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Applying the Rehabilitation Treatment Specification System to Functional Communication Treatment Approaches for Aphasia

Published:November 03, 2021DOI:https://doi.org/10.1016/j.apmr.2021.10.016

      Abstract

      There are many different approaches to the rehabilitation of patients with aphasia, a communication disorder that affects a person's understanding and expression of spoken and written language. One approach called “functional communication interventions” aims to enhance communication success as opposed to solely improving linguistic abilities. This approach encompasses many skills (eg, gesturing) and factors (eg, access to communication supports) that support sending and receiving messages in “real-world” daily activities and environments. Functional communication treatments are highly diverse and not always well described. A framework that may provide structure to the description of functional communication interventions for aphasia is the Rehabilitation Treatment Specification System (RTSS). The RTSS was developed by an interdisciplinary research team to describe interventions across any rehabilitation discipline and in any setting or format. The RTSS uses a common language and a systematic approach to describing treatment and includes 3 connected elements—a single target, 1 or more ingredients, and a mechanism of action—that, taken together, attempt to explain how and why a treatment works. Although the RTTS has been described previously within the field of speech-language pathology, it has not yet been applied to the field of aphasiology. We applied the RTSS framework to a sample of peer-reviewed studies that represent functional communication treatments, including Promoting Aphasics’ Communicative Effectiveness (PACE), modified Response Elaboration Training (M-RET), script training, conversation treatment, and communication partner training. We discuss both the advantages and disadvantages of using the RTSS framework to better understand the important elements of functional communication treatment approaches for aphasia.

      List of abbreviations:

      CPT (communication partner training), ICF (International Classification of Functioning, Disability, and Health), MOA (mechanism of action), M-RET (modified Response Elaboration Training), PACE (Promoting Aphasics’ Communicative Effectiveness), PWA (person with aphasia), RTSS (Rehabilitation Treatment Specification System), TIDieR (Template for Intervention Description and Replication)

      Keywords

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      References

        • Simmons-Mackie N.
        Aphasia in North America: frequency, demographics, impact of aphasia, communication access, services and service gaps.
        AphasiaAccess, Moorestown, NJ2018
        • Cherney LR
        • Robey RR.
        Aphasia treatment: recovery, prognosis, and clinical effectiveness.
        in: Chapey R Language intervention strategies in adult aphasia. Lippincott, Williams, & Wilkins, Baltimore2008: 186-202
        • Brady MC
        • Kelly H
        • Godwin J
        • Enderby P
        • Campbell P.
        Speech and language therapy for aphasia following stroke.
        Cochrane Database Syst Rev. 2016; 2016CD000425
        • Sarno MT.
        The functional assessment of verbal impairment.
        Scand J Rehabil Med Suppl. 1983; 9: 75-81
        • Holland AL.
        Observing functional communication of aphasic adults.
        J Speech Hearing Disord. 1982; 47: 50-56
        • Holland AL.
        The social imperative for aphasia rehabilitation.
        in: Holland AL Elman RJ Neurogenic communication disorders and the life participation approach. Plural Publishing, Inc, San Diego2021: 1-19
        • Doedens WJ
        • Meteyard L.
        Measures of functional, real-world communication for aphasia: a critical review.
        Aphasiology. 2020; 34: 492-514
        • Worrall LE.
        A conceptual framework for a functional approach to acquired neurogenic disorders of communication and swallowing.
        in: Worrall LE Frattali CM Neurogenic communication disorders: a functional approach. Thieme, New York2000: 2-18
        • World Health Organization
        ICF: International classification of functioning, disability, and health.
        World Health Organization, Geneva2017
        • Elman RJ
        • Bernstein-Ellis E.
        What is functional?.
        Am J Speech Lang Pathol. 1995; 4: 115-117
        • Simmons-Mackie N.
        Social approaches to aphasia intervention.
        in: Chapey R Language intervention strategies in aphasia and related neurogenic communication disorders. Wolters Kluwer Health/Lippincott Williams & Wilkins, Philadelphia2008: 290-318
        • Kagan A
        • Simmons-Mackie N
        • Rowland A
        • et al.
        Counting what counts: a framework for capturing real-life outcomes of aphasia intervention.
        Aphasiology. 2008; 22: 258-280
        • Hoffmann TC
        • Glasziou PP
        • Boutron I
        • et al.
        Better reporting of interventions: template for intervention description and replication (tidier) checklist and guide.
        BMJ. 2014; 348: g1687
        • Whyte J
        • Dijkers MP
        • Hart T
        • et al.
        Development of a theory-driven rehabilitation treatment taxonomy: conceptual issues.
        Arch Phys Med Rehabil. 2014; 95: S24-S32
        • Hart T
        • Tsaousides T
        • Zanca JM
        • et al.
        Toward a theory-driven classification of rehabilitation treatments.
        Arch Phys Med Rehabil. 2014; 95: S33-S44
        • Hart T
        • Dijkers MP
        • Whyte J
        • et al.
        A theory-driven system for the specification of rehabilitation treatments.
        Arch Phys Med Rehabil. 2019; 100: 172-180
      1. Hart T, Whyte J, Dijkers M, et al. Manual of rehabilitation treatment specification. Available at: https://acrm.org/acrm-communities/rehabilitation-treatment-specification/manual-for-rehabilitation-treatment-specification. Accessed June 2021.

        • Van Stan JH
        • Dijkers MP
        • Whyte J
        • et al.
        The rehabilitation treatment specification system: implications for improvements in research design, reporting, replication, and synthesis.
        Arch Phys Med Rehabil. 2019; 100: 146-155
        • Whyte J
        • Dijkers MP
        • Hart T
        • et al.
        The importance of voluntary behavior in rehabilitation treatment and outcomes.
        Arch Phys Med Rehabil. 2019; 100: 156-163
        • Zanca JM
        • Turkstra LS
        • Chen C
        • et al.
        Advancing rehabilitation practice through improved specification of interventions.
        Arch Phys Med Rehabil. 2019; 100: 164-171
        • Boyle M
        • Gordon JK
        • Harnish SM
        • et al.
        Evaluating cognitive-linguistic approaches to interventions for aphasia within the rehabilitation treatment specification system (RTSS).
        Arch Phys Med Rehabil. 2021; (XXX)
        • Turkstra LS
        • Norman R
        • Whyte J
        • Dijkers MP
        • Hart T.
        Knowing what we're doing: why specification of treatment methods is critical for evidence-based practice in speech-language pathology.
        Am J Speech Lang Pathol. 2016; 25: 164-171
        • Meulenbroek P
        • Ness B
        • Lemoncello R
        • et al.
        Social communication following traumatic brain injury part two: identifying effective treatment ingredients.
        Int J Speech Lang Pathol. 2019; 21: 128-142
        • Fridriksson J
        • Basilakos A
        • Boyle M
        • et al.
        Demystifying the complexity of aphasia treatment: application of the rehabilitation treatment specification system (RTSS).
        Arch Phys Med Rehabil. 2021 Nov 5; ([Epub ahead of print])
        • Basilakos A
        • Hula WD
        • Johnson LP
        • Kiran S
        • Walker GM
        • Fridriksson J.
        Defining the neurobiological mechanisms of action in aphasia therapies: applying the RTSS framework to research and practice in aphasia.
        Arch Phys Med Rehabil. 2021; (XXX)
        • Macoir J
        • Martel Sauvageau V
        • Boissy P
        • Tousignant M
        • Tousignant M
        In-home synchronous telespeech therapy to improve functional communication in chronic poststroke aphasia: results from a quasi-experimental study.
        Telemed J E Health. 2017; 23: 630-639
        • Wambaugh JL
        • Wright S
        • Nessler C.
        Modified response elaboration training: a systematic extension with replications.
        Aphasiology. 2012; 26: 1407-1439
        • Nicholas LE
        • Brookshire RH.
        A system for quantifying the informativeness and efficiency of the connected speech of adults with aphasia.
        J Speech Hearing Res. 1993; 36: 338-350
        • Lomas J
        • Pickard L
        • Bester S
        • Elbard H
        • Finlayson A
        • Zoghaib C.
        The communicative effectiveness index: development and psychometric evaluation of a functional communication measure for adult aphasia.
        J Speech Hearing Disord. 1989; 54: 113-124
        • Holland A
        • Frattali C
        • Fromm D.
        Communication activities of daily living–second edition (CADL-2).
        Pro-Ed, Austin, TX1999
        • Bilda K.
        Video-based conversational script training for aphasia: a therapy study.
        Aphasiology. 2011; 25: 191-201
        • Elman RJ
        • Bernstein-Ellis E.
        The efficacy of group communication treatment in adults with chronic aphasia.
        J Speech Lang Hearing Res. 1999; 42: 411-419
        • Elman RJ
        • Bernstein-Ellis E.
        Psychosocial aspects of group communication treatment. Preliminary findings.
        Semin Speech Lang. 1999; 20 (quiz 71-2): 65-71
        • DiSimoni FG
        • Keith RL
        • Holt DL
        • Darley FL.
        Practicality of shortening the Porch Index of Communicative Ability.
        J Speech Hearing Res. 1975; 18: 491-497
        • Kertesz A.
        The Western Aphasia Battery.
        Grune & Stratton, New York1982
        • Holland A.
        Communicative abilities in daily living.
        University Park Press, Baltimore1980
        • Purdy M
        • Hindenlang J.
        Educating and training caregivers of persons with aphasia.
        Aphasiology. 2005; 19: 377-388
        • Braungart MM
        • Braungart RG
        • Gramet PR
        Applying learning theories to healthcare practice.
        in: Bastable SB Nurse as educator: principles of teaching and learning for nursing practice. Jones and Bartlett Learning, Burlington, MA2017: 43-71
        • Wilcox M
        • Davis G.
        Procedures for promoting communicative effectiveness in an aphasic adult.
        in: Miniseminar presented at the Annual Convention of American Speech and Hearing Association, San Francisco1978
        • Davis GA
        Pace revisited...promoting aphasic's communicative effectiveness.
        Aphasiology. 2005; 19: 21-38
        • Maher LM
        • Kendall D
        • Swearengin JA
        • et al.
        A pilot study of use-dependent learning in the context of constraint induced language therapy.
        J Int Neuropsychol Soc. 2006; 12: 843-852
        • Raglio A
        • Oasi O
        • Gianotti M
        • Rossi A
        • Goulene K
        • Stramba-Badiale M.
        Improvement of spontaneous language in stroke patients with chronic aphasia treated with music therapy: a randomized controlled trial.
        Int J Neurosci. 2016; 126: 235-242
        • Li EC
        • Kitselman K
        • Dusatko D
        • Spinelli C.
        The efficacy of pace in the remediation of naming deficits.
        J Commun Disord. 1988; 21: 491-503
        • Kurland J
        • Pulvermuller F
        • Silva N
        • Burke K
        • Andrianopoulos M.
        Constrained versus unconstrained intensive language therapy in two individuals with chronic, moderate-to-severe aphasia and apraxia of speech: Behavioral and fmri outcomes.
        Am J Speech Lang Pathol. 2012; 21: S65-S87
        • Kurland J
        • Stanek EJ
        • 3rd Stokes P
        • Li M
        • Andrianopoulos M
        Intensive language action therapy in chronic aphasia: a randomized clinical trial examining guidance by constraint.
        Am J Speech Lang Pathol. 2016; 25: S798-S812
        • Newhoff M
        • Bugbee JK
        • Ferreira A.
        A change of pace: spouses as treatment targets.
        Clin Aphasiol. 1981; 11: 234-243
        • Kagan A
        • Gailey GF.
        Functional is not enough: training conversation partners for aphasic adults. Aphasia treatment.
        Springer, New York1993: 199-225
        • Ehlhardt LA
        • Sohlberg MM
        • Kennedy M
        • et al.
        Evidence-based practice guidelines for instructing individuals with neurogenic memory impairments: what have we learned in the past 20 years?.
        Neuropsychol Rehabil. 2008; 18: 300-342
        • Kearns KP.
        Response elaboration training for patient initiated utterances.
        Clin Aphasiol. 1985; 15: 196-204
        • Wambaugh JL
        • Martinez AL.
        Effects of modified response elaboration training with apraxic and aphasic speakers.
        Aphasiology. 2000; 14: 603-617
        • Wambaugh JL
        • Nessler C
        • Wright S.
        Modified response elaboration training: application to procedural discourse and personal recounts.
        Am J Speech Lang Pathol. 2013; 22: S409-S425
        • Stokes TF
        • Baer DM.
        An implicit technology of generalization.
        J Appl Behav Anal. 1977; 10: 349-367
        • Fillingham JK
        • Hodgson C
        • Sage K
        • Lambon Ralph MA
        The application of errorless learning to aphasic disorders: a review of theory and practice.
        Neuropsychol Rehabil. 2003; 13: 337-363
        • Middleton EL
        • Schwartz MF.
        Errorless learning in cognitive rehabilitation: a critical review.
        Neuropsychol Rehabil. 2012; 22: 138-168
        • Youmans G
        • Holland A
        • Munoz M
        • Bourgeois M.
        Script training and automaticity in two individuals with aphasia.
        Aphasiology. 2005; 19: 435-450
        • Manheim LM
        • Halper AS
        • Cherney LR
        Patient-reported changes in communication after computer-based script training for aphasia.
        Arch Phys Med Rehabil. 2009; 90: 623-627
        • Hubbard HI
        • Nelson LA
        • Richardson JD.
        Can script training improve narrative and conversation in aphasia across etiology?.
        Semin Speech Lang. 2020; 41: 99-124
        • Goldberg S
        • Haley KL
        • Jacks A.
        Script training and generalization for people with aphasia.
        Am J Speech Lang Pathol. 2012; 21: 222-238
        • Cherney LR
        • Halper AS
        • Holland AL
        • Cole R.
        Computerized script training for aphasia: preliminary results.
        Am J Speech Lang Pathol. 2008; 17: 19-34
        • Lee JB
        • Kaye RC
        • Cherney LR.
        Conversational script performance in adults with non-fluent aphasia: treatment intensity and aphasia severity.
        Aphasiology. 2009; 23: 885-897
        • Cherney LR
        • Kaye RC
        • van Vuuren S.
        Acquisition and maintenance of scripts in aphasia: a comparison of two cuing conditions.
        Am J Speech Lang Pathol. 2014; 23: S343-S360
        • Fridriksson J
        • Hubbard HI
        • Hudspeth SG
        • et al.
        Speech entrainment enables patients with broca's aphasia to produce fluent speech.
        Brain. 2012; 135: 3815-3829
        • Cherney LR
        • Halper AS.
        Novel technology for treating individuals with aphasia and concomitant cognitive deficits.
        Top Stroke Rehabil. 2008; 15: 542-554
        • Cherney LR
        • Kaye RC
        • Lee JB
        • van Vuuren S.
        Impact of personal relevance on acquisition and generalization of script training for aphasia: a preliminary analysis.
        Am J Speech Lang Pathol. 2015; 24: S913-S922
        • Holland AL
        • Halper AS
        • Cherney LR.
        Tell me your story: analysis of script topics selected by persons with aphasia.
        Am J Speech Lang Pathol. 2010; 19: 198-203
        • Rhodes NC
        • Isaki E.
        Script training using telepractice with two adults with chronic non-fluent aphasia.
        Int J Telerehabil. 2018; 10: 89-104
        • Logan GD.
        Automaticity, resources, and memory: theoretical controversies and practical implications.
        Hum Factors. 1988; 30: 583-598
        • Cherney LR
        • Braun EJ
        • Lee JB
        • Kocherginsky M
        • Van Vuuren S.
        Optimising recovery in aphasia: learning following exposure to a single dose of computer-based script training.
        Int J Speech Lang Pathol. 2019; 21: 448-458
        • Savage MC
        • Donovan NJ
        • Hoffman PR.
        Preliminary results from conversation therapy in two cases of aphasia.
        Aphasiology. 2014; 28: 616-636
        • DeDe G
        • Hoover E
        • Maas E.
        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.
        J Speech Lang Hearing Res. 2019; 62: 1437-1451
        • Simmons-Mackie N
        • Savage MC
        • Worrall L.
        Conversation therapy for aphasia: a qualitative review of the literature.
        Int J Lang Commun Disord. 2014; 49: 511-526
        • Lee JB
        • Azios JH.
        Facilitator behaviors leading to engagement and disengagement in aphasia conversation groups.
        Am J Speech Lang Pathol. 2020; 29: 393-411
        • Baylor C
        • Burns M
        • McDonough K
        • Mach H
        • Yorkston K.
        Teaching medical students skills for effective communication with patients who have communication disorders.
        Am J Speech Lang Pathol. 2019; 28: 155-164
        • Chang HF
        • Power E
        • O'Halloran R
        • Foster A.
        Stroke communication partner training: a national survey of 122 clinicians on current practice patterns and perceived implementation barriers and facilitators.
        Int J Lang Commun Disord. 2018; 53: 1094-1109
        • Simmons-Mackie N
        • Raymer A
        • Cherney LR.
        Communication partner training in aphasia: an updated systematic review.
        Arch Phys Med Rehabil. 2016; 97: 2202-2221
        • Finch E
        • Copley A
        • Cornwell P
        • Kelly C.
        Systematic review of behavioral interventions targeting social communication difficulties after traumatic brain injury.
        Arch Phys Med Rehabil. 2016; 97: 1352-1365
        • Pritchard M
        • Hilari K
        • Cocks N
        • Dipper L.
        Psychometric properties of discourse measures in aphasia: acceptability, reliability, and validity.
        Int J Lang Commun Disord. 2018; 53: 1078-1093
        • Stark BC
        • Dutta M
        • Murray LL
        • et al.
        Standardizing assessment of spoken discourse in aphasia: a working group with deliverables.
        Am J Speech Lang Pathol. 2021; 30: 491-502
        • Maas E
        • Robin DA
        • Austermann Hula SN
        • et al.
        Principles of motor learning in treatment of motor speech disorders.
        Am J Speech Lang Pathol. 2008; 17: 277-298
        • Thompson CK
        • Shapiro LP
        • Kiran S
        • Sobecks J.
        The role of syntactic complexity in treatment of sentence deficits in agrammatic aphasia: the complexity account of treatment efficacy (CATE).
        J Speech Lang Hearing Res. 2003; 46: 591-607
        • Bright FA
        • Kayes NM
        • Worrall L
        • McPherson KM.
        A conceptual review of engagement in healthcare and rehabilitation.
        Disabil Rehabil. 2015; 37: 643-654
        • Street Jr, RL
        • Makoul G
        • Arora NK
        • Epstein RM.
        How does communication heal? Pathways linking clinician–patient communication to health outcomes.
        Patient Educ Couns. 2009; 74: 295-301
        • Williams MW
        • Rapport LJ
        • Hanks RA
        • Parker HA.
        Engagement in rehabilitation therapy and functional outcomes among individuals with acquired brain injuries.
        Disabil Rehabil. 2021; 43: 33-41
        • Meichenbaum D
        • Turk DC.
        Facilitating treatment adherence: a practitioner's guidebook.
        Plenum Press, New York1987
        • Charles C
        • Gafni A
        • Whelan T
        • O'Brien MA
        Cultural influences on the physician-patient encounter: the case of shared treatment decision-making.
        Patient Educ Couns. 2006; 63: 262-267
        • Rowlands L
        • Coetzer R
        • Turnbull OH
        Building the bond: predictors of the alliance in neurorehabilitation.
        NeuroRehabilitation. 2020; 46: 271-285
        • Skidmore ER
        • Whyte EM
        • Holm MB
        • et al.
        Cognitive and affective predictors of rehabilitation participation after stroke.
        Arch Phys Med Rehabil. 2010; 91: 203-207
        • Efstratiadou EA
        • Papathanasiou I
        • Holland R
        • Archonti A
        • Hilari K
        A systematic review of semantic feature analysis therapy studies for aphasia.
        J Speech Lang Hearing Res. 2018; 61: 1261-1278