Conversation Therapy for Aphasia

Recruiting at 2 trial locations

Overseen By Gayle DeDe, PhD

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: Boston University Charles River Campus

Disqualifiers: Neurological disease, Developmental disabilities, Cancer, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Approved in 3 Jurisdictions This treatment is already approved in other countries

Compensation: Varies

Number of Visits: 24

Duration: 10 weeks

162 Participants Needed

Trial Summary

What is the purpose of this trial?

The proposed research will test the efficacy of group conversation treatment for people with aphasia and explore whether the effects of treatment differ as a result of the following factors: 1. Group size: Do large groups of 6-8 people with aphasia or dyads of 2 people with aphasia demonstrate different levels of improvement with this treatment? 2. Group composition: Do effects of conversation group treatment differ if the groups include members with similar or different types of aphasia? 3. Aphasia severity: Do effects of conversation group treatment differ if the individuals within the group have mild-moderate or moderate-severe profiles of aphasia? Treatment sessions will occur in groups of 6-8 people with aphasia or with 2 people with aphasia. During treatment sessions, discourse will be facilitated on a focused set of every day topics, such as current events or travel. Linguistic and multi modal cueing hierarchies will be tailored to individual client goals and used to maximize communication success. The prediction is that conversation treatment is an effective method for improving communication in people with aphasia, but that specific benefits may differ based on variables such as group size, group composition, and aphasia severity. The results will help inform best practices for aphasia treatment and refine a hypothesized model about the mechanisms underlying conversation treatment.

Do I have to stop taking my current medications for the trial?

The trial protocol does not specify whether you need to stop taking your current medications. However, you must abstain from any concurrent speech language treatment.

Will I have to stop taking my current medications?

The trial protocol does not specify whether you need to stop taking your current medications. However, you will need to stop any concurrent speech language treatment while participating in the trial.

What data supports the idea that Conversation Therapy for Aphasia is an effective treatment?

The available research shows that Conversation Therapy for Aphasia is effective in improving communication skills. One study found that participants who received group communication treatment had significantly higher scores on communication and language tests compared to those who did not receive the treatment. Improvements were seen after just two months and continued after four months of treatment, with no decline in performance after stopping the treatment. Another study compared individual and group treatments and found that both methods led to significant improvements in language abilities, suggesting that group therapy is a viable option for managing aphasia. ^{1 2 3 4 5}

What data supports the effectiveness of the treatment Conversation Therapy for Aphasia?

Research shows that group communication treatment for aphasia can significantly improve communication and language skills in people with chronic aphasia. Participants in group therapy had better scores on communication tests compared to those who did not receive the treatment, and improvements were seen after just two months of therapy. ^{1 2 3 4 5}

What safety data exists for conversation therapy for aphasia?

The provided research does not specifically address safety data for conversation therapy for aphasia. The studies focus on the efficacy, mechanisms of change, and outcomes of the therapy, such as improvements in communication, language impairment, and quality of life. However, there is no mention of adverse effects or safety concerns, suggesting that the therapy is generally considered safe, but specific safety data is not detailed in these abstracts. ^{2 5 6 7 8}

Is conversation therapy for aphasia safe for humans?

The research does not specifically mention safety concerns, suggesting that conversation therapy for aphasia is generally considered safe for humans. ^{2 5 6 7 8}

Is Conversation Treatment for Aphasia a promising treatment?

Yes, Conversation Treatment for Aphasia is promising because it can improve communication skills and reduce social isolation for people with aphasia. It also helps them practice communication in a group setting, which can boost their confidence and help them connect with others. ^{2 4 5 6 9}

How is Conversation Therapy for Aphasia different from other treatments for aphasia?

Conversation Therapy for Aphasia is unique because it focuses on improving communication through group interactions, which can help reduce social isolation and enhance everyday communication skills. Unlike other treatments that may focus solely on linguistic abilities, this therapy also addresses psychosocial aspects by helping individuals negotiate their identity and improve their social participation. ^{2 4 5 6 9}

Research Team

Elizabeth Hoover, PhD

Principal Investigator

Boston University

Gayle DeDe, PhD

Principal Investigator

Temple University

Eligibility Criteria

This trial is for English-speaking adults with aphasia, a language disorder typically caused by stroke. They must be at least 6 months post-stroke and have enough understanding to join in conversations. The study includes all severity levels of aphasia but excludes those with other neurological diseases, developmental disabilities, or serious illnesses like cancer.

Inclusion Criteria

I have been diagnosed with difficulty in speaking or understanding language.

You need to be able to understand and take part in conversations, as shown by standardized tests for language difficulties.

I have severe difficulty speaking or understanding speech.

Exclusion Criteria

I have not had any neurological diseases, except for a stroke.

Participants will be asked to abstain from concurrent speech language treatment

I do not have any serious illnesses right now.

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants receive conversation group treatment for aphasia in either large groups or dyads, facilitated by a speech pathologist focusing on everyday topics.

10 weeks

20 visits (in-person, twice per week)

Follow-up

Participants are monitored for changes in communication ability using the Aphasia Communication Outcome Measure and Comprehensive Aphasia Test.

12 weeks

Assessments at 4 weeks and 12 weeks post-treatment

Treatment Details

Interventions

• Conversation Treatment for Aphasia

Trial Overview The study tests group conversation treatment's effectiveness on communication skills in people with aphasia. It examines how different group sizes (2 vs. 6-8 people) and compositions (similar vs. different types of aphasia), as well as the severity of aphasia, impact the treatment outcome.

Participant Groups

Group I: Experimental: Group composition Experimental Treatment 1 Intervention

Outcomes will be measured for individuals who participate in homogeneous compared to heterogeneous groups (6-8 people with aphasia), based on aphasia severity (severe vs. mild-moderate aphasia).

Group II: Experimental: Group Size x Aphasia Severity Experimental Treatment 1 Intervention

Outcomes will be measured for individuals who participate in large group (6-8 group members) compared to dyads (2 group members), and whether this relationship differs as a function of aphasia severity (severe vs. mild-moderate aphasia).

Group III: Treatment efficacy: Delayed Control Group Active Control 1 Intervention

Treatment cycle 1 only.

Conversation Treatment for Aphasia is already approved in United States, European Union for the following indications:

Approved in United States as Conversation Treatment for Aphasia for:

• Aphasia

Approved in European Union as Group Conversation Treatment for Aphasia for:

• Aphasia
• Stroke-related Aphasia

Who Is Running the Clinical Trial?

Boston University Charles River Campus

Lead Sponsor

Trials

125

Recruited

14,100+

Temple University

Collaborator

Trials

321

Recruited

89,100+

Adler Aphasia Center

Collaborator

Trials

1

Recruited

160+

Findings from Research

In a 4-month study involving 24 adults with chronic aphasia, those who received group communication treatment showed significant improvements in both communicative and linguistic performance compared to those who did not receive treatment.

Participants demonstrated notable progress after just 2 months of treatment, and their improvements were maintained even after a follow-up period without treatment, indicating the lasting benefits of the intervention.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The efficacy of group communication treatment in adults with chronic aphasia. Elman, RJ., Bernstein-Ellis, E.[2022]

The study identified seven mechanisms of change in conversational behavior for people with aphasia, highlighting how therapy enhances skills, motivation, and opportunities for effective communication.

The findings provide valuable insights into the processes that facilitate behavioral change during conversation therapy, distinguishing between motivating change and embedding new strategies, which can inform future clinical practices and research.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Identifying mechanisms of change in a conversation therapy for aphasia using behaviour change theory and qualitative methods. Johnson, FM., Best, W., Beckley, FC., et al.[2019]

Both individual and group therapy significantly improved language abilities in aphasic patients after a left hemisphere stroke, indicating that both treatment methods are effective.

Individual treatment led to better overall performance on the Porch Index of Communicative Ability compared to group therapy, although no significant differences were found on other language measures, suggesting that while individual therapy may have advantages, both approaches are beneficial.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Veterans Administration cooperative study on aphasia: a comparison of individual and group treatment. Wertz, RT., Collins, MJ., Weiss, D., et al.[2019]

In a 6-week group therapy program for three individuals with aphasia, only one participant showed significant improvement in communication skills, specifically in discourse ratings, while the other two showed no notable changes.

The study suggests that the group treatment format may not be effective for enhancing linguistic abilities in people with aphasia, and highlights challenges in measuring improvements in connected speech.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

An Exploration of the Impact of Group Treatment for Aphasia on Connected Speech. Mason, C., Nickels, L., McDonald, B.[2021]

In a randomized controlled trial with 48 participants with chronic aphasia, conversation group treatment improved certain aspects of monologic discourse, particularly in the complete utterance (CU) method, after 10 weeks of treatment.

However, the primary outcome measure, percent correct information units (CIUs), did not show significant changes, indicating that while conversation treatment may enhance the overall amount of language produced, it does not necessarily improve the efficiency of language production.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A Randomized Controlled Trial of the Effects of Group Conversation Treatment on Monologic Discourse in Aphasia. Hoover, E., DeDe, G., Maas, E.[2023]

This review organized 30 studies on conversation therapy for aphasia into a comprehensive taxonomy, highlighting various approaches such as treatment participants, guiding orientations, and service delivery methods.

It identified significant gaps in the literature, particularly regarding one-on-one conversation therapy for individuals with aphasia, and emphasized the need for valid measures of natural conversation and high-quality research in this area.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Conversation therapy for aphasia: a qualitative review of the literature. Simmons-Mackie, N., Savage, MC., Worrall, L.[2022]

Telepractice conversation treatment for people with aphasia led to significant improvements in language function, particularly in tasks like repetition and picture description, compared to no treatment.

While both telepractice and in-person conversation groups showed benefits, the in-person treatment resulted in greater improvements across more outcome measures, suggesting that in-person interactions may be more effective for language recovery.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Efficacy of Aphasia Group Conversation Treatment via Telepractice on Language and Patient-Reported Outcome Measures. Dunne, M., Hoover, E., DeDe, G.[2023]

In a study involving 48 participants with chronic aphasia, conversation group treatment significantly improved language impairment and quality of life compared to a delayed control group, indicating its efficacy.

The results suggested that smaller dyad groups were more effective for improving language impairment, while larger groups were better for enhancing functional communication and discourse production, highlighting the importance of group dynamics in treatment outcomes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Two to Tango or the More the Merrier? A Randomized Controlled Trial of the Effects of Group Size in Aphasia Conversation Treatment on Standardized Tests. DeDe, G., Hoover, E., Maas, E.[2020]

A sociolinguistic analysis of group therapy for aphasia involving eight adults showed that therapy can effectively enhance both communication skills and personal identity through supportive discourse.

Key elements of successful identity negotiation in therapy included ensuring group members felt 'heard', promoting their competence, fostering group solidarity, and managing interactions to support positive personal identities.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Negotiation of identity in group therapy for aphasia: the Aphasia Café. Simmons-Mackie, N., Elman, RJ.[2016]

References

1. United States pubmed.ncbi.nlm.nih.gov

The efficacy of group communication treatment in adults with chronic aphasia. [2022]

2. United States pubmed.ncbi.nlm.nih.gov

Identifying mechanisms of change in a conversation therapy for aphasia using behaviour change theory and qualitative methods. [2019]

3. United States pubmed.ncbi.nlm.nih.gov

Veterans Administration cooperative study on aphasia: a comparison of individual and group treatment. [2019]

4. England pubmed.ncbi.nlm.nih.gov

An Exploration of the Impact of Group Treatment for Aphasia on Connected Speech. [2021]

5. United States pubmed.ncbi.nlm.nih.gov

A Randomized Controlled Trial of the Effects of Group Conversation Treatment on Monologic Discourse in Aphasia. [2023]

6. United States pubmed.ncbi.nlm.nih.gov

Conversation therapy for aphasia: a qualitative review of the literature. [2022]

7. United States pubmed.ncbi.nlm.nih.gov

Efficacy of Aphasia Group Conversation Treatment via Telepractice on Language and Patient-Reported Outcome Measures. [2023]

8. United States pubmed.ncbi.nlm.nih.gov

Two to Tango or the More the Merrier? A Randomized Controlled Trial of the Effects of Group Size in Aphasia Conversation Treatment on Standardized Tests. [2020]

9. United States pubmed.ncbi.nlm.nih.gov

Negotiation of identity in group therapy for aphasia: the Aphasia Café. [2016]