TITLE OF POSTER: CONSTRAINT INDUCED APHASIA THERAPY - THREE SINGLE CASE STUDIES
INTRODUCTION
This research project was inspired by the Specific Interest Group in Aphasia study day given by Professor Pulvermuller in January 2011. Constraint Induced Aphasia Therapy (CIAT) is sometimes referred to as Intensive Language Action Therapy (ILAT). This technique has an impressive research base to support its use for people with aphasia (PWA) and the evidence base includes both single case and randomised control trial evidence (Pulvermuller, Neininger, Elbert, Mohr, Rockstroh, Koebbl & Taub, 2001).
Pulvermuller et al (2001) describe CIAT as a game of pairs. The game is normally played by four players: a therapist and three PWA. A 32 pack of cards consisting of 16 pairs is shuffled and divided equally between the four players. No one can see anyone else’s cards. The aim of the game is to win the most pairs of cards. Clients can win a pair by asking each of the other players in turn, for a matching card. All requests and responses should be verbal but participants may describe the target word or use a gesture in order to achieve saying the word. An essential part of the game is that each player should see and hear the name of the card in play.
RESEARCH METHOD
Three PWA were prioritised from a typical general hospital SLT caseload. All three clients were one to two years post onset of their aphasia and had already been provided with impairment focussed, functional and psychosocial SLT input. They had moderate to severe aphasia, had difficulties at several levels of single word processing and frequently failed to convey their message despite having a degree of linguistic competence and an ability to use alternative communication strategies. Accessible formal assessment measures (Kaplan, Goodglass & Weintraub 1983, Goodglass, Kaplan & Barresi 2000 & Swinburn, Porter & Howard 2004) were used to evaluate the success of therapy in a four step repeated measures research design: Baseline 1, 30 hours CIAT therapy, Baseline 2, Baseline 3.
SUMMARY OF RESULTS
For 2/3 clients, assessment results suggested that participation in the CIAT programme resulted in a positive measurable change in language behaviour. This positive change was not apparent in assessments of understanding. Selective improvement of language ability suggests that the therapy directed at language output had resulted in improved word and sentence level skills for 2/3 of our clients. There were also positive changes that were not captured by the assessment data: reduced use of written and therapist cues, improved repetition skills, improved self-monitoring and a reduced tendency to produce jargon type utterances. Relatives corroborated therapist perceptions.
CONCLUSIONS
In 2006 Beeson & Robey (2006, p162) proposed that rehabilitation outcome research should be conducted in five phases. Our study is one of the first to provide evidence to support the use of intensive CIAT therapy in the community (phase 4 – an effectiveness study). Other studies have assessed the usefulness of the therapeutic effect of ILAT (phase 1), optimised the ILAT procedure (phase 2) and tested its usefulness under ideal conditions (phase 3). The final phase outlined by Beeson & Robey (2006) is the cost-benefit analysis (phase 5) and we would welcome debate within the profession on improving this type of input and the role of Speech and Language Therapists in intensive aphasia therapy provision.
REFERENCES
Pulvermuller, F., Neininger, B., Elbert, T., Mohr, B., Rockstroh, B., Koebbl,P. & Taub, E. (2001) Constraint induced therapy for chronic aphasia after stroke. Stroke, 1621-1626.
Beeson, P. M. & Robey, R.R. (2006) Evaluating single-subject treatment research: Lessons learnt from the aphasia literature. Neuropsychological Review, 16, 161-169.
KAPLAN, E., GOODGLASS, H. and WEINTRAUB, S. (1983) The Boston Naming Test. Philadelphia: Lea and Febiger.
Goodglass, H., Kaplan, E. & Barresi, B. (2000) Boston Diagnostic Aphasia Examination. 3rd Edition. San Antonio: Pearson.
Swinburn, K., Porter, G., & Howard, D. (2004). The Comprehensive Aphasia Test. Hove: Psychology Press
