Experiences of people with severe aphasia and spouses attending an Interdisciplinary Community Aphasia Group

Therapeutic groups run for community-dwelling people with acquired brain injury: a scoping review

PURPOSE

Therapeutic group interventions are commonly provided in acquired brain injury (ABI) inpatient rehabilitation settings, but little is known about the extent of therapeutic groups run for community-dwellers with ABI. This paper seeks to review current literature concerning the nature of therapeutic groups run for community-dwellers with ABI and the involvement of occupational therapists.

MATERIALS & METHODS

A scoping review was conducted with systematic searching of relevant databases guided by Arksey and O'Malley's framework. Studies were included if they reported on therapeutic groups for community-dwellers with ABI. Articles were collated and summarised with key findings presented in narrative form with accompanying tables.

RESULTS

Seventy articles met inclusion. Groups are used as therapeutic change agents for community-dwellers with ABI and target a diverse range of participation barriers. Participants valued group programs that established safe environments, a sense of belonging, growth opportunities and social connections. Group accessibility needs to be improved, with better funding avenues available for service providers, as well as greater consumer involvement in group design and facilitation.

CONCLUSIONS

Groups are a valuable therapeutic modality supporting community-dwellers with ABI. Further research is warranted into the use of groups by occupational therapists working with community-dwellers with ABI.IMPLICATIONS FOR REHABILITATIONTherapeutic groups can support the development of social connections, community participation and help community-dwellers with ABI re-establish a positive self-identity.Conducting groups in community settings and involving consumers in group design and facilitation may enhance the group experience for participants.Occupational Therapists should be involved in the design and delivery of occupation-based and participation focused group-based programs.

Experiences of participating in group-based rehabilitation programmes: A qualitative study of community-dwelling adults with post-stroke aphasia

BACKGROUND

People with post-stroke aphasia tend to have smaller social networks, a higher risk of depression and poorer health-related quality of life than those who do not have aphasia after stroke. Stroke-specific or general rehabilitation programmes offered by community-based organizations are commonly group-based and involve discussions among group members with or without stroke. Research has shown that people with post-stroke aphasia may be unable to participate fully in verbal sharing of experiences and exchange of thoughts.

AIMS

To explore the experiences of people with post-stroke aphasia in relation to participating in group-based rehabilitation programmes organized by community-based organizations.

METHODS & PROCEDURES

A qualitative design was adopted, including individual, semi-structured interviews with 20 adults with post-stroke aphasia recruited from community-based rehabilitation centres and support groups. The participants had a mean age of 68.86 ± 13.54 years and a mean post-stroke duration of 9.24 ± 7.72 years. They had participated in at least one group-based rehabilitation programme organized by community-based organizations in the past year. The participants were asked about their experiences of attending group-based programme(s), thoughts and feelings while interacting with the facilitators and group members, and satisfaction with their participation. The interview data were thematically analysed.

OUTCOMES & RESULTS

Three themes were identified: (1) hurdles to active and fulfilling participation including the dominance of verbal sharing, short duration of the programme, being a minority in the group and accumulated negative experiences; (2) strategies adopted to improve participation including accepting a reduced speaking ability, having support from caregivers, and trying mobile apps to vocalize and supplement meanings; and (3) a preference for certain group conditions including receiving invitations by staff with whom they were familiar, groups that are led by experienced facilitators, a large or small group, the dominance of non-verbal activities, and inclusion of only people with post-stroke aphasia.

CONCLUSIONS & IMPLICATIONS

The findings showed that people with post-stroke aphasia experience difficulties participating more actively in group-based rehabilitation programmes due to hurdles in terms of the structure and format of the programmes and accumulation of negative experiences. Facilitating positive group experiences for these people with innovative methods, such as using technology and providing professional and standby support, would be helpful. Longer sessions with smaller groups, exclusively including people with post-stroke aphasia and involving more non-verbal activities to help them express feelings, are suggested to optimize the benefits they derive from these group-based programmes.

WHAT THIS PAPER ADDS

What is already known on the subject Stroke-specific or general group-based rehabilitation programmes are commonly offered by community-based organizations to support the recovery of people with or without stroke. However, some people with post-stroke aphasia may be unable to participate fully in verbal sharing of experiences and exchange of thoughts during these group-based programmes, which can limit the benefits they derive from these programmes. What this paper adds to existing knowledge This study explored the experiences of people with post-stroke aphasia in relation to participating in group-based rehabilitation programmes not specifically designed for people with stroke-induced aphasia organized by community-based organizations. The findings provide an insight into how these people participate in groups, their thoughts and feelings during interactions with the facilitators and group members, their satisfaction with their level of participation, and the characteristics of the groups they prefer to join. What are the potential or actual clinical implications of this work? People with post-stroke aphasia experience difficulties participating more actively in group-based programmes due to hurdles in terms of the structure and format of the group-based programmes and accumulation of negative experiences contributing to decreased motivation to participating in groups. More positive group experiences can be fostered by adopting longer sessions with smaller groups that exclusively include people with post-stroke aphasia and involve more non-verbal activities to help them express their feelings. Communication partner training for facilitators and the use of technology to support communication are suggested to promote active and fulfilling participation of the people with aphasia in group-based programmes.

Automatic Assessment of Aphasic Speech Sensed by Audio Sensors for Classification into Aphasia Severity Levels to Recommend Speech Therapies

Aphasia is a type of speech disorder that can cause speech defects in a person. Identifying the severity level of the aphasia patient is critical for the rehabilitation process. In this research, we identify ten aphasia severity levels motivated by specific speech therapies based on the presence or absence of identified characteristics in aphasic speech in order to give more specific treatment to the patient. In the aphasia severity level classification process, we experiment on different speech feature extraction techniques, lengths of input audio samples, and machine learning classifiers toward classification performance. Aphasic speech is required to be sensed by an audio sensor and then recorded and divided into audio frames and passed through an audio feature extractor before feeding into the machine learning classifier. According to the results, the mel frequency cepstral coefficient (MFCC) is the most suitable audio feature extraction method for the aphasic speech level classification process, as it outperformed the classification performance of all mel-spectrogram, chroma, and zero crossing rates by a large margin. Furthermore, the classification performance is higher when 20 s audio samples are used compared with 10 s chunks, even though the performance gap is narrow. Finally, the deep neural network approach resulted in the best classification performance, which was slightly better than both K-nearest neighbor (KNN) and random forest classifiers, and it was significantly better than decision tree algorithms. Therefore, the study shows that aphasia level classification can be completed with accuracy, precision, recall, and F1-score values of 0.99 using MFCC for 20 s audio samples using the deep neural network approach in order to recommend corresponding speech therapy for the identified level. A web application was developed for English-speaking aphasia patients to self-diagnose the severity level and engage in speech therapies.

Predictors of Therapy Response in Chronic Aphasia: Building a Foundation for Personalized Aphasia Therapy

Chronic aphasia, a devastating impairment of language, affects up to a third of stroke survivors. Speech and language therapy has consistently been shown to improve language function in prior clinical trials, but few clinicially applicable predictors of individual therapy response have been identified to date. Consequently, clinicians struggle substantially with prognostication in the clinical management of aphasia. A rising prevalence of aphasia, in particular in younger populations, has emphasized the increasing demand for a personalized approach to aphasia therapy, that is, therapy aimed at maximizing language recovery of each individual with reference to evidence-based clinical recommendations. In this narrative review, we discuss the current state of the literature with respect to commonly studied predictors of therapy response in aphasia. In particular, we focus our discussion on biographical, neuropsychological, and neurobiological predictors, and emphasize limitations of the literature, summarize consistent findings, and consider how the research field can better support the development of personalized aphasia therapy. In conclusion, a review of the literature indicates that future research efforts should aim to recruit larger samples of people with aphasia, including by establishing multisite aphasia research centers.

Diagnosing and managing post-stroke aphasia

Introduction: Aphasia is a debilitating language disorder and even mild forms of aphasia can negatively affect functional outcomes, mood, quality of life, social participation, and the ability to return to work. Language deficits after post-stroke aphasia are heterogeneous. Areas covered: The first part of this manuscript reviews the traditional syndrome-based classification approach as well as recent advances in aphasia classification that incorporate automatic speech recognition for aphasia classification. The second part of this manuscript reviews the behavioral approaches to aphasia treatment and recent advances such as noninvasive brain stimulation techniques and pharmacotherapy options to augment the effectiveness of behavioral therapy. Expert opinion: Aphasia diagnosis has largely evolved beyond the traditional approach of classifying patients into specific syndromes and instead focuses on individualized patient profiles. In the future, there is a great need for more large scale randomized, double-blind, placebo-controlled clinical trials of behavioral treatments, noninvasive brain stimulation, and medications to boost aphasia recovery.

A randomised trial of social support group intervention for people with aphasia: A Novel application of virtual reality

About a third of strokes cause aphasia, or language loss, with profound consequences for the person's social participation and quality of life. These problems may be mitigated by group social support. But this intervention is not available to all individuals. This study investigated whether it is feasible to deliver group social support to people with aphasia via a multi-user, virtual reality platform. It also explored the indicative effects of intervention and the costs. Intervention aimed to promote wellbeing and communicative success. It enabled participants to form new social connections and share experiences of living with aphasia. It comprised 14 sessions delivered over 6 months and was led by community based co-ordinators and volunteers. Feasibility measures comprised: recruitment and retention rates, compliance with intervention and assessment of treatment fidelity. Effects of intervention were explored using a waitlist randomised controlled design, with outcome measures of wellbeing, communication, social connectedness and quality of life. Two intervention groups were randomised to an immediate condition and two were randomised to a delayed condition. The main analysis explored scores on the measures between two time points, between which those in the immediate condition had received intervention, but those in the delayed group had not (yet). A comprehensive approach to economic data collection ensured that all costs of treatment delivery were recorded. Feasibility findings showed that the recruitment target was met (N = 34) and 85.3% (29/34) of participants completed intervention. All groups ran the 14 sessions as planned, and participants attended a mean of 11.4 sessions (s.d. 2.8), which was 81.6% of the intended dose. Fidelity checking showed minimal drift from the manualised intervention. No significant change was observed on any of the outcome measures, although the study was not powered to detect these. Costs varied across the four groups, from £7,483 - £12,562 British Pounds Sterling ($10,972 - $18,419 US dollars), depending on travel costs, the relative contributions of volunteers and the number of hardware loans that were needed. The results suggest that a larger trial of remote group support, using virtual reality, would be merited. However the treatment content and regime, and the selection of outcome measures should be reviewed before conducting the trial. Trail registration: Study registered with ClinicalTrials.gov; Identifier: https://www.ncbi.nlm.nih.gov/NCT03115268.