Treatment for Improving Discourse in Aphasia: A Systematic Review and Synthesis of the Evidence Base
Aphasiology
Dipper, L., Marshall, J., et al. (2021).
Aphasiology, 35(9), 1125-1167.
This systematic review explores the impact of various levels of discourse treatments on expressive language outcomes for individuals with aphasia.
Stroke Association
Unspecified
Any study design
25
Limited findings demonstrated that discourse treatments with word-level targets (e.g., Semantic Feature Analysis and Repetition in the Presence of a Picture) were associated with general improvements at the word and morpheme level. These improvements were noted to be maintained at unspecified follow-up times. No studies explored the impact of word-level treatments on sentence or higher level productions. Results should be interpreted with caution due to an overall paucity of research, small sample sizes, and poor methodological rigor of included studies.
Limited findings demonstrated that discourse treatments with sentence-level targets (e.g., Oral Reading for Language in Aphasia, Constraint Induced Aphasia Therapy, Treatment of Underlying Forms, and a modified Response Elaboration Training) were associated with improvements at the word and morpheme level, with improvements maintained at unspecified follow-up times. No benefit was noted in sentence-level discourse production, and no studies investigated the impact of sentence-level discourse treatment on higher level productions. Some influence of severity of aphasia and types of discourse was observed, with one study noting improvements in mild to moderate aphasia only, and another study noting improvements in procedural but not personal discourse. Additionally, one study found generalization of written targets to spoken productions. Results should be interpreted with caution due to an overall paucity of research, poor methodological rigor of included studies, and small sample sizes.
Limited findings demonstrated that discourse script therapies were associated with improvements in at the word and morpheme level, while no studies evaluated impact at the sentence level or higher level productions. Results should be interpreted with caution due to an overall paucity of research with low methodological rigor and small sample sizes.
Limited findings demonstrated that discourse treatments with macro-level production targets (i.e., narratives or procedural discourse) were associated with improvement in word and macro-level productions. At the sentence level, one study found that individuals with aphasia were noted to produce more clauses, but no fewer grammatical errors. Results should be interpreted with caution due to an overall paucity of research, poor methodological rigor of included studies, and small sample sizes.
Findings demonstrated that discourse treatment with targets of varying levels of production (e.g., Promoting Aphasics' Communication Effectiveness, Response Elaboration Treatment, and discourse production training at varying levels) was associated with improvements at the word and sentence level, while mixed results were noted in higher level productions. Results should be interpreted with cautions to to an overall paucity of evidence, small sample sizes, and poor methodological rigor of included studies.
Limited findings demonstrated that discourse treatment provided with a focus on use of augmentative and alternative communication was associated with improvements at the word, morpheme, and sentence levels. In higher level productions, reductions in non-fluencies such as filled pauses, repetitions, revisions, and abandoned phrases were noted. Results should be interpreted with cautions to to an overall paucity of evidence, small sample sizes, and poor methodological rigor of included studies.
