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The methodological quality of short-term/working memory treatments in post-stroke aphasia: A systematic review

Lookup NU author(s): Helen Kelly, Dr Christos Salis



This is the authors' accepted manuscript of an article that has been published in its final definitive form by American Speech-Language-Hearing Association, 2019.

For re-use rights please refer to the publisher's terms and conditions.


Purpose The aim of this systematic review is to provide a critical overview of short-term memory (STM) and working memory (WM) treatments in stroke aphasia and to systematically evaluate the internal and external validity of STM/WM treatments. Method A systematic search was conducted in 2014 February and then updated in 2016 December using 13 electronic databases. We provided descriptive characteristics of the included studies, and assessed their methodological quality using the Risk of Bias in N-of-1 Trials (RoBiNT) quantitative scale, which was completed by two independent raters. Results The systematic search and inclusion/exclusion procedure yielded 17 single case or case-series studies with 37 participants for inclusion. Nine studies targeted auditory STM consisting of repetition and/or recognition tasks, whereas eight targeted attention and WM, such as attention process training (ATP) including n-back tasks with shapes and clock faces, and mental math tasks. In terms of their methodological quality, quality scores on the RoBiNT scale ranged from 4 to 17 (mean = 9.5) on a 0–30 scale, indicating high risk of bias in the reviewed studies. Effects of treatment were most frequently assessed on STM, WM, and spoken language comprehension. Transfer effects on communication and memory in activities of daily living were tested in only 5 studies. Conclusions Methodological limitations of the reviewed studies make it difficult, at present, to draw firm conclusions about the effects of STM/WM treatments in post-stroke aphasia. Further studies with more rigorous methodology and stronger experimental control are needed to determine the beneficial effects of this type of intervention. To understand the underlying mechanisms of STM/WM treatment effects and how they relate to language functioning, a careful choice of outcome measures and specific hypotheses about potential improvements on these measures are required. Future studies need to include outcome measures of memory functioning in everyday life and psychosocial functioning more generally to demonstrate the ecological validity of STM and WM treatments.

Publication metadata

Author(s): Zakariás L, Kelly H, Salis C, Code C

Publication type: Article

Publication status: Published

Journal: Journal of Speech, Language, and Hearing Research

Year: 2019

Volume: 62

Issue: 6

Pages: 1979-2001

Print publication date: 19/06/2019

Online publication date: 21/05/2019

Acceptance date: 24/12/2018

Date deposited: 16/01/2019

ISSN (print): 1092-4388

ISSN (electronic): 1558-9102

Publisher: American Speech-Language-Hearing Association


DOI: 10.1044/2018_JSLHR-L-18-0057


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