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Counseling and script training in PPA (Schaffer et al., 2021)

journal contribution
posted on 2021-07-27, 20:49 authored by Kristin M. Schaffer, William S. Evans, Christina D. Dutcher, Christina Philburn, Maya L. Henry
Purpose: This study sought to determine the initial feasibility and benefit of a novel intervention that combines speech-language treatment with counseling treatment for an individual with the nonfluent/agrammatic variant of primary progressive aphasia (PPA).
Method: Using a single-case experimental design, we evaluated the utility of modified script training paired with aphasia-modified cognitive behavioral therapy. The study employed a multiple baseline design across scripts for the primary linguistic outcome measure and a mixed methods approach for analyzing counseling outcomes. Psychosocial and communicative functioning scales were administered in conjunction with a phenomenological analysis of semi-structured interviews.
Results: The participant completed all study phases and participated in all treatment components. She met the criterion of 90% correct, intelligible scripted words on all trained scripts through 12 months post-treatment. Treatment outcomes were comparable to a comparison cohort that received script training without counseling (Henry et al., 2018). At post-treatment, the participant demonstrated stability or improvement on all measures of psychosocial and communicative functioning, with stability documented on seven out of 11 scales at follow-ups through 12 months post-treatment. A phenomenological analysis revealed pervasive themes of loss and resilience at both time points, and emerging themes of positive self-perception, sense of agency, and emotional attunement following treatment.
Conclusions: Results indicate that script training with aphasia-modified cognitive behavioral therapy is a feasible treatment for an individual with the nonfluent/agrammatic variant of PPA, with immediate and lasting benefits to speech-language production and psychosocial functioning. These findings are the first to support the integration of personal adjustment counseling techniques within a speech-language treatment paradigm for PPA.

Supplemental Material S1. The VISTA+C participant’s performance on WAB-R subtests at each study time point.

Supplemental Material S2. Linguistic parameters used for balancing the trained and untrained scripts of the VISTA+C participant.

Supplemental Material S3. Participant's script characteristics.

Supplemental Material S4. Script rate details.

Supplemental Material S5. Sample dyadic aphasia-modified CBT exchange between patient and clinician.

Schaffer, K. M., Evans, W. S., Dutcher, C. D., Philburn, C., & Henry, M. L. (2021). Embedding aphasia-modified cognitive behavioral therapy in script training for primary progressive aphasia: A single-case pilot study. American Journal of Speech-Language Pathology. Advance online publication.


Clinical and research infrastructure for this project came from the National Institute on Deafness and Other Communication Disorders of the National Institutes of Health under award numbers R01 DC016291 and R03DC013403 (Principal Investigator: Dr. Maya Henry) and 1F31DC019044 (Principal Investigator: Kristin Schaffer), and by funding provided to The University of Texas at Austin by the Darrell K Royal Research Fund for Alzheimer’s Disease (Principal Investigator: Maya Henry).