Disclaimer: this resource is intended for speech and language therapists and students of this profession. If you require therapy for aphasia please contact a speech and language therapist.
Promoting Aphasics’ Communicative Effectiveness (PACE)
Summary: Promoting Aphasics’ Communicative Effectiveness (PACE) is an approach in which therapy is carried out through conversations between the therapist and the client. It focuses on facilitating communication using whichever modality or modalities are most accessible and effective for the client (e.g. gesturing, drawing are equally valid means or response). Therapy takes the form of a picture description task where the therapist and the client take turns to communicate a target to their partner. There are some similarities between PACE and Constraint Induced Language Therapy (see link at bottom of page), however, while the former encourages responses via any modality, the latter forces the client to use a given modality. There are 4 central principles of PACE (see ‘Example’, below).
Criteria for Treatment: Davis (2005) notes that, due to its emphasis on multimodal communication and compensatory approach, PACE can be adapted for a wide range of aphasic presentations (including mild-moderate expressive aphasias). However, individuals experiencing receptive aphasia or any form of severe aphasia are unlikely to benefit from this approach due to its central task requiring relatively intact comprehension (Davis, 1980).
Example:
- A set of picture cards / written word cards are laid, face down on the table. The complexity of stimuli used can be varied according to the ability of the client (e.g. inclusion of similar pictures in the deck which, therefore, require the sender to convey two concepts to be successful - “It’s a little blue ball”).
- The therapist and client take turns communicating a message to one another. Whilst doing so, the following principles are adhered to (Davis, 1980):
- Equal participation - i.e. the therapist and client take turns in the picture description task
- New information - i.e. neither participant is aware of the content that their communication partner is attempting to communicate to them
- Free choice of communication modalities - e.g. speech, gesture, writing and drawing are all acceptable means of completing the task
- Natural feedback - the therapist only provides feedback that would naturally occur in conversation, e.g. facial expressions, body language and prompts that the client has not yet successfully communicated the target
- The therapist can model the use of various modalities to send messages during their turn
Evidence Base: Davis and Wilcox report two studies into the effects of PACE. The first (1981) in which 8 participants with aphasia received either 4 weeks of PACE or 4 weeks of direct stimulation therapy (see link at bottom of page) followed by 4 weeks PACE, found small improvements on the Porch Index of Communicative Ability during the period of PACE therapy and, for 7 of the participants, marked improvements in a role-playing battery during the period of PACE therapy. This was not the case while participants received direct stimulation therapy. An additional single-case study (1985) provided alternating blocks of PACE and direct stimulation to a participant with global aphasia. Results again indicated that progress on a role-playing test improved only during blocks of PACE therapy. (Studies cited in Davis, 2005.)
Freed & Torstensen (2008) compared PACE with Semantic Feature Analysis (see link at bottom of page) in the treatment of two participants with chronic Broca’s aphasia. Results indicate that these treatments are equally effective at improving word-finding for trained stimuli. Some generalisation was also noted in both approaches to untrained stimuli. Both participants expressed a strong preference for PACE over Semantic Feature Analysis and the length or time required to deliver PACE was markedly reduced compared to Semantic Feature Analysis.
Maher et al. (2006) compared the effectiveness of PACE and Constraint Induced Language Therapy. Each therapy was delivered to a group of participants with aphasia for 3 hours a day, 4 days a week over 2 weeks. While there was no significant difference on language measures between treatment groups, Maher et al.’s do report that participants who received Constraint Induced Language Therapy showed better ability to convey narratives and maintenance of gains at 1 month follow-up relative to the PACE treatment group.
Freed & Torstensen (2008) compared PACE with Semantic Feature Analysis (see link at bottom of page) in the treatment of two participants with chronic Broca’s aphasia. Results indicate that these treatments are equally effective at improving word-finding for trained stimuli. Some generalisation was also noted in both approaches to untrained stimuli. Both participants expressed a strong preference for PACE over Semantic Feature Analysis and the length or time required to deliver PACE was markedly reduced compared to Semantic Feature Analysis.
Maher et al. (2006) compared the effectiveness of PACE and Constraint Induced Language Therapy. Each therapy was delivered to a group of participants with aphasia for 3 hours a day, 4 days a week over 2 weeks. While there was no significant difference on language measures between treatment groups, Maher et al.’s do report that participants who received Constraint Induced Language Therapy showed better ability to convey narratives and maintenance of gains at 1 month follow-up relative to the PACE treatment group.
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
Davis, G.A., 2005. PACE revisited. Aphasiology, 19(1), 21-38
Freed, D. & Torstensen, K., 2013. A comparison of Semantic Feature Analysis and Promoting Aphasic Communicative Effectiveness for treating anomia in patients with aphasia. In: Clinical Aphasiology Conference, Tucson, AZ. [online] Available at: <http://eprints-prod-05.library.pitt.edu/2433/1/A_COMPARISON_OF_SEMANTIC_FEATURE_ANALYSIS_AND_PROMOTING_APHASIC_COMMUNICATIVE_EFFECTIVENESS_FOR_TREATING_ANOMIA_IN_PATIENTS_WITH_APHASIA.pdf> [Accessed 02/12/2016]
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
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
Davis, G.A., 2005. PACE revisited. Aphasiology, 19(1), 21-38
Freed, D. & Torstensen, K., 2013. A comparison of Semantic Feature Analysis and Promoting Aphasic Communicative Effectiveness for treating anomia in patients with aphasia. In: Clinical Aphasiology Conference, Tucson, AZ. [online] Available at: <http://eprints-prod-05.library.pitt.edu/2433/1/A_COMPARISON_OF_SEMANTIC_FEATURE_ANALYSIS_AND_PROMOTING_APHASIC_COMMUNICATIVE_EFFECTIVENESS_FOR_TREATING_ANOMIA_IN_PATIENTS_WITH_APHASIA.pdf> [Accessed 02/12/2016]
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
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