What is meant by “multimodal therapy” for aphasia? (Pierce et al., 2019)

Video abstractPurpose: Multimodal therapy is a frequent term in aphasia literature, but it has no agreed upon definition. Phrases such as “multimodal therapy” and “multimodal treatment” are applied to a range of aphasia interventions as if mutually understood, and yet, the interventions reported in the literature differ significantly in methodology, approach, and aims. This inconsistency can be problematic for researchers, policy makers, and clinicians accessing the literature and potentially compromises data synthesis and meta-analysis. A literature review was conducted to examine what types of aphasia treatment are labeled multimodal and determine whether any patterns are present.Method: A systematic search was conducted to identify literature pertaining to aphasia that included the term multimodal therapy (and variants). Sources included literature databases, dissertation databases, textbooks, professional association websites, and Google Scholar.Results: Thirty-three original review articles were identified, as well as another 31 sources referring to multimodal research, all of which used a variant of the term multimodal therapy. Treatments had heterogeneous aims, underlying theories, and methods. The rationale for using more than 1 modality was not always clear, nor was the reason each therapy was considered to be multimodal when similar treatments had not used the title. Treatments were noted to differ across 2 key features. The 1st was whether the ultimate aim of intervention was to improve total communication, as in augmentative and alternative communication approaches, or to improve 1 specific modality, as when gesture is used to improve word retrieval. The 2nd was the point in the treatment that the nonspeech modalities were employed.Discussion: Our review demonstrated that references to “multimodal” treatments represent very different therapies with little consistency. We propose a framework to define and categorize multimodal treatments, which is based both on our results and on current terminology in speech-language pathology.Supplemental Material S1. Secondary sources referring to multimodal treatments. Supplemental Material S2. Data extraction table for original research on "multimodal therapy."Pierce, J. E., O'Halloran, R., Togher, L., & Rose, M. L. (2019). What is meant by "multimodal therapy" for aphasia? American Journal of Speech-Language Pathology, 28, 706–716. https://doi.org/10.1044/2018_AJSLP-18-0157