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Tilton-Bolowsky VE, Hillis AE. A Review of Poststroke Aphasia Recovery and Treatment Options. Phys Med Rehabil Clin N Am 2024; 35:419-431. [PMID: 38514227 DOI: 10.1016/j.pmr.2023.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2024]
Abstract
Poststroke aphasia, which impacts expressive and receptive communication, can have detrimental effects on the psychosocial well-being and the quality of life of those affected. Aphasia recovery is multidimensional and can be influenced by several baseline, stroke-related, and treatment-related factors, including preexisting cerebrovascular conditions, stroke size and location, and amount of therapy received. Importantly, aphasia recovery can continue for many years after aphasia onset. Behavioral speech and language therapy with a speech-language pathologist is the most common form of aphasia therapy. In this review, the authors also discuss augmentative treatment methodologies, collaborative goal setting frameworks, and recommendations for future research.
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Affiliation(s)
- Victoria E Tilton-Bolowsky
- Department of Neurology, Johns Hopkins School of Medicine, 600 North Wolfe Street, Phipps 446F, Baltimore, MD 21287, USA
| | - Argye E Hillis
- Department of Neurology, Johns Hopkins School of Medicine, 600 North Wolfe Street, Phipps 446F, Baltimore, MD 21287, USA.
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Jacobs M, Evans E, Ellis C. Exploring the association between social determinants and aphasia impairment: A retrospective data integration approach. PLoS One 2024; 19:e0299979. [PMID: 38512886 PMCID: PMC10956803 DOI: 10.1371/journal.pone.0299979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 02/19/2024] [Indexed: 03/23/2024] Open
Abstract
INTRODUCTION Traditionally, the study of aphasia focused on brain trauma, clinical biomarkers, and cognitive processes, rarely considering the social determinants of health. This study evaluates the relationship between aphasia impairment and demographic, socioeconomic, and contextual determinants among people with aphasia (PWA). METHODS PWA indexed within AphasiaBank-a database populated by multiple clinical aphasiology centers with standardized protocols characterizing language, neuropsychological functioning, and demographic information-were matched with respondents in the Medical Expenditure Panel Survey based on response year, age, sex, race, ethnicity, time post stroke, and mental health status. Generalized log-linear regression models with bootstrapped standard errors evaluated the association between scores on the Western Aphasia Battery-Revised Aphasia Quotient (WAB-R AQ) and demographic, economic, and contextual characteristics accounting for clustering of respondents and the stratification of data collection. Region, age, and income specific models tested the sensitivity of results. RESULTS PWA over age 60 had 2.4% (SE = 0.020) lower WAB-R AQ scores compared with younger PWA. Compared to White PWA, Black and Hispanic PWA had 4.7% (SE = 0.03) and 0.81% (SE = 0.06) lower WAB-R AQ scores, respectively, as did those and living in the Southern US (-2.2%, SE = 0.03) even after controlling for age, family size, and aphasia type. Those living in larger families (β = 0.005, SE = 0.008), with income over $30,000 (β = 0.017, SE = 0.022), and a college degree (β = 0.030, SE = 0.035) had higher WAB-R AQ relative to their counterparts. Region-specific models showed that racial differences were only significant in the South and Midwest, while ethnic differences are only significant in the West. Sex differences only appeared in age-specific models. Racial and ethnic differences were not significant in the high-income group regression. CONCLUSION These findings support evidence that circumstances in which individuals live, work, and age are significantly associated with their health outcomes including aphasia impairment.
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Affiliation(s)
- Molly Jacobs
- Department of Health Services Research, Management and Policy, College of Public Health and Health Professions, University of Florida, Gainesville, FL, United States of America
| | - Elizabeth Evans
- Department of Speech, Language and Hearing Sciences, Communication Equity and Outcomes Laboratory, College of Public Health and Health Professions, University of Florida, Gainesville, FL, United States of America
| | - Charles Ellis
- Department of Speech, Language and Hearing Sciences, Communication Equity and Outcomes Laboratory, College of Public Health and Health Professions, University of Florida, Gainesville, FL, United States of America
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Evans E, Ellis C. Looking Upstream to Understand Race/Ethnicity as a Moderator for Poststroke Neuroinflammation and a Social Determinant for Poststroke Aphasia Outcomes. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2024; 33:74-86. [PMID: 38085794 PMCID: PMC11000804 DOI: 10.1044/2023_ajslp-23-00315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 10/06/2023] [Accepted: 11/02/2023] [Indexed: 01/05/2024]
Abstract
INTRODUCTION Over the past decade, the stroke literature has begun to acknowledge and explore explanations for longstanding racial/ethnic differences in stroke outcomes. Poststroke cognitive impairment (PSCI) and poststroke aphasia are two such negative poststroke outcomes where racial/ethnic differences exist. Physiological differences, such as stroke type and lesion size, have been used to partially explain the variation in PSCI and aphasia. However, there is some evidence, although limited, that suggests neuroinflammatory processes as part of allostatic load may be a key contributor to the observed disparities. METHOD In this tutorial, we explore the influence of race differences in inflammation on poststroke cognitive outcomes. We suggest lifetime stress and other external determinants of health such as neighborhood environment and discriminatory practices through "weathering" explain differences in inflammation. While using an allostatic load framework, we explore the literature focusing specifically on the role of neuroinflammation on poststroke outcomes. CONCLUSIONS Examination of the immune response poststroke provides a foundation for understanding the mechanisms of PSCI and poststroke aphasia and the potential contributions of neuroinflammatory processes on poststroke cognitive outcomes. Furthermore, understanding of racial differences in those processes may contribute to a better understanding of racial disparities in general stroke outcomes as well as poststroke aphasia.
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Affiliation(s)
- Elizabeth Evans
- Department of Speech, Language and Hearing Sciences, College of Public Health and Health Professions, University of Florida, Gainesville
| | - Charles Ellis
- Department of Speech, Language and Hearing Sciences, College of Public Health and Health Professions, University of Florida, Gainesville
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Jacobs M, Evans E, Ellis C. Intersectional sociodemographic and neurological relationships in the naming ability of persons with post-stroke aphasia. JOURNAL OF COMMUNICATION DISORDERS 2023; 105:106352. [PMID: 37331326 DOI: 10.1016/j.jcomdis.2023.106352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Revised: 05/16/2023] [Accepted: 06/08/2023] [Indexed: 06/20/2023]
Abstract
INTRODUCTION Significant attention has been given to the role of brain function and disruption in determining performance on naming tasks among individuals with aphasia. However, scholarly pursuit of a neurological explanation has overlooked the fundamental cornerstone of individual health-the underlying social, economic, and environmental factors that shape how they live, work, and age, also known as the social determinants of health (SDOH). This study examines the correlation between naming performance and these underlying factors. METHODS Individual level data from the 2010 Moss Aphasia Psycholinguistic Project Database (MAPPD) was matched with the 2009-2011 Medical Expenditure Panel Survey (MEPS) using a propensity score algorithm based on functional, health, and demographic characteristics. Multilevel, generalized, nonlinear regression models were applied to the resulting data set to assess the correlation between the Boston Naming Test (BNT) percentile score and age, income, sex, race, household size, marital status, aphasia type, and region of residence. Poisson regression models with bootstrapped standard errors were used to estimate these relationships RESULTS: Discrete dependent variable estimation with non-normal prior specification included individual level (age, marital status, years of education), socioeconomic (family income), health (aphasia type), household (family size), and environmental (region of residence) characteristics. Regression results indicated that, relative to individuals with Wernicke's, individuals with Anomic (0.74, SE = 0.0008) and Conduction (0.42, SE = 0.0009) aphasia performed better on the BNT. While age at the time of testing was not significantly correlated, higher income level (0.15, SE = 0.0003) and larger family size (0.002, SE = 0.002) was associated with higher BNT score percentiles. Finally, Black persons with aphasia (PWA) (-0.0124, SE = 0.0007) had lower average score percentiles when other factors were held constant. CONCLUSIONS The findings reported here suggest higher income and larger family size are associated with better outcomes. As expected, aphasia type was significantly associated with naming outcomes. However, poorer performance by Black PWA and individuals with low income suggests that SDOH can play a critical role (positive and negative) in naming impairment in some populations with aphasia.
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Affiliation(s)
- Molly Jacobs
- Health Services Research, Management and Policy, College of Public Health and Health Professions, University of Florida, United States
| | - Elizabeth Evans
- Department of Speech, Language and Hearing Sciences, College of Public Health and Health Professions, University of Florida, United States
| | - Charles Ellis
- Department of Speech, Language and Hearing Sciences, College of Public Health and Health Professions, University of Florida, United States.
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Song SE, Krishnamurthy LC, Rodriguez AD, Han JH, Crosson BA, Krishnamurthy V. Methodologies for task-fMRI based prognostic biomarkers in response to aphasia treatment. Behav Brain Res 2023; 452:114575. [PMID: 37423319 DOI: 10.1016/j.bbr.2023.114575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 06/14/2023] [Accepted: 07/06/2023] [Indexed: 07/11/2023]
Abstract
With the diversity in aphasia coupled with diminished gains at the chronic phase, it is imperative to deliver effective rehabilitation plans. Treatment outcomes have therefore been predicted using lesion-to-symptom mapping, but this method lacks holistic functional information about the language-network. This study, therefore, aims to develop whole-brain task-fMRI multivariate analysis to neurobiologically inspect lesion impacts on the language-network and predict behavioral outcomes in persons with aphasia (PWA) undergoing language therapy. In 14 chronic PWA, semantic fluency task-fMRI and behavioral measures were collected to develop prediction methodologies for post-treatment outcomes. Then, a recently developed imaging-based multivariate method to predict behavior (i.e., LESYMAP) was optimized to intake whole-brain task-fMRI data, and systematically tested for reliability with mass univariate methods. We also accounted for lesion size in both methods. Results showed that both mass univariate and multivariate methods identified unique biomarkers for semantic fluency improvements from baseline to 2-weeks post-treatment. Additionally, both methods demonstrated reliable spatial overlap in task-specific areas including the right middle frontal gyrus when identifying biomarkers of language discourse. Thus whole-brain task-fMRI multivariate analysis has the potential to identify functionally meaningful prognostic biomarkers even for relatively small sample sizes. In sum, our task-fMRI based multivariate approach holistically estimates post-treatment response for both word and sentence production and may serve as a complementary tool to mass univariate analysis in developing brain-behavior relationships for improved personalization of aphasia rehabilitation regimens.
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Affiliation(s)
- Serena E Song
- Center for Visual and Neurocognitive Rehabilitation, Atlanta Veterans Affairs Medical Center, 1670 Clairmont Rd., Decatur, GA 30033, United States; Department of Neuroscience and Behavioral Biology, Emory University, 201 Dowman Dr., Atlanta, GA 30322, United States
| | - Lisa C Krishnamurthy
- Center for Visual and Neurocognitive Rehabilitation, Atlanta Veterans Affairs Medical Center, 1670 Clairmont Rd., Decatur, GA 30033, United States; Joint GSU, Georgia Tech, and Emory Center for Translational Research in Neuroimaging and Data Science (TReNDS), Atlanta, GA, United States; Department of Physics and Astronomy, Georgia State University, Atlanta, GA 30302, United States; Department of Radiology and Imaging Sciences, Emory University, 201 Dowman Dr., Atlanta, GA 30322, United States
| | - Amy D Rodriguez
- Center for Visual and Neurocognitive Rehabilitation, Atlanta Veterans Affairs Medical Center, 1670 Clairmont Rd., Decatur, GA 30033, United States; Department of Neurology, Emory University, 201 Dowman Dr., Atlanta, GA 30322, United States
| | - Joo H Han
- Center for Visual and Neurocognitive Rehabilitation, Atlanta Veterans Affairs Medical Center, 1670 Clairmont Rd., Decatur, GA 30033, United States; Department of Physics and Astronomy, Georgia State University, Atlanta, GA 30302, United States
| | - Bruce A Crosson
- Center for Visual and Neurocognitive Rehabilitation, Atlanta Veterans Affairs Medical Center, 1670 Clairmont Rd., Decatur, GA 30033, United States; Department of Neurology, Emory University, 201 Dowman Dr., Atlanta, GA 30322, United States
| | - Venkatagiri Krishnamurthy
- Center for Visual and Neurocognitive Rehabilitation, Atlanta Veterans Affairs Medical Center, 1670 Clairmont Rd., Decatur, GA 30033, United States; Department of Neurology, Emory University, 201 Dowman Dr., Atlanta, GA 30322, United States; Department of Medicine, Division of Geriatrics and Gerontology, Emory University, 201 Dowman Dr., Atlanta, GA 30322, United States.
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El Ouardi L, Yeou M, Rami Y, Belahsen MF. The Moroccan Arabic Bedside Western Aphasia Battery-Revised: Linguistic and Psychometric Properties. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2023:1-14. [PMID: 37227788 DOI: 10.1044/2023_jslhr-22-00475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
PURPOSE The objectives of this study were (a) to linguistically and culturally adapt the English bedside version of the Western Aphasia Battery-Revised (Bedside WAB-R) into Moroccan Arabic (MA) and (b) to assess its psychometric properties. METHOD The Bedside MA-WAB-R was piloted on a population of 20 participants after a process of linguistic adaptation from English to MA. To verify the psychometric properties of the test, a group of healthy controls (n = 106) and a group of persons with chronic aphasia (n = 52) completed the Bedside MA-WAB-R. The test's content validity, construct validity, and the concurrent validity of the aphasia classification system were examined. In addition, the interrater reliability, intrarater reliability, test-retest reliability, and internal consistency of the instrument were evaluated. RESULTS The results indicated that the Bedside MA-WAB-R overall met standard criteria for excellent psychometric properties, as evinced by high content and construct validity and concurrent validity with independent measures of aphasia diagnosis (speech-language pathologists' impression and lesion location) as well as high internal consistency, inter- and intrarater reliability, and test-retest reliability. The test was also found to have very high sensitivity and specificity for the detection of aphasia, as revealed by the performance of controls. By controlling for age and educational level effects, specific cutoff values were determined to optimize the aphasia diagnosis. CONCLUSIONS The Bedside MA-WAB-R is the first standardized quick aphasia assessment tool with associated psychometric properties for clinical use with an MA-speaking population, particularly within the 26- to 58-year age range. It meets standard criteria for a valid and reliable measure than can have a variety of clinical and research applications.
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Affiliation(s)
- Loubna El Ouardi
- Applied Language and Culture Studies Lab, Faculty of Letters and Humanities, Chouaib Doukkali University, El Jadida, Morocco
| | - Mohamed Yeou
- Applied Language and Culture Studies Lab, Faculty of Letters and Humanities, Chouaib Doukkali University, El Jadida, Morocco
| | - Youssef Rami
- Applied Language and Culture Studies Lab, Faculty of Letters and Humanities, Chouaib Doukkali University, El Jadida, Morocco
| | - Mohammed Faouzi Belahsen
- Department of Neurology, Hassan II University Medical Hospital, Fez, Morocco
- Laboratory of Epidemiology, Clinical Research and Community Health, Faculty of Medicine and Pharmacy, Sidi Mohammed Ben Abdellah University, Fez, Morocco
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