EmotionaL and Language Recovery in Aphasia (ELLA): Codesigning and Proof-of-Concept Testing a Novel Intervention

People with aphasia are at risk of becoming depressed, anxious, and isolated. They want therapy to focus on improving communication, confidence, and finding ways to live well; family members want to be involved in the therapy process. We aimed to codesign and test a novel intervention (EmotionaL and Language recovery in Aphasia [ELLA]) that would address these priorities through integrating two evidence-based therapy approaches: elaborated semantic feature analysis (SFA), a naming therapy, and solution-focused brief therapy (SFBT), a psychological therapy.

A series of workshops were held with five people with aphasia (six workshops), three family members (three workshops), and four speech-language pathologists (SLPs; three workshops). In addition, meetings were held with experts in SFBT and elaborated SFA. This information was analyzed using qualitative content analysis and mapped onto a therapy manual. Advisors with aphasia (n = 5) and student SLPs (n = 4) trialed therapy components for further refinement prior to a proof-of-concept pre-post group study (n = 8 participants with aphasia). The therapy was codelivered by student SLPs supervised by an experienced SLP; participants received, on average, 14.25 sessions (SD = 2.25) over 7 weeks. The primary clinical outcome was the Communicative Participation Item Bank (CPIB); participants also took part in in-depth interviews posttherapy analyzed using framework analysis.

Themes from the codesign stage included the following: choosing meaningful therapy targets, integrating impairment and psychological therapy, managing endings, involving family, supporting home practice, dosage and delivery, and achieving real-life change. Participants in the proof-of-concept study made significant gains on the CPIB (p = .006, Cohen's d = 1.37). All participants highly valued the therapeutic relationship and were positive about combining psychological and language components within the same intervention.

ELLA has been designed as a holistic, humanistic language therapy. This study suggests that ELLA may be a promising way to enable SLPs to address both emotional and language recovery.