Promoting Aphasics’ Communication Effectiveness (PACE)

What is PACE? 

Promoting Aphasics' Communication Effectiveness (PACE) is multimodal treatment approach that can help improve conversational skills and overall communicative effectiveness (Roth, 2021). In this treatment activity the patient and clinician take turns being the speaker and the listener in a picture description task. The speaker has a target picture on a hidden card and can use any type of communication to convey this message to the listener. This may include speaking, writing, drawing, gesturing, or using augmentative and alternative communication (AAC) devices. At the end of each turn, the clinician and patient can discuss which strategies worked best for effective communication. If the message was not conveyed effectively, the patient and clinician can work together to figure out a way in which the message could have been communicated. In addition, this activity can also be used as a way to target communication partner training and improve more effective communication at home (Roth, 2021). 

Principles of Implementation: 

• Equal Participation: The turn-taking nature of this activity helps to remove some of the burden of therapy from the person with aphasia and provides an opportunity for the clinician to model a range of appropriate communication modalities.

• New Information: This activity is designed to stimulate the nature of real-life interactions by giving the patient the opportunity to practice sending and receiving new information. 

• Free Choice of Communication Modalities: This approach gives the client the opportunity to use whatever communication modality is most effective for them and allows the clinician to identify communication strategies to target further. 

• Functional Feedback: When providing feedback, the emphasis is on how effectively a message is conveyed, not increasing verbalization. 

From (Davis 1980)

Stimuli Selection and Modifications:

• Use easily recognizable pictures of objects and activities that are meaningful to each individual

• Instead of the clinician choosing the stimuli, have the client's family choose the stimuli so the clinician can participate in the activity with no previous knowledge of the messages the client will be trying to convey

• Stimuli should be changed frequently in order to maintain the exchange of new information

• The complexity of stimuli can be varied depending on each patient's abilities

• For some clients, substituting picture cards for real objects may be appropriate 

• For clients who are unable to provide an oral label for the picture described, an alternative response mode should be made available (e.g., display three picture cards as choices and instruct the client to indicate the correct picture through pointing)

From (Roth, 2021)

Who should I use PACE with? 

PACE therapy is a flexible treatment approach that can be adapted to fit a variety of skill levels and needs. It is appropriate for patients with a wide range of aphasic presentations, including mild-moderate expressive aphasias (Davis, 1980). As the central task of this approach requires relatively intact comprehension, patients with receptive aphasia are unlikely to benefit from this approach (Davis 1980). In order to learn the taught strategy, patients must also have relatively intact cognitive abilities. 

What goals does PACE address?

• Increases use of compensatory strategies during conversations

• Increases overall communicative effectiveness

• Increases accuracy of expressing and comprehending new information

• Increases speed of expressing and comprehending new information

Evidence-Based Practice 

• Davis and colleagues (1980) evaluated the effectiveness of PACE compared to direct stimulation therapy in 8 patients with aphasia. Following four weeks of PACE, all 8 patients demonstrated small improvements on the Porch Index of Communicative Ability. These effects were not observed during the period patients received direct stimulation therapy (Davis, 1980). 

• Frees & Torstensen (2008) evaluated the effectiveness of PACE compared to Semantic Feature Analysis (SFA) for treating anomia in 2 patients with chronic Broca's aphasia. Results showed both treatments were effective at improving word-finding for both trained and untrained stimuli (Freed & Torstensen, 2008). However, both participants expressed a strong preference for PACE over SFA (Freed & Torstensen, 2008). 

• Maher et al. (2006) evaluated the effectiveness of PACE compared to Constrained Induced Language Therapy (CILT). Results showed there was no significant different on language measures between the two groups (Maher et al., 2006). However, patients who received CILT demonstrated better maintenance of skills one month post treatment (Maher et al., 2006). 

References: 

Davis, G.A.,1980. A critical look at PACE therapy. In: Brookshire, R.H. ed. Clinical Aphasiology Conference Proceedings. Minneapolis, MN: BRK Publishers, 248-257 

Freed, D. & Torstensen, K., 2013. A comparison of Semantic Feature Analysis and Prompting Aphasic Communicative Effectiveness for treating anomia on patients with aphasia. In: Clinical Aphasiology Conference, Tucson, AZ. 

Maher, L., Kendall, D., Swearengin, J., Rodriguez, A., Leon, S., Pingel, K., Holland, A., & Gonzalez-Rothi, L., 2006. A pilot study of use-dependent learning in the context of Constraint Induced Language Therapy. Journal of the International Neuropsychological Society, 12(6), 843-852. 

Roth, F. P., & Worthington, C. K. (2021). Treatment resource manual for speech-language pathology. Plural.