Improvements in Chronic Broca

1
Improvements in Chronic Brocas Aphasia
at Impairment and Functional Communication
Levels following SGD Practice and Use   Richard
D. Steele, PhD Chief Scientist, Lingraphicare
America, Inc., Princeton, NJ Computer Science
Professor, Eastern Washington University,
Cheney, WA
2

• Outcomes Study Which  
• Permits no specific attribution of causality
• Uses standardized, valid reliable assessments
• Assesses at both impairment and functional levels
• Analyzes changes after treatment at the 2 levels
• Compares / contrasts patterns of changes at the 2
  levels

3

• Intervention Characteristics
• Sessions (1-hr individ. c SLP) using Lingraphica
  SGD
• SLPs assign home exercises, activities
• Patients have SGDs at home between session for
  practice, use
• Study Inclusion Criteria
• Aphasia diagnosis at Intake (categories from
  WAB) 
• At least 1 month patient participation
• Pre- Post-Tx assessment with WAB (lang.
  subtests)
• Pre- Post-Tx assessment with CETI (16 items)

4
Subjects Sample n 69 Gender 36 males, 33
females Etiology 66 L-CVA, 1 R-CVA, 1 TBI, 1
PPA Age Mean 62.9 y/o (Range, 24 83
y/o) Postonset Mean 3.67 yrs (Range, 0.5
26.8 yrs) WAB Aphasia Diagnostic
Category Brocas aphasia 69 (100)
5
Intervention   Session Frequency Treatment
Duration Mean 1.9 sess/wk Mean 19.4
weeks Range 0.8 3.4 Range 5.1
53.9 Assessment Impairment (test
scores) WAB - Administered by SLPs n 69
(100) Disability (functional ratings) CETI -
Completed by family members n 69
(100)  _________________ characterizing
patients natural-language, unaided performance  
6

• Statistical Data Analysis
• Mean Improvements After Treatment
• Compare pre-/post- tx means (raw WAB, CETI
  scores)
• Establish significance with 1-tailed, matched
  t-tests
• Level for rejection of Null Hypothesis p
  .05 ()

7
WAB Results
WAB Results
8
CETI Results (sampling)
9
(No Transcript)
10
Improvements by Initial Impairment Severity
Levels Item n Initial Mean
Final Mean Difference p Severe Brocas
Aphasia (8 Initial AQ lt 32) WAB AQ
28 20.4 32.2
11.8 lt.0001 CETI
Overall 28 42.2
54.2 12.0
lt.0001 Moderate Brocas Aphasia (32
Initial AQ lt 56) WAB AQ 28
43.0 54.4
11.4 lt.0001 CETI Overall 28
39.5 54.0
14.5 lt.0001 Mild Brocas
Aphasia (56 Initial AQ 80) WAB AQ
13 62.7
77.0 14.3 lt.0001
CETI Overall 13 36.1
61.4 25.3
.0003
11
(No Transcript)
12
Improvements Within Severe Brocas Aphasia
Severity Level n ?WAB AQ
?CETI Overall All 8 AQ lt 32 28
11.8
12.0
__________________________ Severe
Severe 18 6.5
9.5 Severe Moderate
7 16.1
15.0 Severe Mild 3
32.9
20.0
13
Improvements Within Severe Brocas Aphasia
14
Improvements Within Moderate Brocas
Aphasia Severity Levels n
?WAB AQ ?CETI Overall All 32 AQ
lt 56 28 11.4
14.5

__________________________ Moderate
Moderate 10 7.4
7.5 Moderate Mild
3 15.6º
20.0 Moderate Conduction 10
17.1
22.4 _______________ p lt .05 ºp lt .10
15
Improvements Within Moderate Brocas Aphasia
16
Improvements Within Mild Brocas Aphasia
Severity Levels n ?WAB AQ
?CETI Overall All 56 AQ 80 13
14.3
25.3
__________________________ Mild Mild
1 6.8
14.4 Mild Conduction
1 10.0
7.9 Mild Anomic 9
17.1
28.7
17
Improvements Within Mild Brocas Aphasia
18
WAB AQ - Improvements by Categories
19
CETI Overall - Improvements by Categories
20
AQ Improvements by Initial Final Impairment
Levels

• Severe Moderate Mild
  Conduction Anomic
• Severe 18 (6.5) 7 (16.1) 3
  (32.9)
• Moderate 10 ( 7.4) 3
  (15.6º) 10 (17.1)
• Mild
  1 ( 6.8) 1 (10.0) 9 (17.1)

21
Improvements by Initial Final Impairment Levels

• Severe Moderate Mild
  Conduction Anomic
• Severe 64.3 25.0 10.7
• Moderate 35.7
  10.7 35.7
• Mild
  7.7 7.7 69.2

22
Percentages of Initial Groups
23

• Summary
• Significant improvements after SGD use/practice
  across broad ranges of
• Patient demographics
• Times post-onset
• Initial severity levels

24

• Summary
• Significance documented at
• Impairment level
• - all WAB language subtests WAB AQ
• Functional Communication level
• - all individual CETI items overall

25
Summary 1. Impairment improvement in chronic
Brocas aphasia spontaneous
recovery severe gt moderate gt mild Brocas
aphasia gt conduction aphasia / gt anomic
aphasia 2. Functional communication improvement
impairment improvement 3. Chronic
movement to less severe diagnostic categories
suggestive of brain plasticity mechanisms
26
Summary On Improvement heterogeneity
significant mean improvements overall
some register particularly large improvements
better starting points gt increased mean
improvements better starting points gt
increased -age of improvements
27

• Context Some Implications
• Among adults who become aphasic, the desire to
  maximize
• natural language communication is a key
  motivator,
• indicating a strategy of narrowing the gap
  wherever possible,
• and then bridging the gap with AAC as
  required,
• 3. for both goals of which SGDs currently
  represent the sweet
• spot among AAC options for aphasia
  rehabilitation.

28
Q A ___________________ Discussion