Semin Speech Lang 2022; 43(05): 391-405
DOI: 10.1055/s-0042-1756272
Data-Based Research Articles

Behaviorally-Oriented Intensive Aphasia Program: Collaboration Leads to Optimal Outcomes

Shawna Fleming
1   Evergreen Communication Therapy, Waterloo, Ontario, Canada
,
Brittany Clark
1   Evergreen Communication Therapy, Waterloo, Ontario, Canada
› Author Affiliations
› Further Information
Also available at
   Permissions and Reprints

Abstract

Aphasia is an acquired disorder affecting all language components across modalities. While common therapeutic approaches can result in some improvements, multiple studies establish that intensive therapeutic interventions are most effective; however, these approaches are not well defined. In addition, behaviorally-oriented approaches have been shown to be effective for other conditions, but have not yet been introduced to the treatment of aphasia. The purpose of the current study was to examine the efficacy of a novel, behaviorally-oriented, intensive communication intervention for aphasia (BICA) designed by a speech-language pathologist (second author) and a Board Certified Behavior Analyst (first author) for a 71-year-old woman with post–stroke aphasia. Using a case study design, the participant was provided with 12 hours/week of therapy for 12 weeks focusing on functional communication goals using a behavioral interpretation of language and stimulus control transfer procedures. The behavior analyst determined conceptually systematic interventions based on targets selected by the speech-language pathologist. The participant demonstrated substantial improvements in written language expression and comprehension, reading fluency, oral language expression, naming, and improved quality of life. Given the substantial gains the participant made in oral and written language post-stroke using the BICA therapy, further study is warranted.

Keywords

aphasia - collaboration - intensive - language - verbal behavior


Publication History

Article published online:
12 September 2022

© 2022. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Dickey L, Kagan A, Lindsay MP, Fang J, Rowland A, Black S. Incidence and profile of inpatient stroke-induced aphasia in Ontario, Canada. Arch Phys Med Rehabil 2010; 91 (02) 196-202
    CrossrefPubMedGoogle Scholar
  • 2 Laska AC, Hellblom A, Murray V, Kahan T, Von Arbin M. Aphasia in acute stroke and relation to outcome. J Intern Med 2001; 249 (05) 413-422
    CrossrefPubMedGoogle Scholar
  • 3 Maas MB, Lev MH, Ay H. et al. The prognosis for aphasia in stroke. J Stroke Cerebrovasc Dis 2012; 21 (05) 350-357
    CrossrefPubMedGoogle Scholar
  • 4 Cruice M, Worrall L, Hickson L, Murison R. Finding a focus for quality of life with aphasia: social and emotional health, and psychological well-being. Aphasiology 2003; 17 (04) 333-353
    CrossrefPubMedGoogle Scholar
  • 5 Rose ML, Cherney LR, Worrall LE. Intensive comprehensive aphasia programs: an international survey of practice. Top Stroke Rehabil 2013; 20 (05) 379-387
    CrossrefPubMedGoogle Scholar
  • 6 Brady MC, Kelly H, Godwin J, Enderby P, Campbell P. Speech and language therapy for aphasia following stroke. Cochrane Database Syst Rev 2016; 6 (06) CD000425
    PubMedGoogle Scholar
  • 7 Lucchese G, Pulvermüller F, Stahl B, Dreyer FR, Mohr B. Therapy-induced neuroplasticity of language in chronic post stroke aphasia: a mismatch negativity study of (a)grammatical and meaningful/less mini-constructions. Front Hum Neurosci 2017; 10: 669
    CrossrefPubMedGoogle Scholar
  • 8 World Health Organization. International Classification of Functioning, Disability and Health. Geneva: Author; 2001
    Google Scholar
  • 9 Trebilcock M, Worrall L, Ryan B. et al. Increasing the intensity and comprehensiveness of aphasia services: identification of key factors influencing implementation across six countries. Aphasiology 2019; 33 (07) 865-887
    CrossrefPubMedGoogle Scholar
  • 10 MacKenzie D, Creaser G, Sponagle K. et al. Best practice interprofessional stroke care collaboration and simulation: the student perspective. J Interprof Care 2017; 31 (06) 793-796
    CrossrefPubMedGoogle Scholar
  • 11 Farrell C. The ethics and value of true interprofessionalism. AMA J Ethics 2016; 18 (09) 887-890
    CrossrefPubMedGoogle Scholar
  • 12 Slim L, Reuter-Yuill LM. A behavior-analytic perspective on interprofessional collaboration. Behav Anal Pract 2021; 14 (04) 1238-1248
    CrossrefPubMedGoogle Scholar
  • 13 Wong C, Odom SL, Hume KA. et al. Evidence-based practices for children, youth, and young adults with autism spectrum disorder: a comprehensive review. J Aut Dev Disord 2015; 45 (07) 1951-1966
    CrossrefPubMedGoogle Scholar
  • 14 Gerenser JE, Koenig MA. ABA for SLPs: Interprofessional Collaboration for Autism Support Teams. Baltimore, MD: Paul H. Brookes Publishing Co.; 2019: 3-26
    Google Scholar
  • 15 Baker JC, Leblanc LA, Raetz PB. A behavioral conceptualization of aphasia. Anal Verbal Behav 2008; 24 (01) 147-158
    CrossrefPubMedGoogle Scholar
  • 16 Skinner BF. Verbal Behavior. Englewood Cliffs, NJ: Prentice-Hall; 1957
    CrossrefGoogle Scholar
  • 17 Esch BE, LaLonde KB, Esch JW. Speech and language assessment: a verbal behavior analysis. J Speech Lang Pathol Appl Behav Anal 2010; 5 (02) 166-191
    PubMedGoogle Scholar
  • 18 Patterson JP. The effectiveness of cueing hierarchies as a treatment for word retrieval impairment. Perspect Neurophysiol Neurogenic Speech Lang Disord 2001; 11 (02) 11-18
    CrossrefPubMedGoogle Scholar
  • 19 Sidman M. The behavioral analysis of aphasia. Neuropsychologia 1971; 8: 413-422
    PubMedGoogle Scholar
  • 20 Green G. Behavior analytic instruction for learners with autism: advances in stimulus control technology. Focus Autism Other Dev Disabl 2001; 16: 72-85
    CrossrefPubMedGoogle Scholar
  • 21 Shillingsburg MA, Gayman CM, Walton W. Using textual prompts to teach mands for information using “Who?”. Anal Verbal Behav 2016; 32 (01) 1-14
    CrossrefPubMedGoogle Scholar
  • 22 Ritchie H, Reuter-Yuill L, Perez A, Baker J. Assessment-informed intervention for aphasia in an older adult: transfer of stimulus control procedure considerations. Anal Verb Behav 2021; 37 (02) 226-236
    CrossrefPubMedGoogle Scholar
  • 23 Dixon M, Baker JC, Sadowski KA. Applying Skinner's analysis of verbal behavior to persons with dementia. Behav Ther 2011; 42 (01) 120-126
    CrossrefPubMedGoogle Scholar
  • 24 Gross AC, Fuqua RW, Merritt TA. Evaluation of verbal behavior in older adults. Anal Verbal Behav 2013; 29 (01) 85-99
    CrossrefPubMedGoogle Scholar
  • 25 Heinicke MR, Carr JE. Applied behavior analysis in acquired brain injury rehabilitation: a meta-analysis of single-case design intervention research. Behav Interv 2014; 29 (02) 77-105
    CrossrefPubMedGoogle Scholar
  • 26 Mozzoni MP. Applied behavior analysis evaluation strategies and neurorehabilitation. Brain Injury Professional 2008; 5: 29-31
    PubMedGoogle Scholar
  • 27 Finn HE, Miguel CF, Ahearn WH. The emergence of untrained mands and tacts in children with autism. J Appl Behav Anal 2012; 45 (02) 265-280
    CrossrefPubMedGoogle Scholar
  • 28 Ingvarsson ET, Hollobaugh T. Acquisition of intraverbal behavior: teaching children with autism to mand for answers to questions. J Appl Behav Anal 2010; 43 (01) 1-17
    CrossrefPubMedGoogle Scholar
  • 29 May RJ, Downs R, Marchant A, Dymond S. Emergent verbal behavior in preschool children learning a second language. J Appl Behav Anal 2016; 49 (03) 711-716
    CrossrefPubMedGoogle Scholar
  • 30 May RJ, Hawkins E, Dymond S. Brief report: effects of tact training on emergent intraverbal vocal responses in adolescents with autism. J Autism Dev Disord 2013; 43 (04) 996-1004
    CrossrefPubMedGoogle Scholar
  • 31 Dixon MR, Small SL, Rosales R. Extended analysis of empirical citations with Skinner's verbal behavior: 1984–2004. Behav Anal 2007; 30 (02) 197-209
    CrossrefPubMedGoogle Scholar
  • 32 Sundberg ML. 301 research topics from Skinner's book verbal behavior. Anal Verbal Behav 1991; 9: 81-96
    CrossrefPubMedGoogle Scholar
  • 33 Kagan A, Black SE, Duchan FJ, Simmons-Mackie N, Square P. Training volunteers as conversation partners using “Supported Conversation for Adults with Aphasia” (SCA): a controlled trial. J Speech Lang Hear Res 2001; 44 (03) 624-638
    CrossrefPubMedGoogle Scholar
  • 34 Hersh D, Worrall L, O'Halloran R, Brown K, Grohn B, Rodriguez A. Assess for success: evidence for therapeutic assessment. In: Simmons-Mackie N, King J, Beukelman D. eds. Supporting Communication for Adults with Acute and Chronic Aphasia. Baltimore, MD: Paul H. Brookes; 2013
    Google Scholar
  • 35 Kertesz A. Western Aphasia Battery - Revised. San Antonio, TX: The Psychological Corporation; 2007
    Google Scholar
  • 36 McKinnon ET, Fridriksson J, Basilakos A. et al. Types of naming errors in chronic post-stroke aphasia are dissociated by dual stream axonal loss. Sci Rep 2018; 8 (01) 14352
    CrossrefPubMedGoogle Scholar
  • 37 Dunn DM. Peabody Picture Vocabulary Test, 5th ed. Bloomington, MN: NCS Pearson; 2019
    Google Scholar
  • 38 Williams KT. Expressive Vocabulary Test, 3rd ed. Bloomington, MN: NCS Pearson; 2019
    Google Scholar
  • 39 Williams KT. EVT-2 Publication Summary Form. Accessed July 8, 2021 at: https://images.pearsonclinical.com/images/Products/EVT-II/evt2.pdf 2007
    PubMedGoogle Scholar
  • 40 Leslie L, Caldwell J. Qualitative Reading Inventory. 6th ed.. 2017
    Google Scholar
  • 41 Simpson F. Mount Wilga High Level Language Test. 20th Anniversary Revised Edition. 1st ed.. 2006 . Accessed July 8, 2021 at: https://baixardoc.com/documents/mount-wilga-high-level-language-test-revised-2006-5d1a6edc5f9a6
    PubMedGoogle Scholar
  • 42 Simmons-Mackie N, Kagan A, Victor JC. et al. The assessment for living with aphasia: reliability and construct validity. Int J Speech Lang Pathol 2014; 16 (01) 82-94
    CrossrefPubMedGoogle Scholar
  • 43 Haughton EC. Practicing practices: learning by activity. Journal of Precision Teaching 1980; 1: 3-20
    PubMedGoogle Scholar
  • 44 Cohen J. Statistical Power Analysis for the Behavioral Sciences. New York, NY: Routledge Academic; 1988
    Google Scholar
  • 45 Michiels B, Onghena P. Randomized single-case AB phase designs: prospects and pitfalls. Behav Res Methods 2019; 51 (06) 2454-2476
    CrossrefPubMedGoogle Scholar
  • 46 Simmons-Mackie N, Worrall L, Murray LL, Enderby P, Rose ML, Paek EJ. Klippi on behalf of the Aphasia United Best Practices Working Group and Advisory Committee. The top ten: best practice recommendations for aphasia. Aphasiology 2016; 31 (02) 131-151
    PubMedGoogle Scholar