Editing Expressive aphasia (section)

===Constraint-induced therapy===
Constraint-induced aphasia therapy (CIAT) is based on similar principles as [[constraint-induced movement therapy]] developed by Dr. [[Edward Taub]] at the University of Alabama at Birmingham.<ref name='Meinzer' /><ref name='Pulvermuller'>{{cite journal|title=Constraint-Induced Therapy of Chronic Aphasia following Stroke|journal=Stroke|year=2001|first=Friedemann|last=Pulvermuller|pmid=11441210|volume=32|issue=7|pages=1621–1626|url=http://stroke.ahajournals.org/cgi/content/full/32/7/1621|doi=10.1161/01.STR.32.7.1621 |display-authors=etal|citeseerx=10.1.1.492.3416|s2cid=673662}}</ref> Constraint-induced movement therapy is based on the idea that a person with an impairment (physical or communicative) develops a "learned nonuse" by compensating for the lost function with other means such as using an unaffected limb by a paralyzed individual or drawing by a patient with aphasia.<ref name='Pulvermuller2'>{{cite journal|doi=10.1080/02687030701612213|title=Aphasia therapy on a neuroscience basis|journal=Aphasiology|year=2008|first=Friedemann|last=Pulvermuller|author2=Marcelo Berthier|pmid=18923644|volume=22|issue=6|pmc=2557073|pages=563–599}}</ref> In constraint-induced movement therapy, the alternative limb is constrained with a glove or sling and the patient is forced to use the affected limb. In constraint-induced aphasia therapy the interaction is guided by communicative need in a language game context, picture cards, barriers making it impossible to see other players' cards, and other materials, so that patients are encouraged ("constrained") to use the remaining verbal abilities to succeed in the communication game.<ref name='Pulvermuller' />

Two important principles of constraint-induced aphasia therapy are that treatment is very intense, with sessions lasting for up to 6 hours over the course of 10 days and that language is used in a communication context in which it is closely linked to (nonverbal) actions.<ref name='Meinzer' /><ref name='Pulvermuller' />  These principles are motivated by neuroscience insights about learning at the level of nerve cells (synaptic plasticity) and the coupling between cortical systems for language and action in the human brain.<ref name='Pulvermuller2' /> Constraint-induced therapy contrasts sharply with traditional therapy by the strong belief that mechanisms to compensate for lost language function, such as gesturing or writing, should not be used unless absolutely necessary, even in everyday life.<ref name='Meinzer' />

It is believed that CIAT works by the mechanism of increased [[neuroplasticity]]. By constraining an individual to use only speech, it is believed that the brain is more likely to reestablish old neural pathways and recruit new neural pathways to compensate for lost function.<ref>{{Cite journal |last1=Balardin |first1=Joana Bisol |last2=Miotto |first2=Eliane Correa |date=December 2009 |title=A review of Constraint-Induced Therapy applied to aphasia rehabilitation in stroke patients |journal=Dementia & Neuropsychologia |volume=3 |issue=4 |pages=275–282 |doi=10.1590/S1980-57642009DN30400003 |issn=1980-5764 |pmc=5619412 |pmid=29213640}}</ref>

The strongest results of CIAT have been seen in patients with chronic aphasia (lasting over 6 months). Studies of CIAT have confirmed that further improvement is possible even after a patient has reached a "plateau" period of recovery.<ref name='Meinzer' /><ref name='Pulvermuller' /> It has also been proven that the benefits of CIAT are retained long term. However, improvements only seem to be made while a patient is undergoing intense therapy.<ref name='Meinzer' /> Recent work has investigated combining constraint-induced aphasia therapy with drug treatment, which led to an amplification of therapy benefits.<ref name='Berthier'>{{cite journal|doi=10.1002/ana.21597|title=Memantine and constraint-induced aphasia therapy in chronic poststroke aphasia|journal=Annals of Neurology|year=2009|first=Marcelo|last=Berthier|volume=65|issue=5|pages=577–578|pmid=19475666|s2cid=31528532|display-authors=etal}}</ref>