Effects of multimodal communication program on patients with chronic aphasia

A single-subject A-B-A design study

Authors

  • Afshin Samaei Neuromuscular Rehabilitation Research Center, Department of Internal Medicine, Semnan University of MedicalSciences, Semnan, Iran

Keywords:

Chronic aphasia, Stroke, Communication, Reaction time

Abstract

Background and aim: Aphasia as a common consequence of stroke, is an acquired neurologic communication disorder that can affect symbol language processing. Different types of intervention approaches have been introduced. Multimodal Communication Program (MCP) is a new augmentative alternative communication approach in chronic aphasia. The aim of this study was to investigate the effect of MCP on communication skills of patients with chronic aphasia. Methods: This prospective, single subject, A-B-A design study was done during 2016 in Semnan, Iran. Participants were two patients with severe aphasia with a single left-hemisphere stroke. Three phases, including baseline, intervention and follow-up were administered. The patients received nine-hour intervention, over 10 working days.  Results: Three different scores were calculated for each patient: verbal efforts, the frequency of each modality and the accuracy of switching between modalities and the reaction time. The frequency of verbal modality increased for both patients. They could switch between modalities more successfully than before the intervention. The results for the reaction time, however were challenging. The onset reaction time decreased for patient 1, and increased during switching between modalities, and patient 2 showed the opposite. Conclusion: The MCP can improve the communication skills in patients with chronic post stroke aphasia. However, some factors, such as reduction of the patients’ reaction time is probably related to the amount of allocated resources during intervention.  Trial registration: The trial was registered at IRCT center with ID: IRCT2016032325194N3. Funding: The study was financed by Semnan University of Medical Sciences (Grant no.: A-10-333-3).

References

Hallowell B. Aphasia and other acquired neurogenic language disorders: A guide for clinical excellence:Plural Publishing; 2016.2)Chapey R, Hallowell B. Introduction to language intervention strategies in adult aphasia. Languageintervention strategies in aphasia and related neurogenic communication disorders. 2001; 4: 3-8.3)Brust J, Shafer SQ, Richter RW, Bruun B. Aphasia in acute stroke. Stroke. 1976; 7(2): 167-74. doi:10.1161/01.STR.7.2.167. PMID: 1265809.4)Wade DT, Hewer RL, David RM, Enderby PM. Aphasia after stroke: natural history and associateddeficits. J Neurol Neurosurg Psychiatry. 1986; 49(1): 11-6. doi: 10.1136/jnnp.49.1.11. PMID: 2420939,PMCID: PMC1028640.5)Pedersen PM, Jørgensen HS, Nakayama H, Raaschou HO, Olsen TS. Aphasia in acute stroke: incidence,determinants, and recovery. Ann Neurol. 1995; 38(4): 659-66. doi: 10.1002/ana.410380416. PMID:7574464.6)Azarpazhooh MR, Etemadi MM, Donnan GA, Mokhber N, Majdi MR, Ghayour-Mobarhan M, et al.Excessiveincidence of stroke in Iran: evidence from the Mashhad Stroke Incidence Study (MSIS), apopulation-based study of stroke in the Middle East. Stroke. 2010; 41(1): e3-e10. doi:10.1161/STROKEAHA.109.559708. PMID: 19926844.7)Breitenstein C, Grewe T, Flöel A,Ziegler W, Springer L, Martus P, et al. Intensive speech and languagetherapy in patients with chronic aphasia after stroke: a randomised, open-label, blinded-endpoint, controlledtrial in a health-care setting. The Lancet. 2017; 389(10078): 1528-38. doi:10.1016/S0140-6736(17)30067-3.8)Moreaud O, David D, Brutti-Mairesse MP, Debray M, Mémin A. [Aphasia in elderly patients PsycholNeuropsychiatr Vieil. 2010; 8(1): 43-51. doi: 10.1684/pnv.2009.0185. PMID: 20215098.9)LaPointe LL. Foundations: Adaptation, accommodation, Aristos. 2005.10)LaPointe LL. Aphasia and related neurogenic language disorders: Thieme; 2005.11)Hallowell B, Chapey R, Chapey R. Language intervention strategies in aphasia and related neurogeniccomunication disorders. Philadelphia: Lippincott, Williams, & Wilkins; 2008.12)Rose ML, Raymer AM, Lanyon LE, Attard MC. A systematic review of gesture treatments for post-strokeaphasia. Aphasiology. 2013; 27(9): 1090-127. doi: 10.1080/02687038.2013.805726.13)Purdy MH, Duffy RJ, Coelho CA. An investigation of the communicative use of trained symbols followingmultimodality training. Clinical aphasiology. 1994; 22: 345-56

Yoshihata H, Watamori T, Chujo T, Masuyama K. Acquisition and generalization of mode interchangeskills in people with severe aphasia. Aphasiology. 1998; 12(12): 1035-45. doi:10.1080/02687039808249468.15)Purdy M. Executive function ability in persons with aphasia. Aphasiology. 2002; 16(4): 549-57. doi:10.1080/02687030244000176.16)Purdy M, Koch A. Prediction of strategy usage by adults with aphasia.Aphasiology. 2006; 20(2-4): 337-48. doi: 10.1080/02687030500475085.17)Purdy M, Van Dyke JA. Multimodal communication training in aphasia: A pilot study. J Med Speech LangPathol. 2011; 19(3): 45. PMID: 24558295, PMCID: PMC3927416.18)Godecke E. Efficacy of aphasia therapy in the acute setting: Curtin University of Technology. 2008.19)Khatoonabadi AR, Nakhostin-Ansari N, Piran A, Tahmasian H. Development, cross-cultural adaptation,and validation of the Persian Mississippi Aphasia Screening Test in patients with post-stroke aphasia. Iran JNeurol. 2015; 14(2): 101-7. PMID: 26056555, PMCID: PMC4449390.20)Franklin S. Designing single case treatment studies for aphasic patients. NeuropsychologicalRehabilitation. 1997; 7(4): 401-18. doi: 10.1080/713755544.21)Fried-Oken M,Beukelman DR, Hux K. Current and future AAC research considerations for adults withacquired cognitive and communication impairments. Assistive Technol. 2012; 24(1): 56-66. doi:10.1080/10400435.2011.648713. PMID: 22590800, PMCID: PMC3760684.22)Wallace SE,Purdy M, Skidmore E. A multimodal communication program for aphasia during inpatientrehabilitation: A case study. NeuroRehabilitation. 2014; 35(3): 615-25. doi: 10.3233/NRE-141136. PMID:25227547, PMCID: PMC4216742.23)Lyon JG. Communicative drawing: An augmentative mode of interaction. Aphasiology. 1995; 9(1): 84-94.doi: 10.1080/02687039508248694.24)Lyon JG. Drawing: Its value as a communication aid for adults with aphasia. Aphasiology. 1995; 9(1): 33-50. doi: 10.1080/02687039508248687.25)Simmons-Mackie NN, Damico JS. Reformulating the definition of compensatory strategies in aphasia.Aphasiology. 1997; 11(8): 761-81. doi: 10.1080/02687039708250455.

Published

2021-12-24

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Section

Articles