Learned communicative non-use is a reality in very early aphasia recovery: Preliminary results from an ongoing observational study.

Godecke, Erin and Armstrong, Elizabeth and Hersh, Deborah and Bernhardt, Julie (2013) Learned communicative non-use is a reality in very early aphasia recovery: Preliminary results from an ongoing observational study. [Clinical Aphasiology Paper]

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Abstract

Recent neurorehabilitation literature in animal motor models suggests very early (before day five post-stroke) intensive (over 300 repetitions) leads to histological damage (Krakauer et al, 2012) and late rehabilitation (commenced after day 30 post-stroke) is much less effective than intervention started earlier in recovery. The intricacies of directly applying animal models of stroke recovery and rehabilitation to human language have been well documented (Varley, 2011). In humans, the first 90 days post-stroke however, are believed to be the "window of opportunity” (Meyer et al., 2010) for neuronal changes to occur as part of neuroplasticity. Research investigating human stroke recovery models, indicates that the timing of commencement of therapy combined with therapy intensity are likely to be pivotal elements in overall stroke recovery (Kerr et al, 2011). Therapy intensity to facilitate stroke recovery in humans is noted to be far less than that in animal models (Krakauer at al., 2012). Research investigating overall activity levels in stroke survivors in the acute recovery demonstrated that patients spent only 13% of their time engaged in activity and spent 60% of the time alone (Berhardt et al, 2004). Further research showed that task specific movement practice occurred in only 51% of sessions during acute and sub-acute therapy sessions (Lang et al., 2009). Similarly, aphasia research in early stroke recovery demonstrated that on average stroke survivors received between 14 minutes (Godecke et al, 2011) and 1.3 hours (Bowen et al, 2012) of therapy per week during the first month post-stroke. To better understand the interactions that occur in early stroke recovery, this study focused on observed communicative activities that may underlie the neuroplasticity principles of “use it or lose it”, and “learned non-use” (Kleim 2011).

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