Conversational use of writing in severe aphasia: A group treatment approach

Background: Several studies have documented the ability of individuals with severe aphasia to relearn the spelling of target words so that written communication can augment limited spoken language abilities. To date, there has been little documentation of clinical methods to facilitate the conversational use of written communication in such individuals. Aims: The present study was designed to examine treatment outcomes in response to single-word writing treatment complemented by a group treatment approach to facilitate the use of writing for conversation. Methods & procedures: Four individuals with chronic, severe aphasia and agraphia received copy and recall treatment (CART) that included repeated copying and recall trials for spelling target words, as well as small group writing treatment. Single-subject multiple baseline designs were implemented to document progress on sets of words sequentially targeted for treatment. Writing was probed in the context of individual treatment sessions, structured group conversation, and in conversation with an unfamiliar person. Outcomes & results: All four participants responded positively to treatment by demonstrating improved spelling of target words in individual sessions, and use of single-word writing in structured group conversations. In addition, all subjects showed the ability to use telegraphic written communication with new people, albeit with fewer words written in the most naturalistic context. Conclusions: Single-word writing abilities may improve with treatment despite persistent impairments to spoken language and considerable passage of time since the onset of aphasia. Group treatment appears to be an appropriate context to facilitate conversational use of written communication in such individuals.