Investigating outcomes of impairment therapy and communication therapy for people with non-fluent aphasia

Abstract

The ultimate goal in any programme of aphasia rehabilitation is a social one - that behaviours targeted in therapy will generalise to everyday use for people with aphasia (PWA). Conversation is the most frequent communicative activity in daily life. While conversation provides a rich source of data for investigating a range of potential therapy effects, it presents methodological challenges to an experimental design. Thus, the effects of impairment-focused therapy on conversation have been investigated by only a handful of studies. This thesis aimed to contribute to the growing interest in measuring the effects of impairment-based therapies on everyday conversation. A sequential model of therapy was designed which targeted increasing levels of language production from verb retrieval, to syntactic construction and storytelling, with on-going sampling of conversation data. The effects of each therapy were tracked across contexts of decreasing constraint. Quantitative measures were developed that a) investigated stability of variables of interest in baseline conversation, b) compared changes on variables of interest in test/retest analysis, and c) were applicable to connected speech data and conversation. A case design was used in which nine participants with non-fluent aphasia took part in two empirical studies and four participants in a third study. Verb retrieval therapy consisted of semantic feature analysis (SFA), gesture production and phonemic cueing and targeted semantically light and heavy verbs as well as verbs which were personally relevant to each participant. Syntactic construction therapy included a mapping approach and reduced syntax therapy (REST). Both studies found strong effects of therapy on direct measures, with less clear patterns on indirect measures. Regarding baseline conversation data, analysis within both studies indicated a lack of statistically significant variability in behaviours of interest, but no evidence of change within the group following therapy. Analysis of individual participant's performance revealed post-therapy quantitative and qualitative changes for a subset of participants after receiving these therapy interventions. The final therapy incorporated the rich communicative environment of storytelling to draw upon and extend the work of the previous therapies (i.e., verb retrieval, grammatically-reduced verb phrases, gesture). An approach which combined both the PWA and their conversation partner was designed whereby the PWA received treatment targeting narrative production (through thinking for speaking and story grammar) and the conversation partner received treatment targeting their role in co-constructing the story (through conversation coaching). Both approaches within the final therapy utilised personalised therapy goals, modelling, video feedback and discussion. On post-therapy assessment, the performances of two couples demonstrated a quantitative change which was attributed to the therapy programme. For one of these couples, single case analysis revealed changes in how the conversation partner participated in the storytelling task before and after therapy, with similarities within conversation data before and after therapy. The thesis presents an argument in support of multi-component therapies and also explicit therapeutic focus on the generalisation of linguistic skills to an everyday communicative situation.

Date of Award	1 Aug 2013
Original language	English
Awarding Institution	The University of Manchester
Supervisor	Paul Conroy (Supervisor) & Karen Sage (Supervisor)