Releasing communication through clown therapy: a pilot study in expressive aphasia

Background Clown therapy has become a recognized intervention for older adults and people with dementia, showing a positive impact on well-being. However, there is limited investigation on the effects of this intervention for people with aphasia.Aims This study aimed to examine the effects of clown therapy on quality of life and functional communication, and to explore possible language benefits, in a group of people with chronic stroke-related expressive aphasia in southern Brazil.Methods and procedures This proof-of-concept Phase I pre- and post-test study investigated outcomes in 26 people with aphasia who were more than one year post-stroke, after participating in five months of clown therapy, offered either as a sole treatment or as an adjunct to conventional therapy. The intervention was provided once a week, each session lasting 2 hours. The primary outcomes were quality of life, assessed using the Stroke and Aphasia Quality of Life Scale – SAQOL-39, and functional communication, assessed through the social communication domain of the ASHA Functional Assessment of Communication Skills (ASHA-FACS). Changes in language performance were explored using the Brief Language and Aphasia Assessment Battery (ABLA).Outcomes and Results An improvement in quality of life was found (Z = −3.000; p = 0.003), particularly an increase in the communication domain of SAQOL-39 (Z = −2.400; p = 0.016). Functional communication also improved (Z = −3,667; p = 0.001). The exploration of pre-post comparisons regarding language skills demonstrated that there was significant increase in total language scores (Z = −1.956; p = 0.05), with improvement in directed interview (Z = −2.016; p = 0.039), word repetition (Z = −2.323; p = 0.020), noun naming (Z = −1.973; p = 0.049) and verb naming (Z = −2.165; p = 0.030) tasks. Given the humor-based nature of our intervention, we explored whether the presence of a diagnosis of either depression or anxiety would interact with QoL, functional communication or overall language outcomes. We found that participants who had a clinical diagnosis of depression or anxiety showed significantly greater increase in the energy domain of SAQOL-39 (p = 0.047). These participants also showed a greater improvement in their total language score than those without such a diagnosis (p = 0.031).Conclusions This pilot study showed that this novel intervention was well accepted and may be a valuable approach to be integrated in aphasia rehabilitation. This therapeutic method may be more effective with people with chronic expressive aphasia who have a clinical diagnosis of either depression or anxiety.