Aphasia rehabilitation can target discourse

5.13 Aphasia rehabilitation can target discourse at the:
     ● monologue level
     ● interactional discourse (conversation) level.

References: Azios et al., 2022: Scoping review of 64 studies (26 case studies, 18 single subject design studies, 8 group studies, 1 qualitative study, 11 studies that examined tool / process); Dede et al., 2019: RCT; De Kleine et al., 2023: Systematic review of 7 studies (1 single case observational study, 6 postobservational experimental designs); Dipper et al., 2021: Systematic review of 25 studies (7 RCTs, 7 single-case reports with no control, 6 case series, 3 group studies without control, 2 non-randomised group studies with control); Hickin et al., 2022: Systematic review of 33 studies (14 case series, 12 single-case studies, 5 case series with group results reported, 2 group studies); Poirier et al., 2023: Systematic review of 25 studies (all single- or multiplecase studies using SCED); Simmons-Mackie et al., 2014: Narrative review; Whitworth et al., 2015: RCT 

NHMRC Levels of Evidence - II

Rationale: Aphasia treatment may target discourse (i.e. language beyond the sentence level) specifically. Such therapies may vary in their underlying models, settings (e.g., individual versus group), therapeutic emphasis (e.g., generic versus individualised, compensatory), involvement of communication partners, and types of activities (Simmons-Mackie et al., 2014), as well as the purpose of the discourse interaction. 

There is no consensus on the most suitable measure for assessing discourse in aphasia, which complicates the interpretation of research findings (Azios et al., 2022). A systematic review found, however, that discourse treatment is efficacious, with benefits reported most commonly for the production of words in discourse, and some indication of improvements at the sentence production and discourse macrostructure level (Dipper et al., 2021) when those levels are intentionally treated. The most promising outcomes are from multilevel discourse treatment approaches (Dipper et al., 2021). An RCT also found that conversation therapy was more likely to lead to discourse-level improvements when delivered in groups than in dyads (Dede, et al., 2019). 

Discourse and functional communication may also improve as a result of treatments targeting other domains, such as verb naming, sentence production, or gesture treatments (De Kleine et al., 2023; Hickin et al., 2022; Poirier et al., 2023).

Two discourse interventions that have specifically shown promise are:
● Novel Approach to Real-life communication: Narrative Intervention in Aphasia (NARNIA; Whitworth et al., 2015), and
● Language Underpins Narrative in Aphasia (LUNA; Dipper et al., 2024).

References: 

1. Azios, J.H., Archer, B., Simmons-Mackie, N., Raymer, A., Carragher, M., Shashikanth, S., & Gulick, E. (2022). Conversation as an outcome of aphasia treatment: A systematic scoping review. American Journal of Speech-Language Pathology, 31(6), 2920-2942. DOI: 10.1044/2022_AJSLP-22-00011
2. DeDe, G., Hoover, E., & Maas, E. (2019). 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. Journal of Speech, Language, and Hearing Research, 62(5), 1437-1451. DOI: 10.1044/2019_JSLHR-L-18-0404.
3. Dipper, L., Marshall, J., Boyle, M., Botting, N., Hersh, D., Pritchard, M. & Cruise, M. (2021). Treatment for improving discourse in aphasia: A systematic review and synthesis of the evidence base. Aphasiology, 35(9), 1125-1167, DOI: 10.1080/02687038.2020.1765305
4. Hickin, J., Cruise, M., & Dipper, L. (2022). A systematically conducted scoping review of the evidence and fidelity of treatments for verb and sentence deficits in aphasia: Sentence treatments. American Journal of Speech-Language Pathology, 31(1), 431-462. DOI: 10.1044/2021_AJSLP-21-00120
5.  Poirier, S., Fossard, M., & Monetta, L. (2023). The efficacy of treatments for sentence production deficits in aphasia: A systematic review. Aphasiology, 37(1). 122-142.DOI: 10.1080/02687038.2021.1983152
6. Simmons-Mackie, N., Savage, M.C. & Worrall, L. (2014). Conversation therapy for aphasia: A qualitative review of the literature. International Journal of Language & Communication Disorders, 49(5), 511-526. DOI: 10.1111/1460-6984.12097
7. Whitworth, A., Leitão, S., Cartwright, J., Webster, J., Hankey, G. J., Zach, J., Howard, D., & Wolz, V. (2015). NARNIA: a new twist to an old tale. A pilot RCT to evaluate a multilevel approach to improving discourse in aphasia. Aphasiology, 29(11), 1345–1382. https://doi.org/10.1080/02687038.2015.1081143