Aphasia newest application for Constraint Induced Therapy

Researchers at UAB are using Constraint Induced Therapy, a rehab technique first developed for stroke, in a new way — as a therapy for patients with aphasia.



Wilmer Poynor has always been a pretty outgoing fellow. You don’t spend 50 years in the life insurance business without spending a lot of time talking to a lot of people. So the stroke he suffered in June of 2009 was especially devastating because it robbed him of one of his most cherished assets – the ability to communicate.

Following Wilmer’s stroke, he was left with a condition called aphasia, a language disorder that can affect comprehension, speech, writing and reading. It can occur after stroke or other brain trauma. According to the National Aphasia Association, approximately 100,000 people acquire aphasia each year.

Because of his stroke, Wilmer could only say a few words, and communicated mostly through pointing and gestures.

“Losing the ability to communicate can be significantly devastating,” said Margaret Johnson, SLP.D., a doctor of speech-language pathology and an assistant professor at the University of Montevallo. “Your personality changes, your whole ability to feel connected to people changes. It is a serious, serious problem.”

Johnson took a sabbatical from Montevallo to come to the University of Alabama at Birmingham to research Constraint Induced (CI) Therapy for aphasia, because UAB is the home of CI therapy. It was developed by UAB neuroscientist Edward Taub, Ph.D., a professor of psychology. Based on ground-breaking studies Taub has conducted for more than 31 years, CI Therapy in essence helps the brain re-wire itself after injury.

“It turns out the adult brain is quite plastic — meaning it has the ability to make new connections,” said Taub. “CI Therapy helps the brain re-connect the wiring and restore functional ability that has been lost due to injury.”

Taub’s first application for CI Therapy was in motor deficit after stroke. Since then, the therapy has been shown to have beneficial applications for a variety of conditions, including traumatic brain injury, cerebral palsy and multiple sclerosis. The current application of CI Therapy to aphasia is a revision and much-improved version of an earlier therapy devised by Taub and German colleagues in 2002.

Wilmer Poynor was one of the first two volunteers for the Constraint Induced Therapy for aphasia trial at UAB developed by Taub and Johnson.

“We use various tasks like sentence repetition, word repetition, verbal card games, role-playing tasks, picture description and finally home practice,” said Leslie Harper, a speech/language pathologist participating in the research. “Constraints are used to prevent subjects from using gestures or facial expressions in order to increase their complexity of verbal expression.”

The “constraint” in aphasia therapy is different than it is for motor deficit. Therapists helping a patient regain the use of the arm and hand will physically restrain the unaffected hand with a mitt, forcing the patient to use the affected hand for all tasks. When treating aphasia, the restraint is more subtle. Gestures are not allowed, and the focus is on creating complete sentences.

“We place barriers in front of our patients, because a lot of aphasic patients want to use facial expressions and gestures to help them communicate,” said Harper. “They use telegraphic speech, trying to get their communication partner to pull out some of the things they want to say. We don’t allow any of that. This study requires them to use all of the language that they have.”

After four hours of therapy a day every day for three weeks, Wilmer is now returning for weekly follow up visits with his therapists. His wife Carol has seen a profound change

“He used to just point but now he says words, and sentences,” she says. “His communication has increased so much, as has his self-esteem because he can communicate better. To be able to express his thoughts, needs and feelings again has made a huge difference.”

Margaret Johnson says preliminary results of the trial indicate that the therapy is producing a remarkably large change in use of language and communication skills.

“I’m definitely encouraged by what I see,” she says.

So is Carol Poynor. “We continue to work; we do our homework all the time. Both of us are absolutely counting on his speech getting even better.”

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