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Semin Speech Lang 2020; 41(01): 099-124
DOI: 10.1055/s-0039-3401030
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Can Script Training Improve Narrative and Conversation in Aphasia across Etiology?

H. Isabel Hubbard
1   Department of Communication Sciences and Disorders, University of Kentucky, Lexington, Kentucky
,
Lori A. Nelson
2   Department of Speech and Hearing Sciences, University of New Mexico, Albuquerque, New Mexico
,
Jessica D. Richardson
2   Department of Speech and Hearing Sciences, University of New Mexico, Albuquerque, New Mexico
› Author Affiliations
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Publication History

Publication Date:
23 December 2019 (online)

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Abstract

Script training is an effective treatment of stable (e.g., stroke-induced) and progressive aphasia of varying severities and subtypes. The theoretical underpinnings of script training are discussed and include fluency-inducing conditions, speech shadowing, principles of neuroplasticity, and automatization. Script training outcomes are reviewed, with a focus on discourse in persons with stable aphasia (PWSAs) and in persons with primary progressive aphasia (PWPPAs). PWSAs and PWPPAs are able to acquire and maintain short scripted monologues or conversational dialogues, with some evidence of generalization to untrained topics and settings. Advances in both technology and access have enriched script training protocols, so they now range from no-tech written script approaches to high-tech audiovisual support and avatars. Advances in audio and/or visual support promote large amounts of practice of less errorful whole-message language processing during a fluent language inducing condition. With enough practice, users decrease reliance on supports and independently produce scripted content. Script training can be delivered in a variety of settings (individual, group, telepractice), lends itself well to homework programs, and is in accordance with the principles of neuroplasticity for neurorehabilitation. Incorporating script training into therapy programming is advantageous throughout aphasia recovery following brain injuries such as stroke. It is also beneficial for persons with progressive disease for prophylaxis, remediation, and compensation. Recommendations for implementing script training in clinical practice and future research directions are presented.

Keywords

aphasia - discourse - primary progressive aphasia - script training - scripts

Disclosures

H.I.H. receives a salary from the University of Kentucky. She has no other financial or nonfinancial disclosures.


L.A.N. receives a salary from the University of New Mexico. She has no other financial or nonfinancial disclosures.


J.D.R. receives a salary from the University of New Mexico and grant support through an Institutional Development Award (IDeA) from the National Institute of General Medical Sciences of the National Institutes of Health under grant number P20GM109089. She also serves as co-chair of the Research Committee at the Triangle Aphasia Project. She has no other financial or nonfinancial disclosures.


 

  • References

  • 1 Simmons-Mackie N. Aphasia in North America. AphasiaAccess; 2018
    Google Scholar
  • 2 Matías-Guiu JA, García-Ramos R. Primary progressive aphasia: from syndrome to disease. Neurologia 2013; 28 (06) 366-374
    CrossrefPubMedGoogle Scholar
  • 3 Hilari K, Needle JJ, Harrison KL. What are the important factors in health-related quality of life for people with aphasia? A systematic review. Arch Phys Med Rehabil 2012; 93 (1, Suppl): S86-S95
    CrossrefPubMedGoogle Scholar
  • 4 Baker C, Worrall L, Rose M, Ryan B. ‘It was really dark’: the experiences and preferences of people with aphasia to manage mood changes and depression. Aphasiology 2019; 33 (12) 1-28
    CrossrefPubMedGoogle Scholar
  • 5 Bakas T, Kroenke K, Plue LD, Perkins SM, Williams LS. Outcomes among family caregivers of aphasic versus nonaphasic stroke survivors. Rehabil Nurs 2006; 31 (01) 33-42
    CrossrefPubMedGoogle Scholar
  • 6 Haley KL, Jacks A, Morrison B, Richardson JD. Balance and preference in activity participation for informal caregivers of people with aphasia: a questionnaire study. Aphasiology 2019; 33: 1-9
    CrossrefPubMedGoogle Scholar
  • 7 Nickels L, Croot K. Understanding and living with primary progressive aphasia: current progress and challenges for the future. Aphasiology 2014; 28 (8–9): 885-899
    CrossrefPubMedGoogle Scholar
  • 8 Simmons-Mackie N, Worrall L, Murray LL. , et al. The top ten: best practice recommendations for aphasia. Aphasiology 2017; 31 (02) 131-151
    CrossrefPubMedGoogle Scholar
  • 9 Shrubsole K, Worrall L, Power E, O'Connor DA. Recommendations for post-stroke aphasia rehabilitation: an updated systematic review and evaluation of clinical practice guidelines. Aphasiology 2017; 31 (01) 1-24
    CrossrefPubMedGoogle Scholar
  • 10 Volkmer A, Rogalski E, Henry M. , et al. Speech and language therapy approaches to managing primary progressive aphasia. Pract Neurol 2019; 0: 1-9
    PubMedGoogle Scholar
  • 11 Cherney LR, Halper AS. Novel technology for treating individuals with aphasia and concomitant cognitive deficits. Top Stroke Rehabil 2008; 15 (06) 542-554
    CrossrefPubMedGoogle Scholar
  • 12 Cherney LR, Kaye RC, van Vuuren S. Acquisition and maintenance of scripts in aphasia: a comparison of two cuing conditions. Am J Speech Lang Pathol 2014; 23 (02) S343-S360
    PubMedGoogle Scholar
  • 13 Fillingham JK, Hodgson C, Sage K, Lambon Ralph MA. The application of errorless learning to aphasic disorders: a review of theory and practice. Neuropsychol Rehabil 2003; 13 (03) 337-363
    CrossrefPubMedGoogle Scholar
  • 14 Kaye RC, Cherney LR. Script templates: a practical approach to script training in aphasia. Top Lang Disord 2016; 36 (02) 136-153
    CrossrefPubMedGoogle Scholar
  • 15 Cherney LR, Halper AS, Holland AL, Cole R. Computerized script training for aphasia: preliminary results. Am J Speech Lang Pathol 2008; 17 (01) 19-34
    CrossrefPubMedGoogle Scholar
  • 16 Fridriksson J, Hubbard HI, Hudspeth SG. , et al. Speech entrainment enables patients with Broca's aphasia to produce fluent speech. Brain 2012; 135 (Pt 12): 3815-3829
    CrossrefPubMedGoogle Scholar
  • 17 Henry ML, Hubbard HI, Grasso SM. , et al. Retraining speech production and fluency in non-fluent/agrammatic primary progressive aphasia. Brain 2018; 141 (06) 1799-1814
    CrossrefPubMedGoogle Scholar
  • 18 Stahl B, Kotz SA, Henseler I, Turner R, Geyer S. Rhythm in disguise: why singing may not hold the key to recovery from aphasia. Brain 2011; 134 (Pt 10): 3083-3093
    CrossrefPubMedGoogle Scholar
  • 19 Poeppel D, Emmorey K, Hickok G, Pylkkänen L. Towards a new neurobiology of language. J Neurosci 2012; 32 (41) 14125-14131
    CrossrefPubMedGoogle Scholar
  • 20 Bonilha L, Hillis AE, Wilmskoetter J. , et al. Neural structures supporting spontaneous and assisted (entrained) speech fluency. Brain 2019; awz309
    PubMedGoogle Scholar
  • 21 Bose A. Phonological therapy in jargon aphasia: effects on naming and neologisms. Int J Lang Commun Disord 2013; 48 (05) 582-595
    CrossrefPubMedGoogle Scholar
  • 22 Max L, Caruso AJ, Vandevenne A. Decreased stuttering frequency during repeated readings: a motor learning perspective. J Fluency Disord 1997; 22 (01) 17-33
    CrossrefPubMedGoogle Scholar
  • 23 Cherry C, Sayers BM. Experiments upon the total inhibition of stammering by external control, and some clinical results. J Psychosom Res 1956; 1 (04) 233-246
    CrossrefPubMedGoogle Scholar
  • 24 Shattuck SR, Lackner JR. Speech production: contribution of syntactic structure. Percept Mot Skills 1975; 40 (03) 931-936
    CrossrefPubMedGoogle Scholar
  • 25 Marslen-Wilson W. Linguistic structure and speech shadowing at very short latencies. Nature 1973; 244 (5417): 522-523
    CrossrefPubMedGoogle Scholar
  • 26 Marslen-Wilson WD. Sentence perception as an interactive parallel process. Science 1975; 189 (4198): 226-228
    CrossrefPubMedGoogle Scholar
  • 27 Kleim JA, Jones TA. Principles of experience-dependent neural plasticity: implications for rehabilitation after brain damage. J Speech Lang Hear Res 2008; 51 (01) S225-S239
    PubMedGoogle Scholar
  • 28 Brookshire RH. Introduction to Neurogenic Communication Disorders. 5th ed. St. Louis, MO: Mosby Year-Book Inc.; 1997
    Google Scholar
  • 29 Worrall L, Sherratt S, Rogers P. , et al. What people with aphasia want: their goals according to the ICF. Aphasiology 2011; 25 (03) 309-322
    CrossrefPubMedGoogle Scholar
  • 30 Meinzer M, Flaisch T, Breitenstein C, Wienbruch C, Elbert T, Rockstroh B. Functional re-recruitment of dysfunctional brain areas predicts language recovery in chronic aphasia. Neuroimage 2008; 39 (04) 2038-2046
    CrossrefPubMedGoogle Scholar
  • 31 Fridriksson J, Bonilha L, Baker JM, Moser D, Rorden C. Activity in preserved left hemisphere regions predicts anomia severity in aphasia. Cereb Cortex 2010; 20 (05) 1013-1019
    CrossrefPubMedGoogle Scholar
  • 32 Fridriksson J, Richardson JD, Fillmore P, Cai B. Left hemisphere plasticity and aphasia recovery. Neuroimage 2012; 60 (02) 854-863
    CrossrefPubMedGoogle Scholar
  • 33 Watkins KE, Strafella AP, Paus T. Seeing and hearing speech excites the motor system involved in speech production. Neuropsychologia 2003; 41 (08) 989-994
    CrossrefPubMedGoogle Scholar
  • 34 Fridriksson J, Moss J, Davis B, Baylis GC, Bonilha L, Rorden C. Motor speech perception modulates the cortical language areas. Neuroimage 2008; 41 (02) 605-613
    CrossrefPubMedGoogle Scholar
  • 35 Jarick M, Jones JA. Effects of seeing and hearing speech on speech production: a response time study. Exp Brain Res 2009; 195 (02) 175-182
    CrossrefPubMedGoogle Scholar
  • 36 Fridriksson J, Baker JM, Whiteside J. , et al. Treating visual speech perception to improve speech production in nonfluent aphasia. Stroke 2009; 40 (03) 853-858
    CrossrefPubMedGoogle Scholar
  • 37 Brzosko Z, Mierau SB, Paulsen O. Neuromodulation of spike-timing-dependent plasticity: past, present, and future. Neuron 2019; 103 (04) 563-581
    CrossrefPubMedGoogle Scholar
  • 38 Wallace SJ, Worrall L, Rose T. , et al. Which outcomes are most important to people with aphasia and their families? an international nominal group technique study framed within the ICF. Disabil Rehabil 2017; 39 (14) 1364-1379
    CrossrefPubMedGoogle Scholar
  • 39 Holland AL, Halper AS, Cherney LR. Tell me your story: analysis of script topics selected by persons with aphasia. Am J Speech Lang Pathol 2010; 19 (03) 198-203
    CrossrefPubMedGoogle Scholar
  • 40 Cherney LR, Kaye RC, Lee JB, van Vuuren S. Impact of personal relevance on acquisition and generalization of script training for aphasia: a preliminary analysis. Am J Speech Lang Pathol 2015; 24 (04) S913-S922
    PubMedGoogle Scholar
  • 41 Lee JB, Kaye RC, Cherney LR. Conversational script performance in adults with non-fluent aphasia: treatment intensity and aphasia severity. Aphasiology 2009; 23 (7–8): 885-897
    CrossrefPubMedGoogle Scholar
  • 42 Logan GD. Toward an instance theory of automatization. Psychol Rev 1988; 95 (04) 492-527
    CrossrefPubMedGoogle Scholar
  • 43 Bebko J. Learning, language, memory, and reading: the role of language automatization and its impact on complex cognitive activities. J Deaf Stud Deaf Educ 1998; 3 (01) 4-14
    CrossrefPubMedGoogle Scholar
  • 44 Gatbonton E, Segalowitz N. Creative automatization: principles for promoting fluency within a communicative framework. TESOL Q 1988; t 22 (03) 473-492
    CrossrefPubMedGoogle Scholar
  • 45 Jiang N. Morphological insensitivity in second language processing. Appl Psycholinguist 2004; 25 (04) 603-634
    CrossrefPubMedGoogle Scholar
  • 46 Dekeyser R, Criado R. Automatization, Skill Acquisition, and Practice in Second Language Acquisition. The Encyclopedia of Applied Linguistics. 1st ed. Oxford, UK: Blackwell Publishing Ltd; 2013
    Google Scholar
  • 47 Youmans G, Holland A, Muñoz M, Bourgeois M. Script training and automaticity in two individuals with aphasia. Aphasiology 2005; 19 (3–5): 435-450
    CrossrefPubMedGoogle Scholar
  • 48 Mirmiran M, van Someren EJ, Swaab DF. Is brain plasticity preserved during aging and in Alzheimer's disease?. Behav Brain Res 1996; 78 (01) 43-48
    CrossrefPubMedGoogle Scholar
  • 49 Hill NL, Kolanowski AM, Gill DJ. Plasticity in early Alzheimer's disease: an opportunity for intervention. Top Geriatr Rehabil 2011; 27 (04) 257-267
    CrossrefPubMedGoogle Scholar
  • 50 Hardy CJD, Marshall CR, Bond RL. , et al. Retained capacity for perceptual learning of degraded speech in primary progressive aphasia and Alzheimer's disease. Alzheimers Res Ther 2018; 10 (01) 70
    CrossrefPubMedGoogle Scholar
  • 51 Tippett DC, Hillis AE, Tsapkini K. Treatment of primary progressive aphasia. Curr Treat Options Neurol 2015; 17 (08) 362
    PubMedGoogle Scholar
  • 52 Cadório I, Lousada M, Martins P, Figueiredo D. Generalization and maintenance of treatment gains in primary progressive aphasia (PPA): a systematic review. Int J Lang Commun Disord 2017; 52 (05) 543-560
    CrossrefPubMedGoogle Scholar
  • 53 Jokel R. Generalization (but not maintenance) of treatment gains from semantic therapy may differ by primary progressive aphasia variant. Evid Based Commun Assess Interv 2019; 15: 1-4
    PubMedGoogle Scholar
  • 54 Henry ML, Hubbard HI, Grasso SM. , et al. Treatment for word retrieval in semantic and logopenic variants of primary progressive aphasia: immediate and long-term outcomes. J Speech Lang Hear Res 2019; 62 (08) 2723-2749
    CrossrefPubMedGoogle Scholar
  • 55 Dial HR, Hinshelwood HA, Grasso SM, Hubbard HI, Gorno-Tempini ML, Henry ML. Investigating the utility of teletherapy in individuals with primary progressive aphasia. Clin Interv Aging 2019; 14: 453-471
    CrossrefPubMedGoogle Scholar
  • 56 Sebastian R, Tsapkini K, Tippett DC. Transcranial direct current stimulation in post stroke aphasia and primary progressive aphasia: current knowledge and future clinical applications. NeuroRehabilitation 2016; 39 (01) 141-152
    CrossrefPubMedGoogle Scholar
  • 57 Youmans G, Youmans SR, Hancock AB. Script training treatment for adults with apraxia of speech. Am J Speech Lang Pathol 2011; 20 (01) 23-37
    CrossrefPubMedGoogle Scholar
  • 58 Munoz M, Karow C. A comparison of treatment outcomes following whole-task and part-task methods for training scripts. Poster presentation at: Clinical Aphasiology Conference; May 2007; Scottsdale, AZ
    PubMedGoogle Scholar
  • 59 Nobis-Bosch R, Springer L, Radermacher I, Huber W. Supervised home training of dialogue skills in chronic aphasia: a randomized parallel group study. J Speech Lang Hear Res 2011; 54 (04) 1118-1136
    CrossrefPubMedGoogle Scholar
  • 60 Goldberg S, Haley KL, Jacks A. Script training and generalization for people with aphasia. Am J Speech Lang Pathol 2012; 21 (03) 222-238
    CrossrefPubMedGoogle Scholar
  • 61 Rhodes NC, Isaki E. Script training using telepractice with two adults with chronic non-fluent aphasia. Int J Telerehabil 2018; 10 (02) 89-104
    PubMedGoogle Scholar
  • 62 Moss L. Functional discourse and quality of life changes following conversational training in a group setting. Presentation at: Clinical Aphasiology Conference; May, 2009; Keystone, CO
    PubMedGoogle Scholar
  • 63 Manheim LM, Halper AS, Cherney L. Patient-reported changes in communication after computer-based script training for aphasia. Arch Phys Med Rehabil 2009; 90 (04) 623-627
    CrossrefPubMedGoogle Scholar
  • 64 Van Vuuren S, Cherney LR. A virtual therapist for speech and language therapy. Presentation at: International Conference on Intelligent Virtual Agents: August 2014; Boston, MA
    PubMedGoogle Scholar
  • 65 Bilda K. Video-based conversational script training for aphasia: a therapy study. Aphasiology 2011; 25 (02) 191-201
    CrossrefPubMedGoogle Scholar
  • 66 Hinckley JJ, Carr TH. Differential contributions of cognitive abilities to success in skill-based versus context-based aphasia treatment. Brain Lang 2001; 79: 3-9
    CrossrefPubMedGoogle Scholar
  • 67 Hinckley J, Carr T. Comparing the outcomes of intensive and non-intensive context-based aphasia treatment. Aphasiology 2005; 19 (10–11): 965-974
    CrossrefPubMedGoogle Scholar
  • 68 Fein M, Bayley C, Rising K, Beeson PM. A structured approach to train text messaging in an individual with aphasia. Aphasiology 2019; 11: 1-7
    PubMedGoogle Scholar
  • 69 Dignam J, Copland D, McKinnon E. , et al. Intensive versus distributed aphasia therapy: a nonrandomized, parallel-group, dosage-controlled study. Stroke 2015; 46 (08) 2206-2211
    CrossrefPubMedGoogle Scholar
  • 70 Steele RD, Baird A, McCall D, Haynes L. Combining teletherapy and on-line language exercises in the treatment of chronic aphasia: an outcome study. Int J Telerehabil 2015; 6 (02) 3-20
    PubMedGoogle Scholar
  • 71 Holland AL, Weinberg P, Dittelman J. How to use apps clinically in the treatment of aphasia. Semin Speech Lang 2012; 33 (03) 223-233
    Article in Thieme ConnectPubMedGoogle Scholar
  • 72 Szabo G, Dittelman J. Using mobile technology with individuals with aphasia: native iPad features and everyday apps. Semin Speech Lang 2014; 35 (01) 5-16
    Article in Thieme ConnectPubMedGoogle Scholar
  • 73 Linebarger MC, Romania JF, Fink RB, Bartlett MR, Schwartz MF. Building on residual speech: a portable processing prosthesis for aphasia. J Rehabil Res Dev 2008; 45 (09) 1401-1414
    CrossrefPubMedGoogle Scholar
  • 74 True G, Bartlett MR, Fink RB, Linebarger MC, Schwartz M. Perspectives of persons with aphasia towards SentenceShaper To Go: a qualitative study. Aphasiology 2010; 24 (09) 1032-1050
    CrossrefPubMedGoogle Scholar
  • 75 Simmons-Mackie N. Thinking beyond language: intervention for severe aphasia. Perspect Neurophysiol Neurogenic Speech Lang Disord 2009; 19 (01) 15-22
    CrossrefPubMedGoogle Scholar
  • 76 Grasso SM, Cruz DF, Benavidez R, Peña ED, Henry ML. Video-implemented script training in a bilingual Spanish-English speaker with aphasia. J Speech Lang Hear Res 2019; 62 (07) 2295-2316
    CrossrefPubMedGoogle Scholar
  • 77 Richardson JD, Dalton SG, Hubbard HI, Shultz C, Hanson J, Adams J. Feasibility of group script training in two variants of primary progressive aphasia. Roundtable presentation at: Clinical Aphasiology Conference; May 2019; Whitefish, MT
    PubMedGoogle Scholar
  • 78 Rogalski EJ, Saxon M, McKenna H. , et al. Communication bridge: a pilot feasibility study of Internet-based speech-language therapy for individuals with progressive aphasia. Alzheimers Dement (N Y) 2016; 2 (04) 213-221
    PubMedGoogle Scholar
  • 79 Rogalski EJ, Khayum B. A life participation approach to primary progressive aphasia intervention. Semin Speech Lang 2018; 39 (03) 284-296
    Article in Thieme ConnectPubMedGoogle Scholar
  • 80 Duffy JR, Strand EA, Josephs KA. Motor speech disorders associated with primary progressive aphasia. Aphasiology 2014; 28 (8-9): 1004-1017
    CrossrefPubMedGoogle Scholar
  • 81 Marslen-Wilson WD, Tyler LK. Central processes in speech understanding. Philos Trans R Soc Lond B Biol Sci 1981; 295 (1077): 317-332
    CrossrefPubMedGoogle Scholar
  • 82 Rosenbek JC, Lemme ML, Ahern MB, Harris EH, Wertz RT. A treatment for apraxia of speech in adults. J Speech Hear Disord 1973; 38 (04) 462-472
    CrossrefPubMedGoogle Scholar
  • 83 Jordan TR, Thomas SM. When half a face is as good as a whole: effects of simple substantial occlusion on visual and audiovisual speech perception. Atten Percept Psychophys 2011; 73 (07) 2270-2285
    CrossrefPubMedGoogle Scholar
  • 84 Maas E, Robin DA, Austermann Hula SN. , et al. Principles of motor learning in treatment of motor speech disorders. Am J Speech Lang Pathol 2008; 17 (03) 277-298
    CrossrefPubMedGoogle Scholar
  • 85 Haley KL, Cunningham KT, Barry J, de Riesthal M. Collaborative goals for communicative life participation in aphasia: the FOURC model. Am J Speech Lang Pathol 2019; 28 (01) 1-13
    CrossrefPubMedGoogle Scholar
  • 86 Ali N, Rafi MS, Ghayas Khan MS, Mahfooz U. The effectiveness of script training to restore lost communication in a patient with Broca's aphasia. J Pak Med Assoc 2018; 68 (07) 1070-1075
    PubMedGoogle Scholar
  • 87 Milman L, Vega-Mendoza M, Clendenen D. Integrated training for aphasia: an application of part-whole learning to treat lexical retrieval, sentence production, and discourse-level communications in three cases of nonfluent aphasia. Am J Speech Lang Pathol 2014; 23 (02) 105-119
    CrossrefPubMedGoogle Scholar
  • 88 Youmans SR, Youmans GL, Hancock AB. The social validity of script training related to the treatment of apraxia of speech. Aphasiology 2011; 25 (09) 1078-1089
    CrossrefPubMedGoogle Scholar