Prediction of strategy usage by adults with aphasia

Abstract

Background: Management of aphasia often focuses on training augmentative communication strategies such as communication books, computerised systems, gestures, writing, or drawing. Although many individuals are able to acquire a targeted skill in a structured format, many do not successfully use the trained skill in more functional situations. Training alternative communication strategies can be a time‐consuming project; thus, it would be beneficial if speech‐language pathologists could predict, a priori, how a patient may respond to this type of treatment approach. It has been hypothesised that use of augmentative communication strategies requires executive functioning, specifically cognitive flexibility, which may be impaired following brain damage. Therefore, assessment of cognitive flexibility may help clinicians determine which persons with aphasia would most likely benefit from training of augmentative communication strategies.

Aims: The purpose of this study was to develop a measure of cognitive flexibility and to determine whether this measure predicted strategy usage during a functional communication task.

Methods and Procedures: A novel scoring system for the Communicative Abilities in Daily Living (CADL) was developed to capture the degree of participants' cognitive flexibility. This score was correlated with the Wisconsin Card Sorting Test (WCST), to determine the validity of the scoring system. The CADL cognitive flexibility score was then correlated with performance on a referential communication task. A multiple regression analysis was conducted with severity of aphasia as an additional predictor variable.

Outcomes and Results: There was a significant correlation between the cognitive flexibility score from the CADL and the WCST, confirming the validity of the scoring system as a measure of cognitive flexibility. Results of the regression analysis demonstrated a significant relationship between the cognitive flexibility score and strategy usage on a functional communication task. This relationship remained significant when the overall severity of aphasia was added to the regression analysis, suggesting that cognitive flexibility is a stronger predictor of strategy usage than severity of aphasia. These results may provide clinicians insight into which individuals would benefit most from the training of compensatory strategies, leading to the development of more appropriate goals and treatment methods.

Notes

1. Items on which participants were required to point to a certain picture (2, 17, 20, 21, 24, 41, 42, 44, 46, 50, 52, 53, 54, 55, 56, 58, 59, 60, 61, and 62).