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Treatments Targeting Phonological Short-Term Memory to Improve Language Health after Stroke

Improving language health in stroke survivors with aphasia

Full Project Name:Treatments Targeting Phonological Short-Term Memory to Improve Language Health after StrokePrincipal Investigator:Priyanka P Shah-Basak, PhD, NeurologyCo-Investigator(s):Jeffrey Binder, MD, Neurology
Sara Pillay, PhD, Neurology
Award Amount:$50,000
Award Date
January2024
Project Duration:18 months

Project Summary:


Stroke is the single largest contributor to death and disability among neurological and psychiatric disorders. In Wisconsin, more than 11,000 hospitalizations in 2017 were with stroke as the principal diagnosis, and about 94% of people hospitalized survived their strokes. Unfortunately, after survival from this initial event, most stroke survivors face an uphill battle to recovery and rarely make a full recovery. Stroke survivors can suffer from a variety of serious long-term disabilities, including cognitive dysfunction, paralysis, vision loss and imbalance. Loss of language abilities, known as aphasia, is a particularly catastrophic outcome.

While no statistics are available regarding incidence and prevalence of aphasia in Wisconsin, at the national level, roughly 25-30% of stroke survivors have aphasia. The NIH estimates that about 2 million, or 1 in 250 people alive today in the U.S., have aphasia, making it one of the most prevalent causes of serious long-term disability. Aphasia can render a person unable to effectively communicate with others, impacting their social, vocational, and emotional well-being. Stroke survivors with aphasia (SWAs) find everyday conversations difficult, resulting in reduced agency as SWAs may be more dependent on caregivers for daily activities. SWAs are often unable to return to work and face social isolation and depression. To put this in perspective, less than 10 days of social isolation during the COVID-19 pandemic in otherwise healthy people was shown to produce long-term neuropsychiatric symptoms. The devastating consequences of a lifetime of social isolation due to lost ability to communicate for SWAs and their families is difficult to imagine. This is the reason why stroke survivors often prioritize speaking over walking as their top rehabilitation goal.

This project’s researchers aim to address a critical need to improve language health in SWAs by developing and evaluating treatments that are rooted in a deep understanding of language neurobiology and aphasia. The objective is to test the feasibility and efficacy of two aphasia treatment protocols to facilitate language-related short-term memory (STM). These treatments were recently developed in the researchers’ lab with neuropsychology and speech language therapy partners. The treatments consist of computerized task modules and cuing procedures to promote verbal STM.

Outcomes & Lessons Learned:


  • Evaluated the feasibility and efficacy of subvocal rehearsal and attentional refreshing treatments targeting verbal short-term memory focused on speech sounds in stroke survivors with aphasia. Rehearsal treatment focused on exercising inner speech strategies, whereas the attentional treatment used a dual-task paradigm to encourage the use of attentional mechanisms.
  • Computerized rehearsal treatment and attentional treatment with algorithms to modulate the difficulty of the therapy based on patients’ progress over time
  • Tested the feasibility with respect to patient and therapist acceptability, implementation, and practicality since the treatment strategies are novel and were not previously evaluated
  • Collected empirical data to evaluate initial efficacy for or against the effectiveness of the proposed treatments and any differences in efficacy between treatments
  • Six stroke survivors with aphasia completed the project, with four of the six participants completing both treatments; whereas 2 participants found the attention therapy protocol too challenging and were not able to complete that therapy

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