To the sentence and beyond: a single case therapy report for mild aphasia

Abstract

Background: Mild aphasia has received limited attention in the research literature, with few published treatment studies despite significant disruption of communication reported by affected individuals. This includes difficulty understanding and producing grammatically complex language, and consequent discourse and/or conversational difficulties. The limited research may be due to a lack of clarity regarding the deficits underlying the disorder, with linguistic and/or cognitive impairments implicated, as well as limited research and treatment resources being targeted at those with more severe deficits.

Aims: This single case study investigated the effectiveness of a multifaceted treatment approach designed to improve the complex sentence and discourse production of a young woman with mild aphasia.

Methods & Procedures: The participant, BM, was a 22-year-old female with mild aphasia following a left-sided embolic cerebro-vascular accident approximately 2 years prior to the study. She participated in 16 sessions of impairment-based treatment on a weekly basis. The study used a multiple baseline design across time and behaviours. Due to the lack of published assessments suitable for mild aphasia, the study included informal outcome measures comprising linguistic analysis of Cinderella narratives, as well as the picture description tasks of the Comprehensive Aphasia Test.

Outcomes & Results: BM’s picture description demonstrated modest improvements in spoken language production immediately post-treatment. Her Cinderella narrative gave further indications of improvements in complex sentence production. Analysis of her functional language output at the end of treatment indicated that improvement was most evident in written narrative production using voice recognition software.

Conclusions: This study provides some preliminary evidence that impairment-based treatment for mild aphasia can improve complex sentence and discourse production. Given the multicomponent nature of treatment, it is not possible to identify what aspects of treatment were (most) effective. However, the study highlights the potential effectiveness of impairment-based treatments for high-level language deficits, and of multimedia technology both as therapy software and in the form of assistive technologies. The development of assessments suitable for mild aphasia and potential future directions for research are discussed.

Keywords:

• mild aphasia
• complex sentences
• narrative
• treatment
• multimedia technology

Acknowledgements

We would like to express our thanks to Madeline Cruice, Shula Chiat, Vicki Joffe, Jane Marshall, and Marcia Linebarger for their invaluable advice. We would also like to thank Ingrid Scholten and two anonymous reviewers for their comments on earlier drafts of this paper, Tim Pring for statistical advice, and finally the students who worked with BM for their boundless enthusiasm.

Notes

1. Our parentheses.

2. See Note 1.

3. BM occasionally produced sentences including a relative clause (e.g., utterance 23 of her Cinderella narrative, Appendix 1) and this could also have been a therapy target. However, we felt that encouraging the use of complex sentence production would be more functionally useful for BM at this stage. (Relative clauses were treated in a subsequent phase of therapy using the Complexity Account of Therapy Effectiveness [CATE] approach [Thompson, Shapiro, Kiran, & Sobecks, 2003] not reported here.)

Additional information

Funding

This research has been supported by the CQUniversity HEALTH CRN (www.cqu.edu.au/crn) and the Australian Government’s Collaborative Research Networks Program.