Developing an Evidence-Based Treatment Continuum for Spoken and Written Language

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DESCRIPTION (provided by applicant): How can recovery from acquired language impairment be maximized? This question is central to the focus of every clinician and clinical researcher working with adults with aphasia, alexia, and agraphia. Nearly six decades of treatment research has yielded evidence supporting the efficacy of a wide range of language rehabilitation approaches. Unfortunately, the research efforts have been directed toward treatment approaches in isolation, and few, if any, researchers have considered the full scope and sequence of treatments necessary to maximize language recovery. In our current research, we tackled this issue with respect to the treatment of acquired agraphia, yielding evidence to support a treatment continuum for single-word writing. In the current proposal, we aim to build on the re-trained skills to maximize lexical retrieval in the spoken language modality, and to extend the treatment sequence to text-level reading and written composition. Our approach is novel in its focus on the interactive contribution of semantic, phonological, and orthographic processes. This perspective stems from evidence that literate adults have strongly established links among these three central language components, and the promotion of interactive processing of residual (and re-trained) skills in each domain can advance performance at multiple levels within the language system (sublexical, lexical, and sentence). We will examine a hierarchically structured treatment continuum where gaining mastery at a given level provides the scaffolding for advancing to the next level. A decision tree is proposed to guide the sequence for each individual in an algorithmic fashion. Using a case series approach, we propose to implement treatment with 50 individuals who reflect a diverse range of severity levels and behavioral and lesion profiles. Individual responses to treatment will be evaluated relative to performance on a comprehensive assessment of language before and after critical phases of treatment, allowing us to test the proposed algorithm. Language behavior and treatment outcomes will also be considered relative to the location and extent of brain damage affecting critical cortical networks. This work will advance the understanding of sequential treatment outcomes, and will serve to establish guidelines regarding treatment candidacy across the continuum. Ultimately, this study has the potential to change the way that clinicians plan treatment: shifting from the administration of isolated treatments to a planned sequence of interventions to maximize language recovery. PUBLIC HEALTH RELEVANCE: More than 1 million Americans have persistent acquired language impairment due to brain damage. The rehabilitation of spoken and written language impairments is a high priority for affected individuals, and the quality and efficiency of treatment approaches are critical issues for patients, family members, speech-language pathologists, and third-party payers. The research proposed here has the potential to significantly impact the planning and implementation of behavioral treatment in a manner that maximizes recovery of function.