CILT and Intensity in Aphasia Rehabilitation: Evidence and

107 Pages·2012·2.83 MB·English

CILT and Intensity in Aphasia
Rehabilitation: Evidence and
Clinical Issues
Anastasia Raymer, Old Dominion
University
Janet Patterson, VA Northern California
Health Care System
Leora Cherney, Rehabilitation Institute
of Chicago ASHA 2011
Acknowledgments:
Systematic review supported by ASHA
National Center for Evidence-based
Practice (NCEP)
NCEP Staff: Tobi Frymark, Tracy
Schooling, Rob Mullen
The authors have no financial conflicts
of interest
Outline of our Talk
 Principles of neuroplasticity in animal
literature: intensity and use it to improve it.
 Evidence based practice and high quality
systematic reviews
 Principles of CILT
 Updated evidence based review of intensity
and CILT in aphasia
 Intensive treatment/CILT in clinical practice
Barriers to and facilitators of intensive
treatment, including CILT
 Discussion and Questions
Principles that guide our clinical
work
Experience-dependent
neuroplasticity
Evidence-based practice
Mechanisms of Neural Dysfunction
Post Brain Injury
Kleim, 2011; Kerr et al., 2011 JCD
 Core: (red) Damaged neurons
 Diaschisis: (green) Dysfunctional
tissue in adjacent (penumbra) and
distant but connected sites
to a region of brain damage
Mechanisms of Neural Dysfunction
Post Brain Injury
Kleim, 2011; Kerr et al., 2011 JCD
 Learned non-use (animals and humans): Following
brain damage, avoid performing tasks that
engage impaired mechanisms because very
difficult; Instead develop compensatory
strategies to complete the task
Experience-dependent
Neuroplasticity
An enriched experience changes the brain
(Rosenzweig & Bennett 1996; Petrosini et al., 2009)
We must understand ways to amplify the experiences in
therapy to maximize benefits and minimize
counterproductive effects
Translational Neuroscience
Animal Models
What can animal models inform us about
language and language rehabilitation?
Principles of neurorehabilitation
-Of course there are limits
but many principles are applicable
Principles of Neuroplasticity:
Animal Models
Kleim & Jones, JSLHR 2008; Kleim JCD 2011;
Kerr et al., JCD 2011
• Use it or Lose it • Time Matters
• Use it and Improve it • Salience Matters
• Specificity necessary • Age Matters
• Repetition Matters • Transference happens
• Intensity Matters • Interference happens
Use it and Improve It
Nudo, 2011 JCD
 Monkeys with lesions to motor cortex in
hand region
 No rehabilitation – hand cortical map
shrinks
 With rehabilitation (pellet retrieval 1 hour
per day) – hand cortical map is
maintained or even expanded;
To encourage monkey to use the impaired
hand, placed in a garment that prevents
use of less affected side – i.e. forced use