Aphasia Rehabilitation: Modulating Cues, Feedback & Practice
Condition: Aphasia; Stroke
MeSH terms: Aphasia
Study type: Interventional

Summary: 
      The purpose of this study is to evaluate how changing different conditions of the
      speech-language treatment (such as cues, feedback, complexity and practice schedule) affects
      the language outcome of study subjects with aphasia (i.e., difficulty with the comprehension
      and expression of spoken and written language) following a stroke.
    

Detailed description: 
      Stroke is the third leading cause of death and the most common cause of disability in the
      United States. According to the American Stroke Association, the prevalence of stroke in the
      U.S. is approximately 4.8 million with approximately 700,000 additional strokes occurring
      annually. Approximately 150,000 to 250,000 stroke survivors becoming severely and permanently
      disabled each year.

      A common neurological deficit among stroke survivors, and thus a substantial contributor to
      post-stroke disability, is aphasia. The loss of, or difficulty with language is extremely
      debilitating. Recently, there has been an emphasis on the need for intensive aphasia
      treatment in order to make the long-term neuroplastic changes associated with recovery.
      However, specific information regarding effective learning parameters is limited.

      A number of variables and practice conditions, deriving from motor learning theory,
      potentially impact the rehabilitation process. Several of these variables have begun to be
      addressed in the literature, but with conflicting or scant evidence to date. Variables
      include the type and degree of external cueing, low versus high feedback conditions, task
      complexity, and practice distribution and schedule.

      The purpose of this study is to:

        -  Modulate variables of cuing, feedback and script complexity that potentially affect
           treatment outcomes, and measure their effects on acquisition, maintenance and
           generalization of script learning. These investigations are conducted as separate
           studies, with the first study being a cross-over study investigating cuing and the
           second study being a 2x2 factorial design investigating feedback and complexity.

        -  Modify and optimize AphasiaScripts-an existing treatment program having experimental
           support for its efficacy-by incorporating these findings.

        -  Conduct a clinical trial, incorporating the optimized AphasiaScripts program, in order
           to measure the effect of massed vs distributed practice, and blocked vs random practice
           schedules, on the acquisition, maintenance and generalization of script learning.

      Measures will include independent pre-and post assessments of acquisition, maintenance and
      generalization of script learning as well as dependent item/cue level measures of progress.

      Results and computational models of acquisition, maintenance and generalization will
      contribute new evidence to support not just the efficacy and delivery of AphasiaScripts, but
      also the application of practice principles to aphasia treatment in general.

      The first part of the study - a cross-over study that evaluates error-free versus
      error-reducing script training has been done. Below is a description of the second part of
      the study which evaluates feedback and script complexity.
    

Intervention name(s): Script training
Intervention type(s): Behavioral
Intervention description(s): 90 minutes/day, 6 days a week; includes 3 weeks of training
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: Aphasia; Speech Rehabilitation