Multimodal Communication Training in Aphasia: A Pilot Study

Management of patients with aphasia often focuses on training nonverbal augmentative communication strategies; however, these strategies frequently do not generalize to natural situations. The limited success may be because training was not sufficient to produce an integrated multimodal semantic representation. The purpose of this study was to examine whether simultaneous training of stimuli in both verbal and nonverbal modalities would solidify the links within the semantic network and improve switching among modalities as needed in conversation. Two individuals with severe aphasia participated in 6 to 8 hours of Multimodal Communication Training (MCT), during which they conveyed a concept by verbalizing, gesturing, writing, and drawing. After practice with all modalities for a single concept, a new concept was introduced. Results showed that one participant increased conveyance of concepts on the functional communication task using a variety of modalities. Although some improvement was seen with the second participant, his overall performance remained poor, likely because of a greater impairment in semantic knowledge. After a brief period of semantic training, the second participant demonstrated additional gains. Thus, MCT may serve to increase switching among verbal and nonverbal modalities in individuals with intact semantic representations, thereby increasing the likelihood that individuals will use an alternative method to communicate.