Intensive Language Action Therapy in Chronic Aphasia: A Randomized Clinical Trial Examining Guidance by Constraint Purpose Intensive language action therapy (ILAT) can be effective in overcoming learned nonuse in chronic aphasia. It is suggested that all three guiding principles (constraint, communication embedding, massed practice) are essential to ILAT's success. We examined whether one of these, guidance by constraint, is critical. Method Twenty-four participants ... Research Article
Research Article  |   December 01, 2016
Intensive Language Action Therapy in Chronic Aphasia: A Randomized Clinical Trial Examining Guidance by Constraint
 
Author Affiliations & Notes
  • Jacquie Kurland
    Department of Communication Disorders, University of Massachusetts Amherst
  • Edward J. Stanek,, III
    Department of Biostatistics and Epidemiology, University of Massachusetts Amherst
  • Polly Stokes
    Department of Communication Disorders, University of Massachusetts Amherst
  • Minming Li
    Department of Biostatistics and Epidemiology, University of Massachusetts Amherst
  • Mary Andrianopoulos
    Department of Communication Disorders, University of Massachusetts Amherst
  • Disclosure: The authors have declared that no competing interests existed at the time of publication.
    Disclosure: The authors have declared that no competing interests existed at the time of publication. ×
  • Correspondence to Jacquie Kurland: jkurland@comdis.umass.edu
  • Editor: Anastasia Raymer
    Editor: Anastasia Raymer×
  • Associate Editor: Janet Patterson
    Associate Editor: Janet Patterson×
Article Information
Special Populations / Older Adults & Aging / Language Disorders / Aphasia / Special Issue: Select Papers From the 45th Clinical Aphasiology Conference / Research Articles
Research Article   |   December 01, 2016
Intensive Language Action Therapy in Chronic Aphasia: A Randomized Clinical Trial Examining Guidance by Constraint
American Journal of Speech-Language Pathology, December 2016, Vol. 25, S798-S812. doi:10.1044/2016_AJSLP-15-0135
History: Received September 14, 2015 , Revised March 12, 2016 , Accepted July 19, 2016
 
American Journal of Speech-Language Pathology, December 2016, Vol. 25, S798-S812. doi:10.1044/2016_AJSLP-15-0135
History: Received September 14, 2015; Revised March 12, 2016; Accepted July 19, 2016

Purpose Intensive language action therapy (ILAT) can be effective in overcoming learned nonuse in chronic aphasia. It is suggested that all three guiding principles (constraint, communication embedding, massed practice) are essential to ILAT's success. We examined whether one of these, guidance by constraint, is critical.

Method Twenty-four participants with aphasia (PWAs) were assigned to ILAT or a modified version of promoting aphasic communicative effectiveness (PACE) in a randomized block, single-blind, parallel-group treatment study. Blocking was by severity (mild/moderate, moderate to severe, severe). Both groups received intensive treatment in the context of therapeutic language action games. Whereas the ILAT group was guided toward spoken responses, the PACE group could choose any response modality.

Results All participants, whether assigned to ILAT or PACE groups, improved on the primary outcome measure, picture naming. There was a Severity × Treatment interaction, with the largest effects estimated for PWAs with mild/moderate and moderate to severe aphasia. Regardless of severity, the ILAT group outperformed the PACE group on untrained pictures, suggesting some benefit of ILAT to generalization. However, this difference was not statistically significant.

Conclusion Although the groups differed in subtle ways, including better generalization to untrained pictures for ILAT, the study was inconclusive on the influence of guidance by constraint.

Acknowledgment
This research was supported by funding from National Institute on Deafness and Other Communication Disorders (NIDCD) Grant R01DC011526 awarded to Jacquie Kurland. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
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