“Do you have mowing the lawn?” – improvements in word retrieval and grammar following constraint-induced language therapy in primary progressive aphasia

ABSTRACT

Background: Much recent progress has been made in developing speech–language therapy in primary progressive aphasia (PPA). Several treatment approaches that have shown significant effects with people with aphasia have been adapted and re-evaluated for PPA. Constraint-induced aphasia therapy (CIAT) is a well-evaluated method that has yielded significant language improvements in people with post-stroke aphasia but has not yet been evaluated with people with PPA. Nevertheless, the combination of CIAT features like massed practice and a motivating communicative setting seem likely to make it a suitable tool for improving the speech and language performance of individuals with PPA as well.

Aims: This study investigates the effectiveness of a modified CIAT protocol on word retrieval, grammatical structure and connected speech in two individuals with non-fluent variant PPA (nfvPPA).

Methods and procedures: Two participants with nfvPPA took part in a 9-day intensive CIAT-based group therapy with additional computer-based home training. Stimuli were 120 photos of people performing daily life activities, which could be described using a simple (e.g., “The man is mowing the lawn”) or reduced (e.g., “mowing the lawn”) sentence structure. During the treatment phase, the participants were required to request picture cards from other group members using spoken language only. The task difficulty was increased hierarchically (shaped) in accordance to each participant’s performance level.

Outcomes and results: Directly after therapy, both participants achieved significant improvements in their noun and verb naming accuracy and their grammatical structure for trained items. Training effects were maintained 2 months after therapy. Moreover, generalisation to different pictures of the same item was found for both participants and one participant also showed improved grammatical structure when describing untrained pictures. No significant generalisation to untrained connected speech samples was observed for either participant.

Conclusion: This study illustrates that CIAT can be effective in people with PPA. However, further modifications of CIAT should be considered to facilitate generalisation and in order to determine which aspects of the treatment are most important.

KEYWORDS:

• Primary progressive aphasia
• non-fluent primary progressive aphasia
• word retrieval
• constraint-induced aphasia therapy

Acknowledgments

This project was supported by the Endeavour Research Fellowship granted by the Australian Government and a Fellowship granted by the Education Fund of the RWTH Aachen University (“Bildungsfonds 2014”) held by Inga Hameister. Lyndsey Nickels was funded by an Australian Research Council Future Fellowship [FT120100102]. Programming of the therapy software application was supported by the ARC Centre of Excellence in Cognition and its Disorders [CE110001021]. We would like to thank Steven Saunders for programming the home programme software application.

Disclosure statement

No potential conflict of interest was reported by the authors.

Notes

1. Collocations are defined as verb–noun compounds that are strongly semantically related and often occur together in spoken language (Schlenck et al., 1995).

2. A phrasal verb is a verb composed of a verb and an adverb or a preposition. In our study they were all of the preposition form (e.g., throwing away, trying on).

3. We would like to thank the anonymous reviewer for this suggestion.

Additional information

Funding

This project was supported by the Endeavour Research Fellowship granted by the Australian Government and a Fellowship granted by the Education Fund of the RWTH Aachen University (“Bildungsfonds 2014”) held by Inga Hameister. Lyndsey Nickels was funded by an Australian Research Council Future Fellowship [FT120100102]. Programming of the therapy software application was supported by the ARC Centre of Excellence in Cognition and its Disorders [CE110001021].