Assessing the Amount of Spontaneous Real-World Spoken Language in Aphasia: Validation of Two Methods.

PURPOSE: The purpose of this article is to present the results of a study evaluating the psychometric properties of 2 new measures that exclusively assess the amount of real-world spoken language in patients with aphasia. METHOD: Forty individuals with aphasia were evaluated on several measures of spoken language in real-world settings. The Verbal Activity Log (VAL; Johnson et al., 2014) has participants, aided by caregivers, indicate current amount and quality of real-world spoken language compared with before stroke. In addition, digital voice recorders objectively measured the amount of real-world spoken language. The Communicative Effectiveness Index (Lomas et al., 1989), a previously validated measure of functional communication, was used as a comparison measure. Nineteen participants received follow-up assessment ≥ 3 weeks later. RESULTS: Validity was supported by Pearson correlations between spoken language recordings and the VAL, r(38) = .70, p < .001. Likewise, correlation with the Communicative Effectiveness Index was strong, r(38) = .73, p < .001. Test-retest reliability for both VAL and audio recording was high, with intraclass correlations ≥ .96 and .90, respectively. CONCLUSIONS: These results present preliminary evidence for the reliability and validity of the VAL and spoken language recording for assessment of the amount of real-world spoken language in aphasia. As a simple patient-reported outcome, the VAL may assist diverse therapies for aphasia.

An enhanced protocol for constraint-induced aphasia therapy II: a case series.

PURPOSE: The initial version of Constraint-Induced Aphasia Therapy (CIAT I) consisted of a single exercise. This study sought to evaluate the feasibility for future trials of an expanded and restructured protocol designed to increase the efficacy of CIAT I. METHOD: The subjects were 4 native English speakers with chronic stroke who exhibited characteristics of moderate Broca's aphasia. Treatment was carried out for 3.5 hr/day for 15 consecutive weekdays. It consisted of 3 components: (a) intensive training by a behavioral method termed shaping using a number of expressive language exercises in addition to the single original language card game, (b) strong discouragement of attempts to use gesture or other nonverbal means of communication, and (c) a transfer package of behavioral techniques to promote transfer of treatment gains from the laboratory to real-life situations. RESULTS: Participation in speech in the life situation improved significantly after treatment. The effect sizes (i.e., d') in this domain were ≥ 2.2; d' values ≥ 0.8 are considered large. Improvement in language ability on a laboratory test, the Western Aphasia Battery-Revised (Kertesz, 2006), did not achieve statistical significance, although the effect size was large--that is, 1.3 (13.1 points). CONCLUSION: These pilot results suggest in preliminary fashion that CIAT II may produce significant improvements in everyday speech.