Language Development and Disorders (LDD): research projects

Research studies

Assessing the Effectiveness of Communication Therapy in the North West - The ACT NoW Study.


The ACTNoW study is a randomised controlled trial and qualitative study evaluating the effectiveness, cost-effectiveness and service user preferences for communication therapy after stroke.


Stroke is the leading cause of long-term disability in the UK. Each year, 130,000 people suffer a stroke in England and Wales. At any time, 250,000 people in the UK live with severe disability following a stroke.

About a third of stroke survivors will suffer some level of communication problems following the stroke. Such problems can affect parts or all of the motor apparatus responsible for producing speech, thus affecting clarity of speech and overall intelligibility (a condition known as dysarthria). Alternatively, stroke can affect the cognitive system for comprehending and formulating language (a condition known as dysphasia or aphasia). Some people will suffer impairment of both speech and language (dysarthria and aphasia). Communication problems can seriously affect a person’s confidence by limiting social participation and leading to social exclusion.

Services for communication problems following stroke vary greatly across the country and are chronically underfunded. There is no national minimum standard and the overall picture of service delivery is patchy at best. Solid research evidence is a pre-requisite for planning service delivery.


The HTA want answers to a very specific question: "What is the effectiveness and cost-effectiveness of speech and language therapy for dysphasia and/or dysarthria following stroke?" The brief further requests that the question be investigated using an RCT of "speech and language therapy strategies…effective yet feasible for routine NHS delivery” versus “attention control involving patient contact but not specific therapy".


Across the recruitment centres, NHS speech and language therapists will assess all people admitted to hospital with a new stroke for presence or absence of communication difficulties. Communication problems can be of varying severity but must consist of either aphasia, dysarthria or a combination of the two. Once consent has been given, newly recruited patients are randomised into either therapy intervention or an attention control delivered by paid 'Visitors'.


The group is testing the effectiveness of an early therapy intervention, delivered by NHS therapists. Patients randomised into the treatment arm will receive therapy of up to three sessions per week for a maximum duration of 16 weeks. People in the control arm will receive a similar level of contact with a 'visitor'. Visitors are paid part-time staff who are trained to deliver a manualised attention control and are regularly monitored to ensure adherence to the research protocol.

Main phase

Having successfully completed a feasibility study across four centres in the North West, the group is going ahead with the main study. The main study consists of three parts:

  • a randomised controlled trial
  • a qualitative study of patient and carer preferences
  • a health economic assessment.


The ACTNoW Study was granted MREC approval in August 2006. The trial completed patient recruitment in February 2010 and thanks to the phenomenal dedication and hard work of those involved, the target of 170 participants were recruited across twelve sites in the North West of England (85 in each arm of the trial). The study finished in October 2010.
Results will be publicly available from December 2010 - the Chief Investigator, Audrey Bowen will be giving an invited presentation on the results at the UK Stroke Forum in Glasgow (30th November - 2nd Dec)
The results will be published in the NIHR HTA monograph and a short report on the results will be available from the study website: 
Please check the study websites for updates.

Funding body

The NHS Health Technology Assessment Programme (HTA) is funding the study. The HTA is the sector of the NHS dealing with assessing performance in order to plan future service delivery and to ensure that high-quality research information on the costs, effectiveness and broader impact of health technologies is produced in the most effective way for those who use, manage and provide care in the NHS.

Members of the project

Dr Audrey BowenPrincipal investigator
Professor Alys YoungInvestigator
Professor Andy VailInvestigator
Dr Anne HeskethInvestigator
Dr Karen SageInvestigator
Professor Linda DaviesInvestigator
Professor Matthew Lambon RalphInvestigator
Professor Pippa TyrrellInvestigator


Chief Investigator, Audrey Bowen.

tel: 0161 275 3401


Key references

  1. Sellars C, Hughes T, Langhorne P. Speech and language therapy for dysarthria due to non-progressive brain damage (Cochrane Review). In: The Cochrane Library, Issue 1, 2003. Oxford: Update Software.
  2. Greener J, Enderby P, Whurr R. Speech and language therapy for aphasia following stroke (Cochrane Review). In: The Cochrane Library, Issue 1, 2003. Oxford: Update Software.
  3. Donovan J, Mills N, Smith M et al (2002). Improving design and conduct of randomised trials by embedding them in qualitative research: ProtecT study. BMJ, 325:766-70. 
  4. MRC Health Services and Public Health Research Board. A framework for development and evaluation of RCTs for complex interventions to improve health. Medical Research Council, London, 2000.


ACT NoW project website


Study outputs - including dissemination and resources - as well as more detailed information can be found on the study website: