ECoLoGiC-Tx for conversational language in aphasia (Leaman et al., 2026)

Marion C. Leaman; Lisa A. Edmonds; Jacob J. Oleson; Kristine N. Williams

doi:10.23641/asha.30856571

Purpose: The aim of this study was to evaluate group- and individual-level impact of ECoLoGiC (Expanding Communication and Language Opportunities Generated in Conversation) Treatment (ECoLoGiC-Tx), an aphasia intervention aimed at improving conversational language. In addition, treatment fidelity for the speech-language pathologists (SLPs) who delivered treatment was evaluated, providing feasibility data to optimize successful future field implementation.Method: Ten people with moderate or severe aphasia completed 10 weeks of ECoLoGiC-Tx delivered twice weekly for 1 hour. Testing occurred at pretreatment, posttreatment, and at 6 weeks maintenance. Conversation/monologue samples were collected three times per testing phase. Group results were analyzed using linear mixed models. Individual data were analyzed using effect size and minimal detectable change criteria. Treatment fidelity was analyzed using an established 23-point checklist.Results: Robust results indicate generalization across measure types at group and individual levels. Participants improved their ability to convey meaning in conversation, the primary focus of ECoLoGiC-Tx. They demonstrated an average gain of 11.31 points on the Western Aphasia Battery–Revised (range: −1 to 21.5), and 7/10 participants shifted to a less impaired category of severity (e.g., from severe to moderate aphasia). Group-level change did not occur for reading, sentence construction in a picture task or in monologue, or Grammaticality in conversation/monologue. SLP fidelity was 97.3%.Conclusions: Pilot study findings were replicated, with robust group and individual results. Exceptional improvements occurred for 9/10 participants. Results demonstrate generalization of skills to conversation and reduced aphasia severity for most participants. Deliverability of ECoLoGiC-Tx was evidenced by very high treatment fidelity by practicing SLPs, suggesting good potential for successful field implementation.Supplemental Material S1. Discourse samples: durations, number of utterances, number of words.Supplemental Material S2. Interrater reliability for discourse measures.Supplemental Material S3. SLP treatment fidelity checklists.Supplemental Material S4. SLP fidelity for each participant for each component of therapy and overall.Leaman, M. C., Edmonds, L. A., Oleson, J. J., & Williams, K. N. (2026). Improving language in individual conversation-level therapy: Group and individual results of ECoLoGiC treatment for people with moderate and severe aphasia. American Journal of Speech-Language Pathology. Advance online publication. https://doi.org/10.1044/2025_AJSLP-25-00113

ECoLoGiC-Tx for conversational language in aphasia (Leaman et al., 2026)

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