The Intensive Comprehensive Aphasia Program (ICAP)

Recent research has emphasized the need for intensive aphasia treatment in order to make the
long-term neuroplastic changes associated with recovery and rehabilitation following a
stroke. Furthermore, studies have indicated that intensive aphasia treatment is more
efficacious than less intensive treatment. Rather than being influenced by such evidence, the
reality is that public and private payers are drastically reducing services to persons with
aphasia (PWA). Legislation has seriously curtailed the amount of treatment a PWA may receive
after hospitalization. Often patients are eligible for only a limited number of treatment
sessions over a limited period of time. In some cases, they may not receive any treatment for
their communication disorder following their acute hospitalization. Reduced resources (e.g.
transportation difficulties, therapist shortages in rural areas) also may severely limit
available services.

The Intensive Comprehensive Aphasia Program (ICAP) may be a creative, cost-effective and
sustainable option for delivering meaningful and necessary aphasia services. Despite the
growing numbers of ICAPs, there is little evidence about their efficacy, effectiveness, or
cost-effectiveness. All stakeholders need this evidence. Funding agencies require evidence to
make decisions about their investments in aphasia rehabilitation. People with aphasia and
their families should have evidence prior to investing their money and time into such
programs, and speech and language pathologists have an ethical obligation to provide
evidence-based practices.

Based on evidence regarding treatment intensity that has translated principles of
neuroplasticity from animal models to stroke recovery, the investigators hypothesize that 60
hours of comprehensive treatment will result in significant improvements in (a)
performance-based, (b) client-reported, and (c) surrogate-reported assessments of
communication skills, community participation, and health-related quality of life. They also
hypothesize that when 60 hours of comprehensive treatment is provided intensively over 3
weeks, the magnitude and rate of improvement as well as the extent to which improvements are
maintained will be greater than when the 60 hours of comprehensive treatment is distributed
over 15 weeks. Because the investigators hypothesize that the magnitude and rate of
improvement will be greater with the intensive ICAP than with the distributed ICAP, they
further hypothesize that the intensive ICAP will be more cost-effective than the distributed
ICAP.

Inclusion Criteria:

1. diagnosis of an aphasia subsequent to a left-hemisphere infarct that is confirmed by
CT scan or MRI

2. an Aphasia Quotient score on the Western Aphasia Battery of 20-85.

3. 6 months post injury

4. premorbidly fluent in English

5. receiving no concomitant speech-language therapy

Exclusion Criteria:

1. diagnosis of Global aphasia

2. any other neurological condition (other than cerebral vascular disease) that could
potentially affect cognition or speech, such as Parkinson's Disease, Alzheimer's
disease and other dementias, or traumatic brain injury

3. any significant psychiatric history prior to the stroke, such as severe major
depression or psychotic disorder requiring hospitalization (subjects with mood
disorders who are currently stable on treatment will be considered)

4. active substance abuse.