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Kankam K, Murray L. Rehabilitation of post-stroke aphasia in Ghana. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2024; 59:1308-1321. [PMID: 38156768 DOI: 10.1111/1460-6984.13000] [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: 01/03/2023] [Accepted: 12/11/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND Aphasia, a common consequence of stroke, which affects both communication and social functioning, and in turn, quality of life, is on the rise due to increases in stroke prevalence and survival rate. The rehabilitation of post-stroke aphasia primarily falls within the purview of speech-language pathology and research supports the effectiveness of such services. However, provision of aphasia rehabilitation services in sub-Saharan Africa is associated with challenges. AIMS This study aimed to examine rehabilitation services for individuals with post-stroke aphasia in Ghana by exploring the roles of the stakeholder groups involved in the assessment and treatment of post-stroke aphasia in Ghana, as well as the challenges they encounter in providing or identifying services. The stakeholder groups included educational institutions, interdisciplinary healthcare professionals, and family caregivers of individuals with post-stroke aphasia. METHODS & PROCEDURES A qualitative case study approach was used to collect and integrate from multiple sources data such as demographic information, interview responses and program syllabi to develop a holistic image. Fifteen respondents from the stroke and speech therapy units at Komfo Anokye and Korle-Bu Teaching Hospitals, University of Ghana, and University of Health and Allied Sciences, Ghana were purposively sampled. Interview questions were developed and centred on aphasia education and training, knowledge of speech-language pathology services, speech-language pathology service delivery, access to speech-language pathology services, challenges in both delivery and access to speech-language pathology services and suggestions for improving speech-language pathology services. In-person and virtual interviews were conducted after demographic information was collected. Interviews were analysed thematically, and demographic information and program syllabi were triangulated with the interview data collected. OUTCOMES & RESULTS All stakeholder groups identified concerns with current aphasia services in Ghana. Issues raised included the insufficient number of speech-language pathologists, lack of awareness of speech-language pathology services for post-stroke aphasia (among healthcare professionals and the public), absence of aphasia management information and clinical training in educational programming, lack of interest in speech-language pathology training programs, financial challenges, spiritual and traditional beliefs and geographic barriers (i.e., speech-language pathology services are currently available in only a few cities). CONCLUSIONS & IMPLICATIONS These findings emphasised the need to improve post-stroke aphasia rehabilitation in Ghana. The process of data collection itself educated respondents on the importance of post-stroke aphasia rehabilitation, and by identifying barriers, strategies to improving services, such as designing standardised aphasia assessments for the Ghanaian context, can now be initiated. WHAT THIS PAPER ADDS What is already known on the subject To address post-stroke aphasia, evidence-based speech-language pathology services are provided. However, there is a paucity of studies on post-stroke aphasia services in Ghana, preventing an accurate report of services and practices in the country. What this study adds This study provides an overview of the existing rehabilitation services for post-stroke aphasia in Ghana. It highlights challenges facing the existing services and suggested strategies to improve post-stroke aphasia services. What are the clinical implications of this work? The study created awareness among healthcare professionals and general public (study participants) about the importance of rehabilitation services for post-stroke aphasia. Based on the study findings, appropriate stakeholders such as policy makers, researchers, and healthcare professionals can further design assessments and interventions to improve rehabilitation, including speech-language pathology services, for post-stroke aphasia in Ghana.
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Affiliation(s)
- Keren Kankam
- Health and Rehabilitation Sciences, Faculty of Health Sciences, University of Western Ontario, London, Ontario, Canada
| | - Laura Murray
- Health and Rehabilitation Sciences, Faculty of Health Sciences, University of Western Ontario, London, Ontario, Canada
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Upton E, Doogan C, Fleming V, Leyton PQ, Barbera D, Zeidman P, Hope T, Latham W, Coley-Fisher H, Price C, Crinion J, Leff A. Efficacy of a gamified digital therapy for speech production in people with chronic aphasia (iTalkBetter): behavioural and imaging outcomes of a phase II item-randomised clinical trial. EClinicalMedicine 2024; 70:102483. [PMID: 38685927 PMCID: PMC11056404 DOI: 10.1016/j.eclinm.2024.102483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 01/26/2024] [Accepted: 01/26/2024] [Indexed: 05/02/2024] Open
Abstract
Background Aphasia is among the most debilitating of symptoms affecting stroke survivors. Speech and language therapy (SLT) is effective, but many hours of practice are required to make clinically meaningful gains. One solution to this 'dosage' problem is to automate therapeutic approaches via self-supporting apps so people with aphasia (PWA) can amass practice as it suits them. However, response to therapy is variable and no clinical trial has yet identified the key brain regions required to engage with word-retrieval therapy. Methods Between Sep 7, 2020 and Mar 1, 2022 at University College London in the UK, we carried out a phase II, item-randomised clinical trial in 27 PWA using a novel, self-led app, 'iTalkBetter', which utilises confrontation naming therapy. Unlike previously reported apps, it has a real-time utterance verification system that drives its adaptive therapy algorithm. Therapy items were individually randomised to provide balanced lists of 'trained' and 'untrained' items matched on key psycholinguistic variables and baseline performance. PWA practised with iTalkBetter over a 6-week therapy block. Structural and functional MRI data were collected to identify therapy-related changes in brain states. A repeated-measures design was employed. The trial was registered at ClinicalTrials.gov (NCT04566081). Findings iTalkBetter significantly improved naming ability by 13% for trained items compared with no change for untrained items, an average increase of 29 words (SD = 26) per person; beneficial effects persisted at three months. PWA's propositional speech also significantly improved. iTalkBetter use was associated with brain volume increases in right auditory and left anterior prefrontal cortices. Task-based fMRI identified dose-related activity in the right temporoparietal junction. Interpretation Our findings suggested that iTalkBetter significantly improves PWAs' naming ability on trained items. The effect size is similar to a previous RCT of computerised therapy, but this is the first study to show transfer to a naturalistic speaking task. iTalkBetter usage and dose caused observable changes in brain structure and function to key parts of the surviving language perception, production and control networks. iTalkBetter is being rolled-out as an app for all PWA and anomia: https://www.ucl.ac.uk/icn/research/research-groups/neurotherapeutics/projects/digital-interventions-neuro-rehabilitation-0 so that they can increase their dosage of practice-based SLT. Funding National Institute for Health and Care Research, Wellcome Centre for Human Neuroimaging.
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Affiliation(s)
- Emily Upton
- UCL Queen Square Institute of Neurology, University College London, UK
- Institute of Cognitive Neuroscience, University College London, UK
- Department of Psychology and Language Sciences, University College London, UK
| | - Catherine Doogan
- UCL Queen Square Institute of Neurology, University College London, UK
- Institute of Cognitive Neuroscience, University College London, UK
- St George’s, University of London, UK
| | - Victoria Fleming
- Department of Psychology and Language Sciences, University College London, UK
| | | | - David Barbera
- Institute of Cognitive Neuroscience, University College London, UK
| | - Peter Zeidman
- Wellcome Centre for Human Neuroimaging, University College London, UK
| | - Tom Hope
- Wellcome Centre for Human Neuroimaging, University College London, UK
- Department of Psychology and Social Science, John Cabot University, Rome, Italy
| | - William Latham
- Department of Computing, Goldsmiths, University of London, UK
| | | | - Cathy Price
- Wellcome Centre for Human Neuroimaging, University College London, UK
| | - Jennifer Crinion
- Institute of Cognitive Neuroscience, University College London, UK
- Department of Psychology and Language Sciences, University College London, UK
| | - Alex Leff
- UCL Queen Square Institute of Neurology, University College London, UK
- Institute of Cognitive Neuroscience, University College London, UK
- University College London Hospitals NHS Trust, UK
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Pierce JE, OHalloran R, Togher L, Nickels L, Copland D, Godecke E, Meinzer M, Rai T, Cadilhac DA, Kim J, Hurley M, Foster A, Carragher M, Wilcox C, Steel G, Rose ML. Acceptability, feasibility and preliminary efficacy of low-moderate intensity Constraint Induced Aphasia Therapy and Multi-Modality Aphasia Therapy in chronic aphasia after stroke. Top Stroke Rehabil 2024; 31:44-56. [PMID: 37036031 DOI: 10.1080/10749357.2023.2196765] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 03/24/2023] [Indexed: 04/11/2023]
Abstract
BACKGROUND High-intensity Constraint-Induced Aphasia Therapy Plus (CIAT-Plus) and Multi-Modality Aphasia Therapy (M-MAT) are effective interventions for chronic post-stroke aphasia but challenging to provide in clinical practice. Providing these interventions may be more feasible at lower intensities, but comparative evidence is lacking. We therefore explored feasibility, acceptability, and preliminary efficacy of the treatments at a lower intensity. METHODS A multisite, single-blinded, randomized Phase II trial was conducted within the Phase III COMPARE trial. Groups of participants with chronic aphasia from the usual care arm of the COMPARE trial were randomized to M-MAT or CIAT-Plus, delivered at the same dose as the COMPARE trial but at lower intensity (6 hours/week × 5 weeks rather than 15 hours/week × 2 weeks). Blinded assessors measured aphasia severity (Western Aphasia Battery-Revised Aphasia Quotient), word retrieval, connected speech, multimodal communication, functional communication, and quality of life immediately post interventions and after 12 weeks. Feasibility and acceptability were explored. RESULTS Of 70 eligible participants, 77% consented to the trial; 78% of randomized participants completed intervention and 98% of assessment visits were conducted. Fatigue and distress ratings were low with no related withdrawals. Adverse events related to the trial (n = 4) were mild in severity. Statistically significant treatment effects were demonstrated on word retrieval and functional communication and both interventions were equally effective. CONCLUSIONS Low-moderateintensity CIAT-Plus and M-MAT were feasible and acceptable. Both interventions show preliminary efficacy at a low-moderate intensity. These results support a powered trial investigating these interventions at a low-moderate intensity.
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Affiliation(s)
- John E Pierce
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University, Melbourne, Victoria, Australia
| | - Robyn OHalloran
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University, Melbourne, Victoria, Australia
| | - Leanne Togher
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Lyndsey Nickels
- School of Psychological Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - David Copland
- Queensland Aphasia Research Centre, The University of Queensland, Herston, Queensland, Australia
- Surgical Treatment and Rehabilitation Service Education and Research Allience, Metro North Health, Herston, Queensland, Australia
| | - Erin Godecke
- School of Medical and Health Sciences, Edith Cowan University, Western, Australia
| | - Marcus Meinzer
- Department of Neurology, University Medicine Greifswald, Greifswald, Germany
| | - Tapan Rai
- Graduate Research School, University of Technology Sydney, New South Wales, Australia
| | - Dominique A Cadilhac
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Victoria, Australia
- Speech Pathology, Monash Health, Clayton, Victoria, Australia
| | - Joosup Kim
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Victoria, Australia
- Speech Pathology, Monash Health, Clayton, Victoria, Australia
| | - Melanie Hurley
- CRE Aphasia Recovery and Rehabilitation, La Trobe University, Bundoora, Australia
| | - Abby Foster
- Speech Pathology, Monash Health, Clayton, Victoria, Australia
- School of Allied Health, Human Service & Sport, La Trobe University, Victoria, Australia
- School of Primary & Allied Health Care, Monash University, Victoria, Australia
| | - Marcella Carragher
- CRE Aphasia Recovery and Rehabilitation, La Trobe University, Bundoora, Australia
| | - Cassie Wilcox
- CRE Aphasia Recovery and Rehabilitation, La Trobe University, Bundoora, Australia
| | - Gillian Steel
- CRE Aphasia Recovery and Rehabilitation, La Trobe University, Bundoora, Australia
| | - Miranda L Rose
- CRE Aphasia Recovery and Rehabilitation, La Trobe University, Bundoora, Australia
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Leff A, Doogan C, Bentley J, Makkar B, Zenobi-Bird L, Sherman A, Grobler S, Crinion J. More than one way to improve a CAT: Outcomes and reflections on two iterations of the Queen Square Intensive Comprehensive Aphasia Programme. APHASIOLOGY 2023:1-24. [PMID: 38652694 PMCID: PMC11027995 DOI: 10.1080/02687038.2023.2286703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 11/16/2023] [Indexed: 04/25/2024]
Abstract
Background The field of human expert performance teaches us that high quality, high-dose guided practice is required to make large gains in cognitively driven acts. The same also seems to be true for people with acquired brain injury, yet therapy services for people with aphasia (PWA) have traditionally not been designed with this in mind. Intensive Comprehensive Aphasia Programmes (ICAPs) are one way to address the chronic under-dosing of therapy that most PWA experience. Aims There are several ways to deliver an ICAP; here we describe two iterations of our Queen Square ICAP. There was a 20-month COVID-induced pause between the Year 1 (Y1) and Year 2 (Y2) ICAP groups. We analyse ICAP-induced changes in both groups of PWA on a series of key outcome measures that span the International Classification of Functioning, Disability and Health, covering language impairment and function as well as mood and social participation. Methods & Procedures Forty-six PWA took part in Y1 and 44 in Y2. The PWA were all in the chronic stage post stroke and varied in aphasia severity from mild to severe, with the Y2 group being more impaired than Y1. Quantitative data was collected before and after the ICAP. The Y2 therapy team provided independent reflections on their experiences of delivering an ICAP. Outcomes & Results ICAP-related changes in outcome measures (impairment, function and goal attainment) were generally comparable for the Y1 and Y2 groups, with both groups' speech production abilities improving the most. Both groups made clinically and statistically significant gains on the main quality of life measure. Participation in the ICAP made a big difference to PWAs' self-confidence ratings. Their mood ratings also improved significantly, although they were not, on average, in the depressed range at baseline (directly pre-ICAP). All improvements achieved in both groups were maintained at the 3-month follow-up, highlighting the lasting effects that ICAPs can provide. Conclusions Evidence continues to accrue that ICAPs are an efficient way of increasing the dose of expert coaching required for people with chronic aphasia to make clinically meaningful improvements in their communicative abilities and quality of life. The main challenge remaining is convincing health-care providers to invest in them.
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Affiliation(s)
- Alexander Leff
- UCL Queen Square Institute of Neurology, University College London, London, UK
- University College London Hospitals NHS Trust, London, UK
- Institute of Cognitive Neuroscience, University College London, London, UK
| | - Catherine Doogan
- UCL Queen Square Institute of Neurology, University College London, London, UK
- University College London Hospitals NHS Trust, London, UK
- St Georges, University of London
| | | | - Bani Makkar
- University College London Hospitals NHS Trust, London, UK
| | | | - Amy Sherman
- University College London Hospitals NHS Trust, London, UK
| | - Simon Grobler
- University College London Hospitals NHS Trust, London, UK
| | - Jennifer Crinion
- University College London Hospitals NHS Trust, London, UK
- Institute of Cognitive Neuroscience, University College London, London, UK
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Shekari E, Seyfi M, Modarres Zadeh A, Batouli SA, Valinejad V, Goudarzi S, Joghataei MT. Mechanisms of brain activation following naming therapy in aphasia: A systematic review on task-based fMRI studies. APPLIED NEUROPSYCHOLOGY. ADULT 2023; 30:780-801. [PMID: 35666667 DOI: 10.1080/23279095.2022.2074849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The pattern of brain neuroplasticity after naming therapies in patients with aphasia can be evaluated using task-based fMRI. This article aims to review studies investigating brain reorganization after semantic and phonological-based anomia therapy that used picture-naming fMRI tasks. We searched for those articles that compared the activation of brain areas before and after aphasia therapies in the PubMed and the EMBASE databases from 1993 up to April 2020. All studies (single-cases or group designs) on anomia treatment in individuals with acquired aphasia were reviewed. Data were synthesized descriptively through tables to allow the facilitated comparison of the studies. A total of 14 studies were selected and reviewed. The results of the reviewed studies demonstrated that the naming improvement is associated with changes in the activation of cortical and subcortical brain areas. This review highlights the need for a more systematic investigation of the association between decreased and increased activation of brain areas related to anomia therapy. Also, more detailed information about factors influencing brain reorganization is required to elucidate the neural mechanisms of anomia therapy. Overall, regarding the theoretical and clinical aspects, the number of studies that used intensive protocol is growing, and based on the positive potential of these treatments, they could be suitable for the rehabilitation of people with aphasia.
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Affiliation(s)
- Ehsan Shekari
- Department of Neuroscience, Faculty of Advanced Technologies in Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Milad Seyfi
- Medical Physics and Biomedical Engineering, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Amin Modarres Zadeh
- Department of Speech Therapy, Faculty of Rehabilitation, Tehran University of Medical science, Tehran, Iran
| | - Seyed Amirhossein Batouli
- Neuroimaging and Analysis Group, Tehran University of Medical Sciences, Tehran, Iran
- School of Advanced Technologies in Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Vahid Valinejad
- Department of Speech Therapy, Faculty of Rehabilitation, Tehran University of Medical science, Tehran, Iran
| | - Sepideh Goudarzi
- Department of Pharmacology and Toxicology, Tehran University of Medical Science, Tehran, Iran
| | - Mohammad Taghi Joghataei
- Department of Neuroscience, Faculty of Advanced Technologies in Medicine, Iran University of Medical Sciences, Tehran, Iran
- Cellular and Molecular Research Center, Iran University of Medical Sciences, Tehran, Iran
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Gore KR, Woollams AM, Bruehl S, Halai AD, Lambon Ralph MA. Direct Neural Evidence for the Contrastive Roles of the Complementary Learning Systems in Adult Acquisition of Native Vocabulary. Cereb Cortex 2022; 32:3392-3405. [PMID: 34875018 PMCID: PMC9376875 DOI: 10.1093/cercor/bhab422] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 10/27/2021] [Accepted: 10/28/2021] [Indexed: 01/01/2023] Open
Abstract
The Complementary Learning Systems (CLS) theory provides a powerful framework for considering the acquisition, consolidation, and generalization of new knowledge. We tested this proposed neural division of labor in adults through an investigation of the consolidation and long-term retention of newly learned native vocabulary with post-learning functional neuroimaging. Newly learned items were compared with two conditions: 1) previously known items to highlight the similarities and differences with established vocabulary and 2) unknown/untrained items to provide a control for non-specific perceptual and motor speech output. Consistent with the CLS, retrieval of newly learned items was supported by a combination of regions associated with episodic memory (including left hippocampus) and the language-semantic areas that support established vocabulary (left inferior frontal gyrus and left anterior temporal lobe). Furthermore, there was a shifting division of labor across these two networks in line with the items' consolidation status; faster naming was associated with more activation of language-semantic areas and lesser activation of episodic memory regions. Hippocampal activity during naming predicted more than half the variation in naming retention 6 months later.
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Affiliation(s)
- Katherine R Gore
- Division of Neuroscience and Experimental Psychology, School of Biological Sciences, University of Manchester, Manchester M13 9GB, UK
| | - Anna M Woollams
- Division of Neuroscience and Experimental Psychology, School of Biological Sciences, University of Manchester, Manchester M13 9GB, UK
| | - Stefanie Bruehl
- Division of Neuroscience and Experimental Psychology, School of Biological Sciences, University of Manchester, Manchester M13 9GB, UK
- St Mauritius Rehabilitation Centre, Meerbusch & Heinrich-Heine University, 40225 Duesseldorf, Germany
- Clinical and Cognitive Neurosciences, Department of Neurology, Medical Faculty, RWTH Aachen University, 52074 Aachen, Germany
| | - Ajay D Halai
- MRC Cognition & Brain Sciences Unit, University of Cambridge, Cambridge CB2 7EF, UK
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Cherney LR, Carpenter J. Behavioral interventions for poststroke aphasia. HANDBOOK OF CLINICAL NEUROLOGY 2022; 185:197-220. [PMID: 35078599 DOI: 10.1016/b978-0-12-823384-9.00010-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
There is a long history of behavioral interventions for poststroke aphasia with hundreds of studies supporting the benefits of aphasia treatment. However, interventions for aphasia are complex with many interacting components, and no one treatment is appropriate for all persons with aphasia. We present a novel, simple framework for classifying aphasia interventions. The framework is incorporated within the overarching International Classification of Functioning, Disability, and Health (ICF) model and is consistent with the commonly-held definition that aphasia is a multimodality disorder that impairs, in varying degrees, the understanding and expression of both oral and written language modalities. Furthermore, within the language impairment level, it distinguishes between the linguistic areas of phonology, semantics, and syntax that may be impaired individually or in combination. We define the terminology of the proposed framework and then categorize some common examples of behavioral interventions for post-stroke aphasia. We describe some of these interventions in greater detail to illustrate the extensive toolbox of evidence-based treatments for aphasia. We address some key issues that clinicians, usually speech-language pathologists, consider when selecting interventions for their specific patients with aphasia, including dose. Finally, we address various models of service delivery for persons with aphasia such as Intensive Comprehensive Aphasia Programs (ICAPs) and Aphasia Centers.
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Affiliation(s)
- Leora R Cherney
- Center for Aphasia Research and Treatment, Shirley Ryan AbilityLab, Chicago, IL, United States; Department of Physical Medicine & Rehabilitation, Northwestern University, Chicago, IL, United States; Department of Communication Sciences & Disorders, Northwestern University, Chicago, IL, United States.
| | - Julia Carpenter
- Center for Aphasia Research and Treatment, Shirley Ryan AbilityLab, Chicago, IL, United States
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Nicholas M, Pittmann R, Pennington S, Connor LT, Ambrosi D, Brady Wagner L, Hildebrand M, Savastano M. Outcomes of an interprofessional intensive comprehensive aphasia program's first five years. Top Stroke Rehabil 2021; 29:588-604. [PMID: 34698621 DOI: 10.1080/10749357.2021.1970452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND AND OBJECTIVES This ICAP program is a collaboration between an institute of health professions and a rehabilitation hospital. It was a 6-week intensive treatment program for people with post-stroke aphasia designed to maximize recovery and return to activities. This retrospective study investigated outcomes of this program offered annually from 2015 to 2019. METHODS This is an analysis of existing data collected for other purposes. While conducting a therapeutic program for people with aphasia, data were not collected for the purpose of conducting research. The treatment components addressed the activity participation goals of 35 participants. Programming consisted of individual and group speech-language and occupational therapy, adaptive sports, swimming, music therapy, and a wellness mindfulness group.. Participants received a comprehensive evaluation and a treatment plan addressing their individual participation goals, delivered primarily by SLP and OT graduate students under faculty supervision. Pre- and post-treatment outcomes were measured within four WHO ICF domains: impairment, participation, environment, person. Each cohort consisted of seven or eight community-dwelling participants seen four days/week. RESULTS Significant post-treatment changes were observed on measures within the impairment domain and on self-perception measures of participation, functional communication, and communication confidence. Subsequent analyses found a subset of 15 responders (WAB Aphasia Quotient change of ≥5) drove most significant effects seen on performance-based impairment measures, but that patient-reported self-perception measures showed significant changes in both responders and non-responders. CONCLUSIONS Results support research indicating that short-term intensive, interprofessional comprehensive aphasia programs (ICAPs) are effective treatment options for people with moderate-to-severe aphasia.
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Affiliation(s)
- Marjorie Nicholas
- Department of Communication Sciences and Disorders, MGH Institute of Health Professions, Boston, MA
| | - Rachel Pittmann
- Department of Communication Sciences and Disorders, MGH Institute of Health Professions, Boston, MA
| | - Suzanne Pennington
- Department of Communication Sciences and Disorders, MGH Institute of Health Professions, Boston, MA
| | - Lisa Tabor Connor
- Program in Occupational Therapy and Department of Neurology, Washington University School of Medicine, St. Louis, MO
| | - Denise Ambrosi
- Speech-Language Pathology, Spaulding Rehabilitation Network, Boston, MA
| | | | - Mary Hildebrand
- Department of Occupational Therapy, MGH Institute of Health Professions, Boston, MA
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Simic T, Leonard C, Laird L, Stewart S, Rochon E. The effects of intensity on a phonological treatment for anomia in post-stroke aphasia. JOURNAL OF COMMUNICATION DISORDERS 2021; 93:106125. [PMID: 34166970 DOI: 10.1016/j.jcomdis.2021.106125] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 05/12/2021] [Accepted: 05/18/2021] [Indexed: 06/13/2023]
Abstract
INTRODUCTION The evidence regarding optimal treatment intensity is mixed, and differing definitions have further confounded existing findings. The primary objective of this study was to compare the efficacy of Phonological Components Analysis (PCA) treatment for anomia delivered at intense and non-intense schedules, using a well-controlled design. The number of teaching episodes and active ingredients of therapy are important considerations when defining intensity. We hypothesized that an active ingredient of PCA is the self-generation of phonological components during therapy sessions. Our secondary aim was to examine whether component generation predicted treatment outcome. METHODS Sixteen adults (M = 52.63 years old, SD = 11.40) with chronic post-stroke aphasia (M = 4.52 years post-onset, SD = 5.55) were randomly assigned to intensive (IT) or standard (ST) PCA treatment conditions. Cumulative treatment intensity in both conditions was equivalent: ST participants received PCA 1 hour/day, 3 days/week for 10 weeks, whereas IT participants received PCA 3 hours/day, 4 days/week for 2.5 weeks. The primary outcome was naming accuracy on a set of treated and (matched) untreated words, measured pre- and post-treatment, and at four- and eight-week follow-ups. RESULTS IT and ST conditions were similarly efficacious. However, secondary analyses suggest an advantage for the IT condition in naming of the treated words immediately post-treatment, but not at follow-ups. The self-generation of phonological components emerged as a significant positive predictor of naming accuracy for both the treated and untreated words. However, this relationship did not reach significance once baseline anomia severity was accounted for. CONCLUSIONS Although replication in a larger sample is warranted, results suggest that PCA treatment is similarly efficacious when delivered at different intensities. Other factors related to the quality of treatment (i.e., active ingredients such as cue-generation) may play an important role in determining treatment efficacy and must also be considered when comparing treatment intensities.
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Affiliation(s)
- Tijana Simic
- Department of Speech-Language Pathology, University of Toronto, 160-500 University Avenue, Toronto, ON M5G 1V7, Canada; Rehabilitation Sciences Institute, University of Toronto, 500 University Avenue, Toronto, ON M5G 1V7, Canada; Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, 600 Peter Morand Cres., Suite 206, Ottawa, ON K1G 5Z3, Canada; KITE Research Institute, Toronto Rehab, University Health Network, 550 University Avenue, Toronto, ON M5G 2A2, Canada; Department of Psychology, Université de Montréal, 90 Vincent d'Indy Avenue, Montreal, QC H2V 2S9, Canada; Centre de Recherche de l'Institut Universitaire de Geriatrie de Montreal (CRIUGM), 4545 Queen Mary Rd., Montreal, QC H3W 1W4, Canada.
| | - Carol Leonard
- Department of Speech-Language Pathology, University of Toronto, 160-500 University Avenue, Toronto, ON M5G 1V7, Canada; Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, 600 Peter Morand Cres., Suite 206, Ottawa, ON K1G 5Z3, Canada; School of Rehabilitation Sciences, University of Ottawa, 451 Smyth Rd., Ottawa, ON K1H 8M5, Canada
| | - Laura Laird
- Department of Speech-Language Pathology, University of Toronto, 160-500 University Avenue, Toronto, ON M5G 1V7, Canada; KITE Research Institute, Toronto Rehab, University Health Network, 550 University Avenue, Toronto, ON M5G 2A2, Canada
| | - Steven Stewart
- KITE Research Institute, Toronto Rehab, University Health Network, 550 University Avenue, Toronto, ON M5G 2A2, Canada
| | - Elizabeth Rochon
- Department of Speech-Language Pathology, University of Toronto, 160-500 University Avenue, Toronto, ON M5G 1V7, Canada; Rehabilitation Sciences Institute, University of Toronto, 500 University Avenue, Toronto, ON M5G 1V7, Canada; Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, 600 Peter Morand Cres., Suite 206, Ottawa, ON K1G 5Z3, Canada; KITE Research Institute, Toronto Rehab, University Health Network, 550 University Avenue, Toronto, ON M5G 2A2, Canada
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Abstract
Although the treatment for lexical anomia in individuals with aphasia (IWA) was shown effective, little is known about the optimal treatment intensity required. The aim of this study was to verify whether intensive and non-intensive treatments led to different outcomes when parameters of intensity are rigorously controlled. Six IWA with post-stroke lexical anomia received phonological treatment at two distinct frequencies: intensive (four times a week) and non-intensive (once a week). Results showed that both treatments were equally effective. This finding is especially relevant in contexts in which speech-language therapy delivery services are limited.
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Ferreira ACDS, Silva AA, Paiva LR, Satler C, Cera ML. Intensive naming training for low-educated demented and non-demented elderly. Dement Neuropsychol 2020; 14:403-411. [PMID: 33354294 PMCID: PMC7735057 DOI: 10.1590/1980-57642020dn14-040011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT. Complaints about naming difficulties may be common in the elderly. In dementia, anomia is the most frequent symptom of language disorders. Naming training can improve lexical access and promote better quality of communication for elderly with or without dementia. Objective: To analyze naming scores, response time and the generalization of responses for naming of neurotypical and demented low-educated older adults before and after receiving a naming training program, with and without oral comprehension stimulation. Method: Twenty elderly participants, 10 with dementia and 10 neurotypical, were included after interview, screening for cognition and functionality. The naming training was based on retrieval practice and carried out in 5 sessions. Half of the group underwent exclusive naming training, while the other half received naming training associated with oral comprehension stimulation. Results: Elderly people with dementia performed better after training for scores on oral naming and comprehension of oral words, except for object manipulation. The response time for naming trained and untrained stimuli was also better for elderly people with dementia. After the intervention, neurotypical individuals performed statistically better in comprehension time and in the score in oral naming, comprehension of oral words and object manipulation, for trained and untrained words. Conclusion: Naming training, exclusive or associated with oral comprehension, using the recovery technique benefits the language performance of neurotypical and demented elderly, and provides improvements even for untrained stimuli.
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12
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Harvey S, Carragher M, Dickey MW, Pierce JE, Rose ML. Dose effects in behavioural treatment of post-stroke aphasia: a systematic review and meta-analysis. Disabil Rehabil 2020; 44:2548-2559. [PMID: 33164590 DOI: 10.1080/09638288.2020.1843079] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE Aphasia is a debilitating chronic acquired language disorder that impacts heavily on a person's life. Behavioural treatments aim to remediate language processing skills or to enhance communication between the person with aphasia and others, and a number of different treatments are efficacious. However, it is unclear how much of a particular treatment a person needs in order to optimise recovery of language and communication skills following stroke. MATERIALS AND METHODS Systematic search for and meta-analysis of experimental studies that directly compared different amounts of the same behavioural aphasia treatment, following PRISMA guidelines. RESULTS Treatment dose research in aphasia is an emerging area. Just six studies comparing different doses of the same intervention met all criteria for inclusion. Evidence from these studies was synthesised and meta-analysed, where possible. Meta-analyses were inconclusive due to limited data; however, there are indications that suggest increased dose may confer greater improvement on language and communication measures, but with diminishing returns over time. Aphasia severity and chronicity may affect dose-response relationships. CONCLUSIONS There is currently insufficient evidence to determine the effect of dose on treatment response. A dedicated and coordinated research agenda is required to systematically explore dose-response relationships in post-stroke aphasia interventions.A video abstract is available in the Supplementary Material.Implications for rehabilitationThe investigation of the effect of dose on treatment outcomes in post-stroke aphasia is an emerging research area with few studies reporting comparison of different amounts of the same intervention.In the acute phase of recovery following stroke, higher doses of treatment provided over short periods may not be preferable, tolerable, or superior to lower doses of the same treatment.In the chronic phase, providing additional blocks of treatment may confer additional benefit for some people with aphasia but with diminishing returns.People with chronic aphasia can achieve and maintain significant gains in picture naming after a relatively brief period of high-dose treatment.
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Affiliation(s)
- Sam Harvey
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia.,Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Bundoora, Australia
| | - Marcella Carragher
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia.,Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Bundoora, Australia
| | - Michael Walsh Dickey
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Bundoora, Australia.,Geriatric Research Education and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA.,Department of Communication Science and Disorders, University of Pittsburgh, Pittsburgh, PA, USA
| | - John E Pierce
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia.,Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Bundoora, Australia
| | - Miranda L Rose
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia.,Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Bundoora, Australia
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13
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Kaur H, Nehra A, Chopra S, Sati H, Bhatia R, Kumaran SS, Pandey R, Padma Srivastava MV. Development and Validation of a Comprehensive Neuropsychological and Language Rehabilitation for Stroke Survivors: A Home-Based Caregiver-Delivered Intervention Program. Ann Indian Acad Neurol 2020; 23:S116-S122. [PMID: 33343135 PMCID: PMC7731686 DOI: 10.4103/aian.aian_500_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 07/28/2020] [Accepted: 08/03/2020] [Indexed: 11/30/2022] Open
Abstract
CONTEXT Aphasia is a major disabling condition after a stroke that profoundly affects the quality of life of stroke survivors (SS) and their caregivers. Comprehensive neuropsychological rehabilitation has emerged as a complementary intervention that helps in improving the associated cognitive and psychological deficits and quality of life following a brain injury. A standardized, simple, and easy to administer intervention that can be delivered as a home-based intervention can assist in faster recovery. AIMS To describe the development, validation, and feasibility of a home-based, caregiver-delivered comprehensive neuropsychological and language rehabilitation for SS. METHODS AND MATERIAL A culture-specific picture and task-based 8-week training workbook and manual were developed based on extensive review and focused group discussions. This intervention targeted areas of language (comprehension, fluency, and naming) and cognition (working memory, attention and concentration, executive functioning, and response inhibition). It was standardized on 40 healthy controls (HC) and 15 SS. Before recruitment, written informed consent was obtained from each patient, their primary caregiver, and the HCs. RESULTS All tasks were found to be effective in discriminating the performance of SS from the HC. The performance of the HC with respect to the errors and the time taken for each task was used for the hierarchical arrangement of the tasks. The developed intervention was later validated on 15 SS where they significantly improved in the pre-post assessment of language functioning (P < 0.001), quality of life (P < 0.001), and depression (P < 0.001). CONCLUSIONS This intervention can be feasible to administer as a home-based intervention and may help to alleviate language and neuropsychological complaints after stroke in low-literate or mixed-cultural populations. Further, large sample size studies are recommended.
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Affiliation(s)
- Harsimarpreet Kaur
- Clinical Neuropsychology, Neurosciences Centre, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Ashima Nehra
- Clinical Neuropsychology, Neurosciences Centre, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Sakshi Chopra
- Clinical Neuropsychology, Neurosciences Centre, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Hemchandra Sati
- Department of Biostatistics, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Rohit Bhatia
- Department of Neurology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Senthil S. Kumaran
- Department of NMR, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - R.M. Pandey
- Department of Biostatistics, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - M. V. Padma Srivastava
- Department of Neurology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
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14
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Harvey SR, Carragher M, Dickey MW, Pierce JE, Rose ML. Treatment dose in post-stroke aphasia: A systematic scoping review. Neuropsychol Rehabil 2020; 31:1629-1660. [PMID: 32631143 DOI: 10.1080/09602011.2020.1786412] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Little is known about how the amount of treatment a person with aphasia receives impacts aphasia recovery following stroke, yet this information is vital to ensure effective treatments are delivered efficiently. Furthermore, there is no standard dose terminology in the stroke rehabilitation or aphasia literature. This scoping review aims to systematically map the evidence regarding dose in treatments for post-stroke aphasia and to explore how treatment dose is conceptualized, measured and reported in the literature. A comprehensive search was undertaken in June 2019. One hundred and twelve intervention studies were reviewed. Treatment dose (amount of treatment) has been conceptualized as both a measure of time and a count of discrete therapeutic elements. Doses ranged from one to 100 hours, while some studies reported session doses of up to 420 therapeutic inputs per session. Studies employ a wide variety of treatment schedules (i.e., session dose, session frequency, and intervention duration) and the interaction of dose parameters may impact the dose-response relationship. High dose interventions delivered over short periods may improve treatment efficiency while maintaining efficacy. Person- and treatment-level factors that mediate tolerance of high dose interventions require further investigation. Systematic exploration of dose-response relationships in post-stroke aphasia treatment is required.
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Affiliation(s)
- Sam R Harvey
- Discipline of Speech Pathology, School of Allied Health, Human Services and Sport, College of Science, Health and Engineering, La Trobe University, Bundoora, Australia.,Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Bundoora, Australia
| | - Marcella Carragher
- Discipline of Speech Pathology, School of Allied Health, Human Services and Sport, College of Science, Health and Engineering, La Trobe University, Bundoora, Australia.,Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Bundoora, Australia
| | - Michael Walsh Dickey
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Bundoora, Australia.,Geriatric Research Education and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA.,Department of Communication Sciences and Disorders, University of Pittsburgh, Pittsburgh, PA, USA
| | - John E Pierce
- Discipline of Speech Pathology, School of Allied Health, Human Services and Sport, College of Science, Health and Engineering, La Trobe University, Bundoora, Australia.,Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Bundoora, Australia
| | - Miranda L Rose
- Discipline of Speech Pathology, School of Allied Health, Human Services and Sport, College of Science, Health and Engineering, La Trobe University, Bundoora, Australia.,Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Bundoora, Australia
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15
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Copland DA. Elizabeth Usher Memorial Lecture: Lost in Translation? Challenges and future prospects for a neurobiological approach to aphasia rehabilitation. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2020; 22:270-280. [PMID: 32686593 DOI: 10.1080/17549507.2020.1768287] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
While there has been considerable progress in conducting trials of aphasia therapy, there is no consistent evidence for long-term benefits of aphasia treatment, suggesting the need to reconsider current approaches. There are also no accurate methods for determining the amount, type and timing of aphasia therapy that should be provided for an individual. At the same time, there has been increasing interest in applying various principles of neuroplasticity to aphasia treatment and using measures of brain structure and function to predict recovery. This article will consider the potential of neuroplasticity principles and neurobiological predictors to improve our current approach to aphasia rehabilitation and optimise outcomes. Reviewing these principles highlights some of the challenges of translating animal model-based principles and emphases the need to also consider relevant theories of human learning. While considerable progress has been made in considering neurobiological principles and using measures of brain structure and function to predict recovery, there is significant work required to achieve the full potential of this neurobiological approach to aphasia management.
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Affiliation(s)
- David A Copland
- School of Health and Rehabilitation Sciences, Centre for Clinical Research, Queensland Aphasia Rehabilitation Centre, The University of Queensland, St Lucia, Australia
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16
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Conlon EL, Braun EJ, Babbitt EM, Cherney LR. Treatment Fidelity Procedures for an Aphasia Intervention Within a Randomized Controlled Trial: Design, Feasibility, and Results. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2020; 29:412-424. [PMID: 31419155 DOI: 10.1044/2019_ajslp-cac48-18-0227] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Purpose This study reports on the treatment fidelity procedures implemented during a 5-year randomized controlled trial comparing intensive and distributed comprehensive aphasia therapy. Specifically, the results of 1 treatment, verb network strengthening treatment (VNeST), are examined. Method Eight participants were recruited for each of 7 consecutive cohorts for a total of 56 participants. Participants completed 60 hr of aphasia therapy, including 15 hr of VNeST. Two experienced speech-language pathologists delivered the treatment. To promote treatment fidelity, the study team developed a detailed manual of procedures and fidelity checklists, completed role plays to standardize treatment administration, and video-recorded all treatment sessions for review. To assess protocol adherence during treatment delivery, trained research assistants not involved in the treatment reviewed video recordings of a subset of randomly selected VNeST treatment sessions and completed the fidelity checklists. This process was completed for 32 participants representing 2 early cohorts and 2 later cohorts, which allowed for measurement of protocol adherence over time. Percent accuracy of protocol adherence was calculated across clinicians, cohorts, and study condition (intensive vs. distributed therapy). Results The fidelity procedures were sufficient to promote and verify a high level of adherence to the treatment protocol across clinicians, cohorts, and study condition. Conclusion Treatment fidelity strategies and monitoring are feasible when incorporated into the study design. Treatment fidelity monitoring should be completed at regular intervals during the course of a study to ensure that high levels of protocol adherence are maintained over time and across conditions.
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Affiliation(s)
- Elissa L Conlon
- Center for Aphasia Research and Treatment, Shirley Ryan AbilityLab, Chicago, IL
| | - Emily J Braun
- Center for Aphasia Research and Treatment, Shirley Ryan AbilityLab, Chicago, IL
| | - Edna M Babbitt
- Center for Aphasia Research and Treatment, Shirley Ryan AbilityLab, Chicago, IL
- Department of Physical Medicine & Rehabilitation, Northwestern University, Chicago, IL
| | - Leora R Cherney
- Center for Aphasia Research and Treatment, Shirley Ryan AbilityLab, Chicago, IL
- Department of Physical Medicine & Rehabilitation, Northwestern University, Chicago, IL
- Department of Communication Sciences and Disorders, Northwestern University, Evanston, IL
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17
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Middleton EL, Schuchard J, Rawson KA. A Review of the Application of Distributed Practice Principles to Naming Treatment in Aphasia. TOPICS IN LANGUAGE DISORDERS 2020; 40:36-53. [PMID: 32831450 PMCID: PMC7437680 DOI: 10.1097/tld.0000000000000202] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
It is uncontroversial in psychological research that different schedules of practice, which govern the distribution of practice over time, can promote radically different outcomes in terms of gains in performance and the durability of learning. In contrast, in speech-language treatment research, there is a critical need for well-controlled studies examining the impact of the distribution of treatment on efficacy (for reviews, see Cherney, 2012; Warren, Fey, & Yoder, 2007). In this paper, we enumerate key findings from psychological research on learning and memory regarding how different schedules of practice differentially confer durable learning. We review existing studies of aphasia treatment with a focus on naming impairment that have examined how the distribution of practice affects treatment efficacy. We close by discussing potential productive lines of research to elaborate the clinical applicability of distributed practice principles to language treatment.
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18
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The neural and neurocomputational bases of recovery from post-stroke aphasia. Nat Rev Neurol 2019; 16:43-55. [DOI: 10.1038/s41582-019-0282-1] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/14/2019] [Indexed: 12/15/2022]
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19
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Middleton EL, Rawson KA, Verkuilen J. Retrieval practice and spacing effects in multi-session treatment of naming impairment in aphasia. Cortex 2019; 119:386-400. [PMID: 31408823 DOI: 10.1016/j.cortex.2019.07.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 02/26/2019] [Accepted: 07/03/2019] [Indexed: 11/17/2022]
Abstract
Retrieval practice and spacing are two factors shown to enhance learning in basic psychological research. The present study investigated the clinical applicability of these factors to naming treatment in aphasia. Prior studies have shown that naming treatment that provides retrieval practice (i.e., practice retrieving names for objects from semantic memory) improves later naming performance in people with aphasia (PWA) more so than repetition training. Repetition training is a common form of naming treatment that can support errorless production of names for objects, but it does not provide retrieval practice. Prior work has also demonstrated enhanced naming treatment benefit in PWA when an item's training trials are separated by multiple intervening trials (i.e., spacing) compared to only one intervening trial (i.e., massing). However, in those studies, items were only trained in one session. Also, the effects of the learning factors were probed after one day and one week. The goal of the present study was to examine the effects of retrieval practice and spacing in a more clinically-inspired schedule of delivery and to assess the effects of the learning factors at retention intervals of greater functional significance. Matched sets of errorful items for each of four PWA were presented for multiple trials of retrieval practice or repetition in a spaced or massed schedule in each of multiple training sessions. Mixed regression analyses revealed that retrieval practice outperformed repetition, and spacing outperformed massing, at an initial post-treatment test administered after one week. Furthermore, the advantage for retrieval practice over repetition persisted at a follow-up test administered after one month. The potential clinical relevance of retrieval practice and spacing for multi-session interventions in speech-language treatment is discussed.
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Affiliation(s)
- Erica L Middleton
- Research Department, Moss Rehabilitation Research Institute, Elkins Park, PA, USA.
| | - Katherine A Rawson
- Department of Psychology, 332 Kent Hall, Kent State University, Kent, OH, USA
| | - Jay Verkuilen
- Educational Psychology, City University of New York Graduate Center, New York, NY, USA
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20
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Rapp B, Wiley RW. Re-learning and remembering in the lesioned brain. Neuropsychologia 2019; 132:107126. [PMID: 31226267 DOI: 10.1016/j.neuropsychologia.2019.107126] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 06/13/2019] [Accepted: 06/14/2019] [Indexed: 11/27/2022]
Abstract
It is well known that re-learning language skills after a brain lesion can be very difficult. However, while learning and memory challenges have been extensively researched in amnesic individuals, very little research attention has been directed at understanding the characteristics of learning and memory that are relevant to recovery and rehabilitation of acquired language impairments. Even in the absence of damage to the medial temporal lobe regions classically associated with learning and memory, these individuals often suffer damage to frontal and other subcortical areas associated with learning and memory that may contribute to the learning challenges they face. Therefore, an understanding of the learning and memory profiles of post-stroke language impairments is important for the development and optimization of rehabilitation approaches. In two studies, we examine the degree to which certain basic characteristics of learning and memory, identified in neurotypical individuals, are intact in individuals with post-stroke language impairment. We specifically consider fundamental principles regarding the optimal spacing of learning trials that have been shown to reliably operate in neurotypical adults, across a wide range of language domains. We report on two studies that examine whether or not these principles also apply in language re-learning and retention for individuals with acquired deficits in written language production. Study 1 compared distributed vs. clustered training schedules, while Study 2 examined-for the first time in the context of re-learning-the relationship between the spacing of training trials and the retention period. This investigation revealed that, despite significant cognitive deficits and brain lesions, remarkably similar principles govern re-learning and retention in the lesioned brain as have been found to apply in neurologically healthy individuals. These results allow us to begin to integrate our understanding of recovery with the broader literature on learning and memory and have implications for the optimal organization of rehabilitation. Specifically, the findings raise questions regarding the traditional compression of rehabilitation within relatively short time windows.
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Affiliation(s)
- Brenda Rapp
- Department of Cognitive Science, Johns Hopkins University, USA; Department of Psychological and Brain Science, Johns Hopkins University, USA; Department of Neuroscience, Johns Hopkins University, USA.
| | - Robert W Wiley
- Department of Cognitive Science, Johns Hopkins University, USA; Department of Psychology, University of North Carolina Greensboro, USA
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21
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Kiran S, Thompson CK. Neuroplasticity of Language Networks in Aphasia: Advances, Updates, and Future Challenges. Front Neurol 2019; 10:295. [PMID: 31001187 PMCID: PMC6454116 DOI: 10.3389/fneur.2019.00295] [Citation(s) in RCA: 109] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 03/06/2019] [Indexed: 11/13/2022] Open
Abstract
Researchers have sought to understand how language is processed in the brain, how brain damage affects language abilities, and what can be expected during the recovery period since the early 19th century. In this review, we first discuss mechanisms of damage and plasticity in the post-stroke brain, both in the acute and the chronic phase of recovery. We then review factors that are associated with recovery. First, we review organism intrinsic variables such as age, lesion volume and location and structural integrity that influence language recovery. Next, we review organism extrinsic factors such as treatment that influence language recovery. Here, we discuss recent advances in our understanding of language recovery and highlight recent work that emphasizes a network perspective of language recovery. Finally, we propose our interpretation of the principles of neuroplasticity, originally proposed by Kleim and Jones (1) in the context of extant literature in aphasia recovery and rehabilitation. Ultimately, we encourage researchers to propose sophisticated intervention studies that bring us closer to the goal of providing precision treatment for patients with aphasia and a better understanding of the neural mechanisms that underlie successful neuroplasticity.
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Affiliation(s)
- Swathi Kiran
- Sargent College of Health and Rehabilitation Sciences, Boston University, Boston, MA, United States
| | - Cynthia K. Thompson
- Department of Communication Sciences and Disorders, Northwestern University, Evanston, IL, United States
- Department of Neurology, The Cognitive Neurology and Alzheimer's Disease Center, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
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22
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Godlove J, Anantha V, Advani M, Des Roches C, Kiran S. Comparison of Therapy Practice at Home and in the Clinic: A Retrospective Analysis of the Constant Therapy Platform Data Set. Front Neurol 2019; 10:140. [PMID: 30858819 PMCID: PMC6398324 DOI: 10.3389/fneur.2019.00140] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Accepted: 02/04/2019] [Indexed: 12/03/2022] Open
Abstract
Background: Computer-based therapies can provide an affordable and practical alternative by providing frequent intervention for stroke survivors with chronic aphasia by allowing the opportunity for home exercise practice, however more evidence is needed. The goal of this retrospective analysis was to compare the time course of therapy engagement when therapy was targeted in the clinic or at home by post-stroke individuals. We examined if home users of the therapy were compliant in therapy and if this documented practice time was associated with improved outcomes similar to clinic patients who practiced under the guidance of a clinician. Methods: A retrospective analysis of anonymously aggregated data collected for 3,686 patients with post-stroke aphasia over the course of four years (2013-2017) was conducted. Participants either received therapy delivered through Constant Therapy only at home (N = 2,100) or only in the clinic (N = 1,577). Constant Therapy includes over 70 evidence-based therapies for language and cognitive skills. This program was individualized for each patient with targeted tasks that dynamically adapted to each individual's progress. Results: Patients with <60% accuracy were analyzed to determine how long it took them to reach >90% accuracy. Results showed that both home-therapy and clinic patients reached 90% accuracy on their tasks similarly (Median = 3 sessions), but the frequency of therapy was significantly different with 50% of home users receiving therapy at least every 2 days while 50% of clinic patients only had therapy once every 5 days (p < 0.001). Thus, home-therapy users were able to master tasks in a shorter time (median of 6 days) than clinic patients (median of 12 days) (p < 0.001). Conclusion: Outcomes of treatment are similar for home users and clinic patients indicating the potential usability of a home-based treatment program for rehabilitation for post-stroke aphasia.
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Affiliation(s)
| | | | | | | | - Swathi Kiran
- The Learning Corporation, Newton, MA, United States
- Aphasia Research Laboratory, Speech Language and Hearing Sciences, Boston University, Boston, MA, United States
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23
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Abstract
PURPOSE OF REVIEW We now know that speech and language therapy (SALT) is effective in the rehabilitation of aphasia; however, there remains much individual variability in the response to interventions. So, what works for whom, when and how? RECENT FINDINGS This review evaluates the current evidence for the efficacy of predominantly impairment-focused aphasia interventions with respect to optimal dose, intensity, timing and distribution or spacing of treatment. We conclude that sufficient dose of treatment is required to enable clinical gains and that e-therapies are a promising and practical way to achieve this goal. In addition, aphasia can be associated with other cognitive deficits and may lead to secondary effects such as low mood and social isolation. In order to personalise individual treatments to optimise recovery, we need to develop a greater understanding of the interactions between these factors.
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Affiliation(s)
- Catherine Doogan
- Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, London, UK.
- Institute of Cognititive Neuroscience, UCL, 17 Queen Square, London, UK.
| | - Jade Dignam
- UQ Centre for Clinical Research and School of Health & Rehabilitation Sciences, The University of Queensland, St Lucia, Australia
| | - David Copland
- UQ Centre for Clinical Research and School of Health & Rehabilitation Sciences, The University of Queensland, St Lucia, Australia
| | - Alex Leff
- Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, London, UK
- Institute of Cognititive Neuroscience, UCL, 17 Queen Square, London, UK
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24
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Harnish SM, Rodriguez AD, Blackett DS, Gregory C, Seeds L, Boatright JH, Crosson B. Aerobic Exercise as an Adjuvant to Aphasia Therapy: Theory, Preliminary Findings, and Future Directions. Clin Ther 2017; 40:35-48.e6. [PMID: 29277374 DOI: 10.1016/j.clinthera.2017.12.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 12/05/2017] [Accepted: 12/05/2017] [Indexed: 01/09/2023]
Abstract
PURPOSE This study investigated whether participation in aerobic exercise enhances the effects of aphasia therapy, and the degree to which basal serum brain-derived neurotropic factor (BDNF) concentrations fluctuate after the beginning of aerobic exercise or stretching activities in individuals with poststroke aphasia. METHODS The study used a single-subject, multiple-baseline design. Seven individuals with chronic poststroke aphasia participated in 2 Blocks of aphasia therapy: aphasia therapy alone (Block 1), followed by aphasia therapy with the addition of aerobic activity via bicycle ergometer (n = 5) or stretching (n = 2) (Block 2). Serum BDNF concentrations from blood draws were analyzed in 4 participants who exercised and in 1 participant who stretched. FINDINGS Three of the five exercise participants demonstrated larger Tau-U effects when aphasia therapy was paired with aerobic exercise, whereas 1 of the 2 stretching participants demonstrated a larger effect size when aphasia therapy was paired with stretching. Group-level comparisons revealed a greater overall increase in effect size in the aerobic exercise group, as indicated by differences in Tau-U weighted means. BDNF data showed that all 4 exercise participants demonstrated a decrease in BDNF concentrations during the first 6 weeks of exercise and an increase in BDNF levels near or at baseline during the last 6 weeks of exercise. The stretching participant did not show the same pattern. IMPLICATIONS Additional research is needed to understand the mechanism of effect and to identify the factors that mediate response to exercise interventions, specifically the optimal dose of exercise and timing of language intervention with exercise. ClinicalTrials.gov identifier: NCT01113879.
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Affiliation(s)
- Stacy M Harnish
- Department of Speech and Hearing Science, The Ohio State University, Columbus, Ohio.
| | - Amy D Rodriguez
- Atlanta VA RR&D Center for Visual and Neurocognitive Rehabilitation, Atlanta, Georgia
| | | | - Christopher Gregory
- Department of Health Sciences and Research, Medical University of South Carolina, Charleston, South Carolina
| | - Lauren Seeds
- Department of Physical Therapy, Brooks Rehabilitation, Jacksonville, Florida
| | - Jeffrey H Boatright
- Atlanta VA RR&D Center for Visual and Neurocognitive Rehabilitation, Atlanta, Georgia; Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia
| | - Bruce Crosson
- Atlanta VA RR&D Center for Visual and Neurocognitive Rehabilitation, Atlanta, Georgia; Department of Neurology, Emory University School of Medicine, Atlanta, Georgia; Department of Psychology, Georgia State University, Atlanta, Georgia
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25
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Zhang J, Yu J, Bao Y, Xie Q, Xu Y, Zhang J, Wang P. Constraint-induced aphasia therapy in post-stroke aphasia rehabilitation: A systematic review and meta-analysis of randomized controlled trials. PLoS One 2017; 12:e0183349. [PMID: 28846724 PMCID: PMC5573268 DOI: 10.1371/journal.pone.0183349] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2017] [Accepted: 08/02/2017] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Constraint-induced aphasia therapy (CIAT) has been widely used in post-stroke aphasia rehabilitation. An increasing number of clinical controlled trials have investigated the efficacy of the CIAT for the post-stroke aphasia. PURPOSE To systematically review the randomized controlled trials (RCTs) concerning the effect of the CIAT in post-stroke patients with aphasia, and to identify the useful components of CIAT in post-stroke aphasia rehabilitation. METHODS A computerized database search was performed through five databases (Pubmed, EMbase, Medline, ScienceDirect and Cochrane library). Cochrane handbook domains were used to evaluate the methodological quality of the included RCTs. RESULTS Eight RCTs qualified in the inclusion criteria. Inconsistent results were found in comparing the CIAT with conventional therapies without any component from the CIAT based on the results of three RCTs. Five RCTs showed that the CIAT performed equally well as other intensive aphasia therapies, in terms of improving language performance. One RCT showed that therapies embedded with social interaction were likely to enhance the efficacy of the CIAT. CONCLUSION CIAT may be useful for improving chronic post-stroke aphasia, however, limited evidence to support its superiority to other aphasia therapies. Massed practice is likely to be a useful component of CIAT, while the role of "constraint" is needed to be further explored. CIAT embedded with social interaction may gain more benefits.
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Affiliation(s)
- Jiaqi Zhang
- Master of Science in Neurological Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Jiadan Yu
- School of Rehabilitation Sciences, West China School of Medicine, Sichuan University, Sichuan, China
| | - Yong Bao
- Ruijin Rehabilitation Hospital of Shanghai Jiao Tong University, Shanghai, China
| | - Qing Xie
- Department of Rehabilitation Medicine, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yang Xu
- School of Rehabilitation Sciences, West China School of Medicine, Sichuan University, Sichuan, China
| | - Junmei Zhang
- Department of Physical Education, Wuhan University of Technology, Wuhan, China
| | - Pu Wang
- Department of Rehabilitation Medicine, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- * E-mail:
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Owolabi M, Miranda JJ, Yaria J, Ovbiagele B. Controlling cardiovascular diseases in low and middle income countries by placing proof in pragmatism. BMJ Glob Health 2016; 1. [PMID: 27840737 PMCID: PMC5103314 DOI: 10.1136/bmjgh-2016-000105] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Low and middle income countries (LMICs) bear a huge, disproportionate and growing burden of cardiovascular disease (CVD) which constitutes a threat to development. Efforts to tackle the global burden of CVD must therefore emphasise effective control in LMICs by addressing the challenge of scarce resources and lack of pragmatic guidelines for CVD prevention, treatment and rehabilitation. To address these gaps, in this analysis article, we present an implementation cycle for developing, contextualising, communicating and evaluating CVD recommendations for LMICs. This includes a translatability scale to rank the potential ease of implementing recommendations, prescriptions for engaging stakeholders in implementing the recommendations (stakeholders such as providers and physicians, patients and the populace, policymakers and payers) and strategies for enhancing feedback. This approach can help LMICs combat CVD despite limited resources, and can stimulate new implementation science hypotheses, research, evidence and impact.
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Affiliation(s)
- Mayowa Owolabi
- Department of Medicine, University of Ibadan, and University College Hospital, Ibadan, Nigeria; World Federation for Neurorehabilitation-Blossom Specialist Medical Center, Ibadan, Nigeria
| | - Jaime J Miranda
- Department of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru; CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Joseph Yaria
- Department of Medicine, University of Ibadan, and University College Hospital, Ibadan, Nigeria
| | - Bruce Ovbiagele
- Department of Neurology, Medical University of South Carolina, Charleston, South Carolina, USA
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Koyuncu E, Çam P, Altınok N, Çallı DE, Duman TY, Özgirgin N. Speech and language therapy for aphasia following subacute stroke. Neural Regen Res 2016; 11:1591-1594. [PMID: 27904489 PMCID: PMC5116837 DOI: 10.4103/1673-5374.193237] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2016] [Indexed: 01/25/2023] Open
Abstract
The aim of this study was to investigate the time window, duration and intensity of optimal speech and language therapy applied to aphasic patients with subacute stroke in our hospital. The study consisted of 33 patients being hospitalized for stroke rehabilitation in our hospital with first stroke but without previous history of speech and language therapy. Sixteen sessions of impairment-based speech and language therapy were applied to the patients, 30-60 minutes per day, 2 days a week, for 8 successive weeks. Aphasia assessment in stroke patients was performed with Gülhane Aphasia Test-2 before and after treatment. Compared with before treatment, fluency of speech, listening comprehension, reading comprehension, oral motor evaluation, automatic speech, repetition and naming were improved after treatment. This suggests that 16 seesions of speech and language therapy, 30-60 minutes per day, 2 days a week, for 8 successive weeks, are effective in the treatment of aphasic patients with subacute stroke.
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Affiliation(s)
- Engin Koyuncu
- Department of Physical Medicine and Rehabilitation, Ankara Physical Medicine and Rehabilitation Training and Research Hospital, Ankara, Turkey
| | - Pınar Çam
- Department of Physical Medicine and Rehabilitation, Ankara Physical Medicine and Rehabilitation Training and Research Hospital, Ankara, Turkey
| | - Nermin Altınok
- Department of Psychology, Ankara Physical Medicine and Rehabilitation Training and Research Hospital, Ankara, Turkey
| | - Duygu Ekinci Çallı
- Department of Psychology, Ankara Physical Medicine and Rehabilitation Training and Research Hospital, Ankara, Turkey
| | - Tuba Yarbay Duman
- Department of Linguistics, Amsterdam Center for Language and Communication, Amsterdam Brain and Cognition Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Neşe Özgirgin
- Department of Physical Medicine and Rehabilitation, Ankara Physical Medicine and Rehabilitation Training and Research Hospital, Ankara, Turkey
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Hoover EL, Caplan DN, Waters GS, Carney A. Communication and quality of life outcomes from an interprofessional intensive, comprehensive, aphasia program (ICAP). Top Stroke Rehabil 2016; 24:82-90. [DOI: 10.1080/10749357.2016.1207147] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Elizabeth L. Hoover
- Department of Speech-Language and Hearing Sciences, College of Health and Rehabilitation Sciences: Sargent College, Boston University, Boston, MA, USA
| | - David N. Caplan
- Neuropsychology Lab, Massachusetts General Hospital, Boston MA, USA
| | - Gloria S. Waters
- Department of Speech-Language and Hearing Sciences, College of Health and Rehabilitation Sciences: Sargent College, Boston University, Boston, MA, USA
| | - Anne Carney
- Department of Speech-Language and Hearing Sciences, College of Health and Rehabilitation Sciences: Sargent College, Boston University, Boston, MA, USA
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