How To Do Constraint-Induced Language Therapy

In this article, you’ll learn how to do constraint-induced language therapy.

Constraint-induced language therapy, also known as constraint-induced aphasia therapy, is an evidence-based language treatment for chronic expressive aphasia.

In this article you’ll learn:

  • How to do constraint-induced language therapy
  • What the research says
  • Best practices

Let’s get started!

What is Constraint-Induced Language Therapy?

what is constraint-induced language therapy?

Constraint-Induced Language Therapy (CILT) is an intensive language treatment for expressive aphasia. It’s used to improve verbal speech in those with chronic aphasia who have some verbal output.

CILT is also known as constraint-induced aphasia therapy or CIAT. 

It’s different from any other aphasia rehabilitation approach because it requires ‘forced use’ of spoken language for 2-4 hours every day.

CILT was modeled after Constraint-Induced Movement Therapy, a well-known technique to rehabilitate upper limb movement after a stroke or other neurological injury. It encourages forced use of the affected limb by constraining the less-affected limb, often by covering that hand with a mitt.

Similarly, CILT encourages the forced use of spoken language while discouraging (‘constraining’) compensatory communication strategies like writing, gestures, or AAC. 

It’s a more intense and rigid aphasia treatment, so it won’t be the right fit for all patients. But for some, it can be an effective way of improving verbal output.

What Is The Goal of CILT?  

CILT for aphasia

The goal of constraint-induced language therapy is to increase spoken language through high-intensity training. It uses massed practice, one of the 10 principles of neuroplasticity. 

Who Developed CILT?

Constraint-induced aphasia therapy was developed by Friedemann Pulvermuller and colleagues in 2001.

Their founding study showed that people treated with CIAT scored significantly higher in naming and comprehension than the control groups (Pulvermüller, 2001).

All study participants had chronic aphasia and received 3-4 hours of daily, intensive language exercises for 10 days.

It was a promising start. But 20 years in, what does the research say?

What Does The Research Say?

examples of constraint induced aphasia therapy

Researchers agree that the intensive part of CILT works. But there are mixed findings about whether the ‘forced use’ of verbal language adds value.

A 2020 systematic review found that constraint-induced language therapy improves naming, comprehension, repetition, written language, and oral language when measured by the Western Aphasia Battery. But not when measured by the Boston Naming Test or the Aachen Aphasia Test (Wang, 2020). 

And a 2023 study of systematic reviews and meta-analyses found that constraint-induced language therapy improves language and communication—but not any better than other high-intensity multimodality treatments (Raymer, 2023).

However, Edward Taub, creator of the original constraint-induced movement therapy (and co-creator of the aphasia version) developed an updated protocol that may have better results. It’s called ‘CIAT II.’

More on that below.

What’s The Takeaway?

CILT is one of many great tools to have in your aphasia toolbox. When deciding whether to use it, think patient-centered treatment.

What does your patient want?

What are their strengths and weaknesses?

How are their support systems, including funding and caregiver support? 

If your patient has the motivation, stamina, and support to do intensive language training for 2-4 hours per day, CILT may be a great fit.

Read More About Expressive Aphasia:

How To Do Constraint-Induced Language Therapy?

how to do constraint induced language therapy?

The 3 principles of constraint-induced language therapy are:

  1. Forced Use. Only speaking is allowed
  2. Constraint. No compensations (no gestures, writing, or AAC)
  3. Massed Practice. Intensive practice for 2-4 hours per day (5 days per week)

Constraint-Induced Aphasia Therapy Protocol

constraint-induced language therapy principles

The revised CIAT II protocol is a lot.

Most (but not all) activities are timed, the researchers made up a card game, and the home program has 100 options.

In this article, we’ll review CIAT II’s 5 treatment exercises and top tips for success. Read the full protocol.

5 treatment exercises:

  1. Speech repetition drills (20 minutes)
  2. Activities-of-daily-living-phrases repetition drills (25 minutes)
  3. Naming pictures game. Like Go Fish, but using aphasia picture cards (30 minutes)
  4. Picture description (30 minutes)
  5. Role play of daily scenarios (30 minutes)

How to make constraint-induced aphasia therapy more successful:

  • Shape the patient’s responses:
    • Make every task slightly more complex than the patient can do
    • Make it progressively more difficult as they improve
    • Give praise and encouragement
    • Give breaks
    • Only work on one variable at a time. For example, shape complexity (5-word sentence to 10-word sentence to multiple sentences) OR repetition (5+ photos to 10+ photos) But not both.
  • Keep up the intensity
    • Time their responses and require progressively faster speech rates. Gamify by encouraging patients to beat their score
    • Train caregivers not to talk for the patient
  • Be sure to role-play daily scenarios. Functional and meaningful treatment matter!
  • Train caregivers how to do CILT at home with the patient
    • Have the patient and caregivers make a commitment: The patient will speak as much as possible at home while the caregiver will encourage verbal speech without helping too much
    • Daily homework. Assign and have the patient track their home program

(Based on the CILT II protocol by Taub, 2012; Johnson, 2014)

An Example of CILT

constraint induced aphasia therapy

Here’s an example of using constraint-induced language therapy to help a patient describe a picture using verbal language only. Restrain any gestures, pointing, nodding, writing, or AAC.

Use Picture Cards for this activity. 

Treatment Goal: Describe a picture with a complete sentence.

  1. Show your patient a picture card (girl is petting a cow)
    • The patient says “cow.” The patient points at the cow.
  2. Affirm what your patient says, then request a complete sentence.  “Yes, it’s a cow. Remember, no pointing, only talking. What’s the girl doing?”
    • The patient says “girl…cow.” Patient gestures with hand
  3. Again affirm what your patient is saying, requesting more information. “Yes, the girl is petting the cow.  Remember, just say what you see, do not gesture. Now say it in a complete sentence.”
  4. Have the patient continue to attempt a complete sentence. Cue them to focus only on speaking. Provide a verbal model as needed
  5. Continue this task multiple times, then repeat the steps with additional cards

To up the intensity, time how long it takes for them to respond. Then encourage them to beat their time.

More Aphasia Treatment Approaches

If CILT isn’t the right fit for your patient, here are other evidence-based expressive aphasia treatment approaches to look into:

Read 55 Aphasia Treatments for more expressive language treatment ideas.

More Aphasia Materials

Want to save time and hassle? Download the Aphasia Pack for evidence-based materials designed for speech therapy patients.

References

  • Johnson, M. L., Taub, E., Harper, L. H., Wade, J. T., Bowman, M. H., Bishop-McKay, S., Haddad, M. M., Mark, V. W., & Uswatte, G. (2014). An Enhanced Protocol for Constraint-Induced Aphasia Therapy II: A Case Series. https://doi.org/10580360002300010060
  • Pulvermüller, F., Neininger, B., Elbert, T., Mohr, B., Rockstroh, B., Koebbel, P., & Taub, E. (2001). Constraint-induced therapy of chronic aphasia after stroke. Stroke32(7), 1621–1626. https://doi.org/10.1161/01.str.32.7.1621
  • Raymer, A. M., & Roitsch, J. (2023). Effectiveness of Constraint-Induced Language Therapy for Aphasia: Evidence From Systematic Reviews and Meta-Analyses. American journal of speech-language pathology32(5S), 2393–2401. https://doi.org/10.1044/2022_AJSLP-22-00248
  • Taub, E. (2012). The Behavior-Analytic Origins of Constraint-Induced Movement Therapy: An Example of Behavioral Neurorehabilitation. The Behavior Analyst, 35(2), 155-178. https://doi.org/10.1007/BF03392276
  • Wang, G., Ge, L., Zheng, Q., Huang, P., & Xiang, J. (2020). Constraint-induced aphasia therapy for patients with aphasia: A systematic review. International journal of nursing sciences7(3), 349–358. https://doi.org/10.1016/j.ijnss.2020.05.005
Scroll to Top