Extending the Scope of Sentence Therapy in Aphasia Across English and Arabic

  • Nourah Alohali

Student thesis: Phd

Abstract

Background: Sentence production deficits in aphasia still are under-investigated, especially in non-English speaking countries, and computer-based approaches increasingly important. The thesis will examine the feasibility of a novel method for remediating sentence production deficits in people with aphasia post-stroke in two languages, English and Arabic. It consists of a multilevel theory-driven hybrid approach that integrates three methods: mapping therapy (Schwartz et al., 1994), Verb Network Strengthening Therapy VNeST (Edmonds et al., 2009), and processing prosthesis for temporal window widening, which is central to SentenceShaper computer software (Linebarger et al., 2001). It was designed to allow flexible application across a wide range of aphasia severity and subtypes. Methods: A case series study design and a single-case experimental design with multiple assessment points were implemented. The intervention combined clinician-delivered weekly sessions with independent home practice delivered to 16 participants over 8 to 12 weeks. A range of well-known assessment tools such as Verb and Sentence Test (VAST) (Bastiaanse et al., 2002), the Western Aphasia Battery (WAB) (Kertesz, 2007), and discourse elicitation tasks (cookie theft and dinner party picture stimuli) were used as outcome measures. Results: The findings revealed robust improvements in sentence and discourse production skills, in both English and Arabic. Also, generalisation of therapy gains to untargeted skills such as lexical retrieval and comprehension at the word level and sentence comprehension was noted in some participants. Discussion: The outcomes supported our hypothesis that our combined approach can produce comparable therapy gains, in sentence and discourse production, to those obtained by implementing each original therapy protocol in isolation, as described in the literature. We consider the feasibility of the combined approach superior to individual application as it reduced the intensity of clinician-directed therapy sessions and fostered independence in home-practice. Also, the user-friendly technology we incorporated as a platform to deliver therapy, across very different languages, added a unique component for practicing self-monitoring and self-correction skills. As a result, the dose of language practice, which is known to be associated with better therapy gains (Cherney et al., 2011), can be increased in an accessible and cost-effective way. The thesis also presents preliminary work in creating Arabic language assessment tools and therapy materials. The findings highlight both the potential successes that can be achieved in cultural adaptation and translation within rehabilitation research as well as the many unforeseen challenges in applying methods derived in Western culture to diverse cultures world-wide. Finally, the thesis considers the current barriers to increasing the reliability and validity of assessment tasks and suggests ways to address them in future research.
Date of Award1 Aug 2022
Original languageEnglish
Awarding Institution
  • The University of Manchester
SupervisorYaron Matras (Supervisor) & Paul Conroy (Supervisor)

Keywords

  • Arabic
  • English
  • therapy
  • Aphasia
  • sentence production

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