communication therapy (CTG) or without therapy (usual care). After two weeks of treatment, it was shown that the provision of Constraint Induced Aphasia Therapy to patients with severe aphasia benefited more and scored higher on the post-therapy test, especially in the naming and repetition subtests of AAT.
Whereas the study by Ciccone et al. 12 did not show a difference between CIAT therapy and individual-based disorder therapy, but still provided a higher recovery effect on communication than without any intervention.
B. Descriptive Evaluation of the Influence of Communication Cards (CIAT) on Improving Verbal Communication Abilities in Aphasia
Out of the ten articles analyzed, nine articles showed the effectiveness of Constraint Induced Aphasia Therapy in improving verbal language abilities, including naming, comprehension, pronunciation, and reading abilities (Johnson et al. 14; Kristinsson et al. 8; Mozeiko, Myers & Coelho 9; Pierce et al.16; Rose et al.10; Szaflarski et al. 13; Vuksanović et al.15; Wilssens et al.17; Woldag et al. 11)8–11,13–17. Meanwhile, the study by Ciccone et al. 12 showed a significant improvement in the writing category. The key to success in improving these abilities lies in the consistency and sincerity of patients in undergoing therapy.
Furthermore, in six clinical trials that reported differences in Constraint Induced Aphasia Therapy compared to other therapies, such as: M-MAT therapy, CTG (conventional therapy), individual therapy, and Semantic or BOX, it was shown that the use of Constraint Induced Aphasia Therapy achieved more significant progress in expressive and receptive language skills (Ciccone et al. 12; Pierce et al.16; Rose et al. 10; Vuksanović et al. 15; Wilssens et al.17; Woldag et al. 11). Expressive ability occurs when patients can express their desired message, while receptive ability is when patients can receive and understand the message that has been conveyed well.
C. Factors Affecting the Effectiveness of Constraint Induced Aphasia Therapy
- Timing of Treatment
Based on a meta-analysis of 10 clinical trials, it was shown that the timing of intervention affects the success of the Constraint Induced Aphasia Therapy's impact on improving verbal communication abilities in aphasia patients. The average ideal duration of intervention is 3 hours per day, with a total intervention time of 30–40 hours during treatment. The treatment period is generally less than three weeks, but it is not denied that treatment can be extended beyond three weeks. The most intensive treatments exceeding 3 weeks tend to include a combination of therapies, as in the study by Pierce et al. (2023) 16, which reviewed the comparative effects of Constraint Induced Aphasia Therapy with Multi-Modality Aphasia Therapy. However, it is still unclear whether treatments lasting more than three weeks are more effective than those lasting less than three weeks.
- Effect of Follow-Up Treatment Plan
Based on the analysis of 10 articles, studies by Johnson et al. 14 and Mozeiko, Myers & Coelho 9 were deemed more effective in impacting the regimen with an 8-week follow-up period post-treatment. These studies showed maintenance at a long point in time after treatment completion indicates permanent change. Eight weeks is not enough time to determine if the changes will be long-lasting, but it is considered more informative compared to a four-week follow-up, with a minimal risk of participant drop-out.