Introduction Aphasia is a language disorder which occurs in up to 38% of stroke survivors,

often leaving them with lifelong residual deficits1 .Impairment of language is called aphasia and
the most common cause os aphasia is a stroke affecting the left cerebral hemisphere(a left middle
cerebral artery infarct)2. The focus of this article is on aphasia, establishing the main assessing
and intervention directions after stoke .
Material and method The first step in the management of aphasia requires the initial
diagnosis of the disorder. In the simplest classification ,aphasia is divided into two main
categories:motor aphasia( espressive or anterior aphasia) and sensory aphasia (receptive or
posterior aphasia). Comprehensive evaluation of patients can be performad using aphasia tests:
The Boston Diagnosic Aphasia Examination ,The Western Aphasia Batery, The Porch Index of
communication Ability and the Functional Communication Profile.Other cognitive skills can be
assessed through nonverbal assessments such as Raven’scolored progressive matrices or the
cognitive lingvistic Quick Test. Speech pathologists are typically responsible for diagnosis of
aphasia resulting from stroke[25]. Tests used to assist in this clinical decision making usually
evaluate a range of language skills, identify communicative strengths and weaknesses, aid in
planning treatment and assist with a definitive diagnosis of language impairment [26].
The next step is the incorporation of patient’s family member into functional therapeutic
activities and sessions of speech-language therapy(SLP). In the early stages of rehabilitation it is
important for the therapist to help the patient establish a reliable means for basic yes/no
communication. It is very important that the therapist adapts the rehabilitation program to the
patient and its comorbidities. A randomized controlled trial –Rotterdam aphasia terapy study 3
(2017) that included 152 patients demonstrating that it is not necessary to intervene intensively in
the first three weeks after the stroke, but two recent Cochrane rewiews have made significant
strides toward esthablishing SLT as effective, supporting the neuroplasticity process. Besides the
SLP, another therapeutic method accepted for severe non-fluent aphasia is melodic intonation
Therapy(MIT)- a treatment that uses the musical elements of speech. Berthier et all(2011), Salter
(2013) and Cahana-Amitay(2014) argue that the adding of adjuvant pharmacotherapy like
piracetam , donepezil or memantine improve the SLT effects.
We found 26 different scientific paper, published between 2006-2016 wich used a noninvasive
technique based on transcranial magnetic stimulation(TMS). Acording to the last randomized
controlled trial (2016) TMS should be implemented in aphasia rehabilitation program for
subacute post-stroke patients.Reduction of the excitability of the right peri-sylvian area in a
nonfluent aphasia, can lead to significant improvements. At the turn of this century, a new form
of non-invasive brain stimulation emerged in the field of stroke recovery, transcranial direct
current stimulation (tDCS).Unlike TMS, tDCS uses a low-intensity current of 1–2 mA to
modulate (excite or inhibit) neuronal activity62. It has been explored in stroke rehabilitation as a
method for encouraging brain plasticity, with results often lasting beyond the initial period of
stimulation63. tDCS also has the advantage of being portable, with built-in sham control, making
it suitable for clinical experimentation during behavioral therapies.In addition to the therapies
mentioned, in April 2019, was published a systematic review and meta-analysis of randomized
controlled trials which claims that acupuncture is effective in improving functional
communication in post-stroke40. There is ample agreement in the scientific literature, across
diverse areas of study, that suggests that language and movement are interrelated. In particular, it
is widely held that the upper limb and hand play a key role in language use. A combinatorial
hand-arm-language paradigm that capitalizes on shared neural networks may therefore prove
beneficial for aphasia recovery in stroke patients and requires further exploration.
Conclusion Aphasia is one of the most striking cognitive continuations of strokes that can affect
the rehabilitation program and the reintegration of the patient into social and family life. A model
of how to incorporate the growing knowledge into clinical practice could help to focus future
research.

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Liu G1, Sun JJ1, Yang J2, Zhang QP3.