An investigation into the effect of a novel non-linguistic cognitive intervention on functional communication in global aphasia

Background: Global aphasia is a severe communication disorder affecting all language modalities, commonly caused by stroke. Evidence as to whether the functional communication of people with global aphasia (PwGA) can improve after speech and language therapy is limited and conflicting. This is partly because cognition is essential for successful functional communication and in global aphasia it can be severely impaired. Cognitive treatments aimed at improving functional communication in people with aphasia exist, but few have been trialled with PwGA and none have robustly demonstrated gains. This study explored the effect of a novel cognitive intervention on the functional communication skills of PwGA. Method: A survey investigated the practices, challenges and research priorities of UK based speech and language therapists. Intervention for PwGA was found to commonly target choice-making or non-verbal communication. However, co-occurring cognitive difficulties were reported to limit progress and present a challenge when engaging clients. Synthesising these findings with a review of the literature, a non-linguistic intervention targeting the cognitive skills underpinning functional communication was developed and delivered to six participants (recruited from NHS and independent neurorehabilitation services), three times weekly for up to 6 weeks. A multiple baseline case series design investigated changes in functional communication (as measured by a proxy rating of communication independence and quality, and a new scenario-based observational tool), cognition and auditory comprehension. Results: Participants completed this novel intervention programme in an average of nine sessions. Five out of six participants made significant gains in functional communication as measured by a proxy, and non-verbal semantics. Auditory comprehension also significantly improved in two individuals. Conclusion: There is preliminary evidence that this intervention can improve functional communication in some PwGA. Findings add to the evidence that cognition is critical to functional communication and highlight the benefit of treating cognition via non- linguistic means in PwGA.