Patterns of Recovery From Aphasia in the First 2 Weeks After Stroke

Abstract

Purpose Recovery from aphasia after stroke has a decelerating trajectory, with the greatest gains taking place early and the slope of change decreasing over time. Despite its importance, little is known regarding evolution of language function in the early postonset period. The goal of this study was to characterize the dynamics and nature of recovery of language function in the acute and early subacute phases of stroke. Method Twenty-one patients with aphasia were evaluated every 2-3 days for the first 15 days after onset of acute ischemic or hemorrhagic stroke. Language function was assessed at each time point with the Quick Aphasia Battery (Wilson, Eriksson, Schneck, & Lucanie, 2018), which yields an overall summary score and a multidimensional profile of 7 different language domains. Results On a 10-point scale, overall language function improved by a mean of 1.07 points per week, confidence interval [0.46, 1.71], with 19 of 21 patients showing positive changes. The trajectory of recovery was approximately linear over this time period. There was significant variability across patients, and patients with more impaired language function at Day 2 poststroke experienced greater improvements over the subsequent 2 weeks. Patterns of recovery differed across language domains, with consistent improvements in word finding, grammatical construction, repetition, and reading, but less consistent improvements in word comprehension and sentence comprehension. Conclusion Overall language function typically improves substantially and steadily during the first 2 weeks after stroke, driven mostly by recovery of expressive language. Information on the trajectory of early recovery will increase the accuracy of prognoses and establish baseline expectations against which to evaluate the efficacy of interventions. Supplemental Material https://doi.org/10.23641/asha.7811876.

Figure 1.

Lesion overlay maps for patients with aphasia (n = 21) and patients without aphasia (n = 17).

Figure 2.

Trajectories of early recovery for overall language function and seven language domains. All scores range between 0 (no function) and 10 (normal function). Each patient with aphasia is indicated with a unique arbitrary color, whereas the patients without aphasia are all shown in light gray. Filled circles indicate language evaluations, which are connected by solid lines. For some patients, additional language evaluations were obtained after 15 days, in which case lines are shown so that the subsequent trajectory can be observed. Untestable data points are not shown, so when evaluations begin after the first few days, this implies that the patient was untestable prior to that point. (a) Quick Aphasia Battery (QAB) overall score. (b) Word comprehension. (c) Sentence comprehension. (d) Word finding. (e) Grammatical construction. (f) Speech motor programming. (g) Repetition. (h) Reading.

Figure 3.

The fitted rate of recovery (units/week) for overall language function and seven language domains. Thick horizontal lines show the mean, error bars show 95% confidence intervals, and circles show individual data points. Fitted slopes were derived from mixed models (fixed effect of time postonset, random intercepts and slopes for each patient, correlation between intercepts and slopes), except for speech motor programming where the mixed model was not appropriate, so slopes were fit individually to the two patients who showed improvements in this domain. QAB = Quick Aphasia Battery.