Assessing the outcomes of a clinical trial: Primary outcome measures only tell part of the story

Identifying outcome measures that are sensitive to change and meaningful to participants is a challenge when designing clinical trials of complex communication interventions. Outcome measures encompassing participants’ perceptions of clinically meaningful change and their experience of the treatment process are frequently neglected. This paper presents an overview of the outcome measures used in a 3 arm clinical trial which aimed to investigate (i) social skills training for the person with TBI alone (which we have termed the TBI SOLO condition) and (ii) training communication partners to deal with difficult communication behaviors (the JOINT condition) compared to a delayed waitlist CONTROL condition. The paper asks two research questions: 1. What information did the self-report of perceived communication ability using the La Trobe Communication Questionnaire, and qualitative measures provide in addition to blinded ratings on the Adapted Kagan Scales, the primary outcome measure? 2.How did participants perceive the training experience as measured through post treatment interviews

SemaFoRe: Comparing word retrieval treatments for aphasia via a randomised crossover trial.

Word retrieval difficulties are one of the most prevalent symptoms of aphasia and we now have good evidence from single-case studies and case series that some treatment methods for word retrieval result in improvements, at least with target words (see e.g. Nickels, 2002, for a review). However, important questions remain about predicting outcome for an individual given a particular treatment. This study, SemaFoRe, is a pilot cross-over RCT contrasting two commonly used treatments, Semantic Feature Analysis (SFA; Boyle, 2010) with Repetition in the Presence of the Picture (RIPP) . Both approaches have evidence to support them but they have some key differences: studies using SFA suggest generalisation to items not seen in treatment; it has a semantic focus and, potentially encourages clients to adopt a strategy to aid word retrieval. In contrast, RIPP has a phonological basis and is relatively simple therapy. The SemaFoRe study aims to: (i) Obtain the information needed to design and power a definitive cross-over RCT. (ii) Compare the effectiveness of SFA and RIPP (iii) Evaluate whether the effects of either treatment generalise (iv) Explore prediction of benefit/gain. Within the abstract we present data from an interim analysis of 9 participants who have completed all stages; by the time of the conference we will have final data from 23

Aphasia intervention: Are we missing the forest for the trees?

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Exploring the Relationship between Attention Allocation and Working Memory Processes in Persons with and without Aphasia

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AphasiaBank: 7-Year Interest Rate Index and Yield

At the 2008 Clinical Aphasiology Conference, Holland et al. (2008) presented a general introduction to the AphasiaBank project that had recently been funded by NIH. That report covered: AphasiaBank’s goals, rationale, and discourse samples; the demographic and test data being collected; and brief descriptions of the coding and analysis systems that had been modified from the very well established Child Language Data Exchange (CHILDES, MacWhinney, 2000) for use with persons with aphasia (PWA). The goal was both to explain the project to the CAC audience and to encourage their participation as researchers and educators. Now entering its 8th year of funding, the database has grown to contain 302 transcribed discourse samples from PWA and 161 transcribed discourse samples from non-aphasic comparison participants. AphasiaBank is currently the largest shared database of multi-media interactions for the study of communication in aphasia. The standardized protocol guarantees maximal comparability across the database. Some participants have been retested a second and third time at intervals of a year or more. Transcriptions of the discourse samples are linked to digitized audio/video, all of which are password protected at the website and can be downloaded by AphasiaBank members. Additionally, other data sets at the website include media files of the Famous People Protocol (Holland, Fromm, Forbes & MacWhinney 2013), transcripts and media for several aphasia script treatment protocols, media for aphasia group treatment sessions, a variety of non-standardized transcripts linked to media contributed by other aphasia researchers, plus media and transcripts from aphasia participants whose native language is French, Spanish, Greek, and Mandarin. The purpose of this paper is to present an updated summary of the following: 1) current demographic and test data on PWA who have completed the standardized protocol; 2) professional membership in the database; 3) published clinical research using the database; and 4) educational applications of the database. In addition, performance on the Western Aphasia Battery (WAB, Kertesz, revised, 2007) by the AphasiaBank sample will be compared with that of the norming sample published for the WAB. The larger AphasiaBank WAB data set comprises a different participant pool in that it represents people with chronic aphasia who seek continued support services

Intensive Multimodal Communication Intervention for People with Chronic Aphasia

The purpose of this study was to examine an intensive multimodal intervention for chronic aphasia. The intervention aimed to increase successful initial use of nonverbal communication modalities to prevent communication breakdowns and to improve switching among communication modalities to repair communication breakdowns. Two people with chronic aphasia completed 10 three-hour intervention sessions across a two-week period. Participant one demonstrated increased successful initial nonverbal modality use across three words lists and increased switching to repair breakdowns. Participant two showed limited success using nonverbal modalities initially or as a repair attempt. Clinical implications and future research directions will be discussed

Eye-Movements Are Not Task Specific in Individuals with Aphasia

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Can Drawing Enhance Word Retrieval Skills in Chronic Aphasia?

Aphasia disrupts multiple language processes with anomia being one of the most common and persisting deficit. Individuals may use a variety of compensatory strategies to circumvent the problem, including writing, gesturing, and drawing (Farias, Davis, & Harrington, 2006). However, few formal programs have promoted drawing as a means to facilitate communication. Approaches available typically use drawing as a language substitute rather than as a catalyst for enhancing verbal expression (Sacchett, 2002) and there has been minimal focus on drawing as a compensatory strategy for word retrieval (Lyon, 1995). Furthermore, training usually emphasizes recognizing drawing rather than a format for information exchange (Morgan & Helm-Estabrooks, 1987; Sacchett, 2002). Semantic Feature Analysis (SFA) is a treatment approach based on the premise that although anomic individuals have difficulty retrieving words, ability to access semantic features of targets may be somewhat intact (Beeson, Holland, & Murray, 1995). The semantic system is accessed by producing words related to target words; in SFA, individuals incorporate these strategies as self-cues to retrieve target words (Boyle, 2004; Rider & Wright, 2008). To date, this approach has been used primarily to enhance verbal output only. Taylor and Hough (2013) used drawing to explore improvement of word retrieval skills in a woman with chronic mixed aphasia. Results revealed improvement in naming treatment pictures with some generalization to untreated stimuli as well as relevant increases on the Boston Naming Test-II (BNT-II) (Kaplan, Goodglass, & Weintraub, 2001). The current study extends investigation of drawing treatment to examine if two males with chronic nonfluent aphasia improved ability to name pictured objects through a drawing protocol. In individual single subject designs, HR and TE underwent brief but intense treatment, incorporating drawing with SFA to improve retrieval

Inter- and Intra-Individual Variability in Non-Linguistic Attention in Aphasia

The cognitive skill of attention has previously been found to be impaired in persons with aphasia (PWA) relative to control participants (e.g., Murray, 2012). However, no study to date has examined the degree to which attention fluctuates from day to day in PWA, despite the fact that other neurologically impaired populations, such as Alzheimer’s and Parkinson’s patients, have been found to exhibit a greater degree of day-to-day variability in attention than controls (Burton, Strauss, Hultsch, Moll, & Hunter, 2006). We suggest that day-to-day intra-individual variability (DTD-IIV) in attention is an important area of investigation in aphasia, and furthermore that inter-individual differences in DTD-IIV in attention may be critical in reliably predicting treatment outcomes. The expectation that an individual will improve her skills over time as a function of treatment is based on the assumption that she is able to pay attention consistently during each session. If an individual is in fact able to attend consistently each day, this assumption is fair; however, if her attention fluctuates from day to day, it seems unlikely that she will show rapid or steady improvement. With this in mind, the goal of this study was to systematically assess five types of non-linguistic attention in both PWA and control participants, using a novel computerized task and repeated sampling design. Analyses examined reaction times as well as DTD-IIV

Family ratings of communication largely reflect expressive language and conversation-level ability in people with aphasia

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