Efficacy of Group Language Games as Therapy for Post-Stroke Aphasia

Background and aims: Aphasia rehabilitation can be effective if delivered intensively (Bhogal et al., 2003; Robey, 1998), but this may be difficult for public health systems. There is some evidence that structuring therapy as a group game offers an alternative to individual therapy, but this is very limited (see Meinzer et al., 2012). In our study, we designed and evaluated a new rehabilitation game for word-retrieval difficulties in aphasia.
Method: Our experimental game was based on the social game of charades. Patients were divided into teams. Members of one team guessed target words presented by a teammate. Points were awarded based on whether the participant describing the target spoke the word unaided (correctly or with errors) or whether cueing was necessary. We contrasted three games that differed for type of cueing allowed: only phonemic, phonemic+gesture or phonemic+semantic. Six participants with moderate-severe expressive aphasia took part. Each game treated 60 words (30 nouns and 30 verbs) and was played for 18 hours over 2 weeks. Language assessment took place before therapy (with multiple baselines) and after therapy (immediately afterwards and after 4-8 weeks). Gains were measured using The Comprehensive Aphasia Test, the Boston Naming Test, the Cinderella Story Retell, picture-naming of the targets, and picture description of 9 pictured scenarios designed to elicit the words targeted in therapy.
Results: Results are shown in Figure 1. Data were analysed using log-linear analysis. There was a significant effect of therapy for treated lists, with all patients showing improvements (See panel A; G2 = 407, p<.001). There was a significant interaction between treatment order and word lists (see panel B; G2 = 191; p<.001). Treated words improved after therapy (χ2= 355; p<.001) but untreated words did not, showing no generalisation. Improvements were similar for nouns and verbs (panel C; G2=1.62 p=.45) and for type of cuing (panel D; G2 = -0.88 p=0.93). Therapy gains decreased only slightly during maintenance, although this was significant (Figure 1D; G2 = -4.68, p=.03). Individually, participants showed significant therapy-related improvements in picture-naming, except one, for whom gains bordered on significance.
Language functions besides naming did not change with therapy. There was, however, some generalisation beyond the naming task practiced in therapy. After therapy, target words were produced more often in the description of pictured scenarios (14% vs 29%; G2=73.8, p<.001). Moreover, scores for the Boston Naming Test increased from 12 to 17 (G2=4.77, p=.03) and the percentage of correct information units in the Cinderella Story increased from 28% to 48% (one-tailed test, t= 2.45, p=0.05, d= 1.20). Patients reported enjoying the treatment.
Discussion: Participants showed significant gains in naming words with some generalisation across tasks (description of scenarios) and to untreated items (naming gains in the Boston Naming Test and in retelling Cinderella). Gains were similar to those reported by other studies with individual therapy (Best et al., 2013; Marshall et al., 2012).
Clinical Implications: Group game therapy is a promising way to deliver therapy in a public healthcare setting, intensively, cost effectively, and with strong patient acceptability.