An Evaluation of a New Nonverbal Treatment for Global Aphasia

An Investigation Into the Effect of a Novel, Non Verbal, Cognitive Treatment on Functional Communication in Global Aphasia

People with global aphasia (PwGA) post stroke have little to no meaningful communication abilities (ie limited comprehension, spoken language, reading and writing abilities).A proportion of PwGA will also have limited abilities to use any alternative means of communication e.g. gesture, pictures or computer devices. There is a suggestion in the literature that this is because of co-occurring cognitive deficits. The consequence is that these clients are unable to reliably communicate even their basic needs.This is commonly known as having no functional communication abilities. Such PwGA tend not to respond to standard speech and language therapy interventions.

This research will investigate the effect of a new cognitive intervention designed to improve basic functional communication abilities. The treatment will be nonverbal and involve computer and paperbased tasks ordered hierarchically from basic to more complex tasks. Six to eight participants will take part. All their sessions will take place in their own home. For some this may be a care home. They will first complete a diagnostic communication assessment in order for baseline abilities to be established. Further formal language and cognitive assessments will be conducted over a period of 6 weeks. A relative/friend will complete a questionnaires about mood/communication. The PwGA will also be videoed interacting with the research student e.g. looking at a magazine, completing a jigsaw, answering questions and making choices non-verbally.

The participants then receive the new intervention 3 times a week for 6 consecutive weeks. All intervention sessions will be videoed. Then participants will be reassessed over 2 weeks using the same assessments as prior to the intervention. The questionnaire with their relative/friend and videoed activity session will also be repeated. After a twelve week break the participant will be videoed interacting with the research student complete some of the assessments again and their relative will re-complete the questionnaires.

Study Overview

• Status: Completed
• Conditions: Stroke
• Intervention / Treatment: Behavioral: Cognitive therapy

• Study Type: Interventional
• Enrollment (Actual): 6
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United Kingdom
  • London, United Kingdom, WC1N
    • University College London, Research Dept of Language and Cognition

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• have global aphasia as diagnosed by an SLT
• have little or no verbal output
• inconsistent single word comprehension
• little or no ability to read or write
• little or no ability to use alternative modes of communication
• Little or no ability to make choices in function
• no diagnosis/history of a progressive neurological condition
• no diagnosis of hearing loss
• no diagnosis/history of a mental health condition
• English as a first language

Exclusion Criteria:

• has another form of aphasia
• is able to consistently express basic needs non-verbally or verbally.
• is able to participate in communicative interaction with a familiar other
• has a history of a progressive neurological condition
• has hearing loss
• has a diagnosis/history of a mental health condition
• does not have English as a first language.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Non-Randomized
• Interventional Model: Crossover Assignment
• Masking: None (Open Label)

Number of Arms

3

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
No Intervention: BASELINE TESTING; Language and cognitive assessments conducted
Experimental: Treatment; Intervention given: visual tracking pressing a button every time a picture is seen on the screen; playing dominoes and snap; pressing a button every time a specific picture is seen on the screen; Pressing a button every time a specific sound is heard; Matching objects to a picture; Matching gestures to objects; Matching two connected objects; Sorting objects by categories; Matching sounds to objects; "Complete the category" and "odd on out with objects"; Choosing target objects by pointing; Choosing objects to complete the category by pointing	Behavioral: Cognitive therapy; The tasks are: visually tracking a picture as it moves across the computer screen; pressing a button every time a picture is seen on the screen; pressing a button every time a specific picture is seen on the screen; Pressing a button every time a specific sound is heard; Matching objects to a picture; Matching gestures to objects; Matching two connected objects; Sorting objects by categories; Matching sounds to objects; "Complete the category" and "odd on out with objects"; Choosing target objects by pointing; Choosing objects to complete the category by pointing
No Intervention: Post intervention; Repeated testing

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
American Speech and Hearing Association -Functional Assessment of Communication	Questionnaire completed by friend/relative	27 weeks
Constructed Interaction Task	video recorded interaction	27 weeks

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Aphasia Screening Test	Language assessment	14 weeks
Mood Screen	depression screening tool	27 weeks
Pyramids and Palm Trees Test	pictorial semantic assessment	27 weeks
Wisconsin Card Sorting Test	cognitive assessment	14 weeks
Butt Non verbal reasoning test	cognitive assessment	27 weeks
Western Aphasia Battery cognitive sub test	cognitive assessment	14 weeks

Collaborators and Investigators

• Sponsor: University College, London
• Investigators: Principal Investigator: Suzanne Beeke, PhD, UCL

Study record dates

Study Major Dates

• Study Start (Actual): December 1, 2014
• Primary Completion (Actual): June 1, 2016
• Study Completion (Actual): December 1, 2016

Study Registration Dates

• First Submitted: June 22, 2015
• First Submitted That Met QC Criteria: September 9, 2015
• First Posted (Estimate): September 10, 2015

Study Record Updates

• Last Update Posted (Actual): January 29, 2020
• Last Update Submitted That Met QC Criteria: January 27, 2020
• Last Verified: January 1, 2020

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Nervous System Diseases; Neurologic Manifestations; Neurobehavioral Manifestations; Language Disorders; Communication Disorders; Speech Disorders; Aphasia
• Other Study ID Numbers: 13/0581

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO