Prognosis for aphasia: Relationship between selected biographical and behavioural variables and outcome and improvement

Background: Numerous biographical and behavioural variables have been investigated for their prognostic value in aphasia. Tompkins, Jackson, and Schulz (1990) recommended ways to reconceptualise some of these variables and suggested exploration of additional variables that have been neglected. Aims: The purpose of this investigation was to examine the relationship between selected biographical and behavioural variables and initial performance, outcome, and amount of change in aphasia. Methods & Procedures: A total of 34 participants, from the first Veterans Administration Cooperative Study on Aphasia, composed the study sample. Each was evaluated with the Porch Index of Communicative Ability (PICA) and the Rating of Functional Performance (RFP) (a modification of the Functional Communication Profile) at 4 and 48 weeks post-onset (WPO), before and after a 44-week treatment trial. Information for 10 biographical and behavioural variables was available for each participant at 4 WPO. Spearman's correlations were employed to determine the relationship between each biographical and behavioural variable and initial performance, outcome, and amount of change on the PICA and RFP. Outcomes & Results: Performance at 4 WPO, pre-treatment, on the PICA and RFP was significantly correlated. Similarly, performance on the PICA and RFP at 4 WPO was significantly correlated with conversational, Token Test , and word fluency performance at 4 WPO. Outcome on the PICA and the RFP at 48 WPO, post-treatment, was significantly correlated with PICA, RFP, and word fluency performance at 4 WPO. Moreover, outcome on the PICA at 48 WPO was significantly correlated with conversational and Token Test performance at 4 WPO. Amount of change on the PICA between 4 WPO and 48 WPO was significantly negatively correlated with PICA, word fluency, Token Test , and conversational performance at 4 WPO. Amount of change on the RFP between 4 WPO and 48 WPO was significantly negatively correlated with RFP performance at 4 WPO. Conclusions: The results indicate that there are significant relationships between specific behavioural variables and initial performance, outcome, and amount of change on measures of language impairment and functional communication. Moreover, there is a difference between formulating a prognosis for outcome and amount of change in aphasia--individuals who attain higher outcomes do not necessarily make more improvement. However, the influence of a ceiling effect must be considered in this relationship. Finally, to determine the predictive precision of these relationships, future investigations will require a larger sample size and application of multiple regression analysis.