SPECIAL COMMUNICATIONDefining the Neurobiological Mechanisms of Action in Aphasia Therapies: Applying the Rehabilitation Treatment Specification System Framework to Research and Practice in Aphasia
Section snippets
Rehabilitation Treatment Specification System
As previewed earlier, the RTSS is a framework for defining the elements of a treatment that lead to change(s) in the target behavior. To this end, the RTSS structures treatments so that ingredients (ie, what the clinician does) exert a measurable change on the target skill, via some MOA.3, 4, 5 In turn, the accomplishment of multiple targets leads toward an overall aim, or long-term goal of the treatment. Generally, an aim cannot be met by the improvement of a single skill. If that is the case,
Noninvasive brain stimulation
Thiel10 and Meinzer11 and colleagues used noninvasive brain stimulation to improve language by affecting specific neural mechanisms. Like the other studies reviewed in this article, these 2 studies are examples of organ function treatments. The key ingredients are related to the brain stimulation applied; one method downregulated activity in the right hemisphere to boost left hemisphere activity (Thiel10), and another directly stimulated the stroke-affected left hemisphere (Meinzer11).
First,
Pharmacologic intervention
Pharmacologic interventions have been investigated to modulate brain function. Pharmacologic intervention is another approach that falls within the organ function treatment group and can either be paired with traditional speech-language therapy or used as part of a “drug only” approach to improving aphasia.24 In an example study, Berthier et al15 investigated the effects of a daily dose of 10 mg of memantine on aphasia recovery in 14 participants compared with 13 participants taking a placebo.
Behavioral therapy with explicit neurobiological mechanisms
The last studies we discuss are those that aimed to use behavioral therapy to target language improvements via neural reorganization. These studies are by Abel16,17 and Wilson18 and colleagues. For both studies, treatment ingredients are behavioral speech and language therapies, and targets are language behaviors supported by specific neural processes. Proposed MOAs that improve target behaviors are explained by up and down regulation of key brain regions involved in language,16 promoting more
Discussion
The studies reviewed above illustrate how aphasia therapies can be described using the RTSS framework. Given its emphasis on understanding how treatments work and why, if we frame the aphasia treatment literature according to the RTSS, then we can collate studies to gather evidence supporting how different ingredients influence various neural mechanisms, developing support for theories of the neurobiology of aphasia recovery based on results across multiple studies (and therefore, larger sample
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Cited by (12)
Examining Dose Frameworks to Improve Aphasia Rehabilitation Research
2023, Archives of Physical Medicine and RehabilitationRehabilitation Treatment Specification System: Identifying Barriers, Facilitators, and Strategies for Implementation in Research, Education, and Clinical Care
2023, Archives of Physical Medicine and RehabilitationCitation Excerpt :Because consulting RTSS experts (ie, “identify and prepare champions or external change agents”) helped many respondents to apply the framework, the development of new materials should align with education or training programs designed to increase the number of RTSS experts in various disciplines and specialties, for example, train the trainer models. Most RTSS work has focused on creating educational and training materials to improve the knowledge, beliefs, skills, and self-efficacy of the end-users.9-16,18,19,21-24 However, barriers such as limited available resources, minimal leadership engagement, and lack of outer setting policies would require implementation strategies at the organizational or societal level.
Donepezil alone and combined with intensive language-action therapy on depression and apathy in chronic post-stroke aphasia: A feasibility study
2023, Brain and LanguageCitation Excerpt :Several studies have shown improved language and communication deficits in chronic PSA after administering intensive language-action therapy (ILAT) (for a review, see Pulvermüller et al., 2016). Treatment gains can be augmented and speeded up with cognitive enhancing drugs and non-invasive brain stimulation (Basilakos et al., 2022; Berthier et al., 2009; Berthier, 2021). For instance, a randomized controlled trial (RCT) in chronic PSA showed that the glutamatergic modulator Memantine alone and in combination with ILAT produced significant language and communication benefits, which resulted in an increase of neural activity in both hemispheres (Barbancho et al., 2015; Berthier et al., 2009).
For the Rehabilitation Treatment Specification Networking Group of the American Congress of Rehabilitation Medicine
2022, Archives of Physical Medicine and RehabilitationSpeech-Language Pathology Treatment of Cognitive-Communication Deficits in School-Aged Children With Traumatic Brain Injury: A Scoping Review
2023, Journal of Speech, Language, and Hearing Research
Disclosures: none