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Beyond randomised controlled trials: the case for effective case studies of the effects of treatment in aphasia.

Randomised controlled trials (RCTs) of aphasia therapy have not established that speech therapy is effective with aphasic patients. The characteristics of RCTs, and the assumptions they make, are examined and it is argued that RCTs could never have produced useful information about the effects of treatment with aphasic patients; it is not sensible to investigate the effects of a set of heterogeneous treatment techniques applied to a heterogeneous group of subjects measuring improvement with generalised and insensitive assessment techniques. Instead, effective studies of treatment in aphasia will investigate the usefulness of specific and motivated treatment methods applied to specific aphasic patients. The methodological requirements of scientific studies of aphasia treatment of this kind are discussed, and the appropriateness of three types of experimental design is considered.