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Relations between executive function, language and functional communication in severe aphasia
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Blom Johansson: Speech-Language Pathology.ORCID iD: 0000-0002-7703-2188
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Research and Development, Gävleborg.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Blom Johansson: Speech-Language Pathology.
2019 (English)Conference paper, Poster (with or without abstract) (Refereed)
Abstract [en]

People who, due to aphasia, have severely limited ability to make themselves understood through speech, are forced to find other means of communication. However, the ability to flexibly and efficiently use gesture, drawing, writing, communication aids and so on differs widely in people with severe aphasia. Studies of interventions focusing on use of augmentative and alternative communication (AAC) in aphasia typically show that the participants have ability to learn to use the communication aid in the clinical context, but frequently fails to generalise the use to real-life functional communication (Jacobs, Drew, Ogletree, & Pierce, 2004). The same problem is often seen for other kinds of alternative communication, such as gesture and drawing. Intervention in severe aphasia aims for access to meaningful social interaction in spite of great linguistic barriers (Darrigrand et al., 2011; Koleck et al., 2017),  and a profound understanding of the different factors affecting the functional communication in this population is therefore crucial.

One factor that is thought to play an important role is executive function. It has been shown that people with aphasia often have impaired executive function, and there also seems to be a link to functional communication (Fridriksson, Nettles, Davis, Morrow, & Montgomery, 2006; Murray, 2012; Purdy & Koch, 2006; Ramsberger, 2005). However, the studies are few and conducted on small samples often including participants with a wide variation in aphasia severity. The aim of the present study was to expand the understanding of the relations between executive functions, linguistic ability and functional communication in severe aphasia.

Executive functions, linguistic ability and functional communication were assessed in 47 participants with severe aphasia. Functional communication was assessed using the Scenario Test (van der Meulen, van de Sandt-Koenderman, Duivenvoorden, & Ribbers, 2010). The results were analysed for the total sample as well as separated into a verbal and a non-verbal subgroup.

Impairment of executive function was found in 79% of the participants. Moderate to strong correlations were found between linguistic ability and executive functions. In the total sample, partial correlation analysis showed that functional communication was mainly related to verbal output. In the verbal subgroup, no relations were found between functional communication and the other two variables. In the non-verbal subgroup however, the partial correlation analysis showed a strong relation between executive function and functional communication. Generally, there was large variation of executive functions and functional communication among the participants, especially in the nonverbal subgroup.

The study led to several conclusions. Impairments of executive functions are, as expected, common in people with severe aphasia, and executive function is closely related to linguistic ability. The ability to produce verbal output is, also as expected, strongly related to functional communication and on the group level a small increase in verbal output results in a relatively large increase in functional communication, as measured by the Scenario Test. However, in people with extreme limitation or total absence of verbal output, where use of other modes of communication are ineluctable, executive functions seem to be an important factor. This suggests that executive functions need to be considered when planning intervention. In both design and training to use AAC and other forms of communication support, it is important to understand the demands the task puts on executive functions and, if possible, to minimise them. This also raises the importance of making sure people with severe aphasia are given a proper assessment of their cognitive abilities including executive functions, even though this is often challenging.

 

 

Darrigrand, B., Dutheil, S., Michelet, V., Rereau, S., Rousseaux, M., & Mazaux, J.-M. (2011). Communication impairment and activity limitation in stroke patients with severe aphasia. Disabil Rehabil, 33(13-14), 1169-1178. doi:10.3109/09638288.2010.524271

Fridriksson, J., Nettles, C., Davis, M., Morrow, L., & Montgomery, A. (2006). Functional communication and executive function in aphasia. Clinical Linguistics & Phonetics, 20(6), 401-410. doi:10.1080/02699200500075781

Jacobs, B., Drew, R., Ogletree, B. T., & Pierce, K. (2004). Augmentative and Alternative Communication (AAC) for adults with severe aphasia: where we stand and how we can go further. Disabil Rehabil, 26(21-22), 1231-1240. doi:10.1080/09638280412331280244

Koleck, M., Gana, K., Lucot, C., Darrigrand, B., Mazaux, J. M., & Glize, B. (2017). Quality of life in aphasic patients 1 year after a first stroke. Quality of Life Research, 26(1), 45-54. doi:10.1007/s11136-016-1361-z

Murray, L. L. (2012). Attention and other cognitive deficits in aphasia: Presence and relation to language and communication measures. Am J Speech Lang Pathol, 21(2), s51-s64. doi:10.1044/1058-0360(2012/11-0067)

Purdy, M., & Koch, A. (2006). Prediction of strategy usage by adults with aphasia. Aphasiology, 20(2-4), 337-348. doi:10.1080/02687030500475085

Ramsberger, G. (2005). Achieving conversational success in aphasia by focusing on non-linguistic cognitive skills: A potentially promising new approach. Aphasiology, 19(10-11), 1066-1073. doi:10.1080/02687030544000254

van der Meulen, I., van de Sandt-Koenderman, W. M., Duivenvoorden, H. J., & Ribbers, G. M. (2010). Measuring verbal and non-verbal communication in aphasia: reliability, validity, and sensitivity to change of the Scenario Test. Int J Lang Commun Disord, 45(4), 424-435. doi:10.3109/13682820903111952

 

Place, publisher, year, edition, pages
2019.
Keywords [en]
aphasia, executive function, functional communication
National Category
Other Health Sciences Neurology
Identifiers
URN: urn:nbn:se:uu:diva-387944OAI: oai:DiVA.org:uu-387944DiVA, id: diva2:1331124
Conference
7th Nordic Aphasia Conference, 13−15 June 2019, Turku, Finland
Available from: 2019-06-26 Created: 2019-06-26 Last updated: 2019-10-25Bibliographically approved

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