1. Participants were oBroca’s aphasic as per Western Aphasia Battery (WAB) 14 o Agrammatic speakers as per narrative analysis and Verb Inflection Test (VIT) 11 scores under 70% oAssigned to one of two treatment groups (g-CILT, o-CILT) and matched based on baseline scores and other demographics Repeated measures single-participant design Baseline, Post-I (immediately following tx), Post-II (3-4 months post tx) Assessments  Discourse measures: Proportion of sentences, proportion of well formed sentences, proportion of sentence types, noun:verb ratio, tense accuracy, tense variety, open class vs. closed class, & MLU  Is CILT in its original form (o-CILT) with emphasis on production constraints efficacious for individuals with agrammatic aphasia?  Does a modification to the o-CILT protocol, specifically the inclusion of a morphological constraint, increase the potential benefit for individuals with agrammatic aphasia?. Constraint-Induced Language Therapy (CILT) 1,2 uses principles of  Constraint of compensatory strategies (e.g. gestures/writing)  Massed (intensive) practice in a group therapy format  Shaping of target behavior (i.e. cueing as necessary) To overcome learned non-use & promote cortical reorganization 4,5  The evidence  Greater gains achieved and maintained with CILT vs. treatment allowing all modalities of communication, when matched for intensity (24 hours over 2 weeks) 7  Maintenance of gains with CILT even after 6 months 8  However, CILT groups in prior studies:  Included participants with heterogeneous profiles 6,7  Utilized activities that were not impairment-based  Given that:  In general, impairment-based treatments have well- demonstrated efficacy 8  Agrammatic aphasia is characterized by sentence structural and morphological (tense marking) impairments 9,10 Go Aphasia!: Examining the efficacy of Constraint-Induced Language Therapy for agrammatic aphasia Go Aphasia!: Examining the efficacy of Constraint-Induced Language Therapy for agrammatic aphasia Christine Virion & Yasmeen Faroqi-Shah University of Maryland, College Park Background References Protocol Results Questions Discussion o-CILT produced limited gains, hence:  For agrammatic aphasia, constraint of compensatory strategies may not be sufficient to produce significant changes in test scores, structural and morphological measures. g-cilt produced more significant gains that were maintained over 3 months, hence:  for individuals with agrammatic aphasia, morphosyntactic modifications such as an emphasis on tense marking,  enhance the benefit of CILT  enhance the longevity of benefits from CILT  Would deficit specific modifications for other aphasic deficits demonstrate a benefit over o-CILT?  Would carryover activities and caregiver training increase maintenance of treatment effects?  What is the effectiveness of g-CILT in a clinical setting? Acknowledgements  This work was supported by a University of Maryland MCM Student Research Grant.  Special thanks to the participants, their caregivers, and families for their involvement in this study.  For further information, email: Yasmeen Farqoi-Shah at yshah@hesp.umd.edu or Christine Virion at christinevirion@gmail.com 1.Bhogal, S.,et al. (2003). Stroke, 34, 987-993. 2.Morris, D., & Taub, E. (2001). Stroke Rehabilitation 8, 16-30. 3.Sterr, A., et al. (2006). Cognitive Behavioral Neurology, 19, 48-54. 4.Breier, J., et al. (2006). Neurocase, 12, 322-331. 5.Pulvermuller, F., et al. (2001). Stroke, 32, 1621-1626. 6.Maher, L., et al. (2006). J. of the International Neuropsychological Society,12, 843-852. 7.Meinzer, M., et al. (2005). Stroke, 36, 1462-1466. 8.Holland, A., et al.(1996). J. of Speech and Hearing Research, 39, S27-S36. 9.Faroqi-Shah, Y. & Thompson, C. (2007) J. of Memory and Language, 56, 129-151. 10. Thompson, C. & Shapiro, L. (2005). Aphasiology, 19. 1021-1036. 11. Faroqi-Shah, Y. (unpublished). Verb Inflection Pretest. 12. Goodglass, H., et al. (2000). Boston Diagnostic Aphasia Examination. 13. Kaplan, E., et al. (2000). Boston Naming Test. 14. Kertesz, A. (1982). Western Aphasia Battery. 15. Druks, J. & Masterson, J. (2000). An Object and Action Naming Battery. 16. Szekely, A. et al. (2004). J. of Memory and Language,51, 247-250. Methods Future directions Tests  Western Aphasia Battery Aphasia Quotient (WAB AQ) 14  Boston Naming Test (BNT) 13  Verb Inflection Test (VIT) 11  Object & Action Naming Test 15 Discourse Samples  Cinderella Story retelling  Narrative Discourse subtest- BDAE 12  Tom and Jerry video retelling  Conversational sample Original CILT (o-CILT) AND Grammatical CILT (g-CILT)  24 hours of treatment over 14 days (8 sessions)  Dual card task (similar to Go Fish)  25 picture cards, each with an agent & theme(s), varying in lexical frequency, number and/or color of themes 16  “Speech only” constraint  Hierarchy of constraints (5 levels ranging from “The boy is holding the apple” to “The boy is holding two red apples. Mike, can I have that card, please?”)  Participants completed 3 successful turns before advancing to the next hierarchical level  Cueing provided as necessary o-CILT ONLY  Visual barrier used to replicate previous CILT studies  Participants AP-6 (68 years old, 12 years post stroke) AP-15 (56 years old, 2 years post stroke) g-CILT ONLY  No visual barriers used  Morphological constraint added with a temporal adverb and corresponding verb inflection to be used in sentences  Listener grammaticality judgments  Participants AP-1 (62 years old, 5 years post stroke) AP-14 (45 years old, 2 years post stroke ) o-CILT Test scores ( = significant, = gains maintained ) Structural measures (* = gains maintained)  Verb:Noun ratio (AP-6 only; narratives)  % well-formed sentences (AP-15* only; narratives)  MLU (AP-6 only; decrease for narratives) Morphological measures  Tense accuracy (AP-6 only; conversation and narratives) g-CILT Test scores ( = significant, = gains maintained ) Structural measures (* = gains maintained)  % of sentences (AP-14 only; narratives)  % well-formed sentences (AP-14* & AP-1; both in conversation)  MLU (AP-14 only; decrease for narratives) Morphological measure  Tense accuracy (AP-1* & AP-14; both in conversation only)