An Evaluation of a New Nonverbal Treatment for Global Aphasia

Study Overview
=================
Brief Summary
-----------------
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.

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

Conditions
-----------------
Stroke

Intervention / Treatment
-----------------
* Behavioral: Cognitive therapy


Participation Criteria
=================
Eligibility Criteria
-----------------
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.

Ages Eligible for Study
-----------------
Minimum Age: 18 Years

Sexes Eligible for Study
-----------------
All

Accepts Healthy Volunteers
-----------------
No

Study Plan
=================
How is the study designed?
-----------------

Design Details

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


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| No Intervention: BASELINE TESTING<br>Language and cognitive assessments conducted | |
| Experimental: Treatment<br>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<br>* 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<br>|
| No Intervention: Post intervention<br>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 |