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Abstract

Background and aims: This PhD is part of the Thales Aphasia project. The Thales Aphasia project aimed to provide an in-depth exploration of neuropsychological and linguistic deficits in Greek speaking people with aphasia and to investigate the efficacy of speech and language therapy interventions. Two interventions were evaluated: mapping therapy and Elaborated Semantic Feature Analysis (ESFA). This thesis reports on the efficacy of ESFA. ESFA is a modified version of Semantic Feature Analysis (SFA), which prompts the participant to elaborate the features described into a sentence. Two different aims are investigated: (a) the efficacy of Elaborated Semantic Features Analysis (ESFA) therapy versus no therapy (b) the relative efficacy of two different approaches of delivering therapy – direct (individual therapy) versus combination therapy (individual together with group therapy) and the relative impact of each therapy approach on a range of outcome measures tapping different WHO ICF domains.

Methods: The study is a randomised trial using a waiting list control. Of the 72 participants of Thales, 58 met the eligibility criteria for speech and language therapy and 39 were allocated to ESFA (19 allocated to mapping therapy). Participants were randomised via recruitment order to one of three groups- two groups of therapy (direct or combination) and the waiting list control group. Of the 38 that had ESFA, 12 were randomised to the waiting list control group and 26 to one of the two ESFA therapy approaches. Participants on the therapy approaches were assessed two times before therapy (double baseline, week 1- 6), post-therapy (week 19), and 3-months later (followup). Participants on the waiting list control were assessed three times before therapy (week 1-6-19) and then were randomly allocated to one of the two approaches for ESFA treatment and were reassessed after the 12-week treatment (post-therapy) and 3 months later (follow-up). Both therapy groups had equal intensity and dosage- three hours of ESFA per week for 12 weeks (36 hours): those that received direct ESFA had three 1- hour sessions per week; those that received combination ESFA had one 90-minute session of group ESFA and two 45-minute sessions of individual ESFA per week. The primary outcome measure was confrontation naming of the 260 colourised pictures initially developed by Snodgrass and Vanderwart (1980) (Rossion & Pourtois, 2004). Secondary outcome measures included a range of assessments tapping on all WHO ICF levels: Boston Naming Test (BNT), Discourse Measurement with Cookie Theft picture, Functional Assessment of Communication Skills for adults (ASHA – FACS), Stroke and Aphasia Quality of Life scale (SAQOL-39g), General Health Questionnaire (GHQ-12) and EQ-5D.

Therapy materials appropriate to each person were chosen at baseline before initiation of therapy. At baseline, each participant had to name the 260 pictures. The pictures were randomly presented to each participant for naming across three trials without any cuing or feedback. Based on the results of these trials, the pictures that participants failed to name on at least two trials were selected as potential treatment materials. This process of stimulus selection resulted in a set of treatment and probe items that were individual to each participant.

To test (a) the efficacy of ESFA therapy (n=26) versus no therapy (n=12) mixed within-between ANOVAs were used with group as the between variable (2 groups: ESFA versus control) and time as the within variable (3 levels: weeks 1, 6, 19). To test (b) the relative efficacy of direct (n=22) versus combination (n=14) ESFA, mixed withinbetween ANOVAs were used with group as the between variable (2 groups: direct versus combination ESFA) and time as the within variable (4 levels: two baselines, post-therapy and follow-up).

Results: After applying a Bonferroni correction for multiple comparisons, for (a) therapy versus control, there was a significant main effect of time on the primary outcome measure Greenhouse-Geisser F (1.1, 39.38) = 26.04, p< .001 with a large effect size (η2 p = .42), and a significant interaction effect Greenhouse-Geisser F (1.1, 39.38) = 9.56, p= .003 with a large effect size (η2 p = .21); whereby the therapy group improved significantly more from pre-therapy (week 6) [mean (SD) = 61.96 (49.40)] to post-therapy (week 19) [mean (SD) = 104.38 (73.91)] than the control group [week 6 mean (SD) = 74.33 (62.94), week 19 mean (SD) = 81.83 (69.90)]. There was a significant main effect of time for the BNT (p = .002) with a large effect size (η2 p = .19), with the significant difference between the firsts two baselines and BL3/post therapy. There was an interaction effect, which did not remain significant after adjusting for multiple comparisons, for the SAQOL-39g psychosocial domain (p = .013) (η2 p = .12) and the overall SAQOL-39g score (p = .015) (η2 p =.11), with the therapy group improving with therapy, and the control group not improving.

For (b) direct versus combination ESFA, there was a significant main effect of time on the primary outcome measure for both approaches, Greenhouse-Geisser F (1.89, 64.53) = 32.95, p < 0.001 with large effect size (η2 p = .49). Pairwise comparisons showed there was a significant difference between the two baselines (mean difference = 10.23, p= .003), a significant difference between both the baselines and post-therapy (mean differences= 49.70 and 39.45, ps< .001) and a significant difference between both the baselines and follow- up (mean differences = 43.45 and 33.22, ps< .001). The post therapy gains were maintained, i.e. there was no significant drop from post-therapy to follow up. There was also a significant main effect of time with large effect size for the BNT (p< .001) (η2 p = .29), with significant differences in pairwise comparisons between both baselines and post therapy and both baselines and follow-up; and the ASHA-FACS (p = .001) (η2 p =.18), with significant differences between both baselines and the follow -up assessment. The interaction and group effects were not significant.

Conclusion: This PhD is the first to explore the efficacy of ESFA in a randomised group design. Results supported the efficacy of ESFA therapy versus no therapy. ESFA therapy led to gains in naming, communication and quality of life for people with aphasia. Gains were similar in the two therapy approaches and were maintained over a threemonth follow-up. Pending further research to confirm the reliability of the results and allow meaningful effects to be detected on a range of outcome measures, ESFA may be a useful therapy to adopt in practice.

Publication Type:	Thesis (Doctoral)
Subjects:	P Language and Literature
Departments:	Doctoral Theses School of Health & Psychological Sciences > School of Health & Psychological Sciences Doctoral Theses School of Health & Psychological Sciences > Language & Communication Science

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