Patterns of language improvement in adults with non‐chronic non‐fluent aphasia after specific therapies

Background: Methods for functional and linguistic analysis of discourse have been used for describing recovery from aphasia and examining relationships between patterns of recovery and specific therapeutic programmes. This approach, however, has mainly concerned therapeutic programmes for chronic aphasic symptoms (e.g., therapy for chronic agrammatism in non‐fluent aphasic subjects). Aims: The first aim of this study was to examine whether functional and linguistic analyses of discourse are suitable to describe aspects of language improvement in subjects recovering from non‐fluent aphasia in the first months post‐onset. A second objective was to assess the effectiveness of two therapy programmes for chronic aphasia in increasing informativeness and/or morpho‐syntactic organisation of connected speech. This was made by examining in‐depth the correspondence between each of the two therapy programmes and the results from functional and linguistic analysis of discourse at pre‐ and post‐therapy evaluation. Methods & Procedures: Three subjects with non‐fluent aphasia (12, 18, and 22 weeks post‐onset, respectively), whose speech was characterised by reduced information content and poor morpho‐syntactic organisation, received two consecutive therapy programmes, each consisting of 35 one‐hour sessions in seven weeks. The first programme consisted of stimulus–response exercises for producing well‐formed sentences (HELPSS, Helm‐Estabrooks, Fitzpatrick, & Barresi, 1981 Helm‐Estabrooks, N. A., Fitzpatrick, P. M. and Barresi, B. 1981. Response of an agrammatic patient to a syntax stimulation programme for aphasia.. Journal of Speech and Hearing Disorders, 46: 422–427. [Crossref], [PubMed] , [Google Scholar]). This was followed by a functional treatment programme in PACE format (Carlomagno, Losanno, Emanuelli, & Razzano, 1991 Carlomagno, S., Losanno, N., Emanuelli, S. and Razzano, C. 1991. Expressive language recovery or improved communicative skills: Effects of P.A.C.E. therapy on aphasics' referential communication and story retelling.. Aphasiology, 5: 419–424. [Taylor & Francis Online], [Web of Science ®] , [Google Scholar]) intended to increase informativeness of communicative (verbal and non‐verbal) behaviour. At the three assessments (before and after HELPSS and after modified PACE) the three participants were asked to describe two cartoon stories and two single pictures. These connected speech samples underwent functional analysis (CIUs, Nicholas & Brookshire, 1993 Nicholas, L. and Brookshire, R. 1993. A system for quantifying the informativeness and efficiency of the connected speech of adults with aphasia.. Journal of Speech Hearing Research, 36(2): 338–350. [Crossref], [PubMed] , [Google Scholar]; Main Concept Analysis, Nicholas & Brookshire, 1995 Nicholas, L. and Brookshire, R. 1995. Presence, completeness, and accuracy of main concepts in the connected speech of non‐brain‐damaged adults with aphasia.. Journal of Speech and Hearing Research, 38: 145–156. [Crossref], [PubMed] , [Google Scholar]) and linguistic analysis (Marini, Caltagirone, Carlomagno, & Nocentini, 2005a Marini, A., Caltagirone, C., Carlomagno, S. and Nocentini, U. 2005a. The role played by the right hemisphere in the organisation of complex textual structures.. Brain and Language, 93: 46–54. [Crossref], [PubMed] , [Google Scholar]; Marini, Boewe, Caltagirone, & Carlomagno, 2005b Marini, A., Boewe, A., Caltagirone, C. and Carlomagno, S. 2005b. Age‐related differences in the production of textual descriptions.. Journal of Psycholinguistic Research, 34(5): 439–463. [Crossref], [PubMed] , [Google Scholar]) in order to examine the pattern of language recovery. The three participants also received functional evaluation with the EFCP (Wirz, Skinner, & Dean, 1990 Wirz, S. L., Skinner, C. and Dean, E. 1990. Revised Edinburgh Functional Communication Profile, Tucson, AZ: Communication & Skill Builders. [Google Scholar]) for assessing changes in language performance in communicative interaction. At the beginning and end of the therapy period, further evaluation was performed by means of standardised aphasia tests (AAT, Italian version, Luzzatti, Willems, & DeBleser, 1991 Luzzatti, C., Willems, K. and DeBleser, R. 1991. Aachener Aphasie Test (Versione Italiana), Firenze: Organiszazioni Speciali. [Google Scholar]; CADL, Italian version, Pizzamiglio et al., 1984 Pizzamiglio, L., Laicardi, C., Appicciafuoco, A., Gentili, P., Judica, A.Luglio, L. 1984. Capacità comunicative di pazienti afasici in situazioni di vita quotidiana: adattamento italiano.. Archivio di Psicologia Neurologia e Psichiatria, XLV(2): 187–210. [Google Scholar]). Outcomes & Results: Following the therapy programmes, a few changes were observed on standard aphasia tests. However, the informativeness of the speech samples by the three subjects increased. This corresponded to better rating of their language in the EFCP interview. In two subjects, the linguistic analysis of connected speech samples failed to show consistent syntactic organisation at the post‐therapy evaluation and differences between effects of the two programmes were marginal. In the third, the pattern of recovery did not correspond closely to that predicted by the type of treatment, i.e., better syntactic organisation of speech output became evident only after the second therapy programme. Conclusions: It is suggested that discourse analysis methods are useful for studying functional and linguistic aspects of recovery in subjects with non‐fluent aphasia in the early post‐onset period. Furthermore, in this period, specific therapy for chronic agrammatic symptoms may not reduce them. Nonetheless, this therapeutic approach plays a role in improving language informativeness particularly when combined with a functional approach.