Modified ACT and CART in severe aphasia

Background: Anagram and Copy Treatment (ACT) and Copy and Recall Treatment (CART) have been shown to improve written communication for those with severe aphasia (Beeson, 1999 Beeson, P. M. 1999. Treating acquired writing impairment: Strengthening graphemic representations. Aphasiology, 13: 767–785. Taylor & Francis Online], Web of Science ®] , Google Scholar]; Beeson, Hirsch, & Rewega, 2002 Beeson, P. M., Hirsch, F. M. and Rewega, M. A. 2002. Successful single-word writing treatment: Experimental analysis of four cases. Aphasiology, 16: 473–491. Taylor & Francis Online], Web of Science ®] , Google Scholar]; Beeson, Rising, & Volk, 2003 Beeson, P. M., Rising, K. and Volk, J. 2003. Writing treatment for severe aphasia: Who benefits?. Journal of Speech, Language, and Hearing Research, 46: 1038–1060. Crossref], PubMed], Web of Science ®] , Google Scholar]). More recently, the addition of a spoken repetition component to the CART programme has been suggested to enhance oral naming in moderate aphasia (Beeson & Egnor, 2006 Beeson, P. M. and Egnor, H. 2006. Combining treatment for written and spoken naming. Journal of the International Neuropsychological Society, 12: 816–827. PubMed], Web of Science ®] , Google Scholar]; Wright, Marshall, Wilson, & Page, 2008 Wright, H. H., Marshall, R. C., Wilson, K. B. and Page, J. L. 2008. Using a written cueing hierarchy to improve verbal naming in aphasia. Aphasiology, 22: 522–536. Taylor & Francis Online], Web of Science ®] , Google Scholar]) and in cases with co-existing apraxia of speech (AOS) (de Riesthal, 2007 de Riesthal, M. Changes in written and spoken naming with a modified CART programme. Paper presented at the American Speech and Hearing Association. Boston, MA Google Scholar]). No studies have investigated the use of a modified ACT and CART with spoken repetition in individuals with severe aphasia and AOS.

Aims: The purpose of the study was to examine ACT and CART modified with spoken naming repetition, using visual and auditory stimuli in the ACT sessions and home practice videos in the CART sessions, for individuals with severe aphasia.

Methods & Procedures: Three individuals, RC, AC, and MJ, with severe aphasia and coexisting AOS post left middle cerebral artery strokes participated in a 3-month programme. Participants were enrolled in modified ACT and CART with spoken repetition of the target word. For the CART programme a video was created for each word in a treatment set to facilitate repetition in the home practice programme. Probes of spoken and written performance were obtained at the onset of each session, and during baseline, treatment, and follow-up maintenance

Outcomes & Results: All participants improved in their ability to write the treatment stimuli. A 5-point scoring system (Helm-Estabrooks & Albert, 2003 Helm-Estabrooks, N. and Albert, M. L. 2003. Manual of Aphasia and Aphasia Therapy, Austin, TX: Pro-.  Google Scholar]) was a more sensitive tool than the traditional binary scoring. None of the participants improved in the spoken naming condition with task stimuli. Mild improvement was noted in comparing pre- and post-test naming for MJ.

Conclusions: Our study supports evidence that ACT and CART may improve written naming skills in persons with severe aphasia. The inclusion of spoken repetition in the home practice CART programme may not be appropriate for cases with severe aphasia with AOS. However, further research using the technique with moderate aphasia with AOS may reveal that the technique of practice with auditory and visual stimuli is beneficial. The ease of using digital video tools with computer or augmentative devices has exciting and practical clinical application.