Training verb and sentence production in agrammatic Broca's aphasia

Abstract

Background: Many aphasic speakers have problems producing verbs at both the word and the sentence level. A treatment programme called ACTION (Bastiaanse, Bunge, & Perk, 2004; Bastiaanse, Jonkers, Quak, & Varela Put, 1997) has been developed to train verb production of both fluent and non-fluent aphasic speakers. It consists of four levels: single verbs, filling in infinitives, filling in finite verbs, and sentence construction. For the present study the efficacy of the programme for agrammatic speakers with Broca's aphasia was tested.

Aims: The aim of the study was to measure the effects of treatment with ACTION on non-trained infinitives and finite verbs, and to analyse the generalisation effects on spontaneous speech and verbal communication in daily life.

Methods & Procedure: ACTION was used to train 11 agrammatic patients with Broca's aphasia, following the multiple baseline across behaviours design. The patients were tested weekly on untreated items. Two follow-up assessments were done, 1 and 3 months post-treatment. Generalisation to related and unrelated materials was measured with subtasks of the Aachen Aphasia Test (AAT). Spontaneous speech was analysed, and verbal communication was measured before and after treatment and 3 months post-treatment by the Amsterdam-Nijmegen Everyday Language Test (ANELT).

Outcomes & Results: There was improvement on the untrained infinitives and finite verbs. The improvement on infinitives was relatively minor; finite verbs, which were more impaired than the infinitives prior to treatment, improved up to the level of the infinitives. The improvement generalised to the related tasks of the AAT, but not to the unrelated task; verbal communication improved significantly. This improvement was reflected in relevant variables of spontaneous speech (mean length of utterances, proportion of finite verbs and verb diversity), but not in an unrelated variable (diversity of nouns).

Conclusions: Treatment with ACTION resulted in better production of finite verbs. The effects generalised to spontaneous speech. Most importantly, it was shown that communication in daily life improved.

Keywords:

• Aphasia treatment
• Verb therapy
• Agrammatic aphasia
• Broca's aphasia
• Recovery

We wish to thank the Stichting Beatrixoord Noord-Nederland and the Dutch Aphasia Foundation (Stichting Afasie Nederland: SAN) for their grants which financed this project. We are also very grateful to the speech therapists of Beatrixoord and Revalidatie Friesland, who trained the patients according to the protocol and to Ryan Taylor, Allison Smith, and Eleanor Harding for their comments on an earlier version.

Notes

¹ Base word order in Dutch is subject – object – verb. The infinitives and participles are always at the end and finite verbs in embedded clauses are also in final position. Only in main clauses is the finite verb in second position. In UG theory the finite verb is supposed to “move” to second position, which is notoriously difficult for agrammatic speakers (Bastiaanse et al., 2002). The difference is illustrated in the examples given in Figure 1a and 1b below.Figure 1a).

² The total number of lexical verbs, at the group level, was not different from normal, as in Bastiaanse and Jonkers (1998). Therefore this was not a suitable variable to use. The number of different verbs produced is significantly lower than normal before treatment.

³ Before treatment the spontaneous speech of this patient is very limited. Some “longer” utterances have been chosen to illustrate that he is able to use verbs, but cannot inflect them.