Factors that influence the effectiveness of conversation training for people with aphasia

My project is building on the findings of a previous Stroke Association funded study (TSA 2005/07, 2008-2011) that developed and evaluated a new type of conversation therapy. Traditionally conversation therapy is just offered to the non-aphasic partner but this new study actively taught strategies to a person with aphasia, as well as their conversation partner (1,2).

The study showed that people with aphasia were able to learn new strategies to improve conversation; with the conversational abilities of five out of eight people showing statistically significant positive changes post therapy. However, what was not clear was: why some people with aphasia did not improve, and exactly which tasks within the therapy were required for positive conversational change.

My PhD project aims to explore both of these questions in greater detail via a case series of eight dyads, where one person has aphasia and each participant acts as their own control. The assessment phases will have multiple baselines and will consist of: (i) weekly conversational samples and (ii) a battery of language and cognitive assessments (as results from the previous study suggested that cognitive flexibility, i.e. the ability of a person with aphasia to “switch” from one plan of action or thought to another, may influence strategy use). The eight-week therapy programme will be administered using a crossover design where therapy tasks have been divided into two components (a) education about the way that conversation works, and (b) training in conversation strategy use.

The effect of the two phases of intervention on features of conversation will then be evaluated quantitatively (using a conversation measure developed during the previous study) and qualitatively, using Conversation Analysis. Language and cognitive assessment results will be analysed to investigate the relationship between language, cognition and response to therapy.

In doing this I hope to assist speech and language therapists’ understanding of which people with aphasia are most appropriate for this therapy, and to ensure that the therapy offered is as effective and economically viable as possible.

References:

Beeke, S., Maxim, J., Best, W. & Cooper, F (2011) Redesigning therapy for agrammatism: Initial findings from the ongoing evaluation of a conversation-based intervention study. Journal of Neurolinguistics 24, 222-236.

Beckley, F., Best, W., Edwards, S., Johnson, F., Maxim, J., & Beeke, S. (submitted) Conversation therapy for agrammatism: Exploring the therapeutic process of engagement and learning by a person with aphasia. International Journal of Language and Communication Disorders.