Date of Award

2012

Document Type

Thesis

Publisher

Edith Cowan University

Degree Name

Bachelor of Speech Pathology (Honours)

School

School of Psychology and Social Science

Faculty

Faculty of Computing, Health and Science

First Supervisor

Dr Natalie Ciccone

Second Supervisor

Dr Erin Godecke

Abstract

Background and purpose: Research suggests communication outcomes following stroke may be greater when treatment is administered in the acute phase of recovery. In addition, treatment outcomes are improved when therapy is provided at a greater intensity. Constraint Induced Aphasia Therapy (CIAT) has addressed the issue of treatment intensity by delivering therapy for three hours per weekday for two weeks, but its effectiveness has largely been investigated in the chronic phase of recovery. Treatment outcomes have typically been assessed on standardised tests and few studies have used connected speech and discourse measures to assess change. This research investigated daily intervention in the very early phase of recovery post stroke comparing CIAT and individual, impairment based intervention for individuals with a range of aphasia severities on a range of discourse measures. Methods and Procedures: This study used a deidentified subset from a single blinded, randomised controlled trial Study of Aphasia: Early Intensive Treatment [SAEIT]. Patients with acute stroke were recruited within ten days post-stroke from acute and sub-acute Perth metropolitan hospitals to receive CIAT in a modified dose (45-60 minutes, five days a week) or individual, impairment based intervention (1:1 therapy). Both treatments were delivered in the same intensity for four to five weeks. The current study examined discourse samples which were segmented and formatted following SALT transcription conventions.Therapy outcome measures included the aphasia quotient from the Western Aphasia Battery and discourse measures examining microlinguistic elements of discourse immediately post-treatment and at three months follow-up. Treatment outcomes were analysed using mixed design ANOVAs to assess the within groups effect of treatment and the between groups effect of treatment type. Outcomes and Results: Within groups analyses revealed a statistically significant treatment effect for three discourse measures: mean length of utterances; a measure of grammatical complexity; and the number of utterances containing non-relevant information. Additionally, changes in the AQ severity measure and majority of the remaining discourse measures were not significant but demonstrated a trend towards a positive treatment effect. There was no significant difference between the CIAT and 1:1 therapy groups in any of the outcome measures. Conclusions: This study found daily CIAT to be comparable to 1:1 therapy on all outcome measures in the very early phase of recovery. Participants tolerated very early daily aphasia therapy and positive treatment gains were evident in the microlinguistic elements of discourse for both treatments. The standardised aphasia severity measure did not reflect changes that occurred in connected speech following intervention which suggests discourse measures are an important component of aphasia therapy outcome measurement. CIAT delivered in a group setting may address resource limitations in the acute setting to assist in increasing therapy intensity in very early aphasia recovery.

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