Overcoming Learned Non-Use in Chronic Aphasia

Not Applicable

Completed

• Conditions: Stroke-induced Aphasia
• Interventions: Behavioral: Intensive Language Action Therapy

• Registration Number: NCT02012374
• Lead Sponsor: University of Massachusetts, Amherst

Brief Summary

In this study the investigators are examining the effectiveness of intensive speech therapy in chronic moderate-to-severe stroke-induced aphasia under two conditions - responses "constrained" or unconstrained to speech. Both treatments involve massed practice communicating, using intensive language action therapy 3 hours/day, 5 days/week for two weeks, followed by six months of a home practice program. One treatment stresses spoken responses as the preferred expressive modality during intensive therapy. Before and after treatment, and following the home practice program and a period of no practice, the investigators will administer several tests and discourse samples to examine changes associated with the treatments. Participants will also undergo structural and functional MRI testing at these time points. The investigators will also attempt to quantify the degree to which improvements following intensive language therapy and home practice correlate with changes in Quality of Life measures as perceived by both participants with aphasia and their significant others. It is hypothesized that, whereas both treatments will lead to improvements in naming practiced words and communicating, outcomes will be enhanced for the group randomly assigned to the "constraint" condition. Moreover, performance will be enhanced on words practiced during the home practice program, including those that were not practiced during intensive therapy. Improved naming will correlate with modulation of 'signature' language and attentional networks, whose variability will depend on remaining viable brain structures. Initial severity and site/extent of lesion should predict patients' ability to transfer gains in naming to improvements in discourse.

Detailed Description

Not available

Study Timeline

• Study Start: 2012-02-26
• Study First Submitted: 2013-02-12
• Study First Submitted QC: 2013-12-09
• Study First Posted: 2013-12-16
• Primary Completion: 2015-03-17
• Study Completion: 2015-07-09
• Status Verified: 2022-12
• Last Update Submitted: 2022-12-19
• Last Update Posted: 2022-12-20

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 24

Inclusion Criteria

• unilateral left hemisphere stroke at least 6 months earlier
• aphasia with moderate-to-severe word retrieval impairments
• at least 21 years of age
• premorbidly right handed
• native speaker of English

Exclusion Criteria

• history of developmental learning difficulties
• history of prior neurological illnesses
• chronic medical illnesses that restrict participation in intensive therapy
• recent alcohol or drug dependence
• severe uncorrected impairments of vision or hearing
• any contraindication to a 3T MRI procedure (e.g., claustrophobia, metal implants or fragments in body, pregnancy)

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Unconstrained Intensive Language Action Therapy	Intensive Language Action Therapy	Following a phase of baseline pre-treatment testing, speech therapy sessions take place 5 days/week for 3 hours per session during two consecutive weeks. All communicative responses are encouraged during therapy. Following the intensive 2-week treatment, participants are trained in using individualized home practice programs on iPads. They practice approximately daily for six months, checking in weekly with an SLP via videoconferencing software and return for probes monthly. Six months post-treatment testing will take place following completion of the home practice phase and again at 12 months post-treatment.
Intensive Language Action Therapy ("constrained")	Intensive Language Action Therapy	Following a phase of baseline pre-treatment testing, speech therapy sessions take place 5 days/week for 3 hours per session during two consecutive weeks. Spoken responses are explicitly modeled and encouraged during therapy. Following the intensive 2-week treatment, participants are trained in using individualized home practice programs on iPads. They practice approximately daily for six months, checking in weekly with an SLP via videoconferencing software and return for probes monthly. Six months post-treatment testing will take place following completion of the home practice phase and again at 12 months post-treatment.

Primary Outcome Measures

Name	Time	Method
• Change from baseline on Confrontation Naming Task	Change will be assessed immediately post-treatment (2 weeks)

Secondary Outcome Measures

Name	Time	Method
Change from baseline Boston Diagnostic Aphasia Examination	Change will be assessed immediately post-treatment (2 weeks)

Trial Locations

Locations (1)

University of Massachusetts Amherst; 🇺🇸 Amherst, Massachusetts, United States