Spaced versus massed practice in aphasia therapy.

摘要

Aphasia is a common consequence of stroke. Unfortunately, speech-language therapy (SLT) for persons with chronic aphasia is typically not financially supported by third-party payers and many of these patients go untreated. The effectiveness of speech-language therapy for persons with chronic aphasia has evoked some controversy, although several recent studies and meta-analyses indicate that it is effective if delivered in adequate quantity. Limited research has examined the relative effects of amount versus rate of delivery, which addresses a fundamental concept in learning theory regarding the relative efficacy of spaced versus massed practice. Additionally, research assessing the relative roles of psychological functioning on improvement during SLT is sparse.; The current study compared SLT for patients with chronic aphasia treated in a traditional ("spaced practice") program (3 hours per week for 3-4 months; n = 25) and a time-limited intensive ("massed practice") program (23 hours per week for six weeks; n = 25) and investigated the influence of psychological and neuropsychological variables on the ability of patients to improve. The groups were assessed at baseline and after 30 hours of SLT, and a third assessment was conducted with the Intensive group at the completion of their 6-week protocol.; Results showed that patients in both programs improved significantly. After the initial 30 hours of therapy, there was no significant difference in improvement between the groups; thus, spaced and massed practice models showed equivalent gains. However, when compared at the endpoints of the protocols for each group, the Intensive group showed superior gains to the Traditional group. Baseline language functioning showed significant positive relation to neuropsychological functioning, informant ratings of recovery from stroke, and also to participants' self-ratings of trait affectivity. Remarkably, improvement during SLT from baseline showed significant inverse relations to informant ratings of recovery from stroke and negative affectivity. In a combined predictive model, negative affectivity made a unique contribution to prediction of improvement in language functioning, beyond that accounted for by gross cognitive functioning and stroke recovery ratings.; The findings support the effectiveness of SLT for persons with chronic aphasic in traditional models and indicate that massed-practice models may produce superior gains; however, the specific point at which the benefits of massed practice exceed those of spaced practice remains unclear. Future research examining the roles of psychological functioning in ability to benefit from SLT is warranted.