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Dementia is often associated with word-finding difficulties impacting on everyday life. Previous research on constraint-induced aphasia therapy (CIAT) for word-finding difficulties in people with Primary Progressive Aphasia, a language-based dementia, has reported positive outcomes. No existing research uses CIAT-based therapy with people with other forms of dementia such as Alzheimer's disease. This study aimed to evaluate the effectiveness of CIAT-based therapy in improving communication for people with dementia and whether this generalised to more successful everyday communication. A quantitative and qualitative mixed-methods approach was adopted, with the original described study protocol being significantly revised due to the impact of the coronavirus pandemic. The revised study protocol consisted of two main phases. In Phase 1, two participants with Alzheimer's disease and their communication partners were recruited. Following face-to-face cognitive and communication assessment, participants completed CIAT-based therapy using 60 chosen picture items in 9 face-to-face therapy sessions with the researcher, with additional home practice encouraged. Due to restrictions relating to the coronavirus pandemic, post-therapy communication assessments were redesigned and completed by video-call. In Phase 2, one participant with Posterior Cortical Atrophy and their communication partner were assessed using video-call, and completed self-directed CIAT-based therapy at home. This was supported by one training session, and a written guide developed with the support of a focus group. This study's main contribution was being the first to evaluate CIAT-based therapy for people with Alzheimer's disease. Analysis suggests naming performance did not improve following completion of CIAT-based therapy, although there is some evidence of maintenance of treated nouns for one participant. The discussion considers the findings in the context of existing research. It highlights the limitations of research on impairment-based approaches such as CIAT-based therapy for word-finding difficulties and considers how meaningful language assessment might take place in the context of wider cognitive decline.

Research into the experience of stroke and aphasia has highlighted the physical, emotional and social burdens on people with aphasia (PWA) and their family members, with research mainly conducted in Europe, the USA and Australia. Revealing the experience of PWA can inform research and clinical practice. In clinical practice, goals are fundamental aspects to the provision of aphasia therapy. The existing literature in the area of therapeutic goals has revealed the views of PWA, their family members and speech and language therapists (SLTs) on goals and goal-setting in the same geographical regions. However, there is no evidence in the literature of studies that have investigated the experience of stroke and goal-setting in aphasia therapy in Saudi Arabia. This study aims to explore therapeutic goal-setting in aphasia rehabilitation within the cultural context of experiencing stroke and aphasia in Saudi Arabia. In-depth, semi-structured, individual interviews were conducted with 29 participants who constitute 11 triads. Each triad involved a person with aphasia, a family member and the SLT in charge of the case. Data from PWA’s case records were also collected. Thematic analysis and grounded theory techniques were used to analyse the data. From the data six major themes emerged which are related to the experience of stroke and aphasia, and goal-setting in aphasia rehabilitation in Saudi Arabia. The major themes are as follows: Stroke occurrence and the social context, The impact of stroke and aphasia, Identifying therapeutic goals, Participation in goal-setting, Expectations in aphasia therapy, and The nature of goals in aphasia therapy. Based on the findings of themes, a conceptualisation of goal-setting in Saudi aphasia rehabilitation is presented. Exploring the cultural context of the experience of stroke and aphasia provided a new perspective into goal-setting in aphasia rehabilitation that was not reported previously in the literature. The findings suggest that goal-setting in Saudi aphasia rehabilitation is highly context-based, and that the cultural aspect contributes to the dynamics of that process (Islamic faith and collectivism). The findings also suggest that goal-setting in Saudi aphasia rehabilitation is informal and the complexity of it directs the process to be therapist-led. The findings emphasise the role of SLTs in empowering and supporting PWA and their family members in aphasia rehabilitation in a context-sensitive way. It is suggested that supporting the effective involvement of PWA and their family members in the process of goal-setting facilitates reaching matched expectations; thus, increasing motivation, cooperation, and commitment to aphasia therapy. The current study advocates contextual transparency in research and a context-sensitive approach to goal-setting in aphasia rehabilitation.

The nature of semantic impairment in people with aphasia (PWA) provides the background to the current study, which examines whether different methods of semantic assessment can account for such deficits. Cognitive ability, which has previously been linked to language ability in PWA, may impact on test performance and was therefore also examined. The aims of the current study were to compare performance of control participants and PWA on implicit and explicit assessment of semantics, and to relate it to performance on tests of cognition. The impact of semantically similar versus associative relationship types between test stimuli was also considered. Three experimental semantic tasks were developed, including one implicit measure of semantic processing (Semantic Priming) and two explicit measures (Word to Picture Verification and Word to Picture Matching). Test stimuli were matched in terms of key psycholinguistic variables of frequency, imageability and length, and other factors including visual similarity, semantic similarity, and association. Performance of 40 control participants and 20 PWA was investigated within and between participant groups. The relationship between semantic task performance and existing semantic and cognitive assessments was also explored in PWA. An important finding related to a subgroup of PWA who were impaired on the explicit experimental semantic tasks but demonstrated intact semantic processing via the implicit method. Within tasks some differences were found in the effects of semantically related or associated stimuli. No relationships were found between experimental semantic task performance and cognitive task accuracy. The research offers insights into the role of implicit language testing, the impact of stimuli relationship type, and the complex relationship between semantic processing and cognition. The findings underline the need for valid and accurate measures of semantic processing to be in place to enable accurate diagnosis for PWA, in order to direct appropriate intervention choice and facilitate successful rehabilitation.