Rotterdam Aphasia Therapy Study - 2.

Aim: to evaluate the effect of semantic and phonological treatment on verbal communication in patients with aphasia after stroke.
The study consists of two parts. In Part 1, CLT (BOX and/or FIKS) will be compared with no-CLT (nonspecific aphasia therapy directed to functional language behavior). 80 aphasic patients with semantic and/or phonological disorders will receive treatment 0-6 months post onset. Diagnostic or evaluative tests will be administered pre-therapy, after 3 months and after 6 months. The ANELT is the primary outcome measure. In addition, semantic and phonological tests will be administered. Hypothesis: CLT is more effective than no-CLT.
Depending on the results of Part 1, the intervention contrast will be changed in Part 2. Aphasic patients with semantic and/or phonological disorders (n=80) will be randomized into 2 groups: (1) CLT from 0-3 months, followed by 3 months of no-CLT; (2) no-CLT from 0-3 months, followed by 3 months of CLT. Hypothesis: application in the acute stage, from 0-3 months, enhances the efficacy of CLT.

1. Cognitive linguistic therapy (CLT) is more effective than no-CLT;
2. CLT applied 0-3 months post onset is more effective than applied 3-6 m.p.o.

Assessment:
- Amsterdam-Nijmegen Everyday Language Test (ANELT), scale A
- ScreeLing
- Semantic Association Test (SAT), verbal version
- Semantic Association words with low imageability (PALPA)
- semantic word fluency (animals, professions)
- Nonwords Repetition (PALPA)
- Auditory Lexical Decision (PALPA)
- letter fluency (D, A, T)
- Boston Naming Test
- Token Test (short version)
- Spontaneous Speech
- Partner Communication Questionnaire
- Aachen Aphasia Test
- EuroQol
- Rankin
- Barthel

Therapy:
- CLT: cognitive linguistic therapy using BOX or FIKS or a combination of the two, depending on how the language disorder manifests itself in each patient.
BOX is a lexical semantic treatment program, focused on the interpretation of the semantic features of written words, sentences, and texts.
FIKS is a phonological treatment program focused on sound structure and word form, consisting of exercises for selecting and sequencing speech sounds on word-, sentence- and text level.
Both the paper versions (for individual therapy) and the computerized versions (for additional therapy with homework) can be used.

- no-CLT: all therapy tasks other than cognitive linguistic exercises are allowed. Treatment focused on the linguistic levels (phonology, semantics and syntax) is not permitted. In practice, this means that the control therapy will contain exercises aimed at improving communicative strategies.