Acceptability, feasibility and preliminary efficacy of low-moderate intensity Constraint Induced Aphasia Therapy and Multi-Modality Aphasia Therapy in chronic aphasia after stroke

Figures & data

Figure 1. Timeline in relation to main COMPARE trial.

Figure 2. CONSORT participant flow diagram.

Table 1. Baseline participant characteristics.

	M-MAT (n = 16)	CIAT-Plus (n = 10)	SMD
Age	66.1 (11.2)	60.5 (11.5)	0.491*
Female:Male (% female) Nil reported non-binary/non-disclosed	5:11 (31%)	1:9 (10%)
Years of Education	15.4 (4.5)	14.7 (3.8)	0.176*
Handedness
Right, n (%)	15 (94)	8 (80)
Left ,n (%)	1 (6)	1 (10)
No preference, n (%)	-	1 (10)
Stroke Type
Ischaemic, n (%)	9 (56)	8 (80)
Hemorrhagic, n (%)	6 (38)	2 (20)
Unknown, n (%)	1 (6)	-
Modified Rankin Scale Score
Low (Scored 0–2)	6	4
High (Scored 3–6)	10	6
Months Post Onset Median (IQR)	30.5 (35.5)	46.5 (47.5)
WAB-R AQ Mean (SD)	69.1 (21.5)^a	67.9 (15.3)	0.065
Mild, n (%)	12 (66)	4 (40)
Moderate, n (%)	3 (19)	6 (60)
Severe, n (%)	1 (6)	-
Apraxia Severity Rating Scale
No apraxia, n (%)	7 (44)	3 (30)
Mild, n (%)	3 (19)	1 (10)
Mild–moderate, n (%)	3 (19)	4 (40)
Moderate, n (%)	3 (19)	2 (20)
Pyramids and Palm Trees	48.0 (4.0)	48.8 (2.3)	0.235*
Attention (Elevator Counting)	5.8 (1.8)	6.2 (1.1)	0.282*
Cognitive Flexibility (Visual Elevator)	5.0 (2.8)	5.4 (2.5)	0.144*
Short-term Memory (Forward span – total items recalled on Picture Span Verbal Memory)	42.9 (21.4)	39.7 (18.4)	0.159*
Working Memory (Reverse Span – total items recalled on Picture Span Verbal Memory)	32.3 (14.8)	32.1 (17.0)	0.011
Non-verbal Reasoning (Raven’s Progressive Matrices)	29.3 (6.7)	29.1 (5.7)	0.024

Note: Percentages rounded and may not total 100%.

^aOne WAB-R AQ not available at Baseline 0, instead extracted from Baseline 1 for this table. *SMD exceeds 0.1, indicating possible imbalance.

Figure 3. Mean group changes (± SD) over time for CIAT-Plus and M-MAT.

Note: Purple marks indicate significance of combined group data. * p < .05; ** p < .01.Bonferroni correction applied to p-values within ANOVAs for each outcome measure.

† Data not normally distributed, therefore median displayed

‡ One outlier removed for this figure and for the analysis. Sensitivity test indicated no impact of removal

Table 2. Significant outcomes across this trial and COMPARE.

*Significant main effect of time but no significant differences between timepoints on post hoc analysis.

Table A1. Linguistics levels for nouns and verbs.

Level		Grammatical form	Example
Nouns	1	Noun	“Couch?”
	2	Carrier phrase + noun	“Do you have (a) couch?” or “I have (a) couch”
	3	Carrier phrase + adj + noun	“Do you have (a) red couch?” or “I have (a) red couch”
	4	Carrier phrase + adj + adj + noun	“Do you have (a) large, red couch?” or “I have (a) large, red couch”
	5	Carrier phrase + sub + to be + prep + adj + adj + noun	“Do you have (the) girl (is) on the large, red couch?” or “I have (the) girl (is) on the large, red couch”
	6	Carrier phrase + sub + verb + prep + adj + adj + noun	“Do you have (the) girl (is) sitting on the large, red couch?” or “I have (the) girl (is) sitting on the large, red couch”
Verbs	1	Verb	“Sweeping?”
	2	Carrier phrase + verb	“Do you have sweeping?” or “I have sweeping” “Do you have bouncing” or “I have bouncing”
	3	Carrier phrase + sub + verb	“Do you have (the) girl is sweeping?” or “I have (the) girl is sweeping” “Do you have (the) boy is bouncing?” or “I have (the) boy is bouncing?”
	4	Carrier phrase + sub + verb + object	“Do you have (the) girl is sweeping the floor?” or “I have (the) girl is sweeping the floor”
	5	Carrier phrase + sub + verb + object + prep phrase	“Do you have (the) girl is sweeping the floor with the broom?” or “I have (the) girl is sweeping the floor with the broom”
	6	Carrier phrase + sub + verb + object + prep phrase + conjunction + SVAdj	“Do you have (the) girl is sweeping the floor with the broom because it is dirty?” or “I have (the) girl is sweeping the floor with the broom because it is dirty”

Adj = adjective; sub = subject; prep = preposition; SVAdj = subject, verb, adjectival phrase.

Table A2. Cueing hierarchies for CIAT-Plus and M-MAT.

Step	Description	Correct	Incorrect
CIAT-Plus
1	Participant names item and carrier phrase (e.g. “Couch”? or “Do you have a couch?”)	✔ Move to next participant’s turn	✖️Go to step 2
2	COMPARE Therapist provides phonemic cue (e.g. “It starts with/k/”)	✔ Participant repeats the name three times (e.g. “couch, couch, couch”) Go to step 3	✖️If the participant makes an error on the target word, do not request repetition; go to step 3
3	COMPARE Therapist provides orthographic cue (e.g. the written word “couch”) + verbal name of item (e.g. “It’s a couch….can you say couch?”)	✔ Participant repeats the carrier phrase + name three times while the written word is in view (e.g. “Do you have couch, do you have couch, do you have couch”) Move to next participant’s turn	✖️If participant cannot repeat the word, acknowledge the difficulty, offer encouragement and move to the next participant’s turn
M-MAT
1	Participant names item and carrier phrase (e.g. “Couch”? or “Do you have a couch?”)	✔ Move to next participant’s turn	✖️Go to step 2
2	COMPARE Therapist asks participant to make an iconic gesture and name the item	✔ Repeat carrier phrase + name three times. Move to next participant’s turn	✖️Go to step 3
3	COMPARE Therapist provides iconic gesture model and verbal name of item, and asks participant to copy gesture and repeat name of item	✔ Go to step 4	✖️COMPARE Therapist provides gesture refinement cues Go to step 4
4	COMPARE Therapists asks participant to draw item and name the item	✔ Go to step 5	✖️COMPARE Therapist provides drawing refinement cues Go to step 5
5	COMPARE Therapist asks participant to read, write and name the item	✔ Go to step 6	✖️COMPARE Therapist provides the item name in writing for participant to copy Go to step 6
6	COMPARE Therapist asks participant to repeat the carrier phrase + name of item 3 times with written word and drawing in view	✔ Move to next participant’s turn	✖️If participant cannot repeat the word, acknowledge the difficulty, offer encouragement and move to the next participant’s turn

Data availability statement

The data that support the findings of this study are available from the corresponding author, JEP, upon reasonable request.