The Efficacy of Collaborative Referencing Intervention in Chronic Aphasia: A Mixed-Methods Study

Purpose The feasibility of a collaborative referencing intervention (CRI) for adults with chronic aphasia has been documented in two descriptive case studies (Devanga, 2014; Hengst et al., 2010, 2008). The current Phase II mixed-methods treatment study replicates the CRI with four additional participants (using interpretive research) and investigates how it impacts a traditional measure, participants' confrontational naming abilities, outside of game play (using multiple-probe single-case experimental design). Method Four adults with chronic aphasia participated in the study composed of (a) three preparatory sessions, (b) five baseline sessions, (c) 15 CRI sessions with five treatment probes, and (d) six maintenance sessions. A collaborative confrontation naming (CCN) probe (i.e., dependent variable) was administered in each baseline, treatment probe, and maintenance session. Each CRI session (i.e., independent variable) consisted of a photo-matching game with participant and clinician partner taking alternative turns identifying and matching personally relevant treatment cards. CCN probes were scored using a multidimensional rating scale. Fidelity and social validity were also assessed. Results Replication of the CRI showed successful and consistent referential learning in all four participant pairs. The multiple-probe analysis of CCN revealed a positive treatment effect on naming in three participants indicating that the CRI was efficacious. High fidelity was maintained throughout the study. Social validity interviews revealed positive outcomes and significant impacts of treatment on the participants' lives. Conclusion The CRI demonstrates strong clinical implications for adults with chronic aphasia. Future research exploring the treatment effectiveness and the implementation to a variety of clinical settings is warranted.