Behavioral, Functional Imaging, and Neurophysiological Outcomes of Transcranial Direct Current Stimulation and Speech-Language Therapy in an Individual with Aphasia

Speech-language therapy (SLT) is the most effective technique to improve language performance in persons with aphasia. However, residual language impairments remain even after intensive SLT. Recent studies suggest that combining transcranial direct current stimulation (tDCS) with SLT may improve language performance in persons with aphasia. However, our understanding of how tDCS and SLT impact brain and behavioral relation in aphasia is poorly understood. We investigated the impact of tDCS and SLT on a behavioral measure of scripted conversation and on functional connectivity assessed with multiple methods, both resting-state functional magnetic resonance imaging (rs-fMRI) and resting-state electroencephalography (rs-EEG). An individual with aphasia received 15 sessions of 20-min cathodal tDCS to the right angular gyrus concurrent with 40 min of SLT. Performance during scripted conversation was measured three times at baseline, twice immediately post-treatment, and at 4- and 8-weeks post-treatment. rs-fMRI was measured pre-and post-3-weeks of treatment. rs-EEG was measured on treatment days 1, 5, 10, and 15. Results show that both communication performance and left hemisphere functional connectivity may improve after concurrent tDCS and SLT. Results are in line with aphasia models of language recovery that posit a beneficial role of left hemisphere perilesional areas in language recovery.

Medidas de Calidad de Vida en Personas con Afasia. Revisión Sistemática

La afasia después de un daño cerebral y sus diferentes condiciones negativas derivadas, afectan a la calidad de vida (CdV) de la persona. El objetivo de este estudio es describir y analizar la literatura de los años comprendidos entre 2016 y 2020 para identificar y cuantificar aspectos relevantes de la CdV y su evaluación en personas con afasia (PWA). Para lo anterior, se consultaron tres bases de datos (PsycINFO, Medline y Psicodoc). Se incluyeron 38 estudios. Se codificaron y analizaron las características de los estudios y se evaluó la calidad de los trabajos siguiendo las pautas marcadas por la STROBE y la NIH. Los resultados muestran que la prueba de evaluación de CdV más utilizada fue la Stroke and Aphasia Quality of Life Scale-39 (SAQOL-39) (n= 19, 50.00%). En la mayoría de los estudios, independientemente de las pruebas de evaluación, las PWA presentan una baja CdV. Los estudios seleccionados presentan una calidad metodológica media-alta. Como conclusión cabe destacar que, además de limitar aspectos de la comunicación y el lenguaje, la afasia afecta negativamente a la CdV de forma global de la persona que la padece. El desarrollo de pruebas de evaluación de la CdV puede ayudar a los profesionales a planificar una intervención adecuada.

Using an Implementation Framework to Survey Outcome Measurement and Treatment Practices in Aphasia

PURPOSE

Best practices in the field of aphasia rehabilitation increasingly acknowledge a whole-person approach that values interventions aimed at reducing impairments, while also recognizing the impact of aphasia on participation and quality of life. Guided by the Consolidated Framework for Implementation Research (CFIR), this study aimed to examine whether current clinical practices along levels of service provision reflect this whole-person, multifaceted approach.

METHOD

Speech-language pathologists (SLPs) in the United States who provide intervention to people with aphasia across the continuum of care completed this cross-sectional online survey. Current outcome measurement and treatment practices were evaluated within the Living With Aphasia: Framework for Outcome Measurement via multiple-choice and open-text response questions. Data were analyzed descriptively and using ordinal logistic regression models to compare clinical practices along levels of service provision.

RESULTS

Data from 90 SLPs revealed that language and cognitive skills are assessed with equal consistency across clinical settings; however, functional communication, participation, and quality of life domains are prioritized in settings providing care to clients within the community. Psychological well-being is rarely assessed within clinical practice along most of the rehabilitation process and prioritized within the university clinic setting when clients are in the chronic stage of recovery.

CONCLUSIONS

Clinical practices related to a multifaceted approach to aphasia intervention are variable across levels of service provision. Further exploration of barriers and facilitators to multifaceted aphasia care along the domains of the CFIR is needed to provide an informed approach to implementing change.

The Impact of the COVID-19 Public Health Crisis on Communication and Quality of Life: Insights From a Community of Stroke and Brain Trauma Survivors

Purpose The COVID-19 pandemic has led to stay-at-home orders and social distancing guidelines that have the potential to greatly impact individuals' behavior and social engagement. Adults recovering from stroke or other brain trauma, who often have communication difficulties and other long-term challenges, are a population already at risk of isolation and lower quality of life. We investigated the impact of public health guidelines and related behavioral changes on self-perceptions of communication abilities and psychosocial factors in this population. Method The Stroke Comeback Center, a community-based center for stroke and other brain trauma survivors with communication impairments, disseminated an online survey to current members to investigate changes in communication, social engagement, and quality of life. Results Participants (N = 50) reported a number of changes in their day-to-day activities that reflect the current social distancing guidelines, such as reduced outings into the community and fewer in-person conversations with those living outside one's home. Overall, feelings of connectedness to others and overall quality of life were reported to be decreased when compared to before the COVID-19 pandemic, whereas receptive language abilities and technology skills were reported to have improved. Perhaps most interestingly, certain behavioral changes (including healthy movement activities and participation in virtual programs) had specific relationships with perceived communication abilities and social engagement. Conclusions Changes in daily life resulting from the COVID-19 pandemic have had a tangible impact on self-perceived psychosocial elements (e.g., quality of life) and communication abilities among stroke and other brain trauma survivors. Clinicians and researchers may consider these perceived changes when engaging with this population as the effects of the pandemic continue and in the period of community re-entry that may follow. Supplemental Material https://doi.org/10.23641/asha.14830881.

Perspectives of working-age adults with aphasia regarding social participation

Background

Working-age adults with aphasia experience difficulties in social participation, specifically fulfilling social roles and reintegrating into communities. Literature regarding social participation of people with aphasia (PWA) is predominantly based on studies conducted in high-income countries (HIC), limiting generalisability of findings. Perspectives of social participation are influenced by person, place and cultural background warranting investigation in heterogeneous low- and middle-income countries (LMICs), like South Africa.

Objectives

Describe perspectives of working-age adults with aphasia regarding social participation within the first 2 years post-incident.

Method

Semi-structured interviews gained perspectives of 10 working-age adults (with mild to moderate aphasia) using principles of supported conversation for adults with aphasia. Data were thematically analysed to describe participants' perspectives of social participation.

Results

Seven themes were identified pertaining to participants' perspectives of social participation. Participants considered rehabilitation services, faith-related activities and returning to work as valued areas of social participation. Previous interests, presence of support and characteristics of communication partners determined their preference and willingness to participate with others. Finally, personal attitudes and feelings continued to influence their perspectives of social participation, as well as their motivation to participate.

Conclusion

Successful social participation was dependent on the PWA's perceived value of social activities and presence of support from significant others. Speech-language therapists are in the ideal position to facilitate PWA's communication abilities and their experience of successful participation through the implementation of person-centered care and community-led intervention. This study provided a preliminary investigation of social participation in South Africa and further investigation is warranted.

Effects of Written, Auditory, and Combined Modalities on Comprehension by People With Aphasia

Background People with aphasia experience reading challenges affecting participation in daily activities. Researchers have found combined auditory and written presentation modalities help people with aphasia comprehend contrived sentences and narratives, but less is known about the effects of combined modalities on functional, expository text comprehension. Aims This study's purpose was to examine comprehension accuracy, reviewing time, and modality preference of people with aphasia when presented with edited newspaper articles in written only, auditory only, and combined written and auditory modalities. Method and Procedure Twenty-eight adults with chronic aphasia read and/or listened to 36 passages. Following each passage, participants answered comprehension questions. Then, they ranked the modalities in accordance with preference and provided a rationale for their ranking. Outcomes and Results Comprehension accuracy was significantly better in the combined than auditory-only condition and in the written-only than auditory-only condition; the difference between combined and written-only conditions was not significant. Reviewing time differed significantly among conditions with the written-only condition taking longest and the auditory-only condition taking shortest. Most participants preferred the combined condition. Conclusions Access to combined modalities helps people with aphasia comprehend expository passages such as those found in newspapers better than auditory-only presentation. Furthermore, combined presentation decreases reviewing time from that needed for unsupported reading without compromising comprehension accuracy. Given that most participants preferred combined modality presentation, providing simultaneous auditory and written access to content through text-to-speech technology is a viable strategy when aphasia results in persistent reading challenges.