Date of Completion

5-10-2020

Embargo Period

3-27-2022

Advisors

Jennifer Mozeiko, Carl Coelho, Emily Myers

Field of Study

Speech, Language, and Hearing Sciences

Degree

Master of Arts

Open Access

Open Access

Abstract

Background: Roughly one million people in the United States are living with aphasia, and Wernicke’s aphasia is the most common fluent type. Few treatment options have been thoroughly research for Wernicke’s aphasia; a major obstacle with these patients is lack of awareness of errors. For persons with aphasia in general, it has been found that more intensive treatments are more effective, as long as the treatment is not overly fatiguing and does not lead to drop-out. One intensive treatment is Schuell’s stimulation approach, which focuses on bombardment of the auditory modality in order to effect improvement across all modalities.

Aims: The primary aims of this study were twofold: to investigate the feasibility of intensive Schuell’s stimulation for a participant with chronic Wernicke’s aphasia, and to explore whether such an intensive treatment is reasonable or would lead to fatigue and drop-out. A secondary aim was to compare the results of the current study to a similar study done in 2017, using the same treatment with a participant with nonfluent aphasia.

Methods and Procedures: The participant was M, a 77-year-old female living with chronic severe Wernicke’s aphasia as the result of a stroke. M participated in a 10-day, 30-hour Schuell’s stimulation regimen involving intensive bombardment of auditory comprehension and production using picture cards and verbal commands. Before, immediately after, and five- and ten-weeks post-treatment, M was given as assessment battery including the WAB-R-AQ, the CLQT, the CETI, and others. Before, during, and at all times post-treatment, M was probed for confrontation naming, auditory comprehension, and discourse production. Her performance was assessed on trained tasks and for generalization to untrained tasks and discourse.

Outcomes and Results: M improved on trained probe items but showed no generalization to untrained probes or discourse. She improved on some standardized measures, including the WAB-R-AQ, and declined on others, including the CLQT. Her performance on language measures improved more than her performance on cognitive measures. The administering clinicians, as well as M’s family and M herself, noticed qualitative improvements in M’s communicative abilities, as noted on the CETI and in discussions with M and her family.

Conclusions: The application of intensive Schuell’s stimulation did effect improvements in language in a participant with chronic severe Wernicke’s aphasia. There was a lack of measurable generalization; however, the participant and those who interacted with her noticed improvements in her everyday communication. Schuell’s stimulation is not meant to train functional language, and it may be that this treatment needs to be combined with a more functional treatment, or delivered for a longer period of time, to lead to measurable generalization. While M declined on some cognitive measures, it was concluded that this was due to her increasing awareness of her own errors, which reflects movement in a positive direction. Overall, intensive Schuell’s stimulation approach was effective and appropriate for a participant with chronic Wernicke’s aphasia, leading to improvements on trained tasks and increased participant awareness of errors; what remains to be seen are the patterns of generalization and maintenance that may emerge with a longer or modified treatment.

Major Advisor

Jennifer Mozeiko

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