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Executive Function Influence on Language Outcomes for People with Aphasia

Poster B83 in Poster Session B, Tuesday, October 24, 3:30 - 5:15 pm CEST, Espace Vieux-Port

Amanda Wadams1, Jennifer Mozeiko1; 1University of Connecticut

Introduction. In addition to prominent language deficits, over half of people with aphasia (PWA) present with cognitive deficits (Fonseca et al., 2016), which may compound the effect the primary language impairment has on their functional communication. Executive function (EF), thought to be comprised of initiation, inhibition, planning, problem solving, and cognitive flexibility (Baddeley & Hitch, 1974; Suchy, 2015), is often affected in PWA (Fridrikkson et al., 2006). EF is thought to be a reliable predictor of long-term rehabilitation outcomes (Kaye et al., 1990), where research shows stronger pre-treatment EF skills lead to better engagement in therapy and overall language outcomes (Gilmore et al., 2019; Helm-Estabrooks, 2002). Current research has not yet identified which of the many facets of EF have the strongest influence on language outcomes. Additionally, there is scant literature on treatment that includes the training of cognition in addition to language, though it seems likely that this is crucial in increasing language outcomes in PWA with impaired cognition. The purpose of this study is to identify whether baseline EF skills influence treatment outcomes. Hypotheses are as follows: (1) Intact EF skills will lead to better language outcomes (2) Participants receiving metacognitive-language treatment will achieve greater gains in language outcomes than those receiving language treatment only. Methods. Eight participants with chronic aphasia (mean TPO= 59.25 months) and without other neurological deficits participated in a single subject multiple baseline treatment study comparing the effects of a language-based treatment (M-MAT; Rose & Attard, 2011) to homegrown M-MAT Meta, which integrates metacognitive strategies into M-MAT. Outcome measures included: (1) Western Aphasia Battery-Revised (WAB-R; language outcome), (2) Tower of London (TOL; measure of planning, problem solving, and inhibition), and Wisconsin Card Sorting Test (WCST; measure of cognitive flexibility and ability to maintain set). Following analysis, participants were placed into either a treatment responder (WAB-R AQ +  5 points; Gilmore et al., 2019) or non-responder group. Trends of baseline EF scores from the subtests of the TOL and WCST were compared between responders and non-responders. Results. Four of the eight participants demonstrated a significant increase in language outcomes (WAB-R > 5), and three of the four were those who received M-MAT Meta. Pre-treatment scores on the TOL revealed severe problem solving, planning, and inhibition impairments for three of the four participants (SS < 65); their performance on the WCST ranged from mild-severe (SS 55-85). Similar to the responders, the non-responders presented with severely impaired problem solving and planning skills (SS<65), as well as variable cognitive flexibility skills (SS 74-95). Inhibition was within normal limits for three out of the four non-responders. Conclusion. All eight participants presented with an initial EF impairment in at least one area assessed. Though EF profiles were similar between the two groups, participants receiving M-MAT Meta achieved and maintained language gains over and above those who received M-MAT. Given this, rather than focusing on how baseline EF skills influence language-focused treatment response, we should apply a treatment appropriate for the executive function and language impairments.

Topic Areas: Speech-Language Treatment, Disorders: Acquired

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