Emotional and Language recovery in Aphasia (ELA): a feasibility study developing a novel intervention for people living with post-stroke aphasia

Background and objectives People with post-stroke aphasia, a language disability, are at risk of becoming depressed, anxious and isolated. They want therapy to focus on communication, confidence, mood, and finding ways to live well. We co-designed a novel intervention, ELA (emotional and language recovery after aphasia) to address these priorities.

ELA integrates two evidence-based therapy approaches: elaborated semantic feature analysis, a word-finding therapy, and solution focused brief therapy (SFBT), a brief psychological therapy. A proof-of-concept study had promising results when tested in the university clinic.

This study aims to investigate whether it is feasible to train clinicians to deliver ELA within NHS settings using a model of partially delegated delivery; explore how acceptable ELA is to people with aphasia, family members and clinicians when delivered in community NHS services; and examine mechanisms of change.

It will also assess the feasibility of conducting a future definitive trial investigating clinical and cost effectiveness. Methods Phase One will co-design and develop training packages, resources, and treatment fidelity protocol.

There will be a series of co-design workshops with key stakeholders including people with aphasia, family members, and speech and language therapists.

Since the therapy is designed to be partially delivered by either student speech and language therapists or therapy assistants, we will also have workshops with these stakeholder groups. In addition, we will work with expert trainers and mental health practitioners. Phase Two is a multi-site single arm feasibility study with nested qualitative research.

We will recruit 27 people with aphasia, and up to 27 significant others through four community speech and language therapy services.

The ELA intervention is 22 hours of direct therapy over 8 weeks, with around 14 sessions primarily led by either a student or assistant. We will assess rates of recruitment, retention and missing data.

Participants will also complete outcome measures assessing communicative participation, mood, quality of life and language at baseline, two months (immediately post intervention) and six months (follow up), as well as measures assessing therapeutic alliance and perceived acceptability.

We will interview people with aphasia (n=20), speech and language therapists (n=10), students/ assistants (n=10) and family members (n=5) about their experiences of the intervention, study processes and perspectives on the future trial design. Timelines for delivery Months 1-11: develop the training and therapy manuals.

Months 12-13: deliver training. Month 12-16: recruit participants. The intervention and data collection will be completed in the second year. Months 25-27: complete analysis, disseminate findings, and develop the definitive trial protocol.

Anticipated impact and dissemination We anticipate that participants will improve in confidence, communication and wellbeing; and that clinicians will be better able to address psychological and language needs. User-friendly manuals and online resources will be available at the end of the study.

We will use diverse and inclusive methods to disseminate findings including publications, conferences, events, and a project blog.

ELA may be a promising way to enable speech and language therapists in busy clinical services to support people with both their language and emotional recovery.