Are executive functions predictive of treatment outcome of conversational coaching: Two case studies
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1
The University of Hong Kong, Division of Speech and Hearing Sciences, Hong Kong, SAR China
Background. There has been an increasing interest in promoting functional communication of people with aphasia (PWA). Conversational coaching (Hopper, Holland, & Rewega, 2002) is one of the approaches which promote effective communication in daily contexts. Nevertheless, little is known about the factors contributing to treatment outcomes of such an approach. A recent systematic review revealed that both baseline executive functions (EF) and language abilities were important predictors of treatment success (Simic, Rochon, Greco, & Martino, 2017). As most of the studies in the review focused on word retrieval, the role of EF in conversation-based treatment remains unexplored.
Objectives. This study adopted a case study approach to examine the role of EF in treatment outcome of conversational coaching. Two PWA with comparable performance on discourse production but contrasting EF were recruited. It was hypothesized that the PWA with more preserved EF would benefit more from treatment.
Method. Two Cantonese-speaking PWA, LYH (female; age = 58 years) and YSK (male; age = 42 years), and two neurologically healthy communication partners participated in the study. Both PWA had comparable performance on discourse production as measured by the Main Concept Analysis (Kong, 2009). Their EF profiles differed: YSK performed within normal range in the Test of Nonverbal Intelligence (TONI-3; Brown, Sherbenou, & Johnson, 1997) and Wisconsin Card Sorting Test (WCST; Grant & Berg, 1993) tasks (z scores of -0.84 and -0.86 for TONI-3 and WCST, respectively), LYH performed significantly below normal in WCST (z score = -1.74) and her performance in TONI-3 was considered normal (z score = -0.14). Twelve treatment sessions were given to both dyads. Testing probes consisting of one 4-panel comics and a short video were taken three times forming the pre-treatment baseline, after the completion of the sixth treatment, post-treatment and 8-week post treatment. Each PWA had to narrate the content to their partner who had no prior exposure to the materials. The main concepts (MCs) co-constructed by each dyad and those constructed by the PWA only in the testing probes served as outcome measures. They were then compared across the study period using Tau-U (Lee & Cherney, 2018), a quantitative measure analyzing single-case experimental design data.
Results. The MCs co-constructed by each dyad and by each PWA are illustrated in Figure 1. Table 1 shows that both dyads benefited from treatment, although the effect size associated with YSK’s improvement was somewhat larger than that of LYH. More importantly, only YSK, who had more preserved EF abilities, showed significant improvement in the measure of MCs constructed by PWA only.
Conclusion. Our results have shown that conversational coaching can benefit PWA with varying EF, and EF is relevant to functional treatment outcomes. They also highlight the critical role of communication partner training in conversation therapy, especially for PWA with impaired EF. More in-depth and large-scale investigations in the significance of EF on functional rehabilitation of PWA are warranted. Finally, our data analysis demonstrates the advantages of using Tau-U for analyzing treatment outcomes in single-case design studies.
Acknowledgements
This work was supported by the Seed Fund for Basic Research of the University of Hong Kong under Grant # 201611159051. Special thanks are given to the Neighbourhood Advice-Action Council. The authors would like to sincerely thank the participants, care-takers, volunteering communication partners, speech therapists and student speech therapists for their involvement.
References
Brown, L., Sherbenou, R. J., & Johnson, S. K. (1997). Test of Nonverbal Intelligence: TONI-3, a Language-Free Measure of Cognitive Ability: Pro-ed.
Frankel, T., Penn, C., & Ormond‐Brown, D. (2007). Executive dysfunction as an explanatory basis for conversation symptoms of aphasia: A pilot study. Aphasiology, 21, 814–828. http://doi.org/10.1080/02687030701192448
Grant, D. A., & Berg, E. A. (1993). Wisconsin Card Sorting Test. San Antonio, TX: Psychological Assessment Resources, Inc.
Hopper, T., Holland, A., & Rewega, M. (2002). Conversational coaching: Treatment outcomes and future directions. Aphasiology, 16(7), 745-761.
Kong, A. P.-H. (2009). The use of main concept analysis to measure discourse production in Cantonese-speaking persons with aphasia: A preliminary report. Journal of Communication Disorders, 42(6), 442-464.
Lee, J. B., & C, L. R. (2018). Tau-U: A quantitative approach for analysis of single-case experimental data in aphasia. America Journal of Speech-Language Pathology, 27, 495-503.
Simic, T., Rochon, E., Greco, E., & Martino, R. (2017). Baseline executive control ability and its relationship to language therapy improvements in post-stroke aphasia: a systematic review. Neuropsychological Rehabilitation, 1-45.
Keywords:
aphasia rehabilitation,
executive functions,
conversational coaching,
treatment outcome,
Treatment outcome evaluation
Conference:
Academy of Aphasia 57th Annual Meeting, Macau, Macao, SAR China, 27 Oct - 29 Oct, 2019.
Presentation Type:
Poster presentation
Topic:
Eligible for student award
Citation:
Wong
WW,
Chow
C and
Law
S
(2019). Are executive functions predictive of treatment outcome of conversational coaching: Two case studies.
Front. Hum. Neurosci.
Conference Abstract:
Academy of Aphasia 57th Annual Meeting.
doi: 10.3389/conf.fnhum.2019.01.00009
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Received:
27 Apr 2019;
Published Online:
09 Oct 2019.
*
Correspondence:
Ms. Winsy W Wong, The University of Hong Kong, Division of Speech and Hearing Sciences, Pokfulam, Hong Kong, SAR China, winsywg@gmail.com