Abstract
Background: Language and communication impairments are among the most frequently reported long-term behavioral consequences of brain tumor. Such deficits may persist long after a patient has been discharged from the hospital and can significantly impact return to work, resumption of prior social roles, and interpersonal relations, as well as full engagement in leisure activities. While considerable research has centered on identifying and describing communication impairments in brain tumor survivors, relatively little research has investigated language therapy for this population.Aims: This report (1) reviews the literature and describes the language and cognitive-communicative profile of a 35-year-old man 6 years post glioblastoma excision with subsequent chemo- and radiation therapies; (2) presents cognitive-communication outcome data for this individual following an integrated discourse therapy; and (3) assesses treatment feasibility in face-to-face (F2F) and tele-neurorehabilitation (TNR) contexts.Methods: A battery of tests and weekly conversation probes were administered to evaluate baseline performance and potential changes associated with F2F and TNR treatment delivery. Integrated Conversation Therapy (ICT) was administered across four alternating (F2F and TNR) treatment blocks over 2 months. ICT is a solution-focused discourse intervention that simultaneously targets word finding, sentence processing, and authentic patient-selected conversational interactions.Results: Although the participant presented with long term-language impairments that were clinically distinct from stroke-associated aphasia, statistically significant post-treatment gains (>2 SEM) were evident following F2F and TNR treatment delivery on standardized measures of apraxia, discourse production, verbal memory, and self-ratings of discourse production, communication, and living with aphasia. While objective measures of treatment effect size (probes of CIU discourse data) were consistent across F2F and TNR delivery models, results of a satisfaction survey indicated a slight but statistically significant participant preference for TNR treatment delivery.Conclusions: This study provides preliminary support for F2F and TNR delivery of ICT discourse intervention for glioblastoma survivors. It also highlights the need for more research specifically dedicated to language therapy for this population.
Highlights
Studies report that at least 80% of BT survivors have cognitive and/or communication impairments at the time of initial diagnosis [1,2,3,4,5,6]
While not characteristic of classic anomia, BG’s performance was similar to reports of other BT survivors [27, 57, 58] and to cases of dynamic aphasia associated with BT and/or atypical aphasia resulting from subcortical pathology [59,60,61]
As hypothesized elsewhere [8, 27, 57, 58, 62, 63], these distinct behavioral effects are likely tied to the involvement of widely distributed subcortical networks and the unique pathophysiology precipitated by the tumor and/or medical treatments
Summary
Studies report that at least 80% of BT survivors have cognitive and/or communication impairments at the time of initial diagnosis [1,2,3,4,5,6]. Literature reviews indicate that cognitive rehabilitation for BT survivors is feasible with the majority of individuals showing gains on measures of neuropsychological impairment [10,11,12,13], subjective ratings of cognitive function [11, 14], measures of independence [15, 16], and/or quality of life [17] This literature identifies language impairment as among the most common sequelae of brain tumor [6,7,8, 18], only a few studies have explicitly focused on language intervention. While considerable research has centered on identifying and describing communication impairments in brain tumor survivors, relatively little research has investigated language therapy for this population
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