Impairment vs.Function in Aphasia Chapter 3

Experiment 2: General Overview What is the effect of treatment? Age vs. Time Post-Onset of Aphasia 1 Experiment 2 Participants: 72 n = 39 60.9 yrs Mean age: 63.6 Mean time post4.7 yrs onset: 5.1 Time Post-Onset (in years) 35 30 Baseline Testing Treatment • Standardized Assessments 20 • Study-specific nonstandardized screener • Max of 10-12 weeks • 1-2 sessions/week 25 Post-Treatment Testing • Standardized Assessments • Study-specific nonstandardized screener 15 10 5 0 0 20 40 60 Age (in years) 80 100 Experiment 2: Correlation results Reading, Writing Overall & Number Daily Planning Communication Concepts Independence n = 37† WAB-LQ .906*** .595*** .871*** .807*** .893*** WAB-CQ .920*** .598*** .853*** .825*** .891*** WAB-AQ .904*** .484** .799*** .760*** .834*** CLQT: Attention .495** .591*** .625*** .630*** .644*** CLQT: Memory .849*** .542** .774*** .754*** .819*** CLQT: Executive Functions .558*** .719*** .687*** .698*** .727*** CLQT: Language .850*** .502** .737*** .743*** .797*** CLQT: Visuospatial .421* .603*** .561*** .585*** .590*** CLQT: Composite .765*** .666*** .825*** .811*** .846*** CLQT: Clock Drawing .623*** .604*** .648*** .711*** .715*** BNT .803*** .518** .692*** .773*** .779*** PAPT .614*** .737*** .664*** .681*** .747*** * = p significant at < .05 ** = p significant at < .01 *** = p significant at < .001 Correlation Strength: Green = Strong (1.00 - .700); Yellow = Moderate (.699 - .400); Red = Weak (.399 - .100) † Data not available for two PWA within the sample Social Communication Basic Needs • Strong and highly significant correlations between cognitivelinguistic and functional communication skills at baseline in the subset of PWA who underwent therapy Overall Qualitative Dimensions n = 35†† WAB-LQ .817*** .529** .606*** .826*** .829*** WAB-CQ .813*** .526** .597*** .838*** .829*** WAB-AQ .799*** .487** .578*** .843*** .817*** CLQT: Attention .581*** .560*** .444* .379* .570*** CLQT: Memory .798*** .533** .473** .775*** .778*** CLQT: Executive Functions .659*** .664*** .532*** .519** .697*** CLQT: Language .722*** .428* .442* .754*** .712*** CLQT: Visuospatial .528** .566*** .394* .374* .538** CLQT: Composite .813*** .644*** .559*** .587*** .772*** CLQT: Clock Drawing .544** .662*** .420* .494** .613*** BNT .668*** .395* .395* .636*** .639*** PAPT .560*** .484** .268 (n.s.) .434* .532** * = p significant at < .05 ** = p significant at < .01 *** = p significant at < .001 Correlation Strength: Green = Strong (1.00 - .700); Yellow = Moderate (.699 - .400); Red = Weak (.399 - .100) †† Data not available for two additional PWA Adequacy Appropriateness Promptness Communication Sharing Experiment 2: Intervention and Response Slope analysis of accuracy and response time on trained tasks indicated 35/39 PWA improved significantly on at least one task Naming Reading Writing Problem Solving Memory • PWA significantly improved from pre- to post-therapy on WAB-R CQ and AQ and CLQT Attention and Visuospatial Skills • No significant changes in ASHA FACS domain or dimension scores were noted following therapy • Change-score calculation = post-tx score – pre-tx score Scores (%) Experiment 2: Results in Pre- to Post-Treatment Outcome Measures 74 72 70 68 66 64 62 60 58 56 ** * WAB-R CQ * p < .05 **p < .01 * ** WAB-R AQ Pre-Tx CLQT: CLQT: Attention Visuospatial Skills Post-Tx Experiment 2: Change Score Correlations Correlations between ASHA FACS Communication Independence and cognitive-linguistic measure change scores Social Communication Basic Needs Reading, Writing & Number Concepts Daily Planning Overall Communication Independence n = 37† WAB-LQ .245 (n.s.) .063 (n.s.) .261 (n.s.) .027 (n.s.) .215 (n.s.) WAB-CQ .251 (n.s.) .132 (n.s.) .261 (n.s.) -.030 (n.s.) .200 (n.s.) WAB-AQ .303 (n.s.) .235 (n.s.) .256 (n.s.) .069 (n.s.) .267 (n.s.) CLQT: Attention .076 (n.s.) .034 (n.s.) .160 (n.s.) -.207 (n.s.) .008 (n.s.) CLQT: Memory .181 (n.s.) .090 (n.s.) .148 (n.s.) -.015 (n.s.) .090 (n.s.) CLQT: Executive Functions .103 (n.s.) .131 (n.s.) -.005 (n.s.) -.028 (n.s.) .077 (n.s.) CLQT: Language .164 (n.s.) -.056 (n.s.) .181 (n.s.) .075 (n.s.) .154 (n.s.) CLQT: Visuospatial .067 (n.s.) .177 (n.s.) .074 (n.s.) -.191 (n.s.) -.001 (n.s.) CLQT: Composite .204 (n.s.) .188 (n.s.) .219 (n.s.) -.147 (n.s.) .054 (n.s.) CLQT: Clock Drawing -.218 (n.s.) -.045 (n.s.) -.102 (n.s.) -.040 (n.s.) -.170 (n.s.) BNT .293 (n.s.) .261 (n.s.) .280 (n.s.) .249 (n.s.) .337 (n.s.) PAPT .193 (n.s.) .061 (n.s.) .143 (n.s.) .143 (n.s.) .181 (n.s.) * = p significant at < .05 ** = p significant at < .01 *** = p significant at < .001 Correlation Strength: Green = Strong (1.00 - .700); Yellow = Moderate (.699 - .400); Red = Weak (.399 - .100) † Data not available for two PWA within the sample Experiment 2: Change Score Correlations Correlations between ASHA FACS Qualitative Dimensions and cognitive-linguistic measure change scores Adequacy Appropriateness Promptness Communication Sharing Overall Qualitative Dimensions n = 35†† WAB-LQ .086 (n.s.) .399 (n.s.) .403 (n.s.) .136 (n.s.) .475 (n.s.) WAB-CQ .082 (n.s.) .446 (n.s.) .352 (n.s.) .210 (n.s.) .476 (n.s.) WAB-AQ .147 (n.s.) .600* .325 (n.s.) .283 (n.s.) .570* CLQT: Attention -.093 (n.s.) .330 (n.s.) .238 (n.s.) .245 (n.s.) .303 (n.s.) CLQT: Memory .141 (n.s.) .175 (n.s.) .128 (n.s.) -.142 (n.s.) .193 (n.s.) CLQT: Executive Functions .116 (n.s.) .313 (n.s.) .086 (n.s.) .087 (n.s.) .228 (n.s.) CLQT: Language .067 (n.s.) -.032 (n.s.) -.043 (n.s.) -.239 (n.s.) -.042 (n.s.) CLQT: Visuospatial -.025 (n.s.) .359 (n.s.) .165 (n.s.) .222 (n.s.) .282 (n.s.) CLQT: Composite .065 (n.s.) .568 (n.s.) .106 (n.s.) .161 (n.s.) .356 (n.s.) CLQT: Clock Drawing -.226 (n.s.) .035 (n.s.) -.313 (n.s.) -.332 (n.s.) -.192 (n.s.) BNT .201 (n.s.) .246 (n.s.) .040 (n.s.) -.069 (n.s.) .145 (n.s.) PAPT .325 (n.s.) .247 (n.s.) -.194 (n.s.) -.009 (n.s.) .053 (n.s.) * = p significant at < .05 ** = p significant at < .01 *** = p significant at < .001 Correlation Strength: Green = Strong (1.00 - .700); Yellow = Moderate (.699 - .400); Red = Weak (.399 - .100) †† Data not available for two additional PWA Experiment 2: Interim Conclusions Highly significant, strong Following therapy, PWA positive associations between improved significantly on cognitive-linguistic skills and several tests of cognitivefunctional communication at a linguistic skills but not on any single time point ASHA FACS domains Only two significant correlations between change scores on measures of cognitive-linguistic skills and change scores on ASHA FACS Why is change not related? • The most obvious possibility… • In Experiment #2, scores improved only on cognitive-linguistic measures, NOT on the ASHA FACS • Did all PWA really not change in functional communication? Inter-Individual Variability in PWA Change Scores Impairment Change Scores 40 35 30 25 20 15 10 5 0 -5 -10 Functional Communication Change Scores 2.5 2 1.5 1 0.5 0 -0.5 -1 -1.5 Baseline WAB-R AQ: PWA 1: 93.7 (mild); PWA 2: 48 (moderate); PWA 3: 31.3 (severe) What is the severity of the sample? • Frattali et al.’s field test included only PWA with WAB AQ <93.8 • Our sample included 9 PWA who were perceptibly aphasic but had WAB AQ >93.8 Severity Level based on WAB AQ Frattali et al. (n=131) 38.2% 26.7% 35.1% Revised Present sample (n=39) (n=30) 23.1% 30.0% 33.3% 26.7% 43.6% 43.3%