Patients don't get enough speech therapy

Patients need twice the therapy that insurance is providing and that many are discharged still needing therapy.

Patients need twice therapy they get

In sum, there is good evidence that SLT (Speech  Therapy) benefits patients' functional communication, receptive and expressive language compared to no SLT and it is likely that results are better with intensive rather than low-frequency treatment. There is no evidence that any of the discussed therapies is superior to the others (Brady et al., 2012). Aphasia treatment is usually provided at the intensity of one to five hours per week on average. Recent studies seem to suggest that treatment of such intensity is likely insufficient and it is estimated that almost twice this intensity[ hours per week] is required to achieve significant treatment effects beyond spontaneous recovery (Code and Petheram, 2011).
Recent advances in the treatment of post-stroke aphasia, Neural Regeneration Research, Zumbansen, A. & Thiel, A. (2014). . URL

But resources not available for this Speech Therapy

(above source continues)
However increasing treatment intensity [hours per week] often is not feasible due to economic limitations in most public health systems but also due to the lack of various other resources, such as time and space (Rose et al., 2014). Thus, research on non-behavioral supplementary treatments is needed, which may potentiate the effectiveness of SLT, particularly in acute and subacute stages where the SLT is currently provided with highest intensity (Katz et al., 2000; Verna et al., 2009). Such possible adjuvant strategies may comprise pharmacological approaches as well as non-invasive brain stimulation (NIBS).

 Treatment should be 9h per week. Patients get less than 5

Average hours of treatment for aphasic people in the developed world ranges between 1–5 hours per week, with a great deal of variability, although recent research suggests that intense treatment of 9 hours per week over a relatively short period is needed in order to be effective. It is concluded that there is a significant gap between what the research suggests is the appropriate amount of treatment and actual provision throughout the English-speaking world.
Code, C, Petheram, B 2011. Delivering for aphasia. International Journal of Speech-Language Pathology, 13(1), Pp. 3--10.

Treatment of 2 hours per week was not effective

They found that those studies that showed a significant treatment effect had provided an average of 8.8 hours of therapy per week for 11.2 weeks compared to studies that did not find a significant effect of treatment, which provided only 2 hours per week, but for 22.9 weeks. Studies with a positive outcome had provided an average total of 98.4 hours of therapy, and ineffective studies provided 43.6 hours of therapy.

Total length of therapy time provided was significantly correlated with greater improvement. The study concluded that intensive therapy over a relatively short amount of time can significantly improve outcomes of speech and language. “

Code, C, Petheram, B 2011. Delivering for aphasia. International Journal of Speech-Language Pathology, 13(1), Pp. 3--10.


26% of Patients Discharged Needing More Treatment

From 2006 to 2010, 26.4% of patients were discharged needing more therapy.

From ASHA's Outpatient NOMS 2006-2010, page 15. ASHA is the American Speech-Hearing Association, which licenses and oversees Speech-Language Pathologists.

And 82% of patients are discharged from Outpatient therapy to Home (ASHA Adult NOMS Outpatient Data Report 2011, p 16 Figure 8)

Conclusion & a Solution

We pre-pay for healthcare in the form of Health Insurance and expect to get what we need. And the research shows that what we need is 9 hours of week of treatment. But over a year that would be roughly 468 hours. I've had caregivers tell me they are paying between $100 and $400 per session for speech therapy. And  that sessions are often less than an hour.  So, getting needed level of treatment would likely cost someone $72,200.00 per year for an average patient. Understandably, the insurance company rarely authorizes that much treatment.  And the family can rarely afford that on top of the medical bills the Stroke or brain-injury has already racked up.

So, not surprisingly, patients don't get the amount of therapy they need.
But patients are discharged due to lack of progress rather benefits being exhausted. 

The solution is to make more progress while in therapy. That's what our free Rehab Resources Newsletter is designed to do.


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