Comparative Efficacy of Cognitive Training for Post-Stroke Aphasia: A Systematic Review and Network Meta-Analysis

Neurorehabilitation and Neural Repair

Kong, Q., Wang, J., et al. (2024).

Neurorehabilitation and Neural Repair, 38(11-12), 863-876.

<div>This systematic review and meta-analysis explores the effects of cognitive intervention, in isolation or combined with speech and language therapy (SLT), on language function in individuals with post-stroke aphasia.&nbsp;</div>

National Natural Science Foundation of China; National Administration of Traditional Chinese Medicine; International Cooperation Department for Traditional Chinese Medicine; Base-Type Project of the Special Project of International Cooperation in Traditional Chinese Medicine; Beijing University of Chinese Medicine

From database inception to June 12, 2023

<div>Randomized controlled trials</div>

11

<div>WM training plus SLT had the highest probability of improving WAB Aphasia Quotient (AQ) scores in individuals with post-stroke aphasia.<br><br>WM training plus SLT demonstrated superior WAB AQ outcomes when compared to:</div> <div> <ul> <li>SLT plus computerized cognitive therapy (standardized mean difference [SMD] = 1.55);&nbsp;</li> <li>SLT plus computer-assisted cognitive training delivered via telehealth (SMD = 1.79); and</li> <li>SLT alone (SMD = 1.94).</li> </ul> <div>No significant differences in WAB AQ scores were reported following WM training plus SLT when compared to:</div> <div> <ul> <li>SLT and virtual reality-based (VR-based) cognitive treatments; and</li> <li>SLT plus conventional cognitive training, and attention training.</li> </ul> <div>WM training plus SLT was the only identified treatment to result in statistically significant superiority for WAB AQ scores. Comparisons between all remaining treatments were not statistically significant.</div> <div>&nbsp;</div> <div>Limitations to this review include heterogeneity in study design, significant risk of bias within all included studies, limited available research, and a small scope regarding treatment outcomes (i.e., WAB scores).&nbsp;</div> </div> </div>

<div>Working memory (WM) training plus SLT had the highest probability of improving WAB Spontaneous Speech (SS) scores in individuals with post-stroke aphasia. Specific findings included:&nbsp;</div> <div> <ul> <li>WM training plus SLT resulted in better WAB SS scores when compared to SLT plus computerized cognitive therapy (SMD = 0.87), SLT plus VR-based cognitive treatments (SMD = 1.07), and SLT alone (SMD = 1.13).&nbsp;</li> <li>Attention training plus SLT resulted in better WAB SS scores when compared to SLT plus VR-based cognitive treatments (SMD = 0.72) and SLT alone (SMD = 0.78).</li> <li>Conventional cognitive training plus SLT resulted in better WAB SS scores when compared to SLT alone (SMD = 0.66).</li> <li>For WAB SS scores, no other comparisons between the above treatments were statistically significant.</li> </ul> </div> <div>Limitations to this review include heterogeneity in study design, significant risk of bias within all included studies, limited available research, and a small scope regarding treatment outcomes (i.e., WAB scores).</div>

<div>VR-based cognitive treatment plus SLT had the highest probability of improving WAB Auditory Comprehension (AC) scores for individuals with post-stroke aphasia. Specific findings included:</div> <div> <ul> <li>VR-based cognitive treatments plus SLT improved WAB AC scores when compared to SLT alone (SMD = 1.47).</li> <li>WM training plus SLT improved WAB AC scores when compared to SLT alone (SMD = 1.20).</li> <li>Regarding WAB AC scores, no other treatment comparisons were statistically significant. Other treatments included conventional cognitive training, attention training, and computerized cognitive training delivered face-to-face or via telehealth.&nbsp;</li> </ul> </div> <div>Limitations to this review include heterogeneity in study design, significant risk of bias within all included studies, limited available research, and a small scope regarding treatment outcomes (i.e., WAB scores).</div>

<div>WM training plus SLT had the highest probability of improving WAB Repetition scores in individuals with post-stroke aphasia. Specific findings included:</div> <div> <ul> <li>WM training plus SLT improved WAB Repetition scores when compared to SLT alone (SMD = 1.50).</li> <li>Regarding WAB Repetition scores, no other treatment comparisons were statistically significant. Other treatments included VR-based treatments, conventional cognitive training, attention training, and computerized cognitive training delivered face-to-face or via telehealth.</li> </ul> <div>Limitations to this review include heterogeneity in study design, significant risk of bias within all included studies, limited available research, and a small scope regarding treatment outcomes (i.e., WAB scores).</div> </div>

<div>WM training plus SLT had the highest probability of improving WAB Naming scores in individuals with post-stroke aphasia. Specific findings included:</div> <div> <ul> <li>WM training plus SLT improved WAB Naming scores when compared to SLT alone (SMD = 1.98).</li> <li>Regarding WAB Naming scores, no other treatment comparisons were statistically significant. Other treatments included VR-based treatments, conventional cognitive training, attention training, and computerized cognitive training delivered face-to-face or via telehealth.</li> </ul> <div>Limitations to this review include heterogeneity in study design, significant risk of bias within all included studies, limited available research, and a small scope regarding treatment outcomes (i.e., WAB scores).</div> </div>

<div>SLT combined with cognitive treatments generally led to improved Western Aphasia Battery (WAB) scores in people with post-stroke aphasia when compared to SLT alone. This was especially true for SLT combined with working memory (WM) training and virtual reality-based (VR-based) treatments.</div> <div>&nbsp;</div> <div>Limitations to this review include heterogeneity in study design, significant risk of bias within all included studies, limited available research, and a small scope regarding treatment outcomes (i.e., WAB scores).</div>