Background: A recent review of interaction (or conversation)-focused therapy highlighted the potential of programmes targeting the person with aphasia (PWA) directly. However, it noted the key limitations of current work in this field to be a reliance on single case analyses and qualitative evidence of change, a situation that is not unusual when a complex behavioural intervention is in the early stages of development and evaluation. Aims: This article aims to evaluate an intervention that targeted a PWA and their conversation partner (CP), a dyad, as equals in a novel conversation therapy for agrammatic aphasia, using both quantitative and qualitative evidence of change. The intervention aimed to increase the insight of a dyad into facilitator and barrier conversation behaviours, to increase the understanding of the effect of agrammatism on communication, and to support each speaker to choose three strategies to work on in therapy to increase mutual understanding and enhance conversation. Methods & Procedures: Quantitative and qualitative methods are used to analyse multiple pre-therapy and follow up assessments of conversation for two dyads. Outcomes & Results: Results show that one person with severe and chronic agrammatic aphasia was able to select and practise strategies that led to qualitative and quantitative changes in his post-therapy conversations. The other PWA showed a numerical increase in one of his three strategies post therapy, but no significant quantitative change. Although both CPs significantly reduced barrier behaviours in their post-therapy conversations, neither showed a significant increase in the strategies they chose to work on. For one CP, there was qualitative evidence of the use of different turn types. Conclusions: Individually tailored input from a speech and language therapist can assist some people with chronic agrammatism to develop conversational strategies that enhance communication. Outcomes are influenced by the severity and extent of language deficits affecting, for example, single word writing. In terms of behaviour change for CPs, it appears that it may be easier to reduce barrier behaviours rather than to increase the use of facilitatory strategies. The results have implications for collaborative goal setting with clients undergoing conversation therapy.

Conversation therapies employing video for feedback and to facilitate outcome measurement are increasingly used with people with post-stroke aphasia and their conversation partners; however the evidence base for change in everyday interaction remains limited. We investigated the effect of Better Conversations with Aphasia (BCA), an intervention that is freely available online at https://extend.ucl.ac.uk/. Eight people with chronic agrammatic aphasia, and their regular conversation partners participated in the tailored 8 week program involving significant video feedback. We explored changes in: (i) conversation facilitators (such as multi-modal turns by people with aphasia); and (ii) conversation barriers (such as use of test questions by conversation partners). The outcome of intervention was evaluated directly by measuring change in video-recorded everyday conversations. The study employed a pre-post design with multiple 5 minute samples of conversation before and after intervention, scored by trained raters blind to the point of data collection. Group level analysis showed no significant increase in conversation facilitators. There was, however, a significant reduction in the number of conversation barriers. The case series data revealed variability in conversation behaviors across occasions for the same dyad and between different dyads. Specifically, post-intervention there was a significant increase in facilitator behaviors for two dyads, a decrease for one and no significant change for five dyads. There was a significant decrease in barrier behaviors for five dyads and no significant change for three dyads. The reduction in barrier behaviors was considerable; on average change from over eight to fewer than three barrier behaviors in 5 minutes of conversation. The pre-post design has the limitation of no comparison group. However, change occurs in targeted conversational behaviors and in people with chronic aphasia and their partners. The findings suggest change can occur after eight therapy sessions and have implications for clinical practice. A reduction in barrier behaviors may be easier to obtain, although the controlled case series results demonstrate a significant increase in conversation facilitators is also possible. The rehabilitation tool is available online and video technology was central to delivering intervention and evaluating change.

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Background: We explore the efficacy of a new computer therapy for sentence comprehension and production impairments in post-stroke aphasia. The intervention is based upon the theoretical framework of usage-based Construction Grammar, which has yet to be systematically applied to the management of sentence processing disorders in aphasia. Components of the intervention were trialled in two small case series, with the results of one pilot used to inform a power calculation. The aims of the study are: (1) To determine if UTILISE therapy (Unification Therapy Integrating LexIcon and SEntences) for aphasic sentence processing impairment is more effective than usual care; (2) To determine if non-invasive transcranial direct current stimulation (tDCS) enhances treatment outcomes; (3) To determine if improvements are evident in functional use of language after treatment; (4) To determine if any treatment effects are apparent after an 8-week maintenance period. Methods: We will conduct a Phase II prospective randomised control trial. The behavioural component of the study (computer therapy) is single-blinded on the primary outcome measure, while the tDCS element is double-blinded. The trial is conducted within a university setting and aims to recruit 66 participants with post-stroke aphasia from community and post-acute rehabilitation settings. After first baseline evaluation, participants are randomised on a 2:2:1:1 basis to one of four conditions: 1) immediate treatment + active tDCS; 2) immediate treatment + sham tDCS; 3) deferred treatment + active tDCS; 4) deferred treatment + sham tDCS. A second baseline assessment is completed prior to start of treatment with a gap of four weeks between baselines for the immediate groups, and eight weeks for the deferred groups. The deferred trial entry conditions act as a usual care control across their extended baseline phase. Treatment is administered in 12 x 60-minute sessions over a four-week period. Outcomes are assessed immediately at the end of intervention and after an eight week no treatment period. Participants will also undergo a structural magnetic resonance (MR) brain scan to determine lesion location and extent. The primary outcome measure is degree of connectivity (ratio of three-word combinations to total number of words) in spontaneous narrative speech (personal narratives and narration of picture cartoon series). Speech samples will be audio-recorded and subsequently transcribed and tagged by raters blind to allocation and phase. Analysis will be performed by automated analysis software (Frequency in Language Analysis Tool, FLAT; Zimmerer, Newman, Thomson, Coleman, & Varley, 2018). Secondary outcome measures are spoken sentence comprehension (Test of Reception of Grammar, TROG-2; Bishop, 2003), a study-specific story completion test (adapted from Goodglass, Gleason, Ackerman Bernholtz, & Hyde, 1972), and the Stroke and Aphasia Quality of Life Scale (SAQOL-39; Hilari, Byng, Lamping, & Smith, 2003). A shortened form of a written synonym judgement task (adapted from the Action for Dysphasic Adults Auditory Comprehension Battery, A.D.A.; Franklin, Turner, & Ellis, 1992) is administered as a probe of an untreated behaviour.Discussion: In a series of planned comparisons, we will first determine the stability of behaviour between the two baseline evaluations. We will examine the efficacy of UTILISE through comparison of change in scores between the immediate and deferred entry group, and subsequent maintenance of any behavioural gains by change between the immediate outcome and the follow-up maintenance measures. We will explore the effect of active vs. sham tDCS, and the relationship between outcomes and demographic and behavioural profiles, and lesion size and location.

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