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Azios JH, Archer B, Simmons-Mackie N, Raymer A, Carragher M, Shashikanth S, Gulick E. Conversation as an Outcome of Aphasia Treatment: A Systematic Scoping Review. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2022; 31:2920-2942. [PMID: 36356216 DOI: 10.1044/2022_ajslp-22-00011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
PURPOSE Conversation-focused speech-language pathology services are a top priority for people living with aphasia, but little is known about how researchers measure conversation as an outcome of treatment. This scoping review was undertaken to systematically review the evidence regarding the measurement of conversation in aphasia studies and to identify current practices and existing gaps. METHOD A systematic literature search was conducted for studies published between January 1995 and September 2019 in multiple electronic databases. Covidence software was used to manage search results, study selection, and data charting processes. Data were extracted from each study and then collated and organized to elucidate the breadth of approaches, tools, or procedures oriented to measuring conversation as an outcome and identify gaps in the existing literature. RESULTS The systematic search of the literature resulted in 1,244 studies. A total of 64 studies met inclusion criteria and were included in the review. The review summarizes the various tools and procedures used to measure conversation as an outcome of aphasia intervention, including variations in data collection and analysis procedures. The review also evaluates the quality of conversation measures in terms of psychometric properties and informal measures of validity. There was a total of 211 measures used across the 64 studies. CONCLUSIONS While there was no clear measure that was objectively superior, several measures show promise and warrant future exploration. Some of the orientations, conceptualizations, and procedures we have presented can be seen as options that might be included in a future conversation-focused core outcome set. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.21514062.
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Affiliation(s)
- Jamie H Azios
- Department of Communicative Disorders, University of Louisiana at Lafayette
| | - Brent Archer
- Department of Communication Sciences and Disorders, Bowling Green State University, OH
| | - Nina Simmons-Mackie
- Department of Health & Human Sciences, Southeastern Louisiana University, Hammond
| | - Anastasia Raymer
- Department of Communication Disorders & Special Education, Old Dominion University, Norfolk, VA
| | - Marcella Carragher
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
- Centre for Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University, Melbourne, Victoria, Australia
| | - Shriya Shashikanth
- Department of Communicative Disorders, University of Louisiana at Lafayette
| | - Eleanor Gulick
- Department of Communication Sciences and Disorders, Bowling Green State University, OH
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Mindfulness and Relaxation Techniques for Stroke Survivors with Aphasia: A Feasibility and Acceptability Study. Healthcare (Basel) 2022; 10:healthcare10081409. [PMID: 36011066 PMCID: PMC9407875 DOI: 10.3390/healthcare10081409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 07/25/2022] [Accepted: 07/26/2022] [Indexed: 11/16/2022] Open
Abstract
Stroke survivors with aphasia (SsWA) tend to experience high levels of anxiety and stress, leading to an increased risk of recurrent strokes. Mindfulness and/or relaxation that does not require language outputs could reduce psychosocial stress; however, these approaches work best if they consist of a range of techniques and are modified to suit the needs of SsWA. Using a mixed-methods approach, we examined the feasibility and acceptability of a set of tailored mindfulness and relaxation techniques for SsWA. Nine SsWA were recruited (six men and three women, median age = 51 years). Four relaxation and mindfulness techniques which had been tailored for SsWA were filmed into a DVD/YouTube video and were given to participants together with a practice diary for home practice once daily for 5 weeks. The participants joined focus group discussions and completed a feasibility scale 5 weeks later. The participants perceived these techniques as easy, user-friendly and acceptable for SsWA in general. Although practised less often than instructed, many participants reported benefits of regular practice. The perceived relevance of these techniques to the participants’ own situations and the intention to continue varied. Future research could encourage the regular practice of self-help interventions by incorporating behavioural change techniques such as using prompts and cues.
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Sandberg CW, Nadermann K, Parker L, Kubat AM, Conyers LM. Counseling in Aphasia: Information and Strategies for Speech-Language Pathologists. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2021; 30:2337-2349. [PMID: 34499847 DOI: 10.1044/2021_ajslp-20-00312] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Purpose The purpose of this tutorial is to provide an overview of mental health concerns of persons with aphasia (PWAs), strategies that speech-language pathologists (SLPs) can use to address the mental health concerns of PWAs within their scope of practice, guidance related to how SLPs can help facilitate access to appropriate mental health services, and suggestions for the future of pre- and postcertification education regarding counseling in aphasia for SLPs. Method This tutorial begins with a case study that is used as a reference point throughout the tutorial. It then introduces the gap in mental health services for PWAs that prompted this work, walks SLPs through common mental health concerns PWAs experience, and provides guidance for SLPs related to counseling techniques they can utilize within their sessions and referral to counseling professionals. We end by reiterating the need for more mental health awareness and training for SLPs and suggestions for incorporating more training related to addressing client mental health concerns and developing effective collaborations with rehabilitation and mental health counselors, as needed. Conclusions The mental health needs of PWAs are not being met. This is partly due to a lack of training in counseling for SLPs and a lack of training in communication techniques for rehabilitation and mental health counselors. With this tutorial, we hope to bring more awareness to the current need for mental health services for PWAs and to provide SLPs with some tools for addressing these needs among their clientele.
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Affiliation(s)
- Chaleece W Sandberg
- Department of Communication Sciences and Disorders, The Pennsylvania State University, University Park
| | - Kristen Nadermann
- Department of Educational Psychology, Counseling, and Special Education, The Pennsylvania State University, University Park
| | - Lauren Parker
- Department of Educational Psychology, Counseling, and Special Education, The Pennsylvania State University, University Park
| | - Anne Marie Kubat
- Department of Communication Sciences and Disorders, The Pennsylvania State University, University Park
| | - Liza M Conyers
- Department of Educational Psychology, Counseling, and Special Education, The Pennsylvania State University, University Park
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Laures-Gore J, Stache M, Moore E, Tullis C. App-based data collection, mental imagery, and naming performance in adults with aphasia. Complement Ther Clin Pract 2021; 44:101422. [PMID: 34126364 DOI: 10.1016/j.ctcp.2021.101422] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 05/17/2021] [Accepted: 05/21/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND AND PURPOSE Naming impairments are often found in aphasia. Combining mHealth technology with mental imagery may offer new insights into novel approaches to naming interventions in persons with aphasia. The aims of this study are to (1) explore whether mental imagery can improve performance during a naming task in adults with aphasia; and, (2) demonstrate the use of app-based data collection for research in aphasia rehabilitation through utilization of an app designed specifically for this study. MATERIALS AND METHODS A single subject non-concurrent multiple baseline design across participants was utilized. Four participants with anomic and conduction aphasia were included. Each participant's percentage of naming accuracy was measured before the initiating intervention to establish a baseline level of performance. RESULTS Per overlap metrics, two of the participants demonstrated a strong effect in improving naming from baseline to intervention on items using the app. Two participants showed no effect in naming accuracy from the imagery intervention. CONCLUSION Some participants showed improvement in naming items following an imagery script, suggesting that this complementary health practice should continue to be explored. Additionally, this study demonstrates the successful use of app-based data collection.
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Affiliation(s)
- Jaqueline Laures-Gore
- Department of Communication Sciences and Disorders, Georgia State University, United States.
| | - Monika Stache
- Department of Communication Sciences and Disorders, Georgia State University, United States.
| | - Elliot Moore
- School of Electrical and Computer Engineering at Georgia Institute of Technology, United States.
| | - Chris Tullis
- Department of Communication Sciences and Disorders, Georgia State University, United States; Department of Learning Sciences, Georgia State University, United States.
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Chih YC, Tsai MJ, Stierwalt JAG, LaPointe LL. Assessing Physiological Stress Responses to Word Retrieval in Individuals with Aphasia: A Preliminary Study. Folia Phoniatr Logop 2020; 73:134-145. [PMID: 32160628 DOI: 10.1159/000506335] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 02/03/2020] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Word retrieval difficulty can be distressing for individuals with aphasia. However, physiological stress responses to word retrieval are relatively unstudied. This study aims to measure the physiological response (i.e., heart rate and respiratory rate) and perceived stress in individuals with aphasia during a naming task to understand whether word retrieval may be a stressor to them. METHOD An aphasia group (n = 7) and a healthy group (n = 38) participated in 4 experimental conditions, including rest, counting, and high-frequency and low-frequency word conditions, while their physiological parameters were measured throughout the sessions. Stress ratings were also obtained for each condition. RESULTS Significant differences in heart rate were found while participants were engaged in speech and/or language tasks, compared to the rest condition, for both groups. Significant differences in respiratory rate were found between the rest and low-frequency word conditions in the aphasia group. No significant difference was found in heart rate between 2 groups, but a difference in respiratory rate was found between 2 groups in the low-frequency word condition. There were some discrepancies between stress level and physiological parameters. CONCLUSIONS Individuals with aphasia perceived greater stress in the naming tasks, however, the perceived stress was not necessarily parallel to the physiological parameters.
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Affiliation(s)
- Yu-Chun Chih
- Department of Speech Language Pathology and Audiology, Chung Shan Medical University, Taichung City, Taiwan, .,Rehabilitation Research Center, Chung Shan Medical University, Taichung City, Taiwan, .,Speech and Language Therapy Room, Chung Shan Medical University Hospital, Taichung City, Taiwan,
| | - Meng-Ju Tsai
- Department of Speech Language Pathology and Audiology, Chung Shan Medical University, Taichung City, Taiwan.,Rehabilitation Research Center, Chung Shan Medical University, Taichung City, Taiwan.,Speech and Language Therapy Room, Chung Shan Medical University Hospital, Taichung City, Taiwan
| | - Julie A G Stierwalt
- Division of Speech Pathology, Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Leonard L LaPointe
- School of Communication Science and Disorders, Florida State University, Tallahassee, Florida, USA
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Gillespie DC, Cadden AP, West RM, Broomfield NM. Non-pharmacological interventions for post-stroke emotionalism (PSE) within inpatient stroke settings: a theory of planned behavior survey. Top Stroke Rehabil 2019; 27:15-24. [DOI: 10.1080/10749357.2019.1654241] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- David C Gillespie
- Clinical Neuropsychology Service, Department of Clinical Neurosciences (DCN), Western General Hospital, Edinburgh, UK
| | - Amy P Cadden
- Neuropsychology Service, Great Ormond Street Hospital for Children, London, UK
| | - Robert M West
- Institute of Health Sciences, University of Leeds, Leeds, UK
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Baker C, Worrall L, Rose M, Hudson K, Ryan B, O'Byrne L. A systematic review of rehabilitation interventions to prevent and treat depression in post-stroke aphasia. Disabil Rehabil 2017; 40:1870-1892. [PMID: 28420284 DOI: 10.1080/09638288.2017.1315181] [Citation(s) in RCA: 78] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE Stepped psychological care is the delivery of routine assessment and interventions for psychological problems, including depression. The aim of this systematic review was to analyze and synthesize the evidence of rehabilitation interventions to prevent and treat depression in post-stroke aphasia and adapt the best evidence within a stepped psychological care framework. METHOD Four databases were systematically searched up to March 2017: Medline, CINAHL, PsycINFO and The Cochrane Library. RESULTS Forty-five studies met inclusion and exclusion criteria. Level of evidence, methodological quality and results were assessed. People with aphasia with mild depression may benefit from psychosocial-type treatments (based on 3 level ii studies with small to medium effect sizes). For those without depression, mood may be enhanced through participation in a range of interventions (based on 4 level ii studies; 1 level iii-3 study and 6 level iv studies). It is not clear which interventions may prevent depression in post-stroke aphasia. No evidence was found for the treatment of moderate to severe depression in post-stroke aphasia. CONCLUSIONS This study found some interventions that may improve depression outcomes for those with mild depression or without depression in post-stroke aphasia. Future research is needed to address methodological limitations and evaluate and support the translation of stepped psychological care across the continuum. Implications for Rehabilitation Stepped psychological care after stroke is a framework with levels 1 to 4 which can be used to prevent and treat depression for people with aphasia. A range of rehabilitation interventions may be beneficial to mood at level 1 for people without clinically significant depression (e.g., goal setting and achievement, psychosocial support, communication partner training and narrative therapy). People with mild symptoms of depression may benefit from interventions at level 2 (e.g., behavioral therapy, psychosocial support and problem solving). People with moderate to severe symptoms of depression require specialist mental health/behavioral services in collaboration with stroke care at levels 3 and 4 of stepped psychological care.
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Affiliation(s)
- Caroline Baker
- a School of Health and Rehabilitation Sciences, The University of Queensland , Brisbane , Australia
| | - Linda Worrall
- a School of Health and Rehabilitation Sciences, The University of Queensland , Brisbane , Australia
| | - Miranda Rose
- b School of Allied Health, La Trobe University , Melbourne , Australia
| | - Kyla Hudson
- a School of Health and Rehabilitation Sciences, The University of Queensland , Brisbane , Australia
| | - Brooke Ryan
- a School of Health and Rehabilitation Sciences, The University of Queensland , Brisbane , Australia
| | - Leana O'Byrne
- a School of Health and Rehabilitation Sciences, The University of Queensland , Brisbane , Australia
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Laures-Gore JS, Buchanan TW. Aphasia and the neuropsychobiology of stress. J Clin Exp Neuropsychol 2015; 37:688-700. [DOI: 10.1080/13803395.2015.1042839] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Cahana-Amitay D, Oveis AC, Sayers JT, Pineles SL, Spiro A, Albert ML. Biomarkers of "Linguistic Anxiety" in aphasia: a proof-of-concept case study. CLINICAL LINGUISTICS & PHONETICS 2015; 29:401-413. [PMID: 25815438 DOI: 10.3109/02699206.2015.1014572] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
This is a proof-of-concept case study designed to evaluate the presence of "Linguistic Anxiety" in a person with mild aphasia. The participant (aged 68) was tested on linguistic and non-linguistic cognitive tasks administered under conditions that differed in levels of anxiety. A validated anxiety-induction technique rarely used in previous aphasia studies was employed: the participant was instructed to prepare for a public speaking presentation. Measures of linguistic and non-linguistic cognitive performance, and anxiety (self-report and psychophysiologic) were obtained. The participant exhibited increased psychophysiologic stress reactivity (heart rate, skin conductance and self-report ratings) in the high-anxiety condition. In the state of increased anxiety, performance on language tasks, in particular discourse production, declined relative to performance in low-anxiety settings. Even in mild aphasia, language-based anxiety can interfere with language performance. This finding provides a basis for carrying out a study with a larger sample that can open a new path to assessment and treatment of persons with aphasia.
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Marshall RS, Basilakos A, Williams T, Love-Myers K. Exploring the benefits of unilateral nostril breathing practice post-stroke: attention, language, spatial abilities, depression, and anxiety. J Altern Complement Med 2013; 20:185-94. [PMID: 24116880 DOI: 10.1089/acm.2013.0019] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Unilateral nostril breathing (UNB) is a yogic pranayama technique that has been shown to improve verbal and spatial cognition in neurologically intact individuals. Early study of UNB in healthy individuals has shown benefits for attention and memory. This preliminary study explored whether UNB influenced various measures of attention, language, spatial abilities, depression, and anxiety in post-stroke individuals, both with and without aphasia. DESIGN A within-subjects repeated-measures design was used to determine whether UNB improved cognitive, linguistic, and affect variables in post-stroke individuals. Within-subjects comparisons determined UNB's effects over time, and between-subjects comparison was used to determine whether changes in these variables differed between post-stroke individuals with and without aphasia. SETTING Athens and Atlanta, Georgia. PARTICIPANTS Eleven post-stroke individuals participated in a 10-week UNB program. Five individuals had stroke-induced left hemisphere damage with no diagnosis of aphasia (left hemisphere damage control group; LHD), and six individuals experienced left hemisphere damage with a diagnosis of aphasia (individuals with aphasia group; IWA). MEASURES Individuals were assessed on measures of attention, language, spatial abilities, depression, and anxiety before, during, and after UNB treatment. RESULTS UNB significantly decreased levels of anxiety for individuals in both groups. Performance on language measures increased for the individuals with aphasia. CONCLUSIONS Significant findings for language and affect measures indicate that further investigation regarding duration of UNB treatment and use of UNB treatment alongside traditional speech-language therapy in post-stroke individuals is warranted.
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Affiliation(s)
- Rebecca Shisler Marshall
- Communication Sciences & Special Education, Biomedical & Health Sciences Institute, University of Georgia , Athens, GA
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Orenstein E, Basilakos A, Marshall RS. Effects of mindfulness meditation on three individuals with aphasia. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2012; 47:673-684. [PMID: 23121526 DOI: 10.1111/j.1460-6984.2012.00173.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND There is evidence to suggest that people with aphasia (PWA) may have deficits in attention stemming from the inefficient allocation of resources. The inaccurate perception of task demand, or sense of effort, may underlie the misallocation of the available attention resources. Given the lack of treatment options for improving attention in aphasia, Mindfulness Meditation, shown to improve attention in neurologically intact individuals, may prove effective in increasing attention in PWA. AIMS The purpose of the present study was to determine if Mindfulness Meditation improves divided attention or language in PWA and if it affects the overall sense of effort. METHODS & PROCEDURES A multiple baseline single-subject design was used to determine the effects of Mindfulness Meditation on divided attention for three PWA. Divided attention was measured using a non-linguistic divided attention task. Visual inspection of the data was used to determine changes in performance (sense of effort, reaction time and accuracy, language) over time. OUTCOMES & RESULTS High performance observed on the attention measures suggests that PWA have varying degrees of attentional impairment that may surface when certain demands are presented. There were no observable changes in the performance on the sense of effort or language measures; however, measures of reaction time may indicate Mindfulness Meditation improved efficiency of task completion. CONCLUSIONS & IMPLICATIONS All three participants reported that Mindfulness Meditation was easy to learn and carry out on a daily basis, and reported feeling more 'relaxed' and 'peaceful' after Mindfulness Meditation training than before. With the knowledge that PWA can learn meditative practices, and with such successful findings in neurologically intact individuals, it is important to continue evaluating the benefits of Mindfulness Meditation in PWA.
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da Fontoura DR, Rodrigues JDC, Carneiro LBDS, Monção AM, de Salles JF. Rehabilitation of language in expressive aphasias: a literature review. Dement Neuropsychol 2012; 6:223-235. [PMID: 29213802 PMCID: PMC5619334 DOI: 10.1590/s1980-57642012dn06040006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Objective This paper reviews the methodological characteristics of studies on
rehabilitation of expressive aphasia, describing the techniques of
rehabilitation used. Methods The databases Medline, Science Direct and PubMed were searched for relevant
articles (January 1999 to December 2011) using the keywords Expressive /
Broca / Nonfluent Aphasia, combined with Language or Speech Rehabilitation /
Therapy / Intervention. Results A total of 56 articles were retrieved describing rehabilitation techniques,
including 22 with a focus on lexical processing, 18 on syntax stimulation,
seven with the aim of developing speech and nine with multiple foci. Conclusion A variety of techniques and theoretical approaches are available,
highlighting the heterogeneity of research in this area. This diversity can
be justified by the uniqueness of patients' language deficits, making it
difficult to generalize. In addition, there is a need to combine the formal
measures of tests with measures of pragmatic and social skills of
communication to determine the effect of rehabilitation on the patient's
daily life.
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Affiliation(s)
- Denise Ren da Fontoura
- Fonoaudióloga, Doutora em Ciências da Linguagem/Psicolinguística pela Universidade Nova de Lisboa (UNL), Mestre em Ciências da Saúde/Neurociências pela Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Especialista em Reabilitação Fonoaudiológica/ Voz pelo Instituto Metodista IPA e Pós Graduada em Neuropsicologia/ Linguagem pela PUCRS
| | - Jaqueline de Carvalho Rodrigues
- Psicóloga Clínica, Mestranda em Psicologia no Programa de Pós-Graduação em Psicologia, Universidade Federal do Rio Grande do Sul - UFRGS
| | | | - Ana Maria Monção
- Professora Auxiliar do Departamento de Linguística da Universidade Nova de Lisboa, Doutora em Psicolinguística, Licenciada em Psicoterapia e Mestre em Neuropsicologia e Demências
| | - Jerusa Fumagalli de Salles
- Fonoaudióloga, Doutora em Psicologia, Professora Adjunta do Departamento de Psicologia do Desenvolvimento e da Personalidade, Instituto de Psicologia, Programa de Pós-Graduação em Psicologia, Universidade Federal do Rio Grande do Sul - UFRGS, Coordenadora do Núcleo de estudos em Neuropsicologia Cognitiva - NEUROCOG
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Cahana-Amitay D, Albert ML, Pyun SB, Westwood A, Jenkins T, Wolford S, Finley M. Language as a Stressor in Aphasia. APHASIOLOGY 2011; 25:593-614. [PMID: 22701271 PMCID: PMC3372975 DOI: 10.1080/02687038.2010.541469] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
BACKGROUND: Persons with aphasia often report feeling anxious when using language while communicating. While many patients, caregivers, clinicians and researchers would agree that language may be a stressor for persons with aphasia, systematic empirical studies of stress and/or anxiety in aphasia remain scarce. AIM: The aim of this paper is to review the existing literature discussing language as a stressor in aphasia, identify key issues, highlight important gaps, and propose a program for future study. In doing so, we hope to underscore the importance of understanding aspects of the emotional aftermath of aphasia, which plays a critical role in the process of recovery and rehabilitation. MAIN CONTRIBUTION: Post stroke emotional dysregulation in persons with chronic aphasia clearly has adverse effects for language performance and prospects of recovery. However, the specific role anxiety might play in aphasia has yet to be determined. As a starting point, we propose to view language in aphasia as a stressor, linked to an emotional state we term "linguistic anxiety." Specifically, a person with linguistic anxiety is one in whom the deliberate, effortful production of language involves anticipation of an error, with the imminence of linguistic failure serving as the threat. Since anticipation is psychologically linked to anxiety and also plays an important role in the allostatic system, we suggest that examining physiologic stress responses in persons with aphasia when they are asked to perform a linguistic task would be a productive tool for assessing the potential relation of stress to "linguistic anxiety." CONCLUSION: Exploring the putative relationship between anxiety and language in aphasia, through the study of physiologic stress responses, could establish a platform for investigating language changes in the brain in other clinical populations, such as in individuals with Alzheimer's disease or persons with post traumatic stress disorder, or even with healthy aging persons, in whom "linguistic anxiety" might be at work when they have trouble finding words.
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Affiliation(s)
- Dalia Cahana-Amitay
- Boston University, Department of Neurology, Harold Goodglass Aphasia Research Center, VA Healthcare System, 150 South Huntington Avenue Boston, MA 02130
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Laures-Gore JS, DuBay MF, Duff MC, Buchanan TW. Identifying behavioral measures of stress in individuals with aphasia. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2010; 53:1394-1400. [PMID: 20643788 DOI: 10.1044/1092-4388(2010/09-0236)] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
PURPOSE To develop valid indicators of stress in individuals with aphasia (IWA) by examining the relationship between certain language variables (error frequency [EF] and word productivity [WP]) and cortisol reactivity. METHOD Fourteen IWA and 10 controls participated in a speaking task. Salivary cortisol was collected pre- and posttask. WP and EF were calculated from the language sample elicited during the speaking task. RESULTS As expected, IWA had less WP and a higher EF than did control participants, and these effects were related to aphasia severity. Cortisol reactivity of IWA was moderately associated with WP, such that those with higher WP showed greater cortisol reactivity. The control group did not demonstrate this relation. Neither group demonstrated a relation between salivary cortisol reactivity and EF. CONCLUSION WP in individuals with aphasia holds potential as a behavioral index of stress in this population.
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Affiliation(s)
- Jacqueline S Laures-Gore
- Communication Disorders Program, Department of Educational Psychology and Special Education, Georgia State University, P.O. Box 3979, Atlanta, GA 30302-3979, USA.
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Laures-Gore J, Heim CM, Hsu YS. Assessing cortisol reactivity to a linguistic task as a marker of stress in individuals with left-hemisphere stroke and aphasia. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2007; 50:493-507. [PMID: 17463243 DOI: 10.1044/1092-4388(2007/034)] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
PURPOSE In this study, the authors explore a method of measuring physiologic and perceived stress in individuals with aphasia by investigating salivary cortisol reactivity and subjectively perceived stress in response to a standardized linguistic task. METHOD Fifteen individuals with aphasia and 15 age-matched healthy controls participated in a linguistic task involving speaking to an unfamiliar listener and a nonlinguistic task consisting of the Mirror Drawing Test (Starch, 1910). Salivary cortisol samples were taken following a 30-min baseline period, at the beginning and end of each task, and at 10-min intervals throughout the posttask period. Perceptions of stress also were assessed. RESULTS No significant difference was found in cortisol levels over time within the group with aphasia between the linguistic and nonlinguistic task; however, the control group demonstrated greater cortisol reactivity during the linguistic task than during the nonlinguistic task. For the linguistic task only, the control group demonstrated greater cortisol reactivity than did the group with aphasia. Both groups perceived greater stress posttask than pretask, although the aphasia group perceived greater stress than did the control group. CONCLUSION Adults with aphasia perceived greater stress than did healthy controls; however, this paradigm did not stimulate salivary cortisol reactivity in the aphasia group. A potential reason for this may be differences in the type or degree of psychosocial variables that are important in modulating stress in this population. Other considerations when developing methods for assessing physiologic stress include habituation and hypothalamic-pituitary-adrenal (HPA) axis dysregulation related to the neurological changes poststroke.
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Affiliation(s)
- Jacqueline Laures-Gore
- Department of Educational Psychology and Special Education, Communication Disorders Program,Georgia State University, P.O.Box 3979, Atlanta, Georgia 30302-3979, USA.
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Cicerone KD, Dahlberg C, Malec JF, Langenbahn DM, Felicetti T, Kneipp S, Ellmo W, Kalmar K, Giacino JT, Harley JP, Laatsch L, Morse PA, Catanese J. Evidence-based cognitive rehabilitation: updated review of the literature from 1998 through 2002. Arch Phys Med Rehabil 2005; 86:1681-92. [PMID: 16084827 DOI: 10.1016/j.apmr.2005.03.024] [Citation(s) in RCA: 611] [Impact Index Per Article: 32.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVE To update the previous evidence-based recommendations of the Brain Injury Interdisciplinary Special Interest Group of the American Congress of Rehabilitation Medicine for cognitive rehabilitation of people with traumatic brain injury (TBI) and stroke, based on a systematic review of the literature from 1998 through 2002. DATA SOURCES PubMed and Infotrieve literature searches were conducted using the terms attention, awareness, cognition, communication, executive, language, memory, perception, problem solving, and reasoning combined with each of the terms rehabilitation, remediation, and training. Reference lists from identified articles were reviewed and a bibliography listing 312 articles was compiled. STUDY SELECTION One hundred eighteen articles were initially selected for inclusion. Thirty-one studies were excluded after detailed review. Excluded articles included 14 studies without data, 6 duplicate publications or follow-up studies, 5 nontreatment studies, 4 reviews, and 2 case studies involving diagnoses other than TBI or stroke. DATA EXTRACTION Articles were assigned to 1 of 7 categories reflecting the primary area of intervention: attention; visual perception; apraxia; language and communication; memory; executive functioning, problem solving and awareness; and comprehensive-holistic cognitive rehabilitation. Articles were abstracted and levels of evidence determined using specific criteria. DATA SYNTHESIS Of the 87 studies evaluated, 17 were rated as class I, 8 as class II, and 62 as class III. Evidence within each area of intervention was synthesized and recommendations for practice standards, practice guidelines, and practice options were made. CONCLUSIONS There is substantial evidence to support cognitive-linguistic therapies for people with language deficits after left hemisphere stroke. New evidence supports training for apraxia after left hemisphere stroke. The evidence supports visuospatial rehabilitation for deficits associated with visual neglect after right hemisphere stroke. There is substantial evidence to support cognitive rehabilitation for people with TBI, including strategy training for mild memory impairment, strategy training for postacute attention deficits, and interventions for functional communication deficits. The overall analysis of 47 treatment comparisons, based on class I studies included in the current and previous review, reveals a differential benefit in favor of cognitive rehabilitation in 37 of 47 (78.7%) comparisons, with no comparison demonstrating a benefit in favor of the alternative treatment condition. Future research should move beyond the simple question of whether cognitive rehabilitation is effective, and examine the therapy factors and patient characteristics that optimize the clinical outcomes of cognitive rehabilitation.
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Laures J, Shisler R. Complementary and alternative medical approaches to treating adult neurogenic communication disorders: a review. Disabil Rehabil 2004; 26:315-25. [PMID: 15204483 DOI: 10.1080/0963828032000174106] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PURPOSE This paper reviews studies investigating the effectiveness of treating adult neurogenic communication disorders with complementary and alternative medicines (CAM). CAM is gradually experiencing recognition as a viable treatment approach for a variety of disorders by practitioners and patients. Some patients are using CAM as an adjunct to traditional rehabilitation. Additionally, speech-language pathologists are increasingly using CAM in treating communication disorders. METHOD This review provides a description of various CAM techniques including acupuncture, hypnosis, relaxation training, dreamwork, biofeedback and homeopathy/herbal medicine. Investigations exploring the effectiveness of each of these approaches as they have been applied to aphasia, motor speech disorders, and cognitive impairments are discussed. RESULTS AND CONCLUSIONS Little scientific inquiry into the effectiveness of CAM in the treatment of aphasia, motor speech disorders, and cognitive impairments has occurred. Many of the reviewed studies demonstrate inconsistent results; use limited sample sizes; do not include quantitative measures of cognitive, linguistic or motor speech skills; and are poorly reported. This review suggests that further exploration of this area is required before any strong conclusions regarding effectiveness and efficacy of these techniques can be made.
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Affiliation(s)
- Jacqueline Laures
- Communication Disorders Program, Department of Educational Psychology and Special Education, Georgia State University, Atlanta, GA 30303, USA.
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