Aphasia Treatment: What is the recommended digital speech-language therapy frequency?

If you’re a person living with aphasia after a stroke or traumatic brain injury (TBI)—or a loved one, caregiver, or clinician to one—you’re likely on a quest to find an aphasia treatment plan that yields the best outcomes. Perhaps you’ve dedicated yourself to the Constant Therapy program and wonder whether all your hard work will pay off for your aphasia recovery journey. Fortunately, groundbreaking research published in the peer-reviewed Journal of Medical Internet Research offers decisive evidence that it does.

This BrainWire post will delve into the key findings of that research, “Dosage Frequency Effects on Treatment Outcomes Following Self-Managed Digital Therapy: Retrospective Cohort Study,” and discuss its actionable implications for stroke survivors around the world. 

Aphasia treatment: Research study design

Researchers at Boston University collaborated with Constant Therapy to assess how the frequency of use (“dosage frequency”) of the program affected speech, cognitive, and language skills over a 10-week period. To do so, they analyzed anonymized, de-identified data collected between October 2016 and 2019 from a total of 2,249 patients with aphasia. The average participant was 63 years old and the majority were within the first six months of poststroke recovery. Only data from users who self-reported a stroke diagnosis with subsequent speech, language, and cognitive impairments were included in the study. 

Due to Constant Therapy’s wide range of 85 unique evidence-based tasks spanning multiple skill domains, the program offered the ideal avenue through which to investigate whether gains with dosage frequency accrued evenly across skill areas. Moreover, Constant Therapy’s patented, AI-driven NeuroPerformance Engine, which customizes exercise selection and adapts task difficulty according to user performance, allowed for individualized results from the baseline week 0 through to week 9. 

The research sorted participants into one of five categories according to their median frequency of Constant Therapy practice: 1, 2, 3, 4, or ≥ 5 days of use per week. Participant scores across tasks in 13 skill domains were then measured in relation to usage category to determine how the frequency of Constant Therapy use affected performance over time. The research hypothesis was that patients who used Constant Therapy more frequently every week would exhibit the most significant treatment gains. 

Main takeaway: about 4 days per week of Constant Therapy is optimal for aphasia treatment

The research confirmed the hypothesis and put data behind what many patients, caregivers, and clinicians already knew intuitively—that is, users who more frequently completed digital rehabilitation with Constant Therapy experienced significantly greater improvement in their speech, language, and cognitive abilities compared to less-frequent users. More specifically, researchers found that patients who practiced Constant Therapy four or more days per week exhibited the greatest improvement over the 10 weeks. In fact, incremental improvement accumulated with almost every day of additional practice. Put differently, four-times-a-week Constant Therapy users improved more than thrice-a-week users, thrice-a-week users more than twice-a-week users, and so on, although all usage groups improved from their baseline scores. In short, every daily decision by a patient to self-initiate Constant Therapy practice does make a difference.

Just as significant, while no notable difference between skill-specific scores across usage groups was observed at baseline, that fact changed over the 10-week observation period. The general trend that higher weekly program use led to greater improvement also held in 9 of 13 individual skill domains as well. More frequent Constant Therapy use most significantly led to functional improvement in the analytical and attention span domains. Such a finding has particular relevance for users who, in addition to overall improvement, are looking to regain their abilities in particular skill areas. Regardless of an individual patient’s end goal, this study suggests that more frequent practice of preferably four days each week is the way to go.

This line graph shows that although patients with aphasia across all usage frequency groups improved their skill (“domain”) scores over 10 weeks of Constant Therapy use, those users who practiced four to five days a week for their aphasia treatment exercises experienced the greatest improvement.

Call to action: strive for 4 days of Constant Therapy per week

This research offers a valuable contribution to scientific literature through its discovery that treatment frequency, and not merely total therapy hours, is vital in fostering functional gains. While it acknowledges that a research-practice gap exists in aphasia rehabilitation, this new study goes a step beyond that by offering insight into how efforts to remediate that disparity should take shape. Namely, the gap between the amount of therapy found effective in research and that typically received by patients might best be bridged by more frequent weekly Constant Therapy practice, ideally four days per week, rather than less frequent but longer individual sessions. 

The study’s use of data collected in real-world settings—as opposed to in strictly controlled research environments, which are often difficult to replicate in daily life—only heightens the practical import of its findings. All data emerged from typical patient use of Constant Therapy over the course of everyday life, so usage patterns should be realistically implementable by a wide range of current and prospective users. 

Because this research found that the rate of patient improvement is greatly influenced by the frequency of practice, patients can aim for 4 or more days of Constant Therapy per week to optimize improvement. While even one day of practice per week makes a difference, this study suggests that there is an inherent benefit to more frequent Constant Therapy use, and such a result may well influence clinical dosage guidelines. 

From a clinician’s perspective, for instance, it would be more beneficial to recommend that patients complete Constant Therapy exercises four days a week for a shorter amount of time, rather than a single, longer session in a week. And from a patient’s perspective, if you’re ever feeling discouraged, remember that with each additional day you pick up your tablet, Chromebook, or phone to do even a short Constant Therapy session, you are effecting change in your recovery. 

Read the Research
Cordella, C., Munsell, M., Godlove, J., Anantha, V., Advani, M., & Kiran, S. (2022). Dosage Frequency Effects on Treatment Outcomes Following Self-managed Digital Therapy: Retrospective Cohort Study. Journal of Medical Internet Research, 24(7), e36135. https://doi.org/10.2196/36135

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