Graduation Year

2013

Document Type

Dissertation

Degree

Ph.D.

Degree Granting Department

Communication Sciences and Disorders

Major Professor

Jacqueline Hinckley

Co-Major Professor

Theresa Chisolm

Keywords

aphasia therapy, chronic aphasia, constraint-induced therapy, intensive treatment, single-subject design, stroke rehabilitation

Abstract

Abstract

Background: Individuals with nonfluent aphasia may have significant difficulties with functional spoken communication tasks in their daily life. Aphasia treatment held in a group setting may provide an enriched communicative context wherein the requirements of spoken language are similar to those within functional day-to-day communicative situations. Thus engaging in a spoken language activity in a group setting may directly target generalization of trained skills to those required in real-life, social communication situations. The present study is concerned with an aphasia group treatment that requires focused practice of spoken language during a social-functional communication task. Intensive Language Action Therapy (ILAT) has demonstrated positive communication outcomes in some individuals with chronic aphasia. However, it remains to be seen which clinical measures best index outcomes for ILAT. The purpose of the current study was to determine the effectiveness of ILAT in individuals with nonfluent aphasia by exploring multiple, potential ILAT outcomes. The outcomes included change in performance on assessments of directly trained spoken social-functional communication abilities (proximal outcomes), untrained social-functional communication abilities and language abilities (primary outcomes), and cognitive-communication abilities (secondary outcome). Additionally, the project aimed to explore the participants' perceptions of ILAT (secondary outcome).

Methods and Procedures: ILAT was implemented with four individuals with nonfluent aphasia, using a single-subject multiple baseline design. The treatment was conducted daily for 10 consecutive week days, totaling 25 hours of treatment. Treatment probes (i.e., using trained and untrained picture cards and an unrelated control-task of nonword repetition), a pre/post assessment battery, and a post-treatment survey/interview were administered to assess performance on the treatment task, generalization to other potential ILAT outcomes, and participants' perceptions.

Outcomes & Results: Increased accuracy was observed for trained and untrained items. However, two of the four participants were not able to reach a criteria determined a priori for treatment performance. Performance on items that were untrained resulted in some improvements in performance for all participants. Three of the four participants demonstrated small effect sizes in response to ILAT. One participant who demonstrated a medium effect size in response to ILAT also demonstrated a clinical significant change in discourse abilities, a measure of spoken social-functional communication abilities. All participants demonstrated improvements on at least one primary outcomes measure. Two participants, however, demonstrated a decline. All participants, however, perceived a positive experience with ILAT on a qualitative posttreatment survey/interview.

Conclusions: Patterns were found between skills directly trained during ILAT, proximal outcomes, and performance on primary and secondary outcome measures of language, social-functional communication, and cognitive-communication, meant to assess generalization of trained skills to similar or potentially related untrained skills. A substantial amount of change (e.g., at least a medium effect size) on proximal outcome measures may be required in order for improvements to occur in primary and secondary outcome measures. Participants' perceptions of a positive treatment experience associated with the ILAT program further supports the value of the treatment. Future research should aim to further examine the influence of ILAT treatment components and participants' characteristics.

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