As Kurland explains, "Aphasia can affect any or all aspects of language including speaking and understanding spoken language, reading and/or writing. With brain injury from stroke, for example, people with aphasia know exactly what they want to say but they can’t access the words. In the end what we really want to do is increase the person’s functional independence, improve their language proficiency and maximize their quality of life."
In fact this work, which will focus on more severely aphasic individuals than typical studies, is innovative for its three-pronged approach using behavioral, neuro-imaging and quality-of-life measures to assess meaningful long-term improvements from intensive treatment plus a maintenance home therapy program.
Kurland and a full-time speech-language pathologist will conduct three one-year treatment experiments, enrolling eight different people per year who have chronic, moderate-to-severe aphasia. An important aspect of the study, supported by a National Institutes of Health grant, will be functional magnetic resonance imaging (fMRI) to characterize brain activity patterns that correlate with improved picture naming and to compare such patterns among treatment groups.
One of the key questions Kurland hopes to answer is which of two approaches, constraint-induced language therapy (CILT) or unconstrained language therapy (ULT), is most effective in helping people with aphasia to recover language skills and maintain them over time. In CILT, people are constrained to use only spoken words to communicate about pictured objects and actions during their therapy sessions. With ULT, they can use gestures, drawing, writing, pointing and facial expressions as well as speech.
Both therapies are expected to improve quality of life along with language skills, Kurland notes. But she expects the intense focus on speech in the CILT approach plus at-home practice to prove most effective and long-lasting. "We have anecdotal evidence that this type of training can improve such factors as confidence that can affect a person’s quality of life, but tools for measuring these changes are still being developed," she says.
"When a person has a stroke and aphasia, their social universe suddenly shrinks, they lose their job and the fulfillment of work and they have trouble communicating. Confidence can go way, way down. If we can offer improvement and boost their confidence to pick up the telephone or get out of the house and operate more independently, we’ll have succeeded."
Therapy for study participants, at no cost to them, will be intense, with daily three-hour sessions of speech and language treatment in the laboratory five days a week for two weeks using either CILT or ULT, followed by daily home practice sessions ("overlearning") and regular check-in sessions via video link.
Participants will undergo pre- and post-treatment diagnostic testing, including structural and functional MRI, and two post-treatment testing sessions at six months and one year after their therapy sessions. Kurland says she expects words that are trained and practiced, that is "overlearned" after CILT and ULT will show better maintenance in 12-month follow-up testing.
"The idea is to gradually improve one’s ability to verbally name an object or action that is pictured on a card. On the first day, it may be that a participant is unable to say ‘dog’ when shown a picture of a dog, but following the intensive practice retrieving first the word and then short phrases including the word, the connection between the concept and the word becomes more automatic."
In her experiments, the language researcher also looks for treatment-induced neuroplasticity, which is whether the brain’s structure and activities are changed by treatment as measured by analysis of the four fMRI tests per subject. A group of healthy, non-brain-damaged, age-matched subjects will serve as controls.
For information on eligibility to participate in this study, Kurland encourages persons with aphasia or their significant other to contact the Brain Research on Chronic Aphasia (BRoCA) lab at (413) 545-4008. The lab offers workshops for stroke survivors and family and a monthly support group. It also sponsors an annual Walk for Aphasia Awareness in downtown Amherst, held this year on April 14, 2012.
The aphasia research of Jacquie Kurland is featured in two new articles appearing in Health Care News and in the Springfield Republican. Kurland also recently appeared on WFCR. Follow the links to read more.