Multi-modality aphasia therapy is as efficacious as a constraint-induced aphasia therapy for chronic aphasia: A phase 1 study

Abstract

Background: There is an urgent need for treatment comparison studies for chronic aphasia. Two different treatments, Constraint-Induced Aphasia Therapy Plus (CIAT Plus) and Multi-Modality Aphasia Therapy (M-MAT) aim to improve spoken language production through intensive shaping of responses, and social-mediated repetitive practice. CIAT Plus constrains responses to the verbal modality, while M-MAT includes gesture, drawing, writing and reading-based cues to assist production.

Aims: This Phase 1 study compared the efficacy of CIAT Plus and M-MAT. The study also aimed to investigate the relationship between treatment responsiveness and participant's aphasia severity and cognitive variables.

Methods & Procedures: We utilised 11 single-subject multiple baseline designs with a cross-over for treatment type. Participants had chronic aphasia (17–88 months post onset) and a range of aphasia severities (WAB AQ 36.2–92.8). Participants named 180 noun and verb probes three times at pre-, mid-, post-treatments and at 1- and 3-month follow-ups. Both CIAT Plus and M-MAT were delivered for 32 hours over 2 weeks. Six participants received M-MAT first while five received CIAT Plus first. Standard case charts were developed for visual analysis of each participant's probe results. Within-subject effect sizes (ESs) were calculated on naming the probe scores. Discourse measures were analysed with descriptive statistics. Participant's satisfaction with each treatment type was probed.

Results & Conclusions: A total of 32 (of 44 total) immediate post-treatment ESs reached small (3), medium (7) or large (22) levels, and ranged from –0.96 to 30.6. Higher ESs were found for nouns as compared to verbs, and for items treated during the first treatment phase. The mean ES was comparable for items treated with M-MAT (M = 8.00) and CIAT Plus (M = 8.58) and was well maintained at the 1-month follow-up. As a group, aphasia severity was significantly reduced at the 1-month and 3-month follow-up time points. WAB AQ change scores immediately post-treatment favoured M-MAT for four participants and CIAT Plus for five; however, order effects are likely to have played a significant role. Treatment potency was demonstrated with generalisation to noun (8 participants) and verb production (1 participant) in discourse. Overall , CIAT Plus and M-MAT were equally efficacious for these 11 individuals, although six participants expressed preference for M-MAT and three for CIAT Plus. Delayed treatment effects were present in some participants. Future large-scale studies are required to deal with order effects and a participant's variability.

Keywords:

• Anomia
• Aphasia treatment
• Constraint-induced aphasia therapy plus
• CIAT plus
• Multi-modality aphasia therapy
• M-MAT.

Acknowledgments

The first author was supported by an Australian Research Council Future Fellowship (FT 100100446) and all authors by a National Health and Medical Research Council, Centre for Clinical Research Excellence in Aphasia Rehabilitation grant (56935). We thank Jennifer Walsh from Monash Health for her clinical role.