Critical ingredients of multilevel aphasia interventions for people with post-stroke aphasia

INTERVENTION: Verb Network Strengthening Treatment (VNeST), is an intervention targeting word and sentence levels. VNEST aims to improve word finding and sentence production by focusing on verbs and the roles of other words in a sentence. Materials Required for VNeST (Intervention) VNeST is designed to require minimal materials. For each session, the following items will be used: 1. Pen and paper, or a small tabletop whiteboard with dry erase markers 2. Pre prepared simple sentences for Step 4 (sentences may also be created during the session if required) 3. For the optional Step 5 activity, one picture per target verb per week Intervention Procedures Step 1: The participant generates several scenarios (typically three) incorporating the target verb. This activity is intended to activate and strengthen the participant’s verb network by eliciting a range of possible agents and objects related to the verb. Step 2: The participant reads each scenario aloud three times. This promotes repeated production and consolidation of complete sentences and reinforces basic subject–verb–object sentence structure. Step 3: The participant selects one scenario from Step 1 and answers three WH questions (where, when, why). This step encourages production of more detailed and comple Xsentences and supports engagement with semantic, world, and autobiographical knowledge relevant to the event. Step 4: The clinician reads simple active sentences containing the target verb, and the participant determines whether each sentence is semantically accurate. This activity supports sentence level comprehension and the ability to distinguish and relate individual word meanings. Step 5: The participant is asked to name the target verb they have been workin CONDITION: Cardiovascular ‐ Hypertension Neurological ‐ Other neurological disorders Physical Medicine / Rehabilitation ‐ Speech therapy Post‐ stroke aphasia; ; Post‐ stroke aphasia PRIMARY OUTCOME: Features of discourse organisation (e.g., structural elements such as beginning, middle, end) across functional speaking contexts. (Composite primary outcome)[Use of the Curtin University Discourse Protocol (CUDP) to measure the frequency and type of discourse level structural language elements in connected speech samples. At baseline and 1 (Weeks 13–14) and 5 (Week 18) weeks post‐intervention.] Performance on word retrieval tasks within connected speech samples.[Use of the Curtin University Discourse Protocol (CUDP) to measure the frequency and type of word level elements in discourse samples (Composite primary outcome measure) At baseline and 1 (Weeks 13–14) and 5 (Week 18) weeks post‐intervention.] Sentence structure and syntactic accuracy within connected speech. (composite primary outcome)[Use of the Curtin University Discourse Protocol (CUDP) to measure the frequency and type of sentence structure elements in discourse. At baseline and 1 (Weeks 13–14) and 5 (Week 18) weeks post‐intervention.] SECONDARY OUTCOME: Changes in quality of life.[The Assessment for Living with Aphasia (ALA) (Kagan et al., 2010) will be used to measure participant perspectives of change related to participation, environment, language and personal factors. The Stroke and Aphasia Quality of Life Scale (SAQOL‐39) (Hilari et al., 2003), an international core outcome measure, will be used for comparability with other studies. At baseline and 1 (Weeks 13–14) and 5 (Week 18) weeks post‐intervention.] Discourse performance measured by total words, Correct Information Units (CIUs), percentage CIUs, CIUs per minute, and words per minute. (Composite secondary outcome)[Connected speech elicited via picture description and personal narrative. Each sample will be assessed for total number of words and Correct Information Units (CIUs) by the speech pathologist. Percentage CIUs (%CIU), CIUs per minute, and words per minute (WPM) will be calculated based on these measures. At baseline and 1 (Weeks 13–14) and 5 (Week 18) weeks post‐intervention.] Sentence level performance[Sentence level production measured by Complete Utterances outcome measure, where complete utterance is defined as an utterance containing both a complete sentence frame and relevance to the topic will be used. ; At baseline and 1 (Weeks 13–14) and 5 (Week 18) weeks post‐intervention.] INCLUSION CRITERIA: A person who meets the following criteria will be invited to take part in the study: 1. Has experienced a stroke of any type (stroke defined by ICD‐10 codes 161‐164), as confirmed by medical records. 2. Is medically stable at the time of recruitment and suitable for rehabilitation. 3. Is at least 6 weeks post‐stroke (there is no upper time limit). 4. Has mild to severe aphasia of any type, as determined by the Western Aphasia Battery–Revised AQ (WAB‐R, Kertesz, 2007) (Severe: 26‐50, Moderate: 51‐75, Mild: 76‐93.8). 5. Has normal or corrected hearing and vision. 6. Was proficient in English before the stroke, and used English in daily communication (no interpreter required for therapy). 7. May have mild speech difficulties, such as dysarthria or apraxia of speech, provided these are not the main cause of communication difficulty.