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The effect of multimodality (spoken and written) Verb Network Strengthening Treatment (VNeST) on spoken and written outcomes for three people with distinct clinical presentations of aphasia

Lisa A. Edmonds1*
  • 1 Teachers College, Columbia University, Biobehavioral Sciences, United States

Preliminary efficacy for Verb Network Strengthening Treatment (VNeST) has been reported with increased spoken lexical retrieval within sentences and/or discourse across various aphasia profiles/severities (Edmonds, 2016). Encouraging written outcomes have been reported for three participants for whom writing was incorporated into VNeST to accommodate neologistic verbalizations (P2: Edmonds & Babb, 2011) and sparse, effortful output with apraxia of speech (AOS) (P1/P2: Furnas & Edmonds, 2014). Given the importance of multimodality communication for people with aphasia/AOS, sparsity of sentence-level writing treatments, and importance of writing in today’s society (text/email/functional tasks), the current study evaluates the effect of VNeST with writing on spoken and written outcomes. Method Participants were not excluded for common exclusionary factors (bilingual, jargon aphasia, AOS), resulting in distinct clinical presentations. “Paul” (49 years, Asian-Pacific American, stock broker, 42 months-post onset (MPO) posterior CVA) presented with mild anomic aphasia (high pronoun/vague output, inconsistent self-monitoring), moderate dysgraphia (sparse, semantic errors, neologisms). “Scott” (49 years, Caucasian, CEO, 11 MPO hemorrhagic MCA CVA/craniotomy) presented with moderate conduction/jargon aphasia (empty, errorful, jargonistic output, reduced self-monitoring), sparse/neologistic writing. “Aydin” (47 years, Turkish (bilingual English/Turkish), physician, 18 MPO ischemic MCA) presented with moderate Broca’s aphasia and AOS, sparse/effortful writing. Premorbidly “Aydin” used English in most settings (including home) with high/equal proficiency (rated 7/7) across languages/modalities. Post-stroke he spoke Turkish with his wife. “Aydin” wanted treatment in English due to difficulty communicating with his English-speaking children. Outcome measures and control tasks (nonword writing or repetition depending on participant ability) (Table 1) were tested pre- and post-treatment. Writing was integrated into VNeST’s protocol (Edmonds, 2014) with participants saying then typing their responses. For misspelled/incorrect written words, participants copied the correct spelling provided by the clinician. Since written responses provide opportunity for self-evaluation, an additional (penultimate) treatment step was added: Participants were prompted to say then write a subject-verb-object sentence with specific words to describe pictures (different each week) containing the trained action (e.g., “conductor driving train”). Treatment was two times/week for 10 weeks, 2 hours/session, with 10 verbs, consistent with previous studies (Edmonds, 2016). Transcription, scoring and treatment reliability were >90% across participants and tasks. Results See Table 1. Discussion VNeST with writing resulted in different patterns of improvement across participants, as expected given the distinct presentations/backgrounds. “Paul” showed widespread generalization to the writing portion of the WAB, spoken and written sentences and discourse, largely due to increased accuracy/specificity, and functional communication by report (ACOM). Despite jargon aphasia’s poor treatment prognosis (Marshall, 2006), “Scott’s” written naming and spoken sentence production increased. Similar to a previous participant with jargon aphasia (Edmonds et al., 2015), discourse did not improve. Despite AOS and very limited English use at home, Aydin improved on spoken and written nouns, spoken sentences and discourse. Written discourse increased in quantity and informativeness, notable given his sparse output. While additional research is needed, these findings replicate and extend previous VNeST findings and suggest potential utility of VNeST for not only spoken output, but for people with dysgraphia, AOS and bilingual aphasia (also Lerman et al., 2017).

Acknowledgements

We would like to thank the participants who were committed to the treatment and testing for this study. Additionally, many thanks to the following students in the Aphasia and Bilingualism Research Lab for their assistance with data collection and analysis: Jen Posner, Kelly Patterson, Beth Ann Ingrassia and Jessica Obermeyer.

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Keywords: Aphasia, VNeST, dysgraphia, Anomia, jargon aphasia, treatment outcome, discourse, sentences

Conference: Academy of Aphasia 56th Annual Meeting, Montreal, Canada, 21 Oct - 23 Oct, 2018.

Presentation Type: poster presentation

Topic: not eligible for a student prize

Citation: Edmonds LA (2019). The effect of multimodality (spoken and written) Verb Network Strengthening Treatment (VNeST) on spoken and written outcomes for three people with distinct clinical presentations of aphasia. Conference Abstract: Academy of Aphasia 56th Annual Meeting. doi: 10.3389/conf.fnhum.2018.228.00094

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Received: 30 Apr 2018; Published Online: 22 Jan 2019.

* Correspondence: Dr. Lisa A Edmonds, Teachers College, Columbia University, Biobehavioral Sciences, New York City, New York, 10027, United States, lisa.edmonds@tc.columbia.edu