Beyond randomised controlled trials: the case for effective case studies of the effects of treatment in aphasia.

Randomised controlled trials (RCTs) of aphasia therapy have not established that speech therapy is effective with aphasic patients. The characteristics of RCTs, and the assumptions they make, are examined and it is argued that RCTs could never have produced useful information about the effects of treatment with aphasic patients; it is not sensible to investigate the effects of a set of heterogeneous treatment techniques applied to a heterogeneous group of subjects measuring improvement with generalised and insensitive assessment techniques. Instead, effective studies of treatment in aphasia will investigate the usefulness of specific and motivated treatment methods applied to specific aphasic patients. The methodological requirements of scientific studies of aphasia treatment of this kind are discussed, and the appropriateness of three types of experimental design is considered.

[1]  D. Mulhall,et al.  Comparative trial of volunteer and professional treatments of dysphasia after stroke. , 1979 .

[2]  P. Enderby,et al.  Treatment of acquired aphasia: speech therapists and volunteers compared. , 1982, Journal of neurology, neurosurgery, and psychiatry.

[3]  S. J. Evans.  Uses and abuses of analysis of variance. , 1983, British journal of clinical pharmacology.

[4]  Harold Goodglass,et al.  Clinical Aspects of Dysphasia , 1981 .

[5]  M. Coltheart,et al.  The cognitive neuropsychology of language , 1987 .

[6]  T. Pring.  Speech therapists and volunteers--some comments on recent investigations of their effectiveness in the treatment of aphasia. , 1983, The British journal of disorders of communication.

[7]  G. Mulley,et al.  EFFECTIVENESS OF SPEECH THERAPY FOR APHASIC STROKE PATIENTS A Randomised Controlled Trial , 1984, The Lancet.

[8]  A. B. Hill,et al.  Chemotherapy of Pulmonary Tuberculosis in Young Adults , 1952 .

[9]  T. Pring.  Evaluating the effects of speech therapy for aphasics: developing the single case methodology. , 1986, The British journal of disorders of communication.

[10]  A. L. Cochrane,et al.  Effectiveness and efficiency: random reflections on health services , 1972 .

[11]  C. Hagen.  Communication abilities in hemiplegia: effect of speech therapy. , 1973, Archives of physical medicine and rehabilitation.

[12]  D. Weiss,et al.  Veterans Administration cooperative study on aphasia: a comparison of individual and group treatment. , 1981, Journal of speech and hearing research.

[13]  Carolyn Faulder,et al.  Whose body is it? : the troubling issue of informed consent , 1987 .

[14]  C. Bulpitt.  Randomised Controlled Clinical Trials , 1983, Developments in Biostatistics and Epidemiology.

[15]  Tim Shallice,et al.  Case study approach in neuropsychological research , 1979 .

[16]  E. Capitani,et al.  Influence of rehabilitation on language skills in aphasic patients. A controlled study. , 1979, Archives of neurology.

[17]  Writing in Aphasia: A Learning Study , 1967 .

[18]  A. Kertesz,et al.  Effects of speech and language treatment on recovery from aphasia , 1984, Brain and Language.

[19]  J. Morton,et al.  Treatment of word retrieval deficits in aphasia. A comparison of two therapy methods. , 1985, Brain : a journal of neurology.

[20]  Mp. Departz.  Reeducation of a Deep Dyslexic Patient - Rationale of the Method and Results , 1986 .

[21]  R. Koenigsknecht,et al.  Tapping the lexical store of the adult aphasic: analysis of the improvement made in word retrieval skills. , 1973, Cortex; a journal devoted to the study of the nervous system and behavior.

[22]  N. helm-estabrooks,et al.  Response of an agrammatic patient to a syntax stimulation program for aphasia. , 1981, The Journal of speech and hearing disorders.

[23]  Sally Byng,et al.  Aphasia Therapy Research: Methodological Requirements and Illustrative Results , 1986 .

[24]  J. Morton,et al.  Variability and consistency in picture naming by aphasic patients. , 1984, Advances in neurology.

[25]  F. Darley.  The efficacy of language rehabilitation in aphasia. , 1972, The Journal of speech and hearing disorders.

[26]  M. Wilcox,et al.  Adult Aphasia Rehabilitation: Applied Pragmatics , 1985 .