Integrating technology and targeted treatment to improve narrative production in aphasia: A case study

Abstract

Background: Studies of aphasic sentence production have identified a number of promising approaches to improving performance at the single sentence level, but these studies have typically failed to show measurable effects on multi‐sentence productions (spontaneous or narrative speech). The difficulty for aphasic speakers of producing connected speech during therapy is likely to contribute to this effect. Computer software that allows patients to record, replay, and concatenate partial utterances has shown promise in allowing narrative‐level practice during treatment of even severely non‐fluent patients.

Aims: This single‐case study continues research using SentenceShaper ^®, a computer program that supports speakers' productions while they are being formulated. The goal is to investigate the utility of a two‐step treatment that supplements improvements achieved from use of the software alone with explicit structural treatment (of multi‐clause sentences).

Methods & Procedures: We describe an aphasic speaker (CI) with severely non‐fluent, fragmented, and agrammatic speech who participated in two treatment phases. Initially, as in previous studies, CI practised producing narratives (based on wordless picture books or silent videos) while using SentenceShaper, with no explicit focus on specific syntactic elements. This phase produced marked structural improvement, so a second treatment, focused on the production of multi‐clause sentences, was designed to exploit his success using the system. Following a period of targeted treatment on such structures, CI practiced producing narratives that incorporated these structures with the help of SentenceShaper. Structural analyses based on the Quantitative Production Analysis system compared Baseline and Post‐treatment 1 performance, and then compared improvements Post‐treatment 1 with those shown after treatment 2.

Outcomes & Results: Structural measures (including mean sentence length, proportion of words in sentences and sentence well‐formedness) improved significantly from Baseline following Treatment 1, and improved significantly again following Treatment 2, such that sentence length and well‐formedness moved into the normal range.

Conclusions: Results indicate that this combined approach may be helpful in improving the connected speech of even chronic and severely non‐fluent speakers. The characteristics of this aphasic speaker that might have contributed to this outcome, and the limitations of this study, are considered.

Keywords:

• Aphasia treatment
• Computer assisted.

Notes

This research was funded by NIH Grant R01‐DC05629 from the National Institute on Deafness and Other Communicative Disorders to the University of Maryland School of Medicine. SentenceShaper^® uses methods and computer interfaces covered by U.S. Patent No. 6,068,485 (Linebarger & Romania, 2000) owned by Unisys Corporation and licensed to Psycholinguistic Technologies, Inc. (www.sentenceshaper.com, which has released it as a commercial product. A potential conflict of interest arises because ML serves as Director of Psycholinguistic Technologies. Therefore, ML has not participated in testing or in scoring of raw data in the study reported here.

1. The 26 words recorded on the program's Side Buttons for Treatments 1 and 2 included: seven verbs (go, want, have, take, give, put, make), three wh‐question words (where, what, who), five prepositions (in, on, to, with, for), six pronouns (he, she, you, I, they, it), and five subordinating conjunctions (because, before, after, if, while).

2. The three target conjunctions (because, before, after) were also present on the Side Buttons in Treatment 1. However, in Treatment 2 they were modified by highlighting the font in bold text for easy identification.

3. Training on the target conjunctions lasted a total of 22 weeks. However, usage data from the first 3 weeks of home use were not analysed because home practice during that period did not focus on use of the target structures.