Effectiveness of a Verbal Expressive Skills Management Program for Pakistani Patients with Broca Aphasia: A...

It is estimated that 25% of the patients in Pakistan experience stroke resulting in problems with language. Among many of the conditions, problem with verbal expressive production (Broca's Aphasia) is one of the main problem faced by people having stoke. Many traditional therapies are incorporated to treat symptoms of Aphasia including fluent and non- fluent Aphasia.

The primary objective of the current study was to determine the effectiveness of Verbal Expressive Skill Management Program in Urdu (VESMP-U) with convention speech therapy, Melodic Intonation therapy (MIT) in enhancing the verbal expressive skills in patients with severe Broca's Aphasia. Another objective of this study was to compare the efficacy of Verbal Expressive Skill Management Program in Urdu (VESMP-U) with traditional therapy, as well as the quality of life of patients with severe Broca's Aphasia.

A randomized control trial (NCT03699605, clinicaltrials.gov) was conducted from November 2018 - June 2019 in Pakistan railway Hospital (PRH). Patients having a three-month history of severe Broca's Aphasia, aged between 40-60 years, bilingual (Urdu and English language) and having the ability to use a smart phone were included in the study. Patients with cognitive impairments were excluded. Total of 77 patients were evaluated for eligibility criteria according to the G Power software for sample size. Out of 77, 54 individuals fulfilled the inclusion criteria. The participants were divided into 2 groups (27 each) through sealed envelope method. Patients of both groups were assessed pre and post intervention using the Boston Diagnostic Aphasia Examination (BADE) battery (Primary outcome measure). Experimental group n = 25 received VESMP-U therapy and control group n = 25 (2 drop out in each group) received MIT for 16 weeks i.e. 4 days per week having 64 sessions altogether. Each intervention session lasted up to 30-45 minutes for both groups.

Within and between group analysis after intervention showed that the VESMP-U group had significantly improved BDAE scores (P = .001; 95% CI) than the MIT group for all variables (articulatory intelligibility, phrase length, grammatical form, prosody/intonation, spontaneous speech, word finding, repetition, and auditory comprehension). The BDAE scores of participants in experimental group having VESMP-U therapy pre- and post-intervention were statistically significant (P = .001; 95% CI), which indicates that participant's communication skills were enhanced by use of VESMP-U.

Android based application VESMP-U has been found to be effective in improving expression and quality of life of patients with severe Broca's aphasia.