Using language for social interaction: Communication mechanisms promote recovery from chronic non-fluent aphasia

Abstract

The current results challenge the notion that massed practice alone promotes recovery from chronic post-stroke aphasia. Instead, our results demonstrate that using language for communication and social interaction increases the efficacy of intensive aphasia therapy.

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

“…Correlations between the Composite ACT and the AAT were large at each point in time (T 1 , T 2 , and T 3 : Kendall's τ = 0.66, 0.82, and 0.83; always p ≤ 0.001; overall explained common variance: 60%). The achieved statistical power exceeded the critical threshold of 95% on both outcome measures (calculations with number of groups: 2; number of repeated testing sessions: 3; Cohen's f ≥ 0.5 derived from partial η 2 ≥ 0.21 in our patient sample, congruent with effect sizes reported in Stahl et al, 2016; resulting in 1–β ≥ 0.98; cf. Faul et al, 2009).…”

“…A clinical neuropsychologist tested each patient 1 day before (T 1 ) and 1 day after the first training period (T 2 ), as well as 1 day after the second training period (T 3 ). The neuropsychologist was blinded to the group assignment and did not have patient contact apart from the testing sessions (for further details of the treatment protocols and procedures, see Stahl et al, 2016). …”

“…Further neuroscience data indicate that the neural bases of language and action are functionally interlinked (Pulvermüller et al, 2005; Glenberg et al, 2008; Kemmerer et al, 2008; Willems et al, 2011; Andres et al, 2015). It has therefore been proposed that providing context of communication and social interaction facilitates language processing (Berthier and Pulvermüller, 2011), a claim recently supported by RCT evidence in persons with chronic non-fluent aphasia (Stahl et al, 2016). Consequently, a thorough analysis of verbal expression skills may require more than utterance-centered speech-language testing where patients produce words or sentences in artificial, often school-like settings (e.g., “What do you see ?”—“A bottle.”).…”

“… 1 For simple logistic reasons, it was not possible to administer the current set of aphasia test batteries in the complete patient sample reported in Stahl et al (2016). …”

Neuroplasticity and Functional Recovery after Intensive Language Therapy in Chronic Post Stroke Aphasia: Which Factors Are Relevant?

“…However, it should be noted that intensity, repetition, or inter-individual patient characteristics are not the only factors impacting on learning and language recovery. For example, a recent cross-over RCT demonstrated a significant influence of the therapy method used: Communicative-pragmatic and behaviorally relevant language training in social interactions resulted in significantly better recovery than equally intensive conventional exercises such as naming and describing pictures (Stahl et al, 2016). The importance of behavioral relevance and effective neurorehabilitation techniques for functional outcome has also been suggested in the context of motor deficits caused by stroke (e.g., Taub et al, 2002).…”