None listed
Conditions
Brief summary
A new approach to therapy for people with aphasia (language impairment after stroke) has been developed by our team which, when compared to usual car in a pilot trial, has provided highly promising evidence of greater gains in everyday speaking, participation in daily activities, and quality of life. The protocol, NARNIA (a Novel Approach to Real-life communication: Narrative Intervention in Aphasia), is a highly structured language therapy delivered using a natural interactive approach. As different service delivery models are in place within clinical settings, i.e. individual 1-to-1 therapy and group therapy, 10 people will receive individual therapy and 10 will receive group therapy. We aim to examine treatment effectiveness in a clinical setting, individual variability, and feasibility of group delivery of this approach.
Interventions
Description of Protocol: NARNIA (Novel Approach to Real-life communication: Narrative Intervention in Aphasia) is a behavioural intervention that revolves around usual conversational speaking, but provides structure and feedback to the client using frameworks that are conceptually different to usual aphasia intervention. The NARNIA intervention protocol aims to increase awareness and use of language structures across a diverse range of everyday speaking situations, focusing simultaneously on wor
Description of Protocol: NARNIA (Novel Approach to Real-life communication: Narrative Intervention in Aphasia) is a behavioural intervention that revolves around usual conversational speaking, but provides structure and feedback to the client using frameworks that are conceptually different to usual aphasia intervention. The NARNIA intervention protocol aims to increase awareness and use of language structures across a diverse range of everyday speaking situations, focusing simultaneously on word, sentence and discourse levels. Descriptions and preliminary results of the NARNIA intervention have been published in journals but the full protocol is not currently available. Adaptations for group delivery have been developed where usual clinical service delivery at a site is via group therapy. The protocol will be delivered under two conditions: (1) in 1-to-1 therapy (Study 1) and (2) in group therapy (Study 2). All participants will be assessed using the same assessment battery and undergo the same intervention. Given the two service delivery modes, the data from participants treated in individual sessions and those treated within a group will be analysed separately. While all participants will be analysed individually, performance of individuals in the two separate conditions will be compared in two groups. As numbers may be small, however, these will provide preliminary data only on the comparison of service models.This study is different to the original study in not collecting control data from participants receiving 'usual care'. It is designed specifically to collect data on individuals undergoing the NARNIA intervention, with each individual being analysed using a single case design to identify patterns of responsiveness to the intervention. Aims: The overall study will examine treatment effectiveness in a clinical setting, individual variability, and feasibility of group delivery of this approach.Two separate studies are being conducted based on individual or group service delivery. Study 1 will involve providing NARNIA intervention individually to 10 people who would receive usual individualised out-patient services. Study 2 will involve adapting the NARNIA intervention and delivering this within a group setting to 10 people (3-4 per group), receiving usual group-based out-patient services. Design: A single-case experimental design will be used, using each participant as their own control. Schedule: The NARNIA intervention protocol will be delivered twice-weekly by a qualified speech pathologist, individually in Study 1 and in small groups (3-4 participants per group) in Study 2, over 10 weeks (20 sessions in total). Each sessions will run for one hour. Adherence to the intervention protocol is being carried out in both studies. Therapy integrity will be monitored by the research team via video recording of a subset of sessions. Essential data on client attendance and performance will be collected on standardised data collection forms by treating speech pathologists to record treatment dose for individuals. One session per fortnight per participant will be video-recorded and coded against required essential elements of the NARNIA intervention protocol to establish fidelity. Any deviation from the prescribed therapy protocol will be discussed with the speech pathology team and noted for statistical analysis. Regular feedback will be provided to all therapists by the Research team in regular support meetings.
Sponsors
Curtin University
Study design
Allocation
Non-randomised trial
Intervention model
Other
Primary purpose
Treatment
Masking
Open (masking not used)
Eligibility
Sex/Gender
All
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
(1) stroke defined by ICD-10 codes 161-164, (2) medically stable and suitable for rehabilitation, (3) >3 weeks post onset, with no upper limit for time post stroke, (4) mild-moderate aphasia of any type (>32.3 and <93.8 WAB-R-AQ16), participants with crossed aphasia will be eligible, (5) normal or corrected hearing and vision, and (6) proficient in English prior to stroke (used English in everyday communication [no interpreter required for therapy]).
Exclusion criteria
(1) severe aphasia (<32.3 WAB-R-AQ), (2) primary impairment of apraxia of speech (AoS) or dysarthria, or moderate-severe AoS or dysarthria, (3) a prior diagnosis of dementia, head injury or neurosurgery, (4) a concurrent progressive neurological condition, (5) clinically diagnosed major depression, (8) current participation in an aphasia trial. Previous strokes will not exclude recruitment.
Outcome results
None listed