A written communication strategy for a speaker with aphasia and apraxia of speech: Treatment outcomes and social validity

Abstract

Background: Self-generated cueing strategies have been shown to facilitate communication in persons with speech and language impairments, and multiple benefits may be associated with targeting conversational competence. Aims: The purpose of this study was to train an individual (LG) with longstanding aphasia and apraxia of speech to substitute a self-initiated written word for protracted articulatory struggle, in three conversational settings. Methods & Procedures: A multiple-baseline design across three different settings was utilised, providing an opportunity for strategy practice with both familiar and unfamiliar conversational partners. Topics were constructed to be relevant and meaningful to LG. Several subject-evaluated psychosocial measures, including locus of control, were employed, and social validity ratings were solicited from unfamiliar raters. Outcomes & Results: LG adopted and successfully used the strategy across all settings, with both familiar and unfamiliar partners, at performance levels well above baseline. The number of abandoned conversational targets decreased considerably with strategy use, and social validation ratings indicated beneficial effects pertaining to communicative efficiency and comprehensibility in shorter, but not longer, conversational segments extracted from treatment videotapes. Conclusions: The training protocol was successful in improving LG's facility with targeted compensatory strategy use across designated conversational contexts. However, the clinical significance and social value of LG's strategy use in these settings may be mitigated by the accompanying communicative variables affecting the conversational exchange as a whole. Future efforts could focus on examining what variables in the longer treatment segments appeared to counter the positive effects of LG's strategy use as perceived in the shorter conversational samples. On a more positive note, changes in LG's locus of control scores from extreme internal to more moderate could reflect a greater degree of willingness on her part to allow others to participate in her recovery process, or perhaps herald a more realistic attitude towards the extent of her loss.