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Dipper L, Devane N, Barnard R, Botting N, Boyle M, Cockayne L, Hersh D, Magdalani C, Marshall J, Swinburn K, Cruice M. A feasibility randomised waitlist-controlled trial of a personalised multi-level language treatment for people with aphasia: The remote LUNA study. PLoS One 2024; 19:e0304385. [PMID: 38875279 PMCID: PMC11178191 DOI: 10.1371/journal.pone.0304385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 05/10/2024] [Indexed: 06/16/2024] Open
Abstract
BACKGROUND Stroke survivors with aphasia want to improve their everyday talking (discourse). In current UK practice, 90% of speech and language therapists believe discourse assessment and treatment is part of their role but are hampered by barriers in resources, time and expertise. There is a clinical need for well-articulated discourse assessment and treatments. LUNA is a multi-level treatment targeting words, sentences and discourse macrostructure in personal stories that addresses this clinical need. OBJECTIVES This study aimed to assess the feasibility and acceptability of LUNA trial procedures in a randomised waitlist-controlled trial; and to evaluate preliminary efficacy. METHODS This paper reports a phase II, waitlist-controlled, proof-of-concept feasibility trial. Participants with chronic aphasia (n = 28) were recruited from the community and randomised to an Immediate (n = 14) or Delayed (n = 14) group. LUNA treatment was delivered twice weekly for 10 weeks via the videoconferencing technology, Zoom. Feasibility was assessed in terms of participant recruitment and retention, adherence, missing data, and treatment fidelity. Preliminary treatment efficacy was assessed in terms of between group differences in outcome measures relating to discourse, language, and psychosocial state. RESULTS The remote LUNA trial was feasible: 85% of those eligible consented to the trial; trial retention was 86%; 87% of treatment sessions were delivered as scheduled, and 79% of participants completed 80%+ of the treatment programme; data was missing only for participants who withdrew; treatment fidelity was high at 92% adherence; and only one clinical outcome measure demonstrated ceiling effects. ANCOVA analysis of the clinical outcome measures revealed group differences with medium and large effect sizes, indicating, improvements in the production of words, sentences, discourse macrostructure, overall language functioning (WAB-R), and psychosocial state (VAMS) following LUNA treatment. For most outcomes measured, similar treatment benefits were suggested in a secondary, non-parametric analysis. CONCLUSIONS Large-scale evaluation of the clinical efficacy and cost-effectiveness of LUNA is warranted and supported by these findings. TRIAL REGISTRATION Clinical trials registration: NCT05847023 (clinical trials.gov).
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Affiliation(s)
- Lucy Dipper
- Department of Language and Communication Science, School of Health and Psychological Sciences, City, University of London, London, United Kingdom
| | - Niamh Devane
- Department of Language and Communication Science, School of Health and Psychological Sciences, City, University of London, London, United Kingdom
| | - Rachel Barnard
- Wolfson Institute of Population Health, Queen Mary University of London, London, United Kingdom
| | - Nicola Botting
- Department of Language and Communication Science, School of Health and Psychological Sciences, City, University of London, London, United Kingdom
| | - Mary Boyle
- Montclair State University, Montclair, New Jersey, United States of America
| | - Lin Cockayne
- Department of Language and Communication Science, School of Health and Psychological Sciences, City, University of London, London, United Kingdom
| | - Deborah Hersh
- Curtin School of Allied Health and EnAble Institute, Curtin University, Perth, Australia
| | - Carla Magdalani
- Department of Language and Communication Science, School of Health and Psychological Sciences, City, University of London, London, United Kingdom
| | - Jane Marshall
- Department of Language and Communication Science, School of Health and Psychological Sciences, City, University of London, London, United Kingdom
| | - Kate Swinburn
- Department of Language and Communication Science, School of Health and Psychological Sciences, City, University of London, London, United Kingdom
| | - Madeline Cruice
- Department of Language and Communication Science, School of Health and Psychological Sciences, City, University of London, London, United Kingdom
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Riccardi N, Nelakuditi S, den Ouden DB, Rorden C, Fridriksson J, Desai RH. Discourse- and lesion-based aphasia quotient estimation using machine learning. Neuroimage Clin 2024; 42:103602. [PMID: 38593534 PMCID: PMC11016805 DOI: 10.1016/j.nicl.2024.103602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 04/01/2024] [Accepted: 04/01/2024] [Indexed: 04/11/2024]
Abstract
Discourse is a fundamentally important aspect of communication, and discourse production provides a wealth of information about linguistic ability. Aphasia commonly affects, in multiple ways, the ability to produce discourse. Comprehensive aphasia assessments such as the Western Aphasia Battery-Revised (WAB-R) are time- and resource-intensive. We examined whether discourse measures can be used to estimate WAB-R Aphasia Quotient (AQ), and whether this can serve as an ecologically valid, less resource-intensive measure. We used features extracted from discourse tasks using three AphasiaBank prompts involving expositional (picture description), story narrative, and procedural discourse. These features were used to train a machine learning model to predict the WAB-R AQ. We also compared and supplemented the model with lesion location information from structural neuroimaging. We found that discourse-based models could estimate AQ well, and that they outperformed models based on lesion features. Addition of lesion features to the discourse features did not improve the performance of the discourse model substantially. Inspection of the most informative discourse features revealed that different prompt types taxed different aspects of language. These findings suggest that discourse can be used to estimate aphasia severity, and provide insight into the linguistic content elicited by different types of discourse prompts.
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Affiliation(s)
- Nicholas Riccardi
- Department of Communication Sciences and Disorders, University of South Carolina, United States.
| | | | - Dirk B den Ouden
- Department of Communication Sciences and Disorders, University of South Carolina, United States
| | - Chris Rorden
- Department of Psychology, University of South Carolina, United States
| | - Julius Fridriksson
- Department of Communication Sciences and Disorders, University of South Carolina, United States
| | - Rutvik H Desai
- Department of Psychology, University of South Carolina, United States
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Riccardi N, Zhao X, den Ouden DB, Fridriksson J, Desai RH, Wang Y. Network-based statistics distinguish anomic and Broca's aphasia. Brain Struct Funct 2023:10.1007/s00429-023-02738-4. [PMID: 38160205 DOI: 10.1007/s00429-023-02738-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 11/21/2023] [Indexed: 01/03/2024]
Abstract
INTRODUCTION Aphasia is a speech-language impairment commonly caused by damage to the left hemisphere. The neural mechanisms that underpin different types of aphasia and their symptoms are still not fully understood. This study aims to identify differences in resting-state functional connectivity between anomic and Broca's aphasia measured through resting-state functional magnetic resonance imaging (rs-fMRI). METHODS We used the network-based statistic (NBS) method, as well as voxel- and connectome-based lesion symptom mapping (V-, CLSM), to identify distinct neural correlates of the anomic and Broca's groups. To control for lesion effect, we included lesion volume as a covariate in both the NBS method and LSM. RESULTS NBS identified a subnetwork located in the dorsal language stream bilaterally, including supramarginal gyrus, primary sensory, motor, and auditory cortices, and insula. The connections in the subnetwork were weaker in the Broca's group than the anomic group. The properties of the subnetwork were examined through complex network measures, which indicated that regions in right inferior frontal sulcus, right paracentral lobule, and bilateral superior temporal gyrus exhibit intensive interaction. Left superior temporal gyrus, right postcentral gyrus, and left supramarginal gyrus play an important role in information flow and overall communication efficiency. Disruption of this network underlies the constellation of symptoms associated with Broca's aphasia. Whole-brain CLSM did not detect any significant connections, suggesting an advantage of NBS when thousands of connections are considered. However, CLSM identified connections that differentiated Broca's from anomic aphasia when analysis was restricted to a hypothesized network of interest. DISCUSSION We identified novel signatures of resting-state brain network differences between groups of individuals with anomic and Broca's aphasia. We identified a subnetwork of connections that statistically differentiated the resting-state brain networks of the two groups, in comparison with standard CLSM results that yielded isolated connections. Network-level analyses are useful tools for the investigation of the neural correlates of language deficits post-stroke.
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Affiliation(s)
- Nicholas Riccardi
- Department of Psychology, University of South Carolina, Columbia, SC, USA
| | - Xingpei Zhao
- Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, SC, USA
| | - Dirk-Bart den Ouden
- Department of Communication Sciences and Disorders, University of South Carolina, Columbia, SC, USA
| | - Julius Fridriksson
- Department of Communication Sciences and Disorders, University of South Carolina, Columbia, SC, USA
| | - Rutvik H Desai
- Department of Psychology, University of South Carolina, Columbia, SC, USA
| | - Yuan Wang
- Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, SC, USA.
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Phillips AQ, Campi E, Talbott MR, Baranek GT. Assessment Fidelity of Parents Implementing a Standardized Telehealth Infant Autism Screener. OTJR-OCCUPATION PARTICIPATION AND HEALTH 2023; 43:360-367. [PMID: 37089013 PMCID: PMC10330541 DOI: 10.1177/15394492231164943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
Abstract
Telehealth is effective for service delivery in pediatric occupational therapy across ages and diagnoses. Remote parent coaching provides unique benefits for both parents and infants. As a result of COVID-19, practitioners and researchers pivoted to remote assessment and intervention without much preparation or training. It is critical that we evaluate the quality of these telehealth services. One important component of remote evaluations is assessment fidelity. To examine assessment fidelity of a telehealth-delivered observational autism screening tool for infants. An assessment fidelity checklist was applied as the primary outcome measure. Parents conducted assessments with 82% adherence to the fidelity checklist. Implications: A parent coaching telehealth approach may be valid for assessment in pediatric telehealth. Continually monitoring the assessment fidelity of a tool is critical for the valid administration of remote services.
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Affiliation(s)
| | - Emily Campi
- University of Southern California, Los Angeles, USA
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Kim RY, Thielen CC, Heydeman G, Mulcahey MJ. Standardized administration and scoring guidelines for the Spinal Cord Independence Measure Version 3.0 (SCIM-III). Spinal Cord 2023; 61:296-306. [PMID: 36966259 DOI: 10.1038/s41393-023-00891-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 02/22/2023] [Accepted: 03/10/2023] [Indexed: 03/27/2023]
Abstract
STUDY DESIGN Qualitative studies. OBJECTIVE To develop clear and specific administration and scoring procedures for the Spinal Cord Independence Measure Version 3.0 as a performance-based and interview assessment. SETTING Research lab. METHODS Modified Delphi Technique survey methods were used in this study. Previously developed SCIM-III administration and scoring procedures for performance-based and interview versions were presented to clinicians experienced in SCI and SCIM-III using the Qualtrix (Qualtrics, Provo, UT) online survey platform. Summary and descriptive statistics were used to assess the percent agreement survey responses. RESULTS Three survey rounds were necessary to achieve 80% agreement or above for the performance-based version. Two survey rounds were necessary to achieve 80% agreement or above on the interview version. CONCLUSIONS This study describes the development of standardized administration and scoring procedures for the self-care and mobility sub-scales of the SCIM-III as a performance-based and interview version.
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Affiliation(s)
- Rachel Y Kim
- Center for Outcomes and Measurement, Jefferson College of Rehabilitation Sciences, Thomas Jefferson University, Philadelphia, PA, USA.
| | - Christina Calhoun Thielen
- Center for Outcomes and Measurement, Jefferson College of Rehabilitation Sciences, Thomas Jefferson University, Philadelphia, PA, USA
| | | | - M J Mulcahey
- Center for Outcomes and Measurement, Jefferson College of Rehabilitation Sciences, Thomas Jefferson University, Philadelphia, PA, USA
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Kristinsson S, Basilakos A, den Ouden DB, Cassarly C, Spell LA, Bonilha L, Rorden C, Hillis AE, Hickok G, Johnson L, Busby N, Walker GM, McLain A, Fridriksson J. Predicting Outcomes of Language Rehabilitation: Prognostic Factors for Immediate and Long-Term Outcomes After Aphasia Therapy. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2023; 66:1068-1084. [PMID: 36827514 PMCID: PMC10205105 DOI: 10.1044/2022_jslhr-22-00347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 10/23/2022] [Accepted: 11/30/2022] [Indexed: 05/25/2023]
Abstract
BACKGROUND Aphasia therapy is an effective approach to improve language function in chronic aphasia. However, it remains unclear what prognostic factors facilitate therapy response at the individual level. Here, we utilized data from the POLAR (Predicting Outcomes of Language Rehabilitation in Aphasia) trial to (a) determine therapy-induced change in confrontation naming and long-term maintenance of naming gains and (b) examine the extent to which aphasia severity, age, education, time postonset, and cognitive reserve predict naming gains at 1 week, 1 month, and 6 months posttherapy. METHOD A total of 107 participants with chronic (≥ 12 months poststroke) aphasia underwent extensive case history, cognitive-linguistic testing, and a neuroimaging workup prior to receiving 6 weeks of impairment-based language therapy. Therapy-induced change in naming performance (measured as raw change on the 175-item Philadelphia Naming Test [PNT]) was assessed 1 week after therapy and at follow-up time points 1 month and 6 months after therapy completion. Change in naming performance over time was evaluated using paired t tests, and linear mixed-effects models were constructed to examine the association between prognostic factors and therapy outcomes. RESULTS Naming performance was improved by 5.9 PNT items (Cohen's d = 0.56, p < .001) 1 week after therapy and by 6.4 (d = 0.66, p < .001) and 7.5 (d = 0.65, p < .001) PNT items at 1 month and 6 months after therapy completion, respectively. Aphasia severity emerged as the strongest predictor of naming improvement recovery across time points; mild (ß = 5.85-9.02) and moderate (ß = 9.65-11.54) impairment predicted better recovery than severe (ß = 1.31-3.37) and very severe (ß = 0.20-0.32) aphasia. Age was an emergent prognostic factor for recovery 1 month (ß = -0.14) and 6 months (ß = -0.20) after therapy, and time postonset (ß = -0.05) was associated with retention of naming gains at 6 months posttherapy. CONCLUSIONS These results suggest that therapy-induced naming improvement is predictable based on several easily measurable prognostic factors. Broadly speaking, these results suggest that prognostication procedures in aphasia therapy can be improved and indicate that personalization of therapy is a realistic goal in the near future. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.22141829.
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Affiliation(s)
- Sigfus Kristinsson
- Center for the Study of Aphasia Recovery, University of South Carolina, Columbia
| | - Alexandra Basilakos
- Center for the Study of Aphasia Recovery, University of South Carolina, Columbia
| | - Dirk B. den Ouden
- Center for the Study of Aphasia Recovery, University of South Carolina, Columbia
| | - Christy Cassarly
- Department of Public Health Sciences, Medical University of South Carolina, Charleston
| | - Leigh Ann Spell
- Center for the Study of Aphasia Recovery, University of South Carolina, Columbia
| | - Leonardo Bonilha
- Department of Neurology, Medical University of South Carolina, Charleston
| | - Chris Rorden
- Department of Psychology, University of South Carolina, Columbia
| | - Argye E. Hillis
- Department of Physical Medicine and Rehabilitation, Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, MD
- Department of Cognitive Science, Johns Hopkins University, Baltimore, MD
| | - Gregory Hickok
- Department of Cognitive Sciences, School of Social Sciences, University of California, Irvine
| | - Lisa Johnson
- Center for the Study of Aphasia Recovery, University of South Carolina, Columbia
| | - Natalie Busby
- Center for the Study of Aphasia Recovery, University of South Carolina, Columbia
| | - Grant M. Walker
- Department of Cognitive Sciences, School of Social Sciences, University of California, Irvine
| | - Alexander McLain
- Department of Epidemiology and Biostatistics, University of South Carolina, Columbia
| | - Julius Fridriksson
- Center for the Study of Aphasia Recovery, University of South Carolina, Columbia
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Barbieri E, Thompson CK, Higgins J, Caplan D, Kiran S, Rapp B, Parrish T. Treatment-induced neural reorganization in aphasia is language-domain specific: Evidence from a large-scale fMRI study. Cortex 2023; 159:75-100. [PMID: 36610109 PMCID: PMC9931666 DOI: 10.1016/j.cortex.2022.11.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 08/14/2022] [Accepted: 11/29/2022] [Indexed: 12/23/2022]
Abstract
Studies investigating the effects of language intervention on the re-organization of language networks in chronic aphasia have resulted in mixed findings, likely related to-among other factors-the language function targeted during treatment. The present study investigated the effects of the type of treatment provided on neural reorganization. Seventy individuals with chronic stroke-induced aphasia, recruited from three research laboratories and meeting criteria for agrammatism, anomia or dysgraphia were assigned to either treatment (N = 51) or control (N = 19) groups. Participants in the treatment group received 12-weeks of language intervention targeting sentence comprehension/production, naming, or spelling. At baseline and post-testing, all participants performed an fMRI story comprehension task, with blocks of auditorily-presented stories alternated with blocks of reversed speech. Participants in the treatment, but not control, group significantly improved in the treated language domain. FMRI region-of-interest (ROI) analyses, conducted within regions that were either active (or homologous to active) regions in a group of 22 healthy participants on the story comprehension task, revealed a significant increase in activation from pre-to post-treatment in right-hemisphere homologues of these regions for participants in the sentence and spelling, but not naming, treatment groups, not predicted by left-hemisphere lesion size. For the sentence (but not the spelling) treatment group, activation changes within right-hemisphere homologues of language regions were positively associated with changes in measures of verb and sentence comprehension. These findings support previous research pointing to recruitment of right hemisphere tissue as a viable route for language recovery and suggest that sentence-level treatment may promote greater neuroplasticity on naturalistic, language comprehension tasks, compared to word-level treatment.
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Affiliation(s)
- Elena Barbieri
- Center for the Neurobiology of Language Recovery, Northwestern University, 2240 Campus Drive, Evanston, IL 60208, USA; Department of Communication Sciences and Disorders, School of Communication, Northwestern University, 70 Arts Circle Drive, Evanston, IL 60208, USA.
| | - Cynthia K Thompson
- Center for the Neurobiology of Language Recovery, Northwestern University, 2240 Campus Drive, Evanston, IL 60208, USA; Department of Communication Sciences and Disorders, School of Communication, Northwestern University, 70 Arts Circle Drive, Evanston, IL 60208, USA; Department of Neurology, Feinberg School of Medicine, Northwestern University, 303 East Chicago Avenue, Chicago, IL 60611, USA
| | - James Higgins
- Center for the Neurobiology of Language Recovery, Northwestern University, 2240 Campus Drive, Evanston, IL 60208, USA; Department of Radiology, Feinberg School of Medicine, Northwestern University, 737 N Michigan Avenue, Chicago, IL 60611, USA
| | - David Caplan
- Center for the Neurobiology of Language Recovery, Northwestern University, 2240 Campus Drive, Evanston, IL 60208, USA; Department of Neurology, Massachusetts General Hospital, Harvard Medical School, 15 Parkman Street, Boston, MA 02114, USA
| | - Swathi Kiran
- Center for the Neurobiology of Language Recovery, Northwestern University, 2240 Campus Drive, Evanston, IL 60208, USA; Department of Speech, Language, And Hearing, College of Health & Rehabilitation, Boston University, 635 Commonwealth Avenue, Boston, MA 02215, USA
| | - Brenda Rapp
- Center for the Neurobiology of Language Recovery, Northwestern University, 2240 Campus Drive, Evanston, IL 60208, USA; Department of Cognitive Science, Krieger School of Arts & Sciences, Johns Hopkins Univeristy, 3400 N Charles Street, Baltimore, MD 21218, USA
| | - Todd Parrish
- Center for the Neurobiology of Language Recovery, Northwestern University, 2240 Campus Drive, Evanston, IL 60208, USA; Department of Radiology, Feinberg School of Medicine, Northwestern University, 737 N Michigan Avenue, Chicago, IL 60611, USA
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Morrow EL, Duff MC, Mayberry LS. Mediators, Moderators, and Covariates: Matching Analysis Approach for Improved Precision in Cognitive-Communication Rehabilitation Research. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2022; 65:4159-4171. [PMID: 36306506 PMCID: PMC9940892 DOI: 10.1044/2022_jslhr-21-00551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
PURPOSE The dual goals of this tutorial are (a) to increase awareness and use of mediation and moderation models in cognitive-communication rehabilitation research by describing options, benefits, and attainable analytic approaches for researchers with limited resources and sample sizes and (b) to describe how these findings may be interpreted for clinicians consuming research to inform clinical care. METHOD We highlight key insights from the social sciences literature pointing to the risks of common approaches to linear modeling, which may slow progress in clinical-translational research and reduce the clinical utility of our work. We discuss the potential of mediation and moderation analyses to reduce the research-to-practice gap and describe how researchers may begin to implement these models, even in smaller sample sizes. We discuss how these preliminary analyses can help focus resources for larger trials to fully encapsulate the heterogeneity of individuals with cognitive-communication disorders. RESULTS In rehabilitation research, we study groups, but we use the findings from those studies to treat individuals. The most functional clinical research is about more than establishing only whether a given effect exists for an "average person" in the group of interest. It is critical to understand the active ingredients and mechanisms of action by which a given treatment works (mediation) and to know which circumstances, contexts, or individual characteristics might make that treatment most beneficial (moderation). CONCLUSIONS Increased adoption of mediation and moderation approaches, executed in appropriate steps, could accelerate progress in cognitive-communication rehabilitation research and lead to the development of targeted treatments that work for more clients. In a field that has made limited progress in developing successful interventions for the last several decades, it is critical that we harness new approaches to advance clinical-translational research results for complex, heterogeneous groups with cognitive-communication disorders.
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Affiliation(s)
- Emily L. Morrow
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, TN
- Department of Medicine, Division of General Internal Medicine & Public Health, Vanderbilt University Medical Center, Nashville, TN
- Center for Health Behavior and Health Education, Vanderbilt University Medical Center, Nashville, TN
| | - Melissa C. Duff
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, TN
| | - Lindsay S. Mayberry
- Department of Medicine, Division of General Internal Medicine & Public Health, Vanderbilt University Medical Center, Nashville, TN
- Center for Health Behavior and Health Education, Vanderbilt University Medical Center, Nashville, TN
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Walker GM, Fridriksson J, Hillis AE, den Ouden DB, Bonilha L, Hickok G. The Severity-Calibrated Aphasia Naming Test. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2022; 31:2722-2740. [PMID: 36332139 PMCID: PMC9911092 DOI: 10.1044/2022_ajslp-22-00071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
PURPOSE We present a 20-item naming test, the Severity-Calibrated Aphasia Naming Test (SCANT), that can serve as a proxy measure for an aphasia severity scale that is derived from a thorough test battery of connected speech production, single-word production, speech repetition, and auditory verbal comprehension. METHOD We use lasso regression and cross-validation to identify an optimal subset from a set of 174 pictures to be named for prediction of aphasia severity, based on data from 200 participants with left-hemisphere stroke who were quasirandomly selected to represent the full impairment scale. Data from 20 healthy controls (i.e., participant caretakers/spouses) were also analyzed. We examine interrater reliability, test-retest reliability, sensitivity and specificity to the presence of aphasia, sensitivity to therapy gains, and external validity (i.e., correlation with aphasia severity measures) for the SCANT. RESULTS The SCANT has extremely high interrater reliability, and it is sensitive and specific to the presence of aphasia. We demonstrate the superiority of predictions based on the SCANT over those based on the full set of naming items. We estimate a 15% reduction in power when using the SCANT score versus the full test battery's aphasia severity score as an outcome measure; for example, to maintain the same power to detect a significant group average change in aphasia severity, a study with 25 participants using the full test battery to measure treatment effectiveness would require 30 participants if the SCANT were to be used as the testing instrument instead. CONCLUSION We provide a linear model to convert SCANT scores to aphasia severity scores, and we identify a change score cutoff of four SCANT items to obtain a high degree of confidence based on test-retest SCANT data and the modeled relation between SCANT and aphasia severity scores. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.21476871.
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Affiliation(s)
- Grant M. Walker
- Department of Cognitive Sciences, University of California, Irvine
| | - Julius Fridriksson
- Department of Communication Sciences and Disorders, University of South Carolina, Columbia
| | - Argye E. Hillis
- Departments of Neurology, Physical Medicine & Rehabilitation, and Cognitive Science, Johns Hopkins Medicine, Baltimore, MA
| | - Dirk B. den Ouden
- Department of Communication Sciences and Disorders, University of South Carolina, Columbia
| | | | - Gregory Hickok
- Department of Cognitive Sciences, University of California, Irvine
- Department of Language Science, University of California, Irvine
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Schwen Blackett D, Varkey J, Wilmskoetter J, Roth R, Andrews K, Busby N, Gleichgerrcht E, Desai RH, Riccardi N, Basilakos A, Johnson LP, Kristinsson S, Johnson L, Rorden C, Spell LA, Fridriksson J, Bonilha L. Neural network bases of thematic semantic processing in language production. Cortex 2022; 156:126-143. [PMID: 36244204 PMCID: PMC10041939 DOI: 10.1016/j.cortex.2022.08.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 06/10/2022] [Accepted: 08/03/2022] [Indexed: 11/20/2022]
Abstract
Semantic processing is a central component of language and cognition. The anterior temporal lobe is postulated to be a key hub for semantic processing, but the posterior temporoparietal cortex is also involved in thematic associations during language. It is possible that these regions act in concert and depend on an anteroposterior network linking the temporal pole with posterior structures to support thematic semantic processing during language production. We employed connectome-based lesion-symptom mapping to examine the causal relationship between lesioned white matter pathways and thematic processing language deficits among individuals with post-stroke aphasia. Seventy-nine adults with chronic aphasia completed the Philadelphia Naming Test, and semantic errors were coded as either thematic or taxonomic to control for taxonomic errors. Controlling for nonverbal conceptual-semantic knowledge as measured by the Pyramids and Palm Trees Test, lesion size, and the taxonomic error rate, thematic error rate was associated with loss of white matter connections from the temporal pole traversing in peri-Sylvian regions to the posterior cingulate and the insula. These findings support the existence of a distributed network underlying thematic relationship processing in language as opposed to discrete cortical areas.
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Affiliation(s)
- Deena Schwen Blackett
- Department of Otolaryngology, College of Medicine, Medical University of South Carolina, Charleston, SC, USA; Division of Speech-Language Pathology, College of Health Professions, Medical University of South Carolina, Charleston, SC, USA.
| | - Jesse Varkey
- Department of Neurology, College of Medicine, Medical University of South Carolina, Charleston, SC, USA.
| | - Janina Wilmskoetter
- Division of Speech-Language Pathology, College of Health Professions, Medical University of South Carolina, Charleston, SC, USA.
| | - Rebecca Roth
- Department of Neurology, School of Medicine, Emory University, Atlanta, GA, USA.
| | - Keeghan Andrews
- Department of Neurology, College of Medicine, Medical University of South Carolina, Charleston, SC, USA.
| | - Natalie Busby
- Department of Communication Sciences and Disorders, University of South Carolina, Columbia, SC, USA.
| | - Ezequiel Gleichgerrcht
- Department of Neurology, College of Medicine, Medical University of South Carolina, Charleston, SC, USA.
| | - Rutvik H Desai
- Department of Psychology, University of South Carolina, Barnwell College, Columbia, SC, USA.
| | - Nicholas Riccardi
- Department of Psychology, University of South Carolina, Barnwell College, Columbia, SC, USA.
| | - Alexandra Basilakos
- Department of Communication Sciences and Disorders, University of South Carolina, Columbia, SC, USA.
| | - Lorelei P Johnson
- Department of Communication Sciences and Disorders, University of South Carolina, Columbia, SC, USA.
| | - Sigfus Kristinsson
- Department of Communication Sciences and Disorders, University of South Carolina, Columbia, SC, USA.
| | - Lisa Johnson
- Department of Communication Sciences and Disorders, University of South Carolina, Columbia, SC, USA.
| | - Chris Rorden
- Department of Psychology, University of South Carolina, Barnwell College, Columbia, SC, USA.
| | - Leigh A Spell
- Department of Communication Sciences and Disorders, University of South Carolina, Columbia, SC, USA.
| | - Julius Fridriksson
- Department of Communication Sciences and Disorders, University of South Carolina, Columbia, SC, USA.
| | - Leonardo Bonilha
- Department of Neurology, School of Medicine, Emory University, Atlanta, GA, USA.
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11
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Godecke E, Brogan E, Ciccone N, Rose ML, Armstrong E, Whitworth A, Ellery F, Holland A, Middleton S, Rai T, Hankey GJ, Cadilhac D, Bernhardt J. Treatment fidelity monitoring, reporting and findings in a complex aphasia intervention trial: a substudy of the Very Early Rehabilitation in SpEech (VERSE) trial. Trials 2022; 23:501. [PMID: 35710437 PMCID: PMC9204960 DOI: 10.1186/s13063-022-06433-3] [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: 05/25/2021] [Accepted: 05/27/2022] [Indexed: 11/28/2022] Open
Abstract
Background Treatment fidelity is inconsistently reported in aphasia research, contributing to uncertainty about the effectiveness of types of aphasia therapy following stroke. We outline the processes and outcomes of treatment fidelity monitoring in a pre-specified secondary analysis of the VERSE trial. Methods VERSE was a 3-arm, single-blinded RCT with a 12-week primary endpoint comparing Usual Care (UC) to two higher intensity treatments: Usual Care-Plus (UC-Plus) and VERSE, a prescribed intervention. Primary outcome results were previously reported. This secondary analysis focused on treatment fidelity. Video-recorded treatment sessions in the higher intensity study arms were evaluated for treatment adherence and treatment differentiation. Treatment components were evaluated using a pre-determined fidelity checklist. Primary outcome: prescribed amount of therapy time (minutes); secondary outcomes: (i) adherence to therapy protocol (%) and (ii) treatment differentiation between control and high intensity groups. Results Two hundred forty-six participants were randomised to Usual Care (n=81), Usual Care-Plus (n=82), and VERSE (n=83). One hundred thirty-five (82%) participants in higher intensity intervention arms received the minimum prescribed therapy minutes. From 10,805 (UC 7787; UC-Plus 1450; VERSE 1568) service events, 431 treatment protocol deviations were noted in 114 participants. Four hundred thirty-seven videos were evaluated. The VERSE therapists achieved over 84% adherence to key protocol elements. Higher stroke and aphasia severity, older age, and being in the UC-Plus group predicted more treatment deviations. Conclusions We found high levels of treatment adherence and differentiation between the intervention arms, providing greater confidence interpreting our results. The comprehensive systems for intervention fidelity monitoring and reporting in this trial make an important contribution to aphasia research and, we argue, should set a new standard for future aphasia studies. Trial registration ACTRN 12613000776707 Supplementary Information The online version contains supplementary material available at 10.1186/s13063-022-06433-3.
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Affiliation(s)
- Erin Godecke
- School of Medical and Health Sciences, Edith Cowan University, 270 Joondalup Dve, Joondalup, Western Australia, 6027, Australia. .,Centre of Research Excellence in Aphasia Rehabilitation Recovery, Melbourne, Victoria, Australia. .,Sir Charles Gairdner Hospital, Perth, Western Australia, Australia.
| | - Emily Brogan
- School of Medical and Health Sciences, Edith Cowan University, 270 Joondalup Dve, Joondalup, Western Australia, 6027, Australia.,Centre of Research Excellence in Aphasia Rehabilitation Recovery, Melbourne, Victoria, Australia.,Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Natalie Ciccone
- School of Medical and Health Sciences, Edith Cowan University, 270 Joondalup Dve, Joondalup, Western Australia, 6027, Australia.,Centre of Research Excellence in Aphasia Rehabilitation Recovery, Melbourne, Victoria, Australia
| | - Miranda L Rose
- Centre of Research Excellence in Aphasia Rehabilitation Recovery, Melbourne, Victoria, Australia.,La Trobe University, Melbourne, Victoria, Australia
| | - Elizabeth Armstrong
- School of Medical and Health Sciences, Edith Cowan University, 270 Joondalup Dve, Joondalup, Western Australia, 6027, Australia
| | | | - Fiona Ellery
- Stroke Division, The Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia
| | | | - Sandy Middleton
- Centre of Research Excellence in Aphasia Rehabilitation Recovery, Melbourne, Victoria, Australia.,St Vincent's Health Network Sydney, Sydney, Australia.,Australian Catholic University, Sydney, Australia
| | - Tapan Rai
- University of Technology Sydney, Sydney, New South Wales, Australia
| | - Graeme J Hankey
- School of Medicine and Pharmacology, The University of Western Australia, Perth, Australia
| | - Dominique Cadilhac
- Centre of Research Excellence in Aphasia Rehabilitation Recovery, Melbourne, Victoria, Australia.,Monash University, Melbourne, Victoria, Australia
| | - Julie Bernhardt
- Centre of Research Excellence in Aphasia Rehabilitation Recovery, Melbourne, Victoria, Australia.,Stroke Division, The Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia
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12
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Varkanitsa M, Kiran S. Understanding, facilitating and predicting aphasia recovery after rehabilitation. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2022; 24:248-259. [PMID: 35603543 PMCID: PMC9398975 DOI: 10.1080/17549507.2022.2075036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Purpose: This paper reviews several studies whose aim was to understand the nature of language recovery in chronic aphasia and identify predictors of how people may recover their language functions after a brain injury.Method: Several studies that mostly draw from data collected within the Centre for Neurobiology of Language Recovery were reviewed and categorised in four aspects of language impairment and recovery in aphasia: (a) neural markers for language impairment and recovery, (b) language and cognitive markers for language impairment and recovery, (c) effective treatments and (d) predictive modelling of treatment-induced rehabilitation.Result: Language impairment and recovery in stroke-induced aphasia is multi-factorial, including patient-specific and treatment-specific factors. A combination of these factors may help us predict treatment responsiveness even before treatment begins.Conclusion: Continued work on this topic will lead to a better understanding of the mechanisms that underly language impairment and treatment-induced recovery in aphasia, and, consequently, use this information to predict each person's recovery profile trajectory and provide optimal prescriptions regarding the type and dosage of treatment.
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Affiliation(s)
- Maria Varkanitsa
- Aphasia Research Laboratory, Department of Speech, Language & Hearing Sciences, Sargent College of Health and Rehabilitation Sciences, Boston University, Boston, MA, USA
| | - Swathi Kiran
- Aphasia Research Laboratory, Department of Speech, Language & Hearing Sciences, Sargent College of Health and Rehabilitation Sciences, Boston University, Boston, MA, USA
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13
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Richardson JD, Dalton SG. Assessment of language impairment and function. HANDBOOK OF CLINICAL NEUROLOGY 2022; 185:175-193. [PMID: 35078598 DOI: 10.1016/b978-0-12-823384-9.00009-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
This chapter is written for the qualified neurologist or related professional working with persons who have had a stroke or other sudden brain injury. It is critical that the presence of aphasia is detected, no matter how mild the presentation, and to support that assertion, this chapter highlights the plight of persons with latent aphasia. At the individual level, the impact of aphasia is devastating, with overwhelming evidence that aphasia negatively impacts psychosocial outcomes. At the global level, sensitive detection and accurate diagnosis of aphasia are critical for accurate characterization and quantification of the global burden of aphasia. The word "LANGUAGE" is leveraged as an acronym to create a useful and memorable checklist to guide navigation of aphasia screening and assessment: it begins with the definition of language (L), followed by the definition and diagnostic criteria for aphasia (A). Then language abilities and characteristics to be considered in assessment are presented: naming (N); grammar and syntax (G); unintelligible words, jargon, and paraphasias (U); auditory comprehension and repetition (A); graphemic abilities-reading and writing (G); and everyday communication and discourse (E). Recommendations for improving procedural adherence are provided, and a list of potential brief assessment measures are introduced.
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Affiliation(s)
- Jessica D Richardson
- Department of Speech and Hearing Sciences, University of New Mexico, Albuquerque, NM, United States.
| | - Sarah Grace Dalton
- Department of Speech Pathology and Audiology, Marquette University, Milwaukee, WI, United States
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14
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Hickin J, Cruice M, Dipper L. A Systematically Conducted Scoping Review of the Evidence and Fidelity of Treatments for Verb and Sentence Deficits in Aphasia: Sentence Treatments. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2022; 31:431-462. [PMID: 34941377 DOI: 10.1044/2021_ajslp-21-00120] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
PURPOSE This review article synthesizes and evaluates the evidence for sentence production treatments in aphasia, systematically charting impairment-based and functional communication outcomes. It reports (a) the level of evidence and fidelity of sentence treatments; (b) the impact of treatment on production of trained and untrained verbs and sentences, functional communication, and discourse; and (c) the potential active ingredients of treatment. METHOD The search included studies from January 1980 to June 2019. The level of evidence of each study was documented, as was fidelity in terms of treatment delivery, enactment, and receipt. Studies were also categorized according to treatment methods used. RESULTS Thirty-three studies were accepted into the review and predominantly constituted Level 4 evidence (e.g., case control studies and case series). Thirty studies (90%) described treatment in sufficient detail to allow replication, but dosage was poorly reported, and fidelity of treatment was rarely assessed. The most commonly reported treatment techniques were mapping (10 studies: 30%), predicate argument structure treatment (six studies: 18%), and verb network strengthening treatment (five studies: 15%). Production of trained sentences improved for 83% of participants, and improvements generalized to untrained sentences for 59% of participants. Functional communication was rarely assessed, but discourse production improved for 70% of participants. CONCLUSIONS The evidence for sentence treatments is predominantly generated from Level 4 studies. Treatments were effective for the majority of participants regarding trained sentence and discourse production. However, there is inconsistent use of statistical analysis to verify improvements, and diverse outcome measures are used, which makes interpretation of the evidence difficult. The quality of sentence treatment research would be improved by agreeing a core set of outcome measures and extended by ascertaining the views of participants on sentence treatments.
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Affiliation(s)
- Julie Hickin
- Division of Language and Communication Science, City, University of London, United Kingdom
| | - Madeline Cruice
- Division of Language and Communication Science, City, University of London, United Kingdom
| | - Lucy Dipper
- Division of Language and Communication Science, City, University of London, United Kingdom
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15
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Walker GM, Basilakos A, Fridriksson J, Hickok G. Beyond Percent Correct: Measuring Change in Individual Picture Naming Ability. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2022; 65:215-237. [PMID: 34818508 PMCID: PMC9154021 DOI: 10.1044/2021_jslhr-20-00205] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
PURPOSE Meaningful changes in picture naming responses may be obscured when measuring accuracy instead of quality. A statistic that incorporates information about the severity and nature of impairments may be more sensitive to the effects of treatment. METHOD We analyzed data from repeated administrations of a naming test to 72 participants with stroke aphasia in a clinical trial for anomia therapy. Participants were divided into two groups for analysis to demonstrate replicability. We assessed reliability among response type scores from five raters. We then derived four summary statistics of naming ability and their changes over time for each participant: (a) the standard accuracy measure, (b) an accuracy measure adjusted for item difficulty, (c) an accuracy measure adjusted for item difficulty for specific response types, and (d) a distance measure adjusted for item difficulty for specific response types. While accuracy measures address the likelihood of a correct response, the distance measure reflects that different response types range in their similarity to the target. Model fit was assessed. The frequency of significant improvements and the average magnitude of improvements for each summary statistic were compared between treatment groups and a control group. Effect sizes for each model-based statistic were compared with the effect size for the standard accuracy measure. RESULTS Interrater and intrarater reliability were near perfect, on average, though compromised somewhat by phonological-level errors. The effects of treatment were more evident, in terms of both frequency and magnitude, when using the distance measure versus the other accuracy statistics. CONCLUSIONS Consideration of item difficulty and response types revealed additional effects of treatment on naming scores beyond those observed for the standard accuracy measure. The results support theories that assume naming ability is decomposable into subabilities rather than being monolithic, suggesting new opportunities for measuring treatment outcomes. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.17019515.
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Affiliation(s)
- Grant M. Walker
- Department of Cognitive Sciences, University of California, Irvine
- Department of Language Science, University of California, Irvine
| | - Alexandra Basilakos
- Department of Communication Sciences and Disorders, University of South Carolina, Columbia
| | - Julius Fridriksson
- Department of Communication Sciences and Disorders, University of South Carolina, Columbia
| | - Gregory Hickok
- Department of Cognitive Sciences, University of California, Irvine
- Department of Language Science, University of California, Irvine
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16
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Baboyan V, Basilakos A, Yourganov G, Rorden C, Bonilha L, Fridriksson J, Hickok G. Isolating the white matter circuitry of the dorsal language stream: Connectome-Symptom Mapping in stroke induced aphasia. Hum Brain Mapp 2021; 42:5689-5702. [PMID: 34469044 PMCID: PMC8559486 DOI: 10.1002/hbm.25647] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 08/21/2021] [Indexed: 12/02/2022] Open
Abstract
The application of ℓ1-regularized machine learning models to high-dimensional connectomes offers a promising methodology to assess clinical-anatomical correlations in humans. Here, we integrate the connectome-based lesion-symptom mapping framework with sparse partial least squares regression (sPLS-R) to isolate elements of the connectome associated with speech repetition deficits. By mapping over 2,500 connections of the structural connectome in a cohort of 71 stroke-induced cases of aphasia presenting with varying left-hemisphere lesions and repetition impairment, sPLS-R was trained on 50 subjects to algorithmically identify connectomic features on the basis of their predictive value. The highest ranking features were subsequently used to generate a parsimonious predictive model for speech repetition whose predictions were evaluated on a held-out set of 21 subjects. A set of 10 short- and long-range parieto-temporal connections were identified, collectively delineating the broader circuitry of the dorsal white matter network of the language system. The strongest contributing feature was a short-range connection in the supramarginal gyrus, approximating the cortical localization of area Spt, with parallel long-range pathways interconnecting posterior nodes in supramarginal and superior temporal cortex with anterior nodes in both ventral and-notably-in dorsal premotor cortex, respectively. The collective disruption of these pathways indexed repetition performance in the held-out set of participants, suggesting that these impairments might be characterized as a parietotemporal disconnection syndrome impacting cortical area Spt and its associated white matter circuits of the frontal lobe as opposed to being purely a disconnection of the arcuate fasciculus.
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Affiliation(s)
- Vatche Baboyan
- Department of Cognitive ScienceUniversity of CaliforniaIrvineCaliforniaUSA
| | - Alexandra Basilakos
- Department of Communication Sciences and DisordersUniversity of South CarolinaColumbiaSouth CarolinaUSA
| | - Grigori Yourganov
- Department of PsychologyUniversity of South CarolinaColumbiaSouth CarolinaUSA
| | - Chris Rorden
- Department of PsychologyUniversity of South CarolinaColumbiaSouth CarolinaUSA
| | - Leonardo Bonilha
- Department of NeurologyMedical University of South CarolinaColumbiaSouth CarolinaUSA
| | - Julius Fridriksson
- Department of Communication Sciences and DisordersUniversity of South CarolinaColumbiaSouth CarolinaUSA
| | - Gregory Hickok
- Department of Cognitive ScienceUniversity of CaliforniaIrvineCaliforniaUSA
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17
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Bacon K, Marshall J, Caute A, Monnelly K, Cruice M, Moutou C, Woolf C. Treatment fidelity of technology-enhanced reading therapy (CommuniCATE) for people with aphasia. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2021; 56:1114-1131. [PMID: 34260119 DOI: 10.1111/1460-6984.12637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 05/11/2021] [Accepted: 05/14/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Treatment fidelity (TF), that is, the degree to which the treatment delivery has adhered to protocol, is an important aspect of establishing treatment validity and reliability. Research has shown that establishing TF is only done in a small percentage of aphasia treatment studies. AIMS This project supports the work of the CommuniCATE study, which explored the benefits of technology-enhanced aphasia therapy on participants' reading, writing, speech and conversation skills. It examines the TF of the Reading strand of the CommuniCATE project by assessing whether the therapy adhered to the protocol. The following research questions were asked: Does treatment delivery adhere to treatment protocol? Does the degree of TF vary according to the person delivering the therapy (i.e. student therapist or qualified therapist)? Does the degree of TF vary over time (early treatment sessions compared with later treatment sessions)? Was the checklist tool reliable? METHODS & PROCEDURES This study assessed the fidelity of 38 retrospective video recordings of therapy. It used a checklist measure of criteria to which the delivery of the sessions should adhere, and against which the sessions were rated. Participants were the people with aphasia receiving therapy, the students and qualified speech and language therapists delivering therapy, and the independent raters assessing the sessions. A sample of sessions was randomly chosen, including sessions delivered by qualified therapists and by students, and sessions from different time points in the treatment process. The fidelity was rated by the first author, and the fidelity rating calculated as a percentage. Comparisons in fidelity scores for the different variables were drawn using Mann-Whitney tests. The reliability of the checklist was assessed through inter and intra-rater reliability testing, and the results were analysed using Kappa statistics. OUTCOMES & RESULTS High fidelity was found across all therapy conditions with a mean score of 98.2%. Fidelity scores were not affected by the administrator of therapy; sessions delivered by qualified and student therapists were rated equally highly. There was a small but significant effect of time, with later treatment sessions scoring more highly than earlier sessions. However, scores across both periods > 90%. Inter-rater reliability found a high percentage agreement of 93.3% and a Poor Kappa agreement level. Intra-rater agreement found a high percentage agreement of 97.3% and a Fair Kappa agreement level. CONCLUSIONS & IMPLICATIONS The CommuniCATE reading therapy was implemented as per the protocol across time points, and withstood delegation to students. The high fidelity and good reliability scores have positive implications for the study's validity and reliability, and for the study's replication. WHAT THIS PAPER ADDS What is already known on the subject TF refers to the degree to which the delivery of core components of a treatment matches the implementation guidelines, that is, the adherence to protocol. Despite the acknowledged importance of TF reporting, this is often neglected in the literature. What this paper adds to existing knowledge This paper shows that the TF assessment of the CommuniCATE study (reading strand) found a 98.2% fidelity score, and that high fidelity was not compromised across treatment conditions. This paper outlines the principles of TF and highlights the need for measures to be in place to establish TF, for example, manuals, training and supervision; and to monitor TF, for example, via the use of checklists. This paper also underlines the scarcity of TF measures and checks in aphasia research. This paper therefore serves as a model of TF practice in aphasia therapy research. What are the potential or actual clinical implications of this work? This study contributes to the findings of the CommuniCATE project (reading strand), and the high fidelity findings enhance the validity of the project and indicate that the therapy manual and training enable accurate implementation of delivery. This paper also contributes to the literature on TF evaluation in aphasia studies, which is presently lacking, and highlights the need for increased focus on the optimum strategies of TF reporting.
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Affiliation(s)
| | - Jane Marshall
- Department of Language and Communication, City University, London, UK
| | - Anna Caute
- School of Health and Social Care, University of Essex, Colchester, UK
| | - Katie Monnelly
- Department of Language and Communication, City University, London, UK
| | - Madeline Cruice
- Department of Language and Communication, City University, London, UK
| | | | - Celia Woolf
- Department of Language and Communication, City University, London, UK
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18
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Kristinsson S, Basilakos A, Elm J, Spell LA, Bonilha L, Rorden C, den Ouden DB, Cassarly C, Sen S, Hillis A, Hickok G, Fridriksson J. Individualized response to semantic versus phonological aphasia therapies in stroke. Brain Commun 2021; 3:fcab174. [PMID: 34423302 PMCID: PMC8376685 DOI: 10.1093/braincomms/fcab174] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 04/23/2021] [Accepted: 05/28/2021] [Indexed: 11/12/2022] Open
Abstract
Attempts to personalize aphasia treatment to the extent where it is possible to reliably predict individual response to a particular treatment have yielded inconclusive results. The current study aimed to (i) compare the effects of phonologically versus semantically focussed naming treatment and (ii) examine biographical and neuropsychological baseline factors predictive of response to each treatment. One hundred and four individuals with chronic post-stroke aphasia underwent 3 weeks of phonologically focussed treatment and 3 weeks of semantically focussed treatment in an unblinded cross-over design. A linear mixed-effects model was used to compare the effects of treatment type on proportional change in correct naming across groups. Correlational analysis and stepwise regression models were used to examine biographical and neuropsychological predictors of response to phonological and semantic treatment across all participants. Last, chi-square tests were used to explore the association between treatment response and phonological and semantic deficit profiles. Semantically focussed treatment was found to be more effective at the group-level, independently of treatment order (P = 0.041). Overall, milder speech and language impairment predicted good response to semantic treatment (r range: 0.256-0.373) across neuropsychological tasks. The Western Aphasia Battery-Revised Spontaneous Speech score emerged as the strongest predictor of semantic treatment response (R 2 = 0.188). Severity of stroke symptoms emerged as the strongest predictor of phonological treatment response (R 2 = 0.103). Participants who showed a good response to semantic treatment were more likely to present with fluent speech compared to poor responders (P = 0.005), whereas participants who showed a good response to phonological treatment were more likely to present with apraxia of speech (P = 0.020). These results suggest that semantic treatment may be more beneficial to the improvement of naming performance in aphasia than phonological treatment, at the group-level. In terms of personalized predictors, participants with relatively mild impairments and fluent speech responded better to semantic treatment, while phonological treatment benefitted participants with more severe impairments and apraxia of speech.
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Affiliation(s)
- Sigfus Kristinsson
- Department of Communication Sciences and Disorders, University of South Carolina, Columbia, SC 29208, USA.,Center for the Study of Aphasia Recovery, University of South Carolina, Columbia, SC 29208, USA
| | - Alexandra Basilakos
- Center for the Study of Aphasia Recovery, University of South Carolina, Columbia, SC 29208, USA
| | - Jordan Elm
- Center for the Study of Aphasia Recovery, University of South Carolina, Columbia, SC 29208, USA.,Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC 29425, USA
| | - Leigh Ann Spell
- Department of Communication Sciences and Disorders, University of South Carolina, Columbia, SC 29208, USA.,Center for the Study of Aphasia Recovery, University of South Carolina, Columbia, SC 29208, USA
| | - Leonardo Bonilha
- Center for the Study of Aphasia Recovery, University of South Carolina, Columbia, SC 29208, USA.,Department of Neurology, Medical University of South Carolina, Charleston, SC 29425, USA
| | - Chris Rorden
- Center for the Study of Aphasia Recovery, University of South Carolina, Columbia, SC 29208, USA.,Department of Psychology, University of South Carolina, Columbia, SC 29208, USA
| | - Dirk B den Ouden
- Department of Communication Sciences and Disorders, University of South Carolina, Columbia, SC 29208, USA.,Center for the Study of Aphasia Recovery, University of South Carolina, Columbia, SC 29208, USA
| | - Christy Cassarly
- Center for the Study of Aphasia Recovery, University of South Carolina, Columbia, SC 29208, USA.,Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC 29425, USA
| | - Souvik Sen
- Center for the Study of Aphasia Recovery, University of South Carolina, Columbia, SC 29208, USA.,Department of Neurology, University of South Carolina, Columbia, SC 29208, USA
| | - Argye Hillis
- Center for the Study of Aphasia Recovery, University of South Carolina, Columbia, SC 29208, USA.,Department of Neurology and Physical Medicine & Rehabilitation, Johns Hopkins School of Medicine, Baltimore, MD 21218, USA.,Department of Cognitive Science, Johns Hopkins University, Baltimore, MD 21218, USA
| | - Gregory Hickok
- Center for the Study of Aphasia Recovery, University of South Carolina, Columbia, SC 29208, USA.,Department of Cognitive Sciences and Language Science, University of California, Irvine, CA 92697, USA
| | - Julius Fridriksson
- Department of Communication Sciences and Disorders, University of South Carolina, Columbia, SC 29208, USA.,Center for the Study of Aphasia Recovery, University of South Carolina, Columbia, SC 29208, USA
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19
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Peñaloza C, Scimeca M, Gaona A, Carpenter E, Mukadam N, Gray T, Shamapant S, Kiran S. Telerehabilitation for Word Retrieval Deficits in Bilinguals With Aphasia: Effectiveness and Reliability as Compared to In-person Language Therapy. Front Neurol 2021; 12:589330. [PMID: 34093382 PMCID: PMC8172788 DOI: 10.3389/fneur.2021.589330] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 03/29/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Bilinguals with post-stroke aphasia (BWA) require treatment options that are sensitive to their particular bilingual background and deficits across languages. However, they may experience limited access to bilingual clinical resources due to reduced availability of bilingual practitioners, geographical constraints, and other difficulties. Telerehabilitation can improve access to bilingual clinical services for BWA and facilitate the delivery of specific language treatments at distance, but more evidence on its effectiveness and reliability is needed. This study aimed to determine the equivalence of effectiveness and reliability of a semantic treatment for word retrieval deficits in BWA delivered via telerehabilitation relative to in-person therapy. Methods: We examined the retrospective data of 16 BWA who received 20 sessions of therapy based on semantic feature analysis for word retrieval deficits in person (n = 8) or via telerehabilitation (n = 8). The two groups were comparable on age, years of education, time of post-stroke onset, aphasia severity, and naming ability in both languages. Treatment effectiveness (i.e., effect sizes in the treated and the untreated language, and change on secondary outcome measures) and reliability (i.e., clinician adherence to treatment protocol) were computed for each delivery modality and compared across groups. Results: Significant improvements were observed in most patients, with no significant differences in treatment effect sizes or secondary outcomes in the treated and the untreated language between the teletherapy group and the in-person therapy group. Also, the average percentage of correctly delivered treatment steps by clinicians was high for both therapy delivery methods with no significant differences between the telerehabilitation vs. the in-person modality. Discussion: This study provides evidence of the equivalence of treatment gains between teletherapy and in-person therapy in BWA and the high reliability with which treatment for word retrieval deficits can be delivered via telerehabilitation, suggesting that the essential treatment components of the intervention can be conducted in a comparable manner in both delivery modalities. We further discuss the benefits and potential challenges of the implementation of telerehabilitation for BWA. In the future, telerehabilitation may increase access to therapy for BWA with varying linguistic and cultural backgrounds, thus, offering a more inclusive treatment approach to this population.
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Affiliation(s)
- Claudia Peñaloza
- Aphasia Research Laboratory, Department of Speech, Language and Hearing Sciences, Boston University, Boston, MA, United States
| | - Michael Scimeca
- Aphasia Research Laboratory, Department of Speech, Language and Hearing Sciences, Boston University, Boston, MA, United States
| | - Angelica Gaona
- Aphasia Research Laboratory, Department of Speech, Language and Hearing Sciences, Boston University, Boston, MA, United States
| | - Erin Carpenter
- Aphasia Research Laboratory, Department of Speech, Language and Hearing Sciences, Boston University, Boston, MA, United States
| | - Nishaat Mukadam
- Aphasia Research Laboratory, Department of Speech, Language and Hearing Sciences, Boston University, Boston, MA, United States
| | - Teresa Gray
- Gray Matter Laboratory, Department of Speech, Language and Hearing Sciences, San Francisco State University, San Francisco, CA, United States
| | | | - Swathi Kiran
- Aphasia Research Laboratory, Department of Speech, Language and Hearing Sciences, Boston University, Boston, MA, United States
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20
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Vitti E, Hillis AE. Treatment of post-stroke aphasia: A narrative review for stroke neurologists. Int J Stroke 2021; 16:1002-1008. [PMID: 33949274 DOI: 10.1177/17474930211017807] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This review is intended to help physicians guide patients to optimal management of post-stroke aphasia. We review literature on post-stroke aphasia treatment, focusing on: (1) when and for whom language therapy is most effective, (2) the variety of approaches that can be effective for different individuals, and (3) the extent to which behavioral therapy might be augmented by non-invasive brain stimulation and/or medications.
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Affiliation(s)
- Emilia Vitti
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Argye E Hillis
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, USA
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Fridriksson J, Hillis AE. Current Approaches to the Treatment of Post-Stroke Aphasia. J Stroke 2021; 23:183-201. [PMID: 34102754 PMCID: PMC8189855 DOI: 10.5853/jos.2020.05015] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 02/21/2021] [Accepted: 04/30/2021] [Indexed: 12/16/2022] Open
Abstract
Aphasia, impairment of language after stroke or other neurological insult, is a common and often devastating condition that affects nearly every social activity and interaction. Behavioral speech and language therapy is the mainstay of treatment, although other interventions have been introduced to augment the effects of the behavioral therapy. In this narrative review, we discuss advances in aphasia therapy in the last 5 years and focus primarily on properly powered, randomized, controlled trials of both behavioral therapies and interventions to augment therapy for post-stroke aphasia. These trials include evaluation of behavioral therapies and computer-delivered language therapies. We also discuss outcome prediction trials as well as interventional trials that have employed noninvasive brain stimulation, or medications to augment language therapy. Supported by evidence from Phase III trials and large meta-analyses, it is now generally accepted that aphasia therapy can improve language processing for many patients. Not all patients respond similarly to aphasia therapy with the most severe patients being the least likely responders. Nevertheless, it is imperative that all patients, regardless of severity, receive aphasia management focused on direct therapy of language deficits, counseling, or both. Emerging evidence from Phase II trials suggests transcranial brain stimulation is a promising method to boost aphasia therapy outcomes.
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Affiliation(s)
- Julius Fridriksson
- Department of Communication Sciences and Disorders, University of South Carolina, Columbia, SC, USA
| | - Argye Elizabeth Hillis
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Mazumdar B, Donovan NJ. Maintaining Research Fidelity: Remote Training and Monitoring of Clinical Assistants in Aphasia Research. Ann Indian Acad Neurol 2020; 23:S130-S134. [PMID: 33343137 PMCID: PMC7731684 DOI: 10.4103/aian.aian_489_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 05/25/2020] [Accepted: 05/26/2020] [Indexed: 11/04/2022] Open
Abstract
Background In aphasia research, to improve a study's reliability, the aphasia journals compel their authors to report fidelity. Aphasia researchers are mostly concerned about Type I and Type II errors to maintain the level of confidence. However, the third type (Type III error) can significantly affect the study outcomes and question the research fidelity. Objective This study explains the methodology of how investigators maintained research fidelity in the context of hiring and training remote data collectors and conducted a multi-site data collection. Methods The present study used a descriptive analysis design to explicate the three-step process of remote data collection: (1) remotely selecting and training data collectors, (2) remotely supervising data collection and data management, and (3) optimizing and monitoring screening/assessment fidelity. At the initial step, investigators interviewed seven candidates and short-listed four of them, who were trained using a standard training protocol and participated in a mock data collection. For the next two steps, data collectors video-recorded each study session and e-shared the data with the investigator, who watched all the video-recordings and provided necessary feedback with a focus on the screening sections. The screenings were a part of the inclusion-exclusion criteria. Results Two data collectors (both clinical psychologists) with the highest scores were selected and received final training. One-to-one e-supervision by the investigator resulted in significant improvement in data collectors' performance. Only 4% of the total collected sample size was excluded, and 99 participants' data were analyzed. Conclusion The present study adds information on maintaining research fidelity for remote data collection, where limited studies exist.
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Affiliation(s)
- Barnali Mazumdar
- Department of Communication Sciences and Disorders, Louisiana State University, Baton Rouge, LA, USA
| | - Neila J Donovan
- Department of Communication Sciences and Disorders, Louisiana State University, Baton Rouge, LA, USA
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