Evarina Sembiring, Flora Sijabat, Harold Situmorang, Amila Amila, Zuraidah Mastura Daulay, Dearni Trinitas Zebua

Effectiveness of Symbolic Communication Therapy on Expressive Abilities in Post- Stroke Aphasia

Introduction

Effectiveness of symbolic communication therapy on expressive abilities in post- stroke aphasia. This study shows a symbolic communication therapy (SCT) app effectively improves expressive abilities & functional communication in post-stroke aphasia patients.

Abstract

Background: Aphasia is a major post-stroke complication that causes communication difficulties and significantly reduces patients’ quality of life. Conventional speech therapy is often limited by time and resources, highlighting the need for technology-based alternatives that can be practiced independently at home. This study aimed to evaluate the effectiveness of a symbolic communication therapy (SCT) application in improving communication skills among stroke patients with aphasia. Methods: A one-group pretest–posttest quasi-experimental design was used with 15 motor-aphasia patients recruited from the Neurology Ward of Haji Medan General Hospital. Participants used an Android-based SCT application for six weeks (two 30-minute sessions per day). Functional communication ability was assessed using the Derby Functional Communication Scale (DFCS) before and after intervention. Data were analyzed using the Wilcoxon Signed-Rank Test. Results: The SCT application significantly improved patients’ communication performance. DFCS scores increased in expression (5.93 to 6.93), comprehension (5.47 to 7.93), and interaction (4.93 to 6.93) domains (p < 0.001). Conclusion: The SCT application effectively enhances functional communication in post-stroke aphasia patients and can serve as a complementary, low-cost tool within neurological rehabilitation programs, particularly in resource-limited healthcare settings.

Review

This study addresses a pertinent need for accessible and scalable interventions for post-stroke aphasia, a condition significantly impacting patient quality of life. The development of an Android-based Symbolic Communication Therapy (SCT) application for independent home practice is a timely and innovative approach, aiming to overcome the limitations of conventional speech therapy in terms of time and resources. The research clearly articulates its goal to evaluate the effectiveness of this SCT application in improving communication skills, employing a one-group pretest–posttest quasi-experimental design to assess functional communication using the Derby Functional Communication Scale (DFCS). The results indicating significant improvements across all measured domains of the DFCS—expression, comprehension, and interaction—are promising and suggest a positive impact of the SCT application. The statistical significance (p < 0.001) provides initial support for the intervention's efficacy. However, the study's methodological design, particularly the small sample size of 15 participants and the absence of a control group, represents a significant limitation. Without a control arm, it is challenging to definitively attribute the observed improvements solely to the SCT intervention, as factors such as spontaneous recovery or Hawthorne effects cannot be ruled out. This diminishes the causal interpretability of the findings. Despite these limitations, this pilot study offers valuable preliminary evidence for the potential of technology-based symbolic communication therapy in post-stroke rehabilitation. The emphasis on a low-cost, complementary tool is particularly relevant for healthcare settings with limited resources. To build upon these initial findings, future research should prioritize a more robust methodology, including larger sample sizes, randomized controlled trial designs with a comparison group, and longer follow-up periods to assess the durability of treatment effects. Such studies would provide stronger evidence regarding the SCT application's effectiveness and its potential for broader clinical implementation.

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