Effects of a semantic plus multimodal communication treatment for modality switching in severe aphasia

ABSTRACT

Background: Word retrieval impairments are a hallmark characteristic of aphasia. Intervention can focus on the restoration of language skills and instruction in alternative communication modalities. However, executive function deficits, specifically cognitive flexibility impairments, may interfere with switching among communication modalities to repair communication breakdowns. A multimodal communication treatment was developed to enhance the ability of people with aphasia to switch among nonverbal communication modalities when spoken communication is inaccurate. A previous study found that one participant benefited from the addition of a semantic intervention after a multimodal intervention. Therefore, an intervention that combines multimodal and semantic treatments may be most beneficial for some people with aphasia.

Aims: The purpose of this study was to explore the outcomes of a novel semantic plus multimodal communication treatment, which aims to improve modality switching in people with severe aphasia and severe semantic deficits.

Methods & Procedures: The researchers employed a single-subject, multiple-baseline across stimuli (word lists) design to provide an initial evaluation of a novel treatment protocol. The participant was a 77-year-old male with severe, chronic aphasia and severe semantic deficits as determined by the Pyramids and Palm Trees Test. The participant completed 12 treatment sessions (two phases with six sessions each). Each session, the participant completed an integrated non-verbal semantic treatment and multimodal communication treatment for 10 target words. The examiner administered a referential communication task (RCT) between the participant and a communication partner at the beginning of each session to probe for changes in modality switching.

Outcomes & Results: Following treatment, the participant demonstrated increased modality switching after about 10 treatment sessions. His increased modality switching was also evident on his performance of tasks on the Communicative Activities of Daily Living-2 (CADL-2). Formal assessment revealed some changes in non-verbal semantic skills, but no changes in cognitive or language abilities.

Conclusions: Multimodal plus semantic treatment resulted in increased modality switching on the RCT and CADL-2. However, changes in switching did not occur until the final sessions, suggesting that the participant needed multiple repetitions to improve his use of alternate modalities to repair breakdowns. After treatment, the participant began to frequently combine his verbal attempts with accurate gestures. Future studies should examine the effect of modifications to the intensity and duration of treatment. Additionally, researchers may examine the possibility of combining modalities for increased communication success.

KEYWORDS:

• Aphasia
• multimodal communication
• augmentative and alternative communication
• executive functions
• modality switching

Acknowledgements

These data were collected as part of the second author’s Master’s Thesis project at Duquesne University, Pittsburgh, PA. The authors acknowledge the contributions of the participant and his family, as well as those by Sarah Diehl, Joanne Kinney and Lauren Matthews who assisted with manuscript preparation.

Disclosure statement

No potential conflict of interest was reported by the authors.