CONSTRAINT-INDUCED

LANGUAGE THERAPY (CILT)

Everything you need to know about the CILT protocol

By: Samantha King, Emily O'Brien, Emily Vayo, and Ashley Watson

Purpose of CILT
CILT is an intensive therapy technique that is used to treat clients with aphasia. It emphasizes

restraining the unaffected language system in order to utilize the damaged language areas.

Therefore, clients are prohibited from using other language modalities, including writing,

drawing, and gesturing. Its overall purpose is to improve lexical retrieval, repetition,

comprehension, and short-term memory.

CILT Procedures Appropriate Candidates

CILT is played similarly to “Go Fish” Historically, CILT has been used on clients
Once the level of stimuli is determined for the respective
diagnosed with severe/chronic aphasia. This
client (i.e. Level 1 easier - “shirt”; Level 2 - “blue shirt”; Level
is due to its long, intensive, and repetitive
3 - “three sweaters”; Level 4 - choice between blue jeans
nature aimed to promote retraining of the
and a blue sweater) then the clients are able to ‘play’ each
language system due to damage. Older
other using a specific script.

All communication must be verbalized; use of gesturing, research suggests that clients with mild

acting out, writing, or drawing is discouraged and ignored. aphasia do not reap the benefits of CILT as

Levels of prompting is determined by the level of severity of much when compared to their peers who are
the client (i.e. visual, verbal, tactile, or no prompt).
more severely affected. However, a recent
Clients (players) take turns requesting a card from their
study from the University of Connecticut
hand, without showing anyone else the card.
published in July 2018 analyzed whether
The requesting player must verbally request the stimuli,
severity of aphasia impacted the individual’s
directly addressing another player (e.g. “Susan, do you

have a yellow duck?”) response to CILT treatment. Using a modified

The responding player must either deny the request (e.g. multiple baseline design, researchers were

“No, Gary, I do not have a yellow duck”) or they can able to find that even those with mild
confirm their request, handing them the respective card
aphasia did respond positively to CILT if they
(e.g. “Yes, Gary, I do have a yellow duck”).
were given stimuli that was sufficiently
Appropriate responses are also adjusted according to the
stimulating. This could also be connected to
client's severity. For example, a more severe client could

make a request by saying "yellow duck" and respond by

the role of the SLP when using CILT, since

saying "have" or "don't have." selecting goals and stimuli is an important

Sessions are intensive, typically lasting 3 hours, 5 times a part of the treatment process.

week, for about 2-6 weeks.

Highest Level of Evidence Additional Research Topics
Class I: Evidence from one or more Clarify which individuals will benefit most from

randomized control clinical trials this treatment

Assess CILT on individuals with fluent aphasia

Level 1b: Randomized Control Trial Assess how much CILT practice actually carries

over into everyday life, as well as what

Systematic review looked at 10 adaptations can be made to the CILT protocol to

studies, but only one study provided a improve this

description of their randomization Improve the SLP’s role by altering the stimuli to

sample (Cherney et al., 2008) best fit the client's severity level

Assess cost effectiveness/time constraints

Long-Term Goal Short-Term Goal

Following a 6-week treatment plan, the client Client will follow the CILT treatment model

will receive intervention two times a week for by using a carrier phrase to request objects

60 minutes to improve communication using only verbal output with one verbal

abilities by 70% through verbal output as and/or visual prompt in 80% of trials across

seen in their improvements on the WAB three consecutive sessions.

picture description task and percent CIUs

from pre-treatment to post-treatment.

Clinical Application
Lyman, C. (2012, September 13). Retrieved November 05, 2018, from

https://www.youtube.com/watch?v=VaFeQX7kYoo

The above link contains a video that shows CIAT being implemented in the

group setting. It is a great example of how to utilize this technique with

clients.
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