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Piloting a cognitive-linguistic treatment for fluent aphasia in the outpatient medical setting: A clinical case

Kathy Velasco1* and Elizabeth Galletta1
  • 1 School of Medicine, New York University, United States

Background. Speech-language therapy (SLT) is the only treatment for aphasia [1] and most aphasia research studies have focused on treatment of speech production rather than comprehension [2]. Research on fluent aphasia such as Wernicke’s aphasia (WA) merits further investigation [3] especially since people with WA receive less SLT in hospital and outpatient settings [4]. A potentially relevant approach for the treatment of comprehension deficits is a relatively new lexical-semantic therapy program called “BOX” therapy. This drill-based approach applies cognitive-linguistic tasks to promote language gains in people with fluent aphasia [5]. Treatment targets the interpretation of written words, sentences, and texts with auditory presentation of stimuli applied. Research Questions. Is it feasible to administer a modified research-based treatment for fluent aphasia in an urban outpatient clinic? What is the extent to which training lexical semantic skills through the application of modified-BOX therapy promotes improved language and communication in a patient with moderate fluent aphasia? Method. A sixty-three-year-old monolingual English-speaking male with moderate fluent aphasia (Western Aphasia Battery AQ = 60.9) [6] who sustained a left posterior cerebral artery stroke (2005) followed by a left middle cerebral artery infarct (2017) was examined. He was 16 months post the second stroke at the initial assessment. A comprehensive language assessment battery [7] and standardized clinical assessments were administered pre- and post- treatment. A communication index was also administered [8]. Study design was A-B-A and comprised of pre-treatment testing followed by fourteen 45-minute treatment sessions of modified-BOX therapy 1-2 times per week (for a total of 10.5 hours of SLT) in an outpatient medical setting, and then post-treatment clinical testing. All assessments and treatment occurred in the clinical setting. Treatment stimuli were chosen based on relevance to the patient. Modified BOX treatment involved presenting various semantic decision tasks (semantic categories, syntagmatic and paradigmatic relationships, with semantic gradation), in semantic contexts (e.g. newspaper article) with the purpose of enhancing semantic processing. Each task required the patient to select the incorrect content word within a field of three-to-six words or within the context of a sentence or other text; tasks were written and aurally presented (as necessary). The level of difficulty was determined by modifying the word choice, number of distractors, semantic relatedness, and the ambiguity. There was a minimum of 3-6 trials within a set of each semantic decision task (i.e. semantic categories, syntagmatic and paradigmatic relationships, semantic gradation, and semantic context -newspaper article). Results. Administering modified BOX treatment in an outpatient medical setting is feasible. Post treatment, our patient demonstrated a clinically significant improvement in WAB-R AQ as well as improvement in several other outcome measures, including self-perception of ability to communicate (see Table and Figure). Conclusion. This clinical case suggests that a linguistic impairment-based research treatment can be modified for use in the outpatient medical setting to promote improved outcomes on impairment and communication measures for a person with fluent aphasia. Further study of the use of modified BOX treatment is warranted to recommend its use for others with fluent aphasia.

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Acknowledgements

We thank our participant.

References

[1] National Aphasia Association. (2016). Aphasia FAQs. Retrieved from https://www.aphasia.org/aphasia-faqs/ [2] Doogan, C., Dignam, J., Copland, D., & Leff, A. (2018). Aphasia recovery: When, how and who to treat? Current Neurology and Neuroscience Reports, 18(12), 90. https://doi.org/10.1007/s11910-018-0891-x [3] Raymer, A.M., Beeson, P., Holland, A., et al. (2008). Translational research in aphasia: From neuroscience to neurorehabilitation. Journal of Speech, Language, and Hearing Research, 51(1), S259-75. [4] Duffy, J., Fossett, T., & Thomas, J. (2010). Aphasia care in the acute hospital: Challenges and opportunities. Paper presented at the Clinical Aphasiology Conference, Isle of Palms, SC, May 23-27, 2010. http://aphasiology.pitt.edu/archive/00002123/01/viewpaper.pdf. [5] Wilssens, I., Vandenborre, D., van Dun, K., Verhoeven, J., Visch-Brink, E., & Marien, P. (2015). Constraint-induced aphasia therapy versus intensive semantic treatment in fluent aphasia. American Journal of Speech-Language Pathology, 24(2), 281+. Retrieved from http://link.galegroup.com.lehman.ezproxy.cuny.edu/apps/doc/A416718398/AONE?u=lehman_main&sid=AONE&xid=76f63215 [6] Kertesz, A. (2007). Western Aphasia Battery – Revised. San Antonio, TX: PsychCorp. [7] Goral and Borodkin, unpublished assessment battery. [8] Lomas, J., Pickard, L., Bester, S., Elbard, H., Finlayson, A., & Zoghaib, C. (1989). The communicative effectiveness index: Development and psychometric evaluation of a functional communication measure for adult aphasia. Journal of Speech & Hearing Disorders, 54, 113-124

Keywords: fluent aphasia, Treatment, BOX treatment, lexical-semantic therapy program, Wernicke's aphasia

Conference: Academy of Aphasia 57th Annual Meeting, Macau, Macao, SAR China, 27 Oct - 29 Oct, 2019.

Presentation Type: Poster presentation

Topic: Not eligible for student award

Citation: Velasco K and Galletta E (2019). Piloting a cognitive-linguistic treatment for fluent aphasia in the outpatient medical setting: A clinical case. Front. Hum. Neurosci. Conference Abstract: Academy of Aphasia 57th Annual Meeting. doi: 10.3389/conf.fnhum.2019.01.00045

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Received: 07 May 2019; Published Online: 09 Oct 2019.

* Correspondence: Ms. Kathy Velasco, School of Medicine, New York University, New York City, New York, 10016, United States, velasco.kathy@gmail.com