Intensive language-action therapy (ILAT): The methods

Abstract

Background: Brain and language theories suggest the application of general neuroscientific and linguistic principles in the neurorehabilitation of language. The interwoven nature of language and action has long been emphasised in linguistic pragmatics, and recent neuroscience research has indeed demonstrated tight functional interactions between language and action mechanisms of the human brain. This provides important arguments in favour of practising language in communicative settings, rather than with the sole purpose of producing linguistic structures. Intensive language-action therapy (ILAT), including its most popular form called constraint-induced aphasia therapy (CIAT), realises language-action embedding in synergy with the use of intensive training and guidance by modelling, shaping, and explicit rules. ILAT leads to significant improvement of language performance in chronic post-stroke aphasia within a short period of time. A comprehensive description of its methods has thus far been missing. Aims: We describe the methods of ILAT, illustrate its use, and outline methods for linguistic-pragmatic evaluation of its effects. Main Contribution: We explain the general principles and practical features of ILAT methods and of language-action games (LAGs) constituting this method. The structure of and materials for two LAGs, the REQUEST and PLANNING games, are highlighted by discussing in detail their respective action-structure, materials, and rules. These LAGs are employed to encourage the use of language in communicative contexts through interactive requests and the planning of joint activities. A main linguistic focus is on object nouns in the REQUEST game and on action verbs in the PLANNING game. Focusing and tailoring of LAGs to patients' communicative needs by means of modelling, shaping, and explicitly introduced communication rules are also explained. Finally the assessment of communicative success is illustrated based on clinical measures, performance within LAGs, and the Communicative Aphasia Log (CAL). Conclusions: Different linguistic-pragmatic and social-interactive forms of communication can be translated into specific therapeutic LAGs in the context of ILAT to target specific speech acts and parts of speech. Apart from clinical tests, methods for evaluating communication performance are available for assessment of therapy success.