Getting into shape: the effect of Shape Coding on the spoken language production of two men with chronic aphasia

ABSTRACT

Background: Shape Coding is a visual coding system that has been used to teach English syntax and morphology to school-aged children with language impairment but has the potential to support the language output of people with aphasia. While visual coding has been used effectively in a number of studies targeting basic sentence structure, these approaches are difficult to expand to include more than a limited number of arguments or to encourage individuals to produce more complex sentences. Shape Coding allows the user to work with more complex structures and verb morphology and may be valuable in improving awareness of sentence structure in adults with acquired agrammatism.

Aims: The aim of the current study is to investigate whether Shape Coding could improve the verbal output of two adult chronically agrammatic speakers.

Methods & Procedures: The study involves two men with chronic non-fluent aphasia, one of whom had previously worked with Shape Coding. Repeated baseline measures were collected three times before eight sessions of therapy and once immediately after the programme. These measured single word, sentence and narrative output, as well as communicative effectiveness. Data were analysed by examining the number of verbs used, the number of arguments included in sentences and the thematic completeness of utterances.

Outcomes & Results: For the individual introduced to Shape Coding, improvements in verb retrieval and sentence generation were observed particularly in structured tasks, with the number of obligatory arguments increasing. In tasks requiring more spontaneous production, however, marked difficulties with sentence production remained. The second participant (previously exposed to Shape Coding) was able to produce much richer language after intervention, including a greater number of both obligatory and optional arguments post-therapy, including in the unconstrained tasks. Neither participant made a significant change on the measure of functional communication.

Conclusions: This small-scale study shows encouraging signs that Shape Coding has the potential to be of real value to adults with agrammatic aphasia. The intervention had a positive impact on both participants’ output. Anecdotal evidence also suggested that the framework could be used as a prosthesis in everyday conversations, with the shapes acting as an “internal prompt” for generating sentences. More research is needed to determine the optimal amount of Shape Coding therapy needed: a higher dosage over a longer period would give individuals more time to increase familiarity with the shapes; extending the sentence structures included would increase relevance to the person’s communication needs.

KEYWORDS:

• Acquired aphasia
• agrammatism
• sentence production
• narrative
• intervention

Acknowledgement

The authors wish to thank Helen Davy for her original work with Shape Coding with AS, and both participants who contributed to the study.

Disclosure statement

No potential conflict of interest was reported by the authors.

Notes

1. There is new consensus about the label and definition for the language disorder previously known as Specific Language Impairment: Developmental Language Disorder. However, we have retained the term SLI in the text as this is the one utilised by the studies to which we refer.