Can Script Training Improve Narrative and Conversation in Aphasia across Etiology?

Abstract

Script training is an effective treatment of stable (e.g., stroke-induced) and progressive aphasia of varying severities and subtypes. The theoretical underpinnings of script training are discussed and include fluency-inducing conditions, speech shadowing, principles of neuroplasticity, and automatization. Script training outcomes are reviewed, with a focus on discourse in persons with stable aphasia (PWSAs) and in persons with primary progressive aphasia (PWPPAs). PWSAs and PWPPAs are able to acquire and maintain short scripted monologues or conversational dialogues, with some evidence of generalization to untrained topics and settings. Advances in both technology and access have enriched script training protocols, so they now range from no-tech written script approaches to high-tech audiovisual support and avatars. Advances in audio and/or visual support promote large amounts of practice of less errorful whole-message language processing during a fluent language inducing condition. With enough practice, users decrease reliance on supports and independently produce scripted content. Script training can be delivered in a variety of settings (individual, group, telepractice), lends itself well to homework programs, and is in accordance with the principles of neuroplasticity for neurorehabilitation. Incorporating script training into therapy programming is advantageous throughout aphasia recovery following brain injuries such as stroke. It is also beneficial for persons with progressive disease for prophylaxis, remediation, and compensation. Recommendations for implementing script training in clinical practice and future research directions are presented.

A Window Into Functional Communication: Leveraging Naturalistic Speech Samples in Primary Progressive Aphasia

“…There is a lovely [41] house [2] lovely scenery [44] a tree [15] in the background [64a] with a lovely house. They are also on some kind of-they are also on a lake [10] with a sailboat [6] and another younger [55] person a little [55a] boy [11] is flying [34] a kite [1] and wearing [53a] shorts [49] and having fun [38] with this dog [4] chasing [39] him and in the background we also have someone [45d] in there looks like they're fishing [33] and maybe on the boat out fishing." 2.…”

“…2. "Well, there is a picnic [7] going on, a man [43a] and a woman [8] uh are on a blanket [25] and they have a radio [22] on, I guess, the antenna is up, uh, and the man is reading [36] a book [14] with the glasses [31] and uh the woman is pouring [37] a drink [3] from a bottle [32] uh and the uh there is a picnic basket [30] on the uh blanket [25] between the man and the woman and there is a uh the man has taken his sandals [19] off, and are on the lawn near a lake [10] uh and there is a boy [11] going by flying [34] a kite [1] with a dog [4] at his heels [39], and uh beach [5] out front [64] and a girl [12] building sandcastles [9], yeah, and uh, there is a dock [13] jutting out from the beach where a mans [43b] with a hat on is catching [323] a-a fish [20]and a sailboat [6] going by on the lake [10] , four-seventy is on the sail, there are two people [21] on the boat, and there is a house [2], set back [64a] uh from the lake [10] with a tree [15] in front uh uh sichuous tree in the front of the house".…”

Efficacy of Script Training on Broca’s Aphasia Patients

“…Script training has emerged as a promising therapeutic intervention for individuals with Broca's aphasia, a severe language disorder stemming from damage to the left frontal lobe of the brain, specifically in Broca's area. This condition, characterized by difficulties in fluent speech, grammatical sentence formation, and word retrieval, significantly impairs effective communication and social participation (1). Despite the absence of a cure for Broca's aphasia, various rehabilitation therapies, including script training, have been developed to aid recovery and enhance communication skills (2).…”

Listening to Aphasia Self-Advocacy Scripts: Thoughts and Emotions Reported by Unfamiliar Communication Partners

“…Scripts are brief narratives, typically developed by a client with aphasia and their SLP, containing content the client considers to be communicatively important. In script training, the PWA learns to produce the script fluently through intensive practice (see Hubbard et al (2020) for review). This intensive practice often involves unison production with the clinician or a virtual speaker, which builds on the retained ability of many PWA to produce fluent speech with audiovisual support from a communication partner.…”