Evaluating a Combined Communication and Counseling Intervention in Primary Progressive Aphasia: A Pilot Feasibility Study

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Project Summary Aphasia is a neurogenic communication disorder caused by damage to language regions in the brain, including acute neurological insult or neurodegenerative disease.1 Given that the ability to communicate is entwined with identity, competency, and self-expression, the advent of aphasia often results in negative psychosocial repercussions.2 Individuals with primary progressive aphasia (PPA) are an especially vulnerable population, as they face an ongoing and inevitable decline in communication ability with disease progression. While there is a growing body of research pertaining to the utility of speech-language intervention for PPA, counseling approaches that address the emotional needs of this clinical population are under-studied. In this study, we propose to implement psychosocial approaches alongside speech-language intervention for individuals with PPA. Specifically, we will analyze the acceptability and feasibility of a novel intervention that implements aphasia-modified cognitive behavioral therapy (CBT) approaches alongside tailored speech- language treatment (i.e., script training or lexical retrieval training) in a group of nine participants with mild PPA. During the study, we will refine a novel, aphasia-adapted CBT manual and will conduct mixed methods analyses to contextualize preliminary treatment outcomes. Additionally, we will complete exploratory analyses comparing speech-language and psychosocial outcomes from the proposed study cohort to a speech-language intervention-only cohort as an initial characterization of treatment benefit. This study will serve as an important preliminary stage in a programmatic line of research, setting the stage for larger-scale efficacy research. This project will advance the science of behavioral rehabilitation in aphasia by providing evidence regarding holistic treatment that not only addresses communication impairment, but also incorporates counseling techniques that empower patients to optimally navigate the psychosocial challenges associated with aphasia. This is relevant to public health, as aphasia directly impacts an estimated 2-4 million Americans.27 The aims of this proposal are in direct alignment with the mission of the NIH, as this project endeavors to minimize disability and improve the lives of those who have been impacted by a neurological disorder. This fellowship will provide the applicant with a multifaceted training experience with opportunities to learn new research methodologies, data analysis procedures, and clinical principles. The applicant’s sponsor and contributing members of the training team possess expertise in distinct yet complementary research and clinical areas, including quantitative and qualitative research, experimental design, statistical analysis, speech-language intervention, and counseling methodologies. Taken together, this comprehensive, interdisciplinary training experience will support the applicant in meeting the research aims of this grant and will prepare her to become an independent aphasia researcher.