Date of Award

5-2017

Culminating Project Type

Thesis

Degree Name

Communication Sciences and Disorders: M.S.

Department

Communication Sciences and Disorders

College

School of Health and Human Services

First Advisor

G.N. Rangamani

Second Advisor

Janet Tilstra

Third Advisor

Amanda Hemmesch Breaker

Creative Commons License

Creative Commons License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License.

Keywords and Subject Headings

Aphasia, Conversation Training, Partner Training

Abstract

PROBLEM:

Traditional treatment approaches in aphasia therapy focus on remediation of a specific linguistic impairment or cognitive process and restoration of language functions. These approaches expect that skills will generalize to everyday communication. However, preliminary findings do not present conclusive evidence of such generalization (Savage, Donovan, & Hoffman, 2014). Recently, there has been a growing interest in treatments that adhere to the Life Participation Approach to Aphasia (LPAA) (LPAA Project Group, 2008). Many of these treatments intervene at the conversational level and focus on changing behaviors within natural conversation rather than expecting linguistic skills to generalize to everyday communication (Simmons-Mackie, Savage, & Worrall, 2014). Most conversation-based therapies train a communication partner or the PWA and a communication partner together as a dyad. Very few studies have evaluated the effectiveness of conversation-based therapy for a PWA independent of a communication partner. Many PWAs do not have consistent communication partners and most aphasia therapy is conducted in one-on-one therapy sessions with the PWA (Simmons-Mackie, Savage, & Worrall, 2014). Therefore, the following study was completed to evaluate the effects of conversation training with a PWA independent of partner training.

PROCEDURE:

A single-subject research design was used to determine the effect of independent conversation training with a PWA on language, cognitive-linguistic skills, functional communication, quality of life, support and strain in the spousal relationship, and communicative effectiveness. Outcomes following independent conversation training were compared to outcomes following partner training. The PWA in the present study was a 69-year-old male stroke survivor with moderate expressive and receptive aphasia. The PWA’s spouse was also included in the study and had received no prior partner training. Treatment block 1 consisted of conversation training with the PWA independent of partner training. In treatment block 2, this conversation training was withdrawn and the PWA’s spouse received partner training. Standardized and criterion-referenced assessments were administered prior to and following each block of treatment. Treatment outcomes were analyzed using non-parametric statistics including two-proportions tests and paired-samples t-tests and subjective analyses including effect size changes and discourse analyses as detailed by Nicholas and Brookshire (1993).

FINDINGS:

Conversation training with a PWA independent of partner training resulted in significant gains in language, memory, functional communication skills, quality of life, and communicative effectiveness in discourse. Declines were seen in cognitive skills, quality of life, and language functions when conversation training with the PWA was withdrawn and partner training was provided to the PWA’s spouse, suggesting partner training alone is not effective in maintaining or increasing gains. Direct conversation training with the PWA should be incorporated when training partners to maximize gains. Many of the gains were not maintained during follow-up testing indicating the need for further research to determine appropriate dosage for maintenance.

Comments/Acknowledgements

I would like to thank Dr. G.N. Rangamani for her support, dedication, and commitment to this project and to student learning and research. I would also like to thank Dr. Janet Tilstra and Dr. Amanda Hemmesch Breaker for their input and guidance. I extend my gratitude to the two participants in this study who selflessly gave of their time to assist in my research. Finally, thank you to the SCSU Statistical Consulting & Research Center and to my peers who helped with data analysis.

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