Comparing multi-modality and constraint-induced treatment for aphasia: a preliminary investigation of generalisation to discourse

Abstract

Background: At present, there is no consensus regarding the comparative efficacy of constraint and non-constraint treatments. Moreover, studies to date have measured the effects of treatment using single-word confrontation naming tasks and omnibus aphasia batteries.

Aims: We applied reliable communicative measures of lexical and communicative behaviours to investigate the comparative impact of multi-modality aphasia therapy (M-MAT) and constraint-induced aphasia therapy plus (CIAT Plus) on three discourse genres.

Methods & Procedures: Thirteen people with chronic aphasia each participated in 2 weeks of intensive CIAT Plus and 2 weeks of intensive M-MAT (30 hours over 2 weeks). Seven participants undertook CIAT Plus first, while six undertook M-MAT first. Discourse samples from three conditions were collected (picture description, Cinderella story retell and semi-structured conversation) at three time points (pre-treatment, post-CIAT Plus and post-M-MAT). Primary outcome measures included lexical measures (total words, words per minute) and communication measures (total correct information units (CIUs), CIUs per minute).

Outcomes & Results: Results varied considerably within and across participants and also across the three discourse conditions. Furthermore, changes in both positive and negative directions were evident throughout the data set. There was a slight trend for better outcomes from CIAT Plus for individuals with mild aphasia and from M-MAT for individuals with moderate aphasia.

Conclusions: In order to inform clinical practice and facilitate treatment planning and evaluation, further research is essential to continue to develop reliable discourse measures; to reach consensus on what constitutes “meaningful change” within discourse data and to take steps to mitigate against the variability inherent within discourse.

Keywords:

• aphasia
• therapy
• CIAT
• M-MAT
• discourse

Acknowledgement

The authors wish to thank Associate Professor Gerasimos Fergadiotis for his advice and insight regarding MATTR.

Disclosure statement

No potential conflict of interest was reported by the authors.

Notes

1. At the pre-treatment testing point, SS and LM only managed to produce samples of 8:30 minutes and 12:00 minutes, respectively. Although they both managed to produce longer samples within the semi-structured conversation following CIAT Plus and M-MAT (ranging from 19:30 to 21:09 minutes), all analyses were limited to the 8:30 minute time point for SS and the 12:00 minute time point for LM to facilitate comparison between the samples at each testing phase. Two participants with severe aphasia were not able to achieve the 20-minute target; therefore, the time used for their semi-structured conversation analyses was 5 minutes (CH) and 11 minutes (MT).

2. Excluded from MATTR analysis: CH post-CIAT Plus; MT baseline; BH baseline, post-M-MAT; JB baseline; LM baseline, post-M-MAT.

Additional information

Funding

The first author was supported by an Australian Research Council Future Fellowship [FT100100446] and the first, second and third author by the NHMRC Centre for Clinical Research Excellence in Aphasia Rehabilitation [#56935].