Communicative-Pragmatic Assessment Is Sensitive and Time-Effective in Measuring the Outcome of Aphasia Therapy

Abstract

A range of methods in clinical research aim to assess treatment-induced progress in aphasia therapy. Here, we used a crossover randomized controlled design to compare the suitability of utterance-centered and dialogue-sensitive outcome measures in speech-language testing. Fourteen individuals with post-stroke chronic non-fluent aphasia each received two types of intensive training in counterbalanced order: conventional confrontation naming, and communicative-pragmatic speech-language therapy (Intensive Language-Action Therapy, an expanded version of Constraint-Induced Aphasia Therapy). Motivated by linguistic-pragmatic theory and neuroscience data, our dependent variables included a newly created diagnostic instrument, the Action Communication Test (ACT). This diagnostic instrument requires patients to produce target words in two conditions: (i) utterance-centered object naming, and (ii) communicative-pragmatic social interaction based on verbal requests. In addition, we administered a standardized aphasia test battery, the Aachen Aphasia Test (AAT). Composite scores on the ACT and the AAT revealed similar patterns of changes in language performance over time, irrespective of the treatment applied. Changes in language performance were relatively consistent with the AAT results also when considering both ACT subscales separately from each other. However, only the ACT subscale evaluating verbal requests proved to be successful in distinguishing between different types of training in our patient sample. Critically, testing duration was substantially shorter for the entire ACT (10–20 min) than for the AAT (60–90 min). Taken together, the current findings suggest that communicative-pragmatic methods in speech-language testing provide a sensitive and time-effective measure to determine the outcome of aphasia therapy.

Efficacy of intensive aphasia therapy in patients with chronic stroke: a randomised controlled trial

“… Mean t -scores obtained on the Aachen Aphasia Test (AAT) 9 and on the Action Communication Test (ACT). 16 Thirty individuals with chronic post-stroke aphasia were randomly assigned to one of two treatment groups: patients receiving Intensive Language-Action Therapy with 4 hours (Group I) or with 2 hours of daily practice (Group II). Both treatment groups went through an initial waiting period and two successive training intervals.…”

“…The present RCT included an impairment-centred aphasia test battery (AAT), 9 along with a dialogue-sensitive diagnostic instrument (ACT). 16 This secondary outcome measure was motivated by the communicative-pragmatic character of the training and its potential relevance to everyday discourse. Both outcome measures indeed revealed congruent changes on the ACT when focusing on the waiting period and the first training interval.…”

“…As a secondary outcome measure, we used a newly created and published diagnostic instrument, the Action Communication Test (ACT). 16 Motivated by the lack of both linguistic and functional aphasia test batteries with documented psychometric properties, this method reflects impairment-centred and communicative-pragmatic aspects of language processing. In step 1 of the testing, sets of five real generic objects are presented on a table.…”

Mosaics Fall Apart in Different Ways: Exploring Variation in Communication Breakdown Patterns in Three Aphasic Patients

“…Admittedly, a limitation of the present study is that performance on PREP-R could not be compared to the scores of the patients on any standardized screening battery, as all three patients spent only a limited amount of time in the clinic where we tested them. However, this limitation can be mitigated by the fact that detailed pragmatic ability assessment has been found to be as informative on pa tients' communicative performance and improvement as standardized batteries (Stahl, Mohr, Dreyer, Lucchese, & Pulvermüller, 2017) and has the additional advantage of providing comprehensive information on their actual communicative ability (Kindell, Sage, Keady & Wilkinson, 2013).…”

Long-Term Stability of Short-Term Intensive Language–Action Therapy in Chronic Aphasia: A 1–2 year Follow-Up Study

“…3 Similar to the Western Aphasia Battery’s 26 Aphasia Quotient, this average score provides an estimate of overall language proficiency and the severity of verbal language deficits. As secondary, non-standardized, outcome measures assessing functional communication, we used the quantitative scale of the communicative activity log 3 (CAL) questionnaire answered by close relatives of PWCA and the Action Communication Test 27 (ACT) that consists of 2 subscales assessing verbal naming or requesting performance in game-like interactions similar to ILAT. At LTFU, patients and, if available, their accompanying person were asked for estimates of the weekly amount of “interjacent” therapy received between POST and LTFU testing milestones.…”