Critical ingredients of multilevel aphasia interventions for people with post-stroke aphasia

Verb Network Strengthening Treatment (VNeST), is an intervention targeting word and sentence levels. VNEST aims to improve word finding and sentence production by focusing on verbs and the roles of other words in a sentence. Materials Required for VNeST (Intervention) VNeST is designed to require minimal materials. For each session, the following items will be used: 1. Pen and paper, or a small tabletop whiteboard with dry erase markers 2. Pre prepared simple sentences for Step 4 (sentences may also be created during the session if required) 3. For the optional Step 5 activity, one picture per target verb per week Intervention Procedures Step 1: The participant generates several scenarios (typically three) incorporating the target verb. This activity is intended to activate and strengthen the participant’s verb network by eliciting a range of possible agents and objects related to the verb. Step 2: The participant reads each scenario aloud three times. This promotes repeated production and consolidation of complete sentences and reinforces basic subject–verb–object sentence structure. Step 3: The participant selects one scenario from Step 1 and answers three WH questions (where, when, why). This step encourages production of more detailed and complex sentences and supports engagement with semantic, world, and autobiographical knowledge relevant to the event. Step 4: The clinician reads simple active sentences containing the target verb, and the participant determines whether each sentence is semantically accurate. This activity supports sentence level comprehension and the ability to distinguish and relate individual word meanings. Step 5: The participant is asked to name the target verb they have been working on. This step assesses independent retrieval of the verb. Step 6: The participant repeats Step 1 without cues, providing an opportunity for independent production of scenarios following completion of the earlier intervention activities. Intervention Provider The intervention will be delivered by a student researcher, a qualified speech pathologist with training in aphasia therapy delivery. All intervention activities will occur under the supervision of the principal investigator. Intervention Frequency and Duration • Weeks 1–2: Baseline assessments • Weeks 3–12: Intervention phase (two one hour sessions per week for 10 weeks) • Weeks 13–14: Post intervention assessments • Week 18: Follow up assessment Total participation duration will be approximately 18 weeks. Mode of Delivery Therapy will be provided either in person or via a secure telepractice platform (COVIU). The mode of delivery will be determined by participant preference and geographic location. Adherence and Fidelity Monitoring To ensure fidelity to the intervention protocol: • One therapy session per participant per week will be video recorded and reviewed against the protocol’s essential elements. • Any deviations from the protocol will be reviewed with the Supervisory Team and documented for inclusion in analyses. • The student researcher will complete standardised data collection forms, maintain a fidelity log, and record detailed therapy information for each participant, including treatment dosage and intensity (session number, timing, and duration).