Effect of individual on group therapies in aphasia

Thesis (Ph.D.)--Boston UniversityCurrently, two treatment orientations exist in remediation of aphasia: an impairment-based approach and a socially oriented approach. Both are theoretically driven and strive to improve communication in aphasia, yet rarely are they administered in a collaborative, integrated manner. Based on a review of these orientations, it was hypothesized that chronic patients with aphasia (PWA) would benefit from treatment that is grounded in both philosophies. Additionally, there is evidence that greater intensity of treatment leads to better outcomes and that interdisciplinary treatment might be beneficial. There are currently no studies of the effects of intensive, short duration, interdisciplinary treatments of PWA that use both impairment-based and socially oriented approaches. The present research evaluated the benefits of such a treatment program. In Study 1, 14 PWA were provided with 30 hours of interdisciplinary treatment a week for four weeks in both individual and group formats. Strong levels of change were observed post treatment, and targeted areas of language function continued to improve at three months post treatment suggesting lasting results from treatment. In Study 2, we examined the effectiveness of training verbs in a combined treatment model (individual + group) compared to those trained for the same duration in only individual or group paradigms a new cohmt of 12 PWA. No significant effect was seen for verbs trained in one condition over another; however, all verbs demonstrated significant improvements as a result of treatment. Strong treatment effects were seen for the group on generalized measures of noun and verb naming as well as the number of complete sentences produced in constrained picture description tasks. Moderate changes in functional communication and quality of life measures also were seen as a result of this treatment. Overall, the findings demonstrate significant linguistic and psychosocial changes as a result of intensive, short duration, interdisciplinary treatment of chronic PWA. This may have clinical implications. There was no benefit of an integrated approach over impairment-based or socially oriented approaches alone. The failure of the integrated approach to achieve better results may be due to the uncontrolled use of target items in the socially oriented approach in all conditions