Script Templates: A Practical Approach to Script Training in Aphasia.

PURPOSE: Script training for aphasia involves repeated practice of relevant phrases and sentences that, when mastered, can potentially be used in other communicative situations. Although an increasingly popular approach, script development can be time-consuming. We provide a detailed summary of the evidence supporting this approach. We then describe a method in which scripts at various levels of difficulty are created by systematically manipulating readability and grammatical and semantic components. We assess the appropriateness of using these template-based scripts with persons with aphasia of differing severities. METHOD: We evaluated the oral reading performance of eight individuals with chronic non-fluent aphasia on scripts developed from the templates. Scripts were either of high or low difficulty relative to their aphasia severity, and personalized by inserting the participant's town and the name of an acquaintance. Oral reading probes were taken on three separate days within a week and performance within and across participants was examined. RESULTS: Regardless of the participant's aphasia severity, scripts in the low-difficulty condition were read with significantly greater accuracy than scripts in the high-difficulty condition. DISCUSSION: These findings support the use of graded script templates to ensure that appropriately challenging scripts are delivered to persons with aphasia for both clinical practice and research.

Impact of Personal Relevance on Acquisition and Generalization of Script Training for Aphasia: A Preliminary Analysis.

PURPOSE: The importance of personalization in script training in aphasia has been assumed but never tested. This study compared acquisition and generalization of personally relevant versus generic words or phrases appearing in the same scripts. METHOD: Eight individuals (6 men; 2 women) with chronic aphasia received 3 weeks of intensive computer-based script training. For each participant, 2 scripts, a trained and an untrained generalization script, were embedded with 4 personally relevant word choices and 2-4 generic items that were similar across participants. Scripts were probed for accuracy at baseline and posttreatment. Significance testing was conducted on baseline and posttreatment scores, and for gains in personally relevant versus generic items. Effect sizes were computed. RESULTS: Both personally relevant and generic items improved significantly on trained scripts. Improvements on untrained scripts were smaller, with only personally relevant items reaching significance. There was no significant difference on gains made on personalized versus generic items for trained scripts (p = .059), but the effect size was large (d = 0.90). For generalization scripts, this effect was small (d = 0.25) and nonsignificant. CONCLUSIONS: Personally relevant words and phrases were acquired, although not generalized, more successfully than generic words and phrases. Data supports the importance of personalization in script training, but the degree of that importance requires further investigation.

Acquisition and maintenance of scripts in aphasia: a comparison of two cuing conditions.

PURPOSE: This study was designed to compare acquisition and maintenance of scripts under two conditions: high cue, which provided numerous multimodality cues designed to minimize errors, and low cue, which provided minimal cues. METHOD: In a randomized controlled crossover study, eight individuals with chronic aphasia received intensive computer-based script training under two cuing conditions. Each condition lasted 3 weeks, with a 3-week washout period. Trained and untrained scripts were probed for accuracy and rate at baseline, during treatment, immediately posttreatment, and at 3 and 6 weeks posttreatment. Significance testing was conducted on gain scores, and effect sizes were calculated. RESULTS: Training resulted in significant gains in script acquisition with maintenance of skills at 3 and 6 weeks posttreatment. Differences between cuing conditions were not significant. When severity of aphasia was considered, there also were no significant differences between conditions, although magnitude of change was greater in the high-cue condition versus the low-cue condition for those with more severe aphasia. CONCLUSIONS: Both cuing conditions were effective in acquisition and maintenance of scripts. The high-cue condition may be advantageous for those with more severe aphasia. Findings support the clinical use of script training and the importance of considering aphasia severity.

Epidural cortical stimulation and aphasia therapy.

BACKGROUND: There are several methods of delivering cortical brain stimulation to modulate cortical excitability and interest in their application as an adjuvant strategy in aphasia rehabilitation after stroke is growing. Epidural cortical stimulation, although more invasive than other methods, permits high frequency stimulation of high spatial specificity to targeted neuronal populations. AIMS: First, we review evidence supporting the use of epidural cortical stimulation for upper limb recovery after focal cortical injury in both animal models and human stroke survivors. These data provide the empirical and theoretical platform underlying the use of epidural cortical stimulation in aphasia. Second, we summarize evidence for the application of epidural cortical stimulation in aphasia. We describe the procedures and primary outcomes of a safety and feasibility study (Cherney, Erickson & Small, 2010), and provide previously unpublished data regarding secondary behavioral outcomes from that study. MAIN CONTRIBUTION: In a controlled study comparing epidural cortical stimulation plus language treatment (CS/LT) to language treatment alone (LT), eight stroke survivors with nonfluent aphasia received intensive language therapy for 6 weeks. Four of these participants also underwent surgical implantation of an epidural stimulation device which was activated only during therapy sessions. Behavioral data were collected before treatment, immediately after treatment, and at 6 and 12 weeks following the end of treatment. The effect size for the primary outcome measure, the Western Aphasia Battery Aphasia Quotient, was benchmarked as moderate from baseline to immediately post-treatment, and large from baseline to the 12-week follow-up. Similarly, effect sizes obtained at the 12-week follow-up for the Boston Naming Test, the Communicative Effectiveness Index, and for correct information units on a picture description task were greater than those obtained immediately post treatment. When effect sizes were compared for individual subject pairs on discourse measures of content and rate, effects were typically larger for the investigational subjects receiving CS/LT than for the control subjects receiving LT alone. These analyses support previous findings regarding therapeutic efficacy of CS/LT compared to LT i.e. epidural stimulation of ipsilesional premotor cortex may augment behavioral speech-language therapy, with the largest effects after completion of therapy. CONCLUSIONS: Continued investigation of epidural cortical stimulation in combination with language training in post-stroke aphasia should proceed cautiously. Carefully planned studies that customize procedures to individual profiles are warranted. Information from research on non-invasive methods of CS/LT may also inform future studies of epidural cortical stimulation.

Computer-based script training for aphasia: emerging themes from post-treatment interviews.

This study presents results of post-treatment interviews following computer-based script training for persons with chronic aphasia. Each of the 23 participants received 9 weeks of AphasiaScripts training. Post-treatment interviews were conducted with the person with aphasia and/or a significant other person. The 23 interviews yielded 584 coded comments that were categorized into ten themes. Five of the themes related to the communication behaviors of the participant, whereas the other five related to the computer program and study procedures. Examples of each theme are presented. The themes provide qualitative evidence of change and generalization, supporting the use of this computer-based script training program.