Counseling and script training in PPA (Schaffer et al., 2021)
Creators: name: Schaffer, Kristin M.
name: Evans, William S.
name: Dutcher, Christina D.
name: Philburn, Christina
name: Henry, Maya L.
Publisher: name: ASHA journals
Year: 2021
Subjects: subject: Language
subject: 110321 Rehabilitation and Therapy (excl. Physiotherapy)
subject: FOS: Clinical medicine

description: <b>Purpose: </b>This study sought to determine the initial feasibility and benefit of a novel intervention that combines speech-language treatment with counseling treatment for an individual with the nonfluent/agrammatic variant of primary progressive aphasia (PPA).<b>Method:</b> Using a single-case experimental design, we evaluated the utility of modified script training paired with aphasia-modified cognitive behavioral therapy. The study employed a multiple baseline design across scripts for the primary linguistic outcome measure and a mixed methods approach for analyzing counseling outcomes. Psychosocial and communicative functioning scales were administered in conjunction with a phenomenological analysis of semi-structured interviews.<b>Results: </b>The participant completed all study phases and participated in all treatment components. She met the criterion of 90% correct, intelligible scripted words on all trained scripts through 12 months post-treatment. Treatment outcomes were comparable to a comparison cohort that received script training without counseling (Henry et al., 2018). At post-treatment, the participant demonstrated stability or improvement on all measures of psychosocial and communicative functioning, with stability documented on seven out of 11 scales at follow-ups through 12 months post-treatment. A phenomenological analysis revealed pervasive themes of <i>loss </i>and <i>resilience </i>at both time points, and emerging themes of<i> positive self-perception</i>,<i> sense of agency</i>, and <i>emotional attunement</i> following treatment.<b>Conclusions: </b>Results indicate that script training with aphasia-modified cognitive behavioral therapy is a feasible treatment for an individual with the nonfluent/agrammatic variant of PPA, with immediate and lasting benefits to speech-language production and psychosocial functioning. These findings are the first to support the integration of personal adjustment counseling techniques within a speech-language treatment paradigm for PPA.<br><b>Supplemental Material S1. </b>The VISTA+C participant’s performance on WAB-R subtests at each study time point.<br><b>Supplemental Material S2.</b> Linguistic parameters used for balancing the trained and untrained scripts of the VISTA+C participant.<br><b>Supplemental Material S3. </b>Participant's script characteristics. <br><b>Supplemental Material S4. </b>Script rate details. <br><b>Supplemental Material S5.</b> Sample dyadic aphasia-modified CBT exchange between patient and clinician. <br>Schaffer, K. M., Evans, W. S., Dutcher, C. D., Philburn, C., &amp; Henry, M. L. (2021). Embedding aphasia-modified cognitive behavioral therapy in script training for primary progressive aphasia: A single-case pilot study. <i>American Journal of Speech-Language Pathology</i>. Advance online publication. https://doi.org/10.1044/2021_AJSLP-20-00361