Addressing concomitant executive dysfunction and aphasia: previous approaches and the new brain budget protocol

Background: Findings from a number of researchers have suggested that many individuals with aphasia demonstrate concomitant, non-linguistic cognitive deficits, particularly affecting executive function, and that such deficits are not directly related to nor predictable from the primary linguistic deficit. These impairments are an important component of aphasia management, given that they not only may underlie or exacerbate aphasia symptoms, but also hamper language reacquisition and learning and use of communication support strategies. Aims: This paper provides a review of procedures in the recent aphasia literature designed to address executive function deficits. Additionally, a case study is presented in which a self-management treatment protocol was provided to an individual with aphasia. The protocol was based on existing metacognitive strategies successfully utilised with non-aphasic patient populations presenting with executive dysfunction. Main Contribution: Three general intervention approaches addressing executive dysfunction were identified across the aphasia literature, with negligible examination of strategy training approaches. To address this research gap, the Brain Budget protocol presented in our case study offers collaborative, dynamic metacognitive strategy training in the context of traditional aphasia therapy, is consistent with best practices for cognitive rehabilitation, and reflects the realities of current medical reimbursement policies. Conclusions: Despite the prevalent co-occurrence of non-linguistic cognitive deficits and aphasia, relatively few aphasia studies describe evidence-based, executive function treatment approaches. Future research should explore the application of such paradigms under controlled conditions and with a variety of aphasia profiles.