A feasibility randomised waitlist-controlled trial of a personalised multi-level language treatment for people with aphasia: The remote LUNA study.

BACKGROUND: Stroke survivors with aphasia want to improve their everyday talking (discourse). In current UK practice, 90% of speech and language therapists believe discourse assessment and treatment is part of their role but are hampered by barriers in resources, time and expertise. There is a clinical need for well-articulated discourse assessment and treatments. LUNA is a multi-level treatment targeting words, sentences and discourse macrostructure in personal stories that addresses this clinical need. OBJECTIVES: This study aimed to assess the feasibility and acceptability of LUNA trial procedures in a randomised waitlist-controlled trial; and to evaluate preliminary efficacy. METHODS: This paper reports a phase II, waitlist-controlled, proof-of-concept feasibility trial. Participants with chronic aphasia (n = 28) were recruited from the community and randomised to an Immediate (n = 14) or Delayed (n = 14) group. LUNA treatment was delivered twice weekly for 10 weeks via the videoconferencing technology, Zoom. Feasibility was assessed in terms of participant recruitment and retention, adherence, missing data, and treatment fidelity. Preliminary treatment efficacy was assessed in terms of between group differences in outcome measures relating to discourse, language, and psychosocial state. RESULTS: The remote LUNA trial was feasible: 85% of those eligible consented to the trial; trial retention was 86%; 87% of treatment sessions were delivered as scheduled, and 79% of participants completed 80%+ of the treatment programme; data was missing only for participants who withdrew; treatment fidelity was high at 92% adherence; and only one clinical outcome measure demonstrated ceiling effects. ANCOVA analysis of the clinical outcome measures revealed group differences with medium and large effect sizes, indicating, improvements in the production of words, sentences, discourse macrostructure, overall language functioning (WAB-R), and psychosocial state (VAMS) following LUNA treatment. For most outcomes measured, similar treatment benefits were suggested in a secondary, non-parametric analysis. CONCLUSIONS: Large-scale evaluation of the clinical efficacy and cost-effectiveness of LUNA is warranted and supported by these findings. TRIAL REGISTRATION: Clinical trials registration: NCT05847023 (clinical trials.gov).

Correction and turn completion as collaborative repair strategies in conversations following Wernicke's aphasia.

This study explores repair practices deployed by the interlocutor of a speaker with Wernicke's aphasia, their relationship to types of aphasic difficulty, and how mutual understanding and the progression of talk is maintained. A 75-year-old woman with Wernicke's aphasia of 16 months duration and her friend video recorded 36 minutes of conversation at home. Using conversation analytic methods two patterns of other-repair by the non-aphasic interlocutor were identified. The first practice was turn completion, which occurred in the context of self-initiated word search by the person with aphasia. The second was correction in the context of trouble with reference to person or place, manifested as an erroneous word, mis-selection of a gendered pronoun, or use of a pronoun where a person's name was expected. This correction was mainly overt, completed via a short side sequence dealing with the repair, although a few examples were embedded, where a word or phrase was replaced with a corrected form without overtly drawing attention to the correction. None of the examples included an account for the error. Unlike in typical talk, the person with aphasia did not repeat or use the corrected form in subsequent talk. For this dyad, correction and completion function as interactionally acceptable collaborative repair strategies, maintaining progressivity and a focus on topic development rather than on repair itself. There is no evidence that other-correction is dispreferred, which accords with recent findings for typical interaction but differs from other studies of aphasic talk. Correction should not be dismissed out of hand as a negative interactional practice when talking to someone with Wernicke's aphasia.