Effect of an intensive comprehensive aphasia program on language and communication in chronic aphasia

ABSTRACT

Intensity has been identified as an important determinant of treatment effectiveness in aphasia, especially in the chronic phase. Intensive Comprehensive Aphasia Program (ICAP) is a popular treatment delivery model that includes an array of treatment approaches provided at a high level of intensity. Only a few studies have reported the effect of ICAPs on language and communication so far. The effect of intensity on different interventions provided as part of the program should also be studied to optimize the delivery schedule. The first aim of this study was to measure the effect of an ICAP for people with chronic aphasia using consensus outcome measures and other standard tests. The second aim was to test the effect of intensity on naming treatments provided during the ICAP. People with aphasia (n = 7) who had their strokes at least 6 months before the beginning of the study attended an ICAP that was provided for 4 hours a day, 3 days a week over 4 weeks (48 hours in total). On each treatment day, participants received 2 hours of individual therapy, 1 hour of technology-based therapy, and 1 hour of group therapy. Individual therapy included a naming treatment using two equivalent lists of words. One list was treated once a week for 4 weeks while the other was treated on four consecutive treatment days. Lists were controlled for word length, word frequency, number of words from a specific semantic category, and average naming accuracy at baseline. Both lists were treated using the same approach. As a group, participants had higher total scores on the Boston Naming Test (BNT) after attending the ICAP. The change on the Western Aphasia Battery – Revised Aphasia Quotient (WAB-R AQ) was not significant. No change was observed on measures of emotional well-being, quality of life, and functional communication. Individual comparisons using published benchmarks for significant change following aphasia treatments showed significant changes in all participants on the BNT, the WAB-R AQ, or both. Participants made significant naming gains for words treated once a week over four weeks and words treated on four consecutive treatment days. There was no difference between the two naming treatment schedules. All participants made measurable language gains following their participation in an ICAP. More studies are needed to understand the effect of intensity on components of ICAPs and to apply this knowledge to optimize treatments.

KEYWORDS:

• Intensive comprehensive aphasia program (ICAP)
• naming
• intensity
• aphasia
• chronic

Acknowledgments

We would like to thank Sarah AlFraih and Claudio Ales who conducted assessments and intervention sessions under the supervision of Lauren Tittley, Katherine Haentjens who helped with the preparation of the naming treatment, and Katerina Pisegna and Dominique Louër who provided independent ratings for the analysis of scoring reliability and treatment fidelity. We also want to thank the Association Québecoise des Personnes Aphasiques for their help with recruitment. This project was funded by a partnership grant from the Provincial Rehabilitation Research Network and the Ordre des Orthophonistes et Audiologistes du Québec. Noémie Auclair-Ouellet is supported by a Research Scholar – Junior 1 Salary Award from the Fonds de recherche du Québec – Santé.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This work was supported by the Fonds de Recherche du Québec - Santé [Research Scholars Junior 1,Réseau provincial de recherche en adaptation-réa].