Training verb and sentence production in agrammatic Broca's aphasia

Background: Many aphasic speakers have problems producing verbs at both the word and the sentence level. A treatment programme called ACTION (Bastiaanse, Bunge, Perk, 2004; Bastiaanse, Jonkers, Quak, Varela Put, 1997) has been developed to train verb production of both fluent and non-fluent aphasic speakers. It consists of four levels: single verbs, filling in infinitives, filling in finite verbs, and sentence construction. For the present study the efficacy of the programme for agrammatic speakers with Broca's aphasia was tested. Aims: The aim of the study was to measure the effects of treatment with ACTION on non-trained infinitives and finite verbs, and to analyse the generalisation effects on spontaneous speech and verbal communication in daily life. Methods Procedure: ACTION was used to train 11 agrammatic patients with Broca's aphasia, following the multiple baseline across behaviours design. The patients were tested weekly on untreated items. Two follow-up assessments were done, 1 and 3 months post-treatment. Generalisation to related and unrelated materials was measured with subtasks of the Aachen Aphasia Test (AAT). Spontaneous speech was analysed, and verbal communication was measured before and after treatment and 3 months post-treatment by the Amsterdam-Nijmegen Everyday Language Test (ANELT). Outcomes Results: There was improvement on the untrained infinitives and finite verbs. The improvement on infinitives was relatively minor; finite verbs, which were more impaired than the infinitives prior to treatment, improved up to the level of the infinitives. The improvement generalised to the related tasks of the AAT, but not to the unrelated task; verbal communication improved significantly. This improvement was reflected in relevant variables of spontaneous speech (mean length of utterances, proportion of finite verbs and verb diversity), but not in an unrelated variable (diversity of nouns). Conclusions: Treatment with ACTION resulted in better production of finite verbs. The effects generalised to spontaneous speech. Most importantly, it was shown that communication in daily life improved.