Roberts, Sophie Madeleine; (2024) The effect of age, education, and early speech and language therapy on aphasia outcomes and recovery. Doctoral thesis (Ph.D), UCL (University College London).

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Abstract

Post-stroke aphasia outcomes vary due to the influence of many stroke- and non-stroke-related factors. My thesis investigates how ‘predictor’ variables, which are known early post-stroke, influence long-term language scores and participant-reported recovery in a sample of 749 stroke survivors with heterogeneous lesions and symptoms. The effect of early clinical therapy was also investigated in a smaller sample of participants with left hemisphere lesions and severe-to-moderate initial aphasia. Five variables had a significant influence on long-term language scores: left hemisphere lesion size, initial severity of aphasia symptoms, age at stroke, amount of formal education and provision of early therapy. The size and significance of these effects, and the proportion of variance explained by these variables depended on the sample investigated. Specifically, age was significant in both samples, whereas education was only significant in the larger and more heterogeneous sample, and early therapy was only significant in the smaller sample of patients with aphasia. Crucially, these experiments also identified how significant effects of one variable depended on others. Unsurprisingly, larger left hemisphere lesion size and initial aphasia severity had the greatest effect on language ability. Nevertheless, the disadvantage of older age, and the benefit of more education were remarkably robust across language tasks and participants with different lesion sizes and initial language abilities. The exception was participants with large lesions and severe initial aphasia. This group had the lowest scores, irrespective of age or education. Finally, early post-stroke clinical speech and language therapy resulted in better short- and long-term language outcomes. These results have novel implications for future studies aiming to predict individual patients' speech and language outcomes after stroke, and their response to therapy. They also have implications for clinicians providing information and speech and language therapy. Ultimately, this contributes to improving patients’ understanding of their recovery potential.

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