Semin Speech Lang 2020; 41(01): 061-070
DOI: 10.1055/s-0039-3399500
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Conversational Therapy in Aphasia: From Behavioral Intervention to Neuromodulation

Paola Marangolo
1   Department of Humanities Studies, University Federico II, Naples, Italy
2   Aphasia Research Lab, IRCCS Santa Lucia Foundation, Rome, Italy
,
Francesca Pisano
1   Department of Humanities Studies, University Federico II, Naples, Italy
› Author Affiliations
Further Information

Publication History

Publication Date:
23 December 2019 (online)

Abstract

This article describes the conversational therapy approach for the treatment of persons with aphasia (PWAs). Around 1970s, this approach was inspired by a series of pragmatic principles and techniques to aphasia rehabilitation whose main objective was to set up a condition of communicative exchange with the PWA using his/her own available communicative resources. Indeed, although language represents the most powerful behavior that humans use for communicating, within the conversational approach any intentional action (i.e., gestures, body movements, facial expression, drawing) can be used to communicate. For this reason, its application is particularly suitable for severe PWAs whose damage has compromised all the modalities of language (i.e., production, comprehension, reading, and writing). In this perspective, the speech-language pathologist's (SLP's) goal is not necessarily focused on restoring the damaged linguistic functions, still today pursued by the cognitive approach, but to ameliorate the use of language by teaching the PWA compensatory, productive strategies, and strengthening his/her residual communicative abilities. In this review, the fundamental principles of the conversational approach together with its modalities of treatment, which emphasize the importance of an active interaction between the SLP and the PWA, are reported. A brief summary of recent experimental evidence which combines conversational therapy with a noninvasive brain stimulation technique, transcranial direct current stimulation, is also included.

Financial Disclosure

None.


 
  • References

  • 1 Schuell H, Jenkins JJ, Jimenez-Pabon E. Aphasia in Adults. New York: Harper Row; 1964
  • 2 Basso A. Aphasia Therapy. The Oxford Press; 2005
  • 3 Brady MC, Kelly H, Godwin J, Enderby P, Campbell P. Speech and language therapy for aphasia following stroke. Cochrane Database Syst Rev 2016; (06) CD000425
  • 4 Caramazza A, Berndt RS. Semantic and syntactic processes in aphasia: a review of the literature. Psychol Bull 1978; 85 (04) 898-918
  • 5 Martin RC. Language processing: functional organization and neuroanatomical basis. Annu Rev Psychol 2003; 54: 55-89
  • 6 Soroker N, Kasher A, Giora R. , et al. Processing of basic speech acts following localized brain damage: a new light on the neuroanatomy of language. Brain Cogn 2005; 57 (02) 214-217
  • 7 Coltheart M. The assumptions of cognitive neuropsychology: reflections on Caramazza (1984, 1986). Cogn Neuropsychol 2017; 34 (7-8): 397-402
  • 8 Shallice T. From Neuropsychology to Mental Structure. New York, NY: Cambridge University Press; 1988
  • 9 Caramazza A, Coltheart M. Cognitive neuropsychology twenty years on. Cogn Neuropsychol 2006; 23 (01) 3-12
  • 10 Guilford AM, O'Connor JK. Pragmatic functions in aphasia. J Commun Disord 1982; 15 (05) 337-346
  • 11 David G, Wilcox M. Adult Aphasia Rehabilitation: Applied Pragmatics. Windsor, UK: NFER-Nelson; 1985
  • 12 Prutting CA, Kirchner DM. A clinical appraisal of the pragmatic aspects of language. J Speech Hear Disord 1987; 52 (02) 105-119
  • 13 Davis GA. Cognitive pragmatics of language disorders in adults. Semin Speech Lang 2007; 28 (02) 111-121
  • 14 Holland AL. Pragmatic aspects of intervention in aphasia. J Neurolinguist 1991; 6: 197-211
  • 15 Sarno MT. Recovery and Rehabilitation in Aphasia. In: Acquired Aphasia, 2nd ed. San Diego, CA: Academic Press; 1991: 521-582
  • 16 Ulatowska HK, Freedman-Stern R, Doyel AW, Macaluso-Haynes S, North AJ. Production of narrative discourse in aphasia. Brain Lang 1983; 19 (02) 317-334
  • 17 Wilkinson R, Wielaert S. Rehabilitation targeted at everyday communication: can we change the talk of people with aphasia and their significant others within conversation?. Arch Phys Med Rehabil 2012; 93 (1, Suppl): S70-S76
  • 18 Perkins L. Applying conversation analysis to aphasia: clinical implications and analytic issues. Eur J Disord Commun 1995; 30 (03) 372-383
  • 19 Damico J, Tetnowski J, Lynch K. , et al. Facilitating authentic conversation: an intervention employing principles of constructivism and conversation analysis. Aphasiology 2015; 29: 400-421
  • 20 Beeke S, Maxim J, Wilkinson R. Using conversation analysis to assess and treat people with aphasia. Semin Speech Lang 2007; 28 (02) 136-147
  • 21 Herrmann M, Koch U, Johannsen-Horbach H, Wallesch CW. Communicative skills in chronic and severe nonfluent aphasia. Brain Lang 1989; 37 (02) 339-352
  • 22 Rousseaux M, Daveluy W, Kozlowski O. Communication in conversation in stroke patients. J Neurol 2010; 257 (07) 1099-1107
  • 23 Simmons-Mackie N, Savage MC, Worrall L. Conversation therapy for aphasia: a qualitative review of the literature. Int J Lang Commun Disord 2014; 49 (05) 511-526
  • 24 Wilkinson R. Intervening with conversation analysis in speech and language therapy: improving aphasic conversation. Res Lang Soc Interact 2014; 47: 219-238
  • 25 Walker T, Thomson J, Watt I. Displays and claims of understanding in conversation by people with aphasia. Aphasiology 2016; 30: 750-764
  • 26 Savage MC, Donovan NJ. Comparing linguistic complexity and efficiency in conversations from stimulation and conversation therapy in aphasia. Int J Lang Commun Disord 2017; 52 (01) 21-29
  • 27 Marangolo P, Fiori V, Caltagirone C, Marini A. How conversational therapy influences language recovery in chronic non-fluent aphasia. Neuropsychol Rehabil 2013; 23 (05) 715-731
  • 28 Basso A. Natural conversation: a treatment for severe aphasia. Aphasiology 2010; 24: 466-479
  • 29 Grice P. Logic and conversation. In: Cole P, Morgan J. , eds. Syntax and Semantics: Speech Arts. Vol 3. New York: Academic Press; 1975: 41-58
  • 30 Vigorelli P. L’approccio conversazionale nella cura del malato di Alzheimer: i principi generali. Milano, Italy: J Medical Books Edizioni; 2007
  • 31 Marangolo P. The potential effects of transcranial direct current stimulation (tDCS) on language functioning: combining neuromodulation and behavioral intervention in aphasia. Neurosci Lett 2017; 133329
  • 32 Monte-Silva K, Kuo MF, Hessenthaler S. , et al. Induction of late LTP-like plasticity in the human motor cortex by repeated non-invasive brain stimulation. Brain Stimul 2013; 6 (03) 424-432
  • 33 Nitsche MA, Paulus W. Transcranial direct current stimulation--update 2011. Restor Neurol Neurosci 2011; 29 (06) 463-492
  • 34 Marangolo P, Caltagirone C. Options to enhance recovery from aphasia by means of non-invasive brain stimulation and action observation therapy. Expert Rev Neurother 2014; 14 (01) 75-91
  • 35 Baker JM, Rorden C, Fridriksson J. Using transcranial direct-current stimulation to treat stroke patients with aphasia. Stroke 2010; 41 (06) 1229-1236
  • 36 Fridriksson J, Richardson JD, Baker JM, Rorden C. Transcranial direct current stimulation improves naming reaction time in fluent aphasia: a double-blind, sham-controlled study. Stroke 2011; 42 (03) 819-821
  • 37 Marangolo P, Fiori V, Di Paola M. , et al. Differential involvement of the left frontal and temporal regions in verb naming: a tDCS treatment study. Restor Neurol Neurosci 2013; b 31 (01) 63-72
  • 38 Fiori V, Cipollari S, Di Paola M, Razzano C, Caltagirone C, Marangolo P. tDCS stimulation segregates words in the brain: evidence from aphasia. Front Hum Neurosci 2013; 7: 269
  • 39 Fiori V, Coccia M, Marinelli CV. , et al. Transcranial direct current stimulation improves word retrieval in healthy and nonfluent aphasic subjects. J Cogn Neurosci 2011; 23 (09) 2309-2323
  • 40 Monti A, Cogiamanian F, Marceglia S. , et al. Improved naming after transcranial direct current stimulation in aphasia. J Neurol Neurosurg Psychiatry 2008; 79 (04) 451-453
  • 41 Volpato C, Cavinato M, Piccione F, Garzon M, Meneghello F, Birbaumer N. Transcranial direct current stimulation (tDCS) of Broca's area in chronic aphasia: a controlled outcome study. Behav Brain Res 2013; 247: 211-216
  • 42 Marangolo P, Fiori V, Calpagnano MA. , et al. tDCS over the left inferior frontal cortex improves speech production in aphasia. Front Hum Neurosci 2013; c 7: 539
  • 43 Marangolo P, Fiori V, Gelfo F. , et al. Bihemispheric tDCS enhances language recovery but does not alter BDNF levels in chronic aphasic patients. Restor Neurol Neurosci 2014; a 32 (02) 367-379
  • 44 Marangolo P, Fiori V, Campana S. , et al. Something to talk about: enhancement of linguistic cohesion through tDCS in chronic non fluent aphasia. Neuropsychologia 2014; b 53: 246-256
  • 45 Burns MS, Fahy J. Broca's area: rethinking classical concepts from a neuroscience perspective. Top Stroke Rehabil 2010; 17 (06) 401-410
  • 46 Hagoort P. On Broca, brain, and binding: a new framework. Trends Cogn Sci 2005; 9 (09) 416-423
  • 47 Koechlin E, Jubault T. Broca's area and the hierarchical organization of human behavior. Neuron 2006; 50 (06) 963-974