Adjei-Nicol Sharon, Sacchett Carol, Beeke Suzanne
School of Allied and Public Health Professions, Canterbury Christ Church University, Canterbury, UK.
Department of Language and Cognition, University College London, London, UK.
Int J Lang Commun Disord. 2025 Jan-Feb;60(1):e13155. doi: 10.1111/1460-6984.13155.
Global aphasia is a severe communication disorder affecting all language modalities, commonly caused by stroke. Evidence as to whether the functional communication of people with global aphasia (PwGA) can improve after speech and language therapy (SLT) is limited and conflicting. This is partly because cognition, which is relevant to participation in therapy and implicated in successful functional communication, can be severely impaired in global aphasia. Cognitive treatments that aim to improve functional communication for people with aphasia do exist, but few have been trialled with PwGA and no studies have robustly demonstrated gains.
This study aimed to explore the effect of a novel non-linguistic cognitive intervention on the functional communication skills of PwGA.
A non-linguistic intervention, developed to target cognitive skills underpinning functional communication, was delivered to six participants three times weekly for up to 6 weeks (depending on the rate of progression through the intervention programme). All participants met the criteria for global aphasia following screening with the Western Aphasia Battery Bedside Record Form. A multiple baseline case series design was employed to investigate changes in functional communication using the American Speech and Hearing Association Functional Assessment of Communication (ASHA-FACS). Secondary outcome measures were auditory comprehension and informal tests of non-verbal cognition. Statistical analyses of change after intervention were performed using the Wilcoxon signed-ranks test and weighted statistics.
Participants completed the intervention programme in an average of nine sessions. Four out of six participants made statistically significant gains in functional communication as measured by communication independence (amount of assistance or prompting required) on the ASHA-FACS. Five of six participants made statistically significant gains in non-verbal semantics, two in non-verbal reasoning and two in auditory comprehension.
The findings provide preliminary evidence that a non-linguistic cognitive intervention delivered with a dose replicable in clinical practice can improve functional communication and non-verbal cognition in some PwGA. This finding contrasts with much existing evidence suggesting that improvements in global aphasia can be achieved only after intensive or prolonged input over many years.
What is already known on the subject People with global aphasia (PwGA) have the potential to make impairment level gains after intensive or prolonged speech and language therapy (SLT). However, evidence of functional communication gains is limited. Cognition plays an important role in functional communication, particularly the ability to switch to alternative means of communication and switch modalities. What this study adds Contrary to many previous studies, the findings indicate that PwGA can benefit from SLT and make functional communication gains with a relatively low dose of intervention. The findings highlight cognitive skills that appear relevant to basic functional communication abilities in PwGA. These are: attention, visual perception, semantics and non-verbal problem solving. What are the clinical implications of this work? This work suggests that clinicians should offer cognitive, non-linguistic interventions to PwGA and consider delivering intervention using little to no verbal language.
完全性失语是一种严重的沟通障碍，影响所有语言模式，通常由中风引起。关于完全性失语患者（PwGA）在言语和语言治疗（SLT）后功能沟通是否能改善的证据有限且相互矛盾。部分原因是认知与参与治疗相关且对成功的功能沟通有影响，而在完全性失语中认知可能会严重受损。旨在改善失语症患者功能沟通的认知治疗确实存在，但很少在PwGA中进行试验，也没有研究有力地证明有改善效果。
本研究旨在探讨一种新型非语言认知干预对PwGA功能沟通技能的影响。
一种针对支持功能沟通的认知技能开发的非语言干预措施，每周三次提供给6名参与者，为期6周（取决于干预计划的进展速度）。所有参与者经西方失语症成套测验床边记录表筛查后均符合完全性失语标准。采用多基线病例系列设计，使用美国言语和听力协会沟通功能评估（ASHA - FACS）来研究功能沟通的变化。次要结果指标是听觉理解和非语言认知的非正式测试。使用Wilcoxon符号秩检验和加权统计对干预后的变化进行统计分析。
参与者平均完成9次干预课程。在ASHA - FACS上，6名参与者中有4名在功能沟通方面取得了统计学上的显著改善，以沟通独立性（所需的协助或提示量）衡量。6名参与者中有5名在非语言语义方面取得了统计学上的显著改善，2名在非语言推理方面，2名在听觉理解方面。
研究结果提供了初步证据，表明在临床实践中可重复剂量实施的非语言认知干预可以改善一些PwGA的功能沟通和非语言认知。这一发现与许多现有证据形成对比，现有证据表明只有经过多年的强化或长期投入才能实现完全性失语的改善。
关于该主题的已知信息 完全性失语患者（PwGA）在强化或长期言语和语言治疗（SLT）后有可能在损伤程度上有所改善。然而，功能沟通改善的证据有限。认知在功能沟通中起着重要作用，特别是切换到替代沟通方式和切换模式的能力。本研究补充了什么 与许多先前的研究相反，研究结果表明PwGA可以从SLT中受益，并通过相对低剂量的干预在功能沟通方面取得改善。研究结果突出了与PwGA基本功能沟通能力相关的认知技能。这些技能包括：注意力、视觉感知、语义和非语言问题解决能力。这项工作的临床意义是什么？这项工作表明临床医生应该为PwGA提供认知性、非语言干预，并考虑使用很少或不使用言语语言进行干预。
