The Feasibility of Modified Multimodal Communication Treatment With Discourse via Telepractice for People With Aphasia

Purpose: Multimodal Communication Treatment with discourse via telepractice (teleMCT+D) is a modified version of Multimodal Communication Treatment for people with aphasia to expand instruction in resolving communication breakdowns to the discourse level. Due to potential barriers to telepractice with nonspoken communication modalities, we aimed to evaluate its feasibility in a single-subject design study. Method: Two people with aphasia completed teleMCT+D across 10 weeks (two 1-hr sessions per week) and posttreatment interviews. The feasibility was evaluated for the five categories (recruitment, data collection, acceptability, resources, and responses) from Orsmond and Cohn (2015). Each category of feasibility was evaluated by several outcome measures. Results: Findings demonstrated high feasibility for recruitment and data collection, although one participant's assessment fidelity was moderate. Participants found teleMCT+D to be acceptable. They viewed the telepractice format positively; however, minimal negative reactions and events were also reported. Regarding resources, all participants and care partners had the technology skills and materials needed to participate. Additional resources, including clinician training, supervision, and regular team meetings, assured ethical conduct. Finally, the treatment response results showed mixed effects on accuracy and nonspoken modality use but no improvement in spoken modality productions. Participants also reported that they used nonspoken modalities (e.g., gesturing) frequently for daily conversations. Conclusions: We discussed the advantages and challenges of teleMCT+D based on the feasibility results such as limited view and control of the environment, which limited nonspoken modality training at times. Future directions include following the suggested modifications in a large sample with various types and severities of aphasia. Preliminary evidence supporting that a telepractice format for communication breakdown resolution treatment for people with aphasia is feasible and acceptable can provide better access to underserved populations.