Playing a team game improves word production in poststroke aphasia

Abstract

Background: High intensity, one-to-one rehabilitation therapy is effective in the treatment of poststroke aphasia, but it can put strain on public health providers, as well as lead to high attrition. Working within a group of peers may be efficient for professional speech and language therapists, as well as reduce feelings of isolation and lack of confidence in patients, which can negatively affect progress. Evidence-based, structured group-based approaches, however, are lacking. Aims: We wanted to assess the feasibility a new group-delivered game-based intervention, designed to provide efficacious word-retrieval rehabilitation, in a cost-effective and motivating environment. Method & Procedure: Two cohorts of six participants took part. Each was split into two teams to play language games where pictures were named with the help of team members and facilitation from a speech and language therapist. Facilitation was varied in three different cueing conditions: phonemic, gesture + phonemic, and semantic + phonemic. Overall, 180 words were practiced (90 nouns and 90 verbs). Therapy was delivered 3 days per week, for 6 weeks (for a total of 54 hr). Outcomes & Results: Our intervention was equally effective across the three cueing conditions and for nouns and verbs. Gains were demonstrated in naming the pictures used in training, but also in the description of pictured scenes designed to elicit the same words. With these tasks, there were improvements of 25% and 18% from base-line accuracy, which compares well with gains reported in the literature using individually delivered speech and language therapy based on picture naming. Improvements were mostly maintained at both 4–7 weeks and 6-months post-therapy and were significant in all but the two most severely affected participants. There was some generalization of gains to narrative production, but not to other language tasks, nor to untreated words in picture naming. These positive language outcomes were combined with a high level of engagement and satisfaction (with participants stating a preference for games over standard therapy). Conclusions: Our results support embedding theoretically and empirically based techniques for aphasia rehabilitation within games with a strong social aspect, which may promote linguistic recovery in a way that is both time and cost-efficient and engaging. Future research should explore more formally outcomes in terms of increased well-being and reduced social isolation, as well as language proficiency.