1
|
Sackley CM, Rick C, Brady MC, Woolley R, Burton C, Patel S, Masterson-Algar P, Nicoll A, Smith CH, Jowett S, Ives N, Beaton G, Dickson S, Ottridge R, Sharp L, Nankervis H, Clarke CE. Lee Silverman voice treatment versus NHS speech and language therapy versus control for dysarthria in people with Parkinson's disease (PD COMM): pragmatic, UK based, multicentre, three arm, parallel group, unblinded, randomised controlled trial. BMJ 2024; 386:e078341. [PMID: 38986549 PMCID: PMC11232530 DOI: 10.1136/bmj-2023-078341] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/12/2024]
Abstract
OBJECTIVES To assess the clinical effectiveness of two speech and language therapy approaches versus no speech and language therapy for dysarthria in people with Parkinson's disease. DESIGN Pragmatic, UK based, multicentre, three arm, parallel group, unblinded, randomised controlled trial. SETTING The speech and language therapy interventions were delivered in outpatient or home settings between 26 September 2016 and 16 March 2020. PARTICIPANTS 388 people with Parkinson's disease and dysarthria. INTERVENTIONS Participants were randomly assigned to one of three groups (1:1:1): 130 to Lee Silverman voice treatment (LSVT LOUD), 129 to NHS speech and language therapy, and 129 to no speech and language therapy. LSVT LOUD consisted of four, face-to-face or remote, 50 min sessions each week delivered over four weeks. Home based practice activities were set for up to 5-10 mins daily on treatment days and 15 mins twice daily on non-treatment days. Dosage for the NHS speech and language therapy was determined by the local therapist in response to the participants' needs (estimated from prior research that NHS speech and language therapy participants would receive an average of one session per week over six to eight weeks). Local practices for NHS speech and language therapy were accepted, except for those within the LSVT LOUD protocol. Analyses were based on the intention to treat principle. MAIN OUTCOME MEASURES The primary outcome was total score at three months of self-reported voice handicap index. RESULTS People who received LSVT LOUD reported lower voice handicap index scores at three months after randomisation than those who did not receive speech and language therapy (-8.0 points (99% confidence interval -13.3 to -2.6); P<0.001). No evidence suggests a difference in voice handicap index scores between NHS speech and language therapy and no speech and language therapy (1.7 points (-3.8 to 7.1); P=0.43). Patients in the LSVT LOUD group also reported lower voice handicap index scores than did those randomised to NHS speech and language therapy (-9.6 points (-14.9 to -4.4); P<0.001). 93 adverse events (predominately vocal strain) were reported in the LSVT LOUD group, 46 in the NHS speech and language therapy group, and none in the no speech and language therapy group. No serious adverse events were recorded. CONCLUSIONS LSVT LOUD was more effective at reducing the participant reported impact of voice problems than was no speech and language therapy and NHS speech and language therapy. NHS speech and language therapy showed no evidence of benefit compared with no speech and language therapy. TRIAL REGISTRATION ISRCTN registry ISRCTN12421382.
Collapse
Affiliation(s)
- Catherine M Sackley
- School of Health Science, University of Nottingham, Queen's Medical Centre, Nottingham, UK
- NIHR Nottingham Biomedical Research Centre
- Population Health Sciences, Addison House, King's College London, Guy's Campus, London, UK
| | - Caroline Rick
- Nottingham Clinical Trials Unit, University of Nottingham, Applied Health Research Building, University Park, Nottingham, UK
- Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - Marian C Brady
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Rebecca Woolley
- Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - Christopher Burton
- School of Allied and Public Health Professions, Canterbury Christ Church University, Canterbury, UK
| | - Smitaa Patel
- Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | | | - Avril Nicoll
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Christina H Smith
- Division of Psychology and Language Science, Faculty of Brain Sciences, University College London, London, UK
- NHS Lothian
| | - Sue Jowett
- Health Economics Unit, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Natalie Ives
- Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - Gillian Beaton
- Queen Elizabeth Hospital, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Sylvia Dickson
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Ryan Ottridge
- Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | | | - Helen Nankervis
- School of Health Science, University of Nottingham, Queen's Medical Centre, Nottingham, UK
- Population Health Sciences, Addison House, King's College London, Guy's Campus, London, UK
| | - Carl E Clarke
- Institute for Applied Health Research, University of Birmingham, Birmingham, UK
- Department of Neurology, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
| |
Collapse
|
2
|
Tilton-Bolowsky VE, Hillis AE. A Review of Poststroke Aphasia Recovery and Treatment Options. Phys Med Rehabil Clin N Am 2024; 35:419-431. [PMID: 38514227 DOI: 10.1016/j.pmr.2023.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2024]
Abstract
Poststroke aphasia, which impacts expressive and receptive communication, can have detrimental effects on the psychosocial well-being and the quality of life of those affected. Aphasia recovery is multidimensional and can be influenced by several baseline, stroke-related, and treatment-related factors, including preexisting cerebrovascular conditions, stroke size and location, and amount of therapy received. Importantly, aphasia recovery can continue for many years after aphasia onset. Behavioral speech and language therapy with a speech-language pathologist is the most common form of aphasia therapy. In this review, the authors also discuss augmentative treatment methodologies, collaborative goal setting frameworks, and recommendations for future research.
Collapse
Affiliation(s)
- Victoria E Tilton-Bolowsky
- Department of Neurology, Johns Hopkins School of Medicine, 600 North Wolfe Street, Phipps 446F, Baltimore, MD 21287, USA
| | - Argye E Hillis
- Department of Neurology, Johns Hopkins School of Medicine, 600 North Wolfe Street, Phipps 446F, Baltimore, MD 21287, USA.
| |
Collapse
|
3
|
Breitenstein C, Wallace SJ, Gilmore N, Finch E, Pettigrove K, Brady MC. Invaluable Benefits of 10 Years of the International Collaboration of Aphasia Trialists (CATs). Stroke 2024; 55:1129-1135. [PMID: 38527148 DOI: 10.1161/strokeaha.124.046487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 02/13/2024] [Indexed: 03/27/2024]
Abstract
Aphasia research has traditionally been considered a (unidisciplinary) niche topic in medical science. The international Collaboration of Aphasia Trialists (CATs) is a global collaboration of multidisciplinary aphasia researchers. Over the past 10 years, CATs has collectively taken a rigorous approach to systematically address persistent challenges to aphasia research quality. This article summarizes the achievements over the past decade. CATs' achievements include: standardizing terminology, advancing aphasia research design by aphasia expert consensus recommendations, developing a core data set and intervention descriptors, facilitating the involvement of people with the language impairment aphasia in the research process, translating, and adapting assessment tools into global languages, encouraging data sharing, developing innovative secondary data analysis methodologies and promoting the transparency and accessibility of high quality aphasia research reports. CATs' educational and scientific achievements over the past 10 years far exceed what individual researchers in the field could have ever achieved.
Collapse
Affiliation(s)
| | - Sarah J Wallace
- Queensland Aphasia Research Centre, Brisbane, Australia (S.J.W.)
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane,
Australia (S.J.W., E.F., M.C.B.)
| | - Natalie Gilmore
- Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital, Boston, MA (N.G.)
| | - Emma Finch
- Research and Innovation, West Moreton Health, Ipswich, Australia (E.F.)
- Speech Pathology Department, Princess Alexandra Hospital, Brisbane, Australia (E.F.)
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane,
Australia (S.J.W., E.F., M.C.B.)
| | - Kathryn Pettigrove
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University, Melbourne, Australia (K.P.)
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia (K.P.)
| | - Marian C Brady
- Nursing, Midwifery and Allied Health Professionals Research Unit, Glasgow Caledonian University, Glasgow, United Kingdom (M.C.B.)
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane,
Australia (S.J.W., E.F., M.C.B.)
| |
Collapse
|
4
|
Upton E, Doogan C, Fleming V, Leyton PQ, Barbera D, Zeidman P, Hope T, Latham W, Coley-Fisher H, Price C, Crinion J, Leff A. Efficacy of a gamified digital therapy for speech production in people with chronic aphasia (iTalkBetter): behavioural and imaging outcomes of a phase II item-randomised clinical trial. EClinicalMedicine 2024; 70:102483. [PMID: 38685927 PMCID: PMC11056404 DOI: 10.1016/j.eclinm.2024.102483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 01/26/2024] [Accepted: 01/26/2024] [Indexed: 05/02/2024] Open
Abstract
Background Aphasia is among the most debilitating of symptoms affecting stroke survivors. Speech and language therapy (SLT) is effective, but many hours of practice are required to make clinically meaningful gains. One solution to this 'dosage' problem is to automate therapeutic approaches via self-supporting apps so people with aphasia (PWA) can amass practice as it suits them. However, response to therapy is variable and no clinical trial has yet identified the key brain regions required to engage with word-retrieval therapy. Methods Between Sep 7, 2020 and Mar 1, 2022 at University College London in the UK, we carried out a phase II, item-randomised clinical trial in 27 PWA using a novel, self-led app, 'iTalkBetter', which utilises confrontation naming therapy. Unlike previously reported apps, it has a real-time utterance verification system that drives its adaptive therapy algorithm. Therapy items were individually randomised to provide balanced lists of 'trained' and 'untrained' items matched on key psycholinguistic variables and baseline performance. PWA practised with iTalkBetter over a 6-week therapy block. Structural and functional MRI data were collected to identify therapy-related changes in brain states. A repeated-measures design was employed. The trial was registered at ClinicalTrials.gov (NCT04566081). Findings iTalkBetter significantly improved naming ability by 13% for trained items compared with no change for untrained items, an average increase of 29 words (SD = 26) per person; beneficial effects persisted at three months. PWA's propositional speech also significantly improved. iTalkBetter use was associated with brain volume increases in right auditory and left anterior prefrontal cortices. Task-based fMRI identified dose-related activity in the right temporoparietal junction. Interpretation Our findings suggested that iTalkBetter significantly improves PWAs' naming ability on trained items. The effect size is similar to a previous RCT of computerised therapy, but this is the first study to show transfer to a naturalistic speaking task. iTalkBetter usage and dose caused observable changes in brain structure and function to key parts of the surviving language perception, production and control networks. iTalkBetter is being rolled-out as an app for all PWA and anomia: https://www.ucl.ac.uk/icn/research/research-groups/neurotherapeutics/projects/digital-interventions-neuro-rehabilitation-0 so that they can increase their dosage of practice-based SLT. Funding National Institute for Health and Care Research, Wellcome Centre for Human Neuroimaging.
Collapse
Affiliation(s)
- Emily Upton
- UCL Queen Square Institute of Neurology, University College London, UK
- Institute of Cognitive Neuroscience, University College London, UK
- Department of Psychology and Language Sciences, University College London, UK
| | - Catherine Doogan
- UCL Queen Square Institute of Neurology, University College London, UK
- Institute of Cognitive Neuroscience, University College London, UK
- St George’s, University of London, UK
| | - Victoria Fleming
- Department of Psychology and Language Sciences, University College London, UK
| | | | - David Barbera
- Institute of Cognitive Neuroscience, University College London, UK
| | - Peter Zeidman
- Wellcome Centre for Human Neuroimaging, University College London, UK
| | - Tom Hope
- Wellcome Centre for Human Neuroimaging, University College London, UK
- Department of Psychology and Social Science, John Cabot University, Rome, Italy
| | - William Latham
- Department of Computing, Goldsmiths, University of London, UK
| | | | - Cathy Price
- Wellcome Centre for Human Neuroimaging, University College London, UK
| | - Jennifer Crinion
- Institute of Cognitive Neuroscience, University College London, UK
- Department of Psychology and Language Sciences, University College London, UK
| | - Alex Leff
- UCL Queen Square Institute of Neurology, University College London, UK
- Institute of Cognitive Neuroscience, University College London, UK
- University College London Hospitals NHS Trust, UK
| |
Collapse
|
5
|
Harvey S, Stone M, Zingelman S, Copland DA, Kilkenny MF, Godecke E, Cadilhac DA, Kim J, Olaiya MT, Rose ML, Breitenstein C, Shrubsole K, O'Halloran R, Hill AJ, Hersh D, Mainstone K, Mainstone P, Unsworth CA, Brogan E, Short KJ, Burns CL, Baker C, Wallace SJ. Comprehensive quality assessment for aphasia rehabilitation after stroke: protocol for a multicentre, mixed-methods study. BMJ Open 2024; 14:e080532. [PMID: 38514146 PMCID: PMC10961567 DOI: 10.1136/bmjopen-2023-080532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 02/27/2024] [Indexed: 03/23/2024] Open
Abstract
INTRODUCTION People with aphasia following stroke experience disproportionally poor outcomes, yet there is no comprehensive approach to measuring the quality of aphasia services. The Meaningful Evaluation of Aphasia SeRvicES (MEASuRES) minimum dataset was developed in partnership with people with lived experience of aphasia, clinicians and researchers to address this gap. It comprises sociodemographic characteristics, quality indicators, treatment descriptors and outcome measurement instruments. We present a protocol to pilot the MEASuRES minimum dataset in clinical practice, describe the factors that hinder or support implementation and determine meaningful thresholds of clinical change for core outcome measurement instruments. METHODS AND ANALYSIS This research aims to deliver a comprehensive quality assessment toolkit for poststroke aphasia services in four studies. A multicentre pilot study (study 1) will test the administration of the MEASuRES minimum dataset within five Australian health services. An embedded mixed-methods process evaluation (study 2) will evaluate the performance of the minimum dataset and explore its clinical applicability. A consensus study (study 3) will establish consumer-informed thresholds of meaningful change on core aphasia outcome constructs, which will then be used to establish minimal important change values for corresponding core outcome measurement instruments (study 4). ETHICS AND DISSEMINATION Studies 1 and 2 have been registered with the Australian and New Zealand Clinical Trial Registry (ACTRN12623001313628). Ethics approval has been obtained from the Royal Brisbane and Women's Hospital (HREC/2023/MNHB/95293) and The University of Queensland (2022/HE001946 and 2023/HE001175). Study findings will be disseminated through peer-reviewed publications, conference presentations and engagement with relevant stakeholders including healthcare providers, policy-makers, stroke and rehabilitation audit and clinical quality registry custodians, consumer support organisations, and individuals with aphasia and their families.
Collapse
Affiliation(s)
- Sam Harvey
- Queensland Aphasia Research Centre, The University of Queensland, Saint Lucia, Queensland, Australia
- Surgical, Treatment and Rehabilitation Service Education and Research Alliance, The University of Queensland and Metro North Hospital and Health Service, Herston, Queensland, Australia
| | - Marissa Stone
- Queensland Aphasia Research Centre, The University of Queensland, Saint Lucia, Queensland, Australia
- St Vincent's Hospital Melbourne Pty Ltd, Fitzroy, Victoria, Australia
| | - Sally Zingelman
- Queensland Aphasia Research Centre, The University of Queensland, Saint Lucia, Queensland, Australia
- Surgical, Treatment and Rehabilitation Service Education and Research Alliance, The University of Queensland and Metro North Hospital and Health Service, Herston, Queensland, Australia
| | - David A Copland
- Queensland Aphasia Research Centre, The University of Queensland, Saint Lucia, Queensland, Australia
- Surgical, Treatment and Rehabilitation Service Education and Research Alliance, The University of Queensland and Metro North Hospital and Health Service, Herston, Queensland, Australia
| | - Monique F Kilkenny
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
- Stroke Theme, The Florey Institute of Neuroscience and Mental Health, Parkville, Victoria, Australia
| | - Erin Godecke
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
- Centre for Research Excellence in Aphasia Recovery and Rehabilitation, Melbourne, Victoria, Australia
| | - Dominique A Cadilhac
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
- Stroke Theme, The Florey Institute of Neuroscience and Mental Health, Parkville, Victoria, Australia
| | - Joosup Kim
- Stroke Theme, The Florey Institute of Neuroscience and Mental Health, Parkville, Victoria, Australia
- Department of Medicine, School of Clinical Sciences, Monash University, Clayton, Victoria, Australia
| | - Muideen T Olaiya
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
| | - Miranda L Rose
- Centre for Research Excellence in Aphasia Recovery and Rehabilitation, Melbourne, Victoria, Australia
- School of Allied Health, Human Services and Sport, La Trobe University College of Science Health and Engineering, Bundoora, Victoria, Australia
| | - Caterina Breitenstein
- Department of Neurology with Institute of Translational Neurology, University of Muenster, Muenster, Germany
| | - Kirstine Shrubsole
- Queensland Aphasia Research Centre, The University of Queensland, Saint Lucia, Queensland, Australia
- Metro South Hospital and Health Service, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | - Robyn O'Halloran
- Centre for Research Excellence in Aphasia Recovery and Rehabilitation, Melbourne, Victoria, Australia
- School of Allied Health, Human Services and Sport, La Trobe University College of Science Health and Engineering, Bundoora, Victoria, Australia
| | - Annie J Hill
- Centre for Research Excellence in Aphasia Recovery and Rehabilitation, Melbourne, Victoria, Australia
- School of Allied Health, Human Services and Sport, La Trobe University College of Science Health and Engineering, Bundoora, Victoria, Australia
| | - Deborah Hersh
- Curtin School of Allied Health and EnAble Institute, Curtin University, Perth, Western Australia, Australia
- Australian Aphasia Association, Perth, Western Australia, Australia
| | - Kathryn Mainstone
- Queensland Aphasia Research Centre, The University of Queensland, Saint Lucia, Queensland, Australia
| | - Penelope Mainstone
- Queensland Aphasia Research Centre, The University of Queensland, Saint Lucia, Queensland, Australia
| | - Carolyn A Unsworth
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
- Institute of Health and Wellbeing, Federation University, Ballarat, Victoria, Australia
| | - Emily Brogan
- Edith Cowan University, Joondalup, Western Australia, Australia
- Fiona Stanley Fremantle Hospitals Group, South Metropolitan Health Service, Palmyra, Western Australia, Australia
| | - Kylie J Short
- Surgical, Treatment and Rehabilitation Service Education and Research Alliance, The University of Queensland and Metro North Hospital and Health Service, Herston, Queensland, Australia
| | - Clare L Burns
- Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Herston, Queensland, Australia
| | - Caroline Baker
- Centre for Research Excellence in Aphasia Recovery and Rehabilitation, Melbourne, Victoria, Australia
- Speech Pathology Department, Monash Health, Clayton, Victoria, Australia
| | - Sarah J Wallace
- Queensland Aphasia Research Centre, The University of Queensland, Saint Lucia, Queensland, Australia
- Surgical, Treatment and Rehabilitation Service Education and Research Alliance, The University of Queensland and Metro North Hospital and Health Service, Herston, Queensland, Australia
| |
Collapse
|
6
|
Kushnir A, Kachmar O, Bonnechère B. STASISM: A Versatile Serious Gaming Multi-Sensor Platform for Personalized Telerehabilitation and Telemonitoring. SENSORS (BASEL, SWITZERLAND) 2024; 24:351. [PMID: 38257442 PMCID: PMC10818392 DOI: 10.3390/s24020351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 12/21/2023] [Accepted: 01/04/2024] [Indexed: 01/24/2024]
Abstract
Telemonitoring and telerehabilitation have shown promise in delivering individualized healthcare remotely. We introduce STASISM, a sensor-based telerehabilitation and telemonitoring system, in this work. This platform has been created to facilitate individualized telerehabilitation and telemonitoring for those who need rehabilitation or ongoing monitoring. To gather and analyze pertinent and validated physiological, kinematic, and environmental data, the system combines a variety of sensors and data analytic methodologies. The platform facilitates customized rehabilitation activities based on individual needs, allows for the remote monitoring of a patient's progress, and offers real-time feedback. To protect the security of patient data and to safeguard patient privacy, STASISM also provides secure data transmission and storage. The platform has the potential to significantly improve the accessibility and efficacy of telerehabilitation and telemonitoring programs, enhancing patients' quality of life and allowing healthcare professionals to provide individualized care outside of traditional clinical settings.
Collapse
Affiliation(s)
- Anna Kushnir
- Elita Rehabilitation Center, 79000 Lviv, Ukraine;
- REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, 3590 Diepenbeek, Belgium;
| | - Oleh Kachmar
- Elita Rehabilitation Center, 79000 Lviv, Ukraine;
| | - Bruno Bonnechère
- REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, 3590 Diepenbeek, Belgium;
- Technology-Supported and Data-Driven Rehabilitation, Data Sciences Institute, Hasselt University, 3590 Diepenbeek, Belgium
- Department of PXL-Healthcare, PXL University of Applied Sciences and Arts, 3500 Hasselt, Belgium
| |
Collapse
|
7
|
Leff A, Doogan C, Bentley J, Makkar B, Zenobi-Bird L, Sherman A, Grobler S, Crinion J. More than one way to improve a CAT: Outcomes and reflections on two iterations of the Queen Square Intensive Comprehensive Aphasia Programme. APHASIOLOGY 2023:1-24. [PMID: 38652694 PMCID: PMC11027995 DOI: 10.1080/02687038.2023.2286703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 11/16/2023] [Indexed: 04/25/2024]
Abstract
Background The field of human expert performance teaches us that high quality, high-dose guided practice is required to make large gains in cognitively driven acts. The same also seems to be true for people with acquired brain injury, yet therapy services for people with aphasia (PWA) have traditionally not been designed with this in mind. Intensive Comprehensive Aphasia Programmes (ICAPs) are one way to address the chronic under-dosing of therapy that most PWA experience. Aims There are several ways to deliver an ICAP; here we describe two iterations of our Queen Square ICAP. There was a 20-month COVID-induced pause between the Year 1 (Y1) and Year 2 (Y2) ICAP groups. We analyse ICAP-induced changes in both groups of PWA on a series of key outcome measures that span the International Classification of Functioning, Disability and Health, covering language impairment and function as well as mood and social participation. Methods & Procedures Forty-six PWA took part in Y1 and 44 in Y2. The PWA were all in the chronic stage post stroke and varied in aphasia severity from mild to severe, with the Y2 group being more impaired than Y1. Quantitative data was collected before and after the ICAP. The Y2 therapy team provided independent reflections on their experiences of delivering an ICAP. Outcomes & Results ICAP-related changes in outcome measures (impairment, function and goal attainment) were generally comparable for the Y1 and Y2 groups, with both groups' speech production abilities improving the most. Both groups made clinically and statistically significant gains on the main quality of life measure. Participation in the ICAP made a big difference to PWAs' self-confidence ratings. Their mood ratings also improved significantly, although they were not, on average, in the depressed range at baseline (directly pre-ICAP). All improvements achieved in both groups were maintained at the 3-month follow-up, highlighting the lasting effects that ICAPs can provide. Conclusions Evidence continues to accrue that ICAPs are an efficient way of increasing the dose of expert coaching required for people with chronic aphasia to make clinically meaningful improvements in their communicative abilities and quality of life. The main challenge remaining is convincing health-care providers to invest in them.
Collapse
Affiliation(s)
- Alexander Leff
- UCL Queen Square Institute of Neurology, University College London, London, UK
- University College London Hospitals NHS Trust, London, UK
- Institute of Cognitive Neuroscience, University College London, London, UK
| | - Catherine Doogan
- UCL Queen Square Institute of Neurology, University College London, London, UK
- University College London Hospitals NHS Trust, London, UK
- St Georges, University of London
| | | | - Bani Makkar
- University College London Hospitals NHS Trust, London, UK
| | | | - Amy Sherman
- University College London Hospitals NHS Trust, London, UK
| | - Simon Grobler
- University College London Hospitals NHS Trust, London, UK
| | - Jennifer Crinion
- University College London Hospitals NHS Trust, London, UK
- Institute of Cognitive Neuroscience, University College London, London, UK
| |
Collapse
|
8
|
Dávila G, Torres-Prioris MJ, López-Barroso D, Berthier ML. Turning the Spotlight to Cholinergic Pharmacotherapy of the Human Language System. CNS Drugs 2023; 37:599-637. [PMID: 37341896 PMCID: PMC10374790 DOI: 10.1007/s40263-023-01017-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/24/2023] [Indexed: 06/22/2023]
Abstract
Even though language is essential in human communication, research on pharmacological therapies for language deficits in highly prevalent neurodegenerative and vascular brain diseases has received little attention. Emerging scientific evidence suggests that disruption of the cholinergic system may play an essential role in language deficits associated with Alzheimer's disease and vascular cognitive impairment, including post-stroke aphasia. Therefore, current models of cognitive processing are beginning to appraise the implications of the brain modulator acetylcholine in human language functions. Future work should be directed further to analyze the interplay between the cholinergic system and language, focusing on identifying brain regions receiving cholinergic innervation susceptible to modulation with pharmacotherapy to improve affected language domains. The evaluation of language deficits in pharmacological cholinergic trials for Alzheimer's disease and vascular cognitive impairment has thus far been limited to coarse-grained methods. More precise, fine-grained language testing is needed to refine patient selection for pharmacotherapy to detect subtle deficits in the initial phases of cognitive decline. Additionally, noninvasive biomarkers can help identify cholinergic depletion. However, despite the investigation of cholinergic treatment for language deficits in Alzheimer's disease and vascular cognitive impairment, data on its effectiveness are insufficient and controversial. In the case of post-stroke aphasia, cholinergic agents are showing promise, particularly when combined with speech-language therapy to promote trained-dependent neural plasticity. Future research should explore the potential benefits of cholinergic pharmacotherapy in language deficits and investigate optimal strategies for combining these agents with other therapeutic approaches.
Collapse
Affiliation(s)
- Guadalupe Dávila
- Cognitive Neurology and Aphasia Unit, Centro de Investigaciones Médico-Sanitarias, University of Malaga, Marqués de Beccaria 3, 29010, Malaga, Spain
- Instituto de Investigación Biomédica de Malaga-IBIMA, Malaga, Spain
- Department of Psychobiology and Methodology of Behavioral Sciences, Faculty of Psychology and Speech Therapy, University of Malaga, Malaga, Spain
- Language Neuroscience Research Laboratory, Faculty of Psychology and Speech Therapy, University of Malaga, Malaga, Spain
| | - María José Torres-Prioris
- Cognitive Neurology and Aphasia Unit, Centro de Investigaciones Médico-Sanitarias, University of Malaga, Marqués de Beccaria 3, 29010, Malaga, Spain
- Instituto de Investigación Biomédica de Malaga-IBIMA, Malaga, Spain
- Department of Psychobiology and Methodology of Behavioral Sciences, Faculty of Psychology and Speech Therapy, University of Malaga, Malaga, Spain
- Language Neuroscience Research Laboratory, Faculty of Psychology and Speech Therapy, University of Malaga, Malaga, Spain
| | - Diana López-Barroso
- Cognitive Neurology and Aphasia Unit, Centro de Investigaciones Médico-Sanitarias, University of Malaga, Marqués de Beccaria 3, 29010, Malaga, Spain
- Instituto de Investigación Biomédica de Malaga-IBIMA, Malaga, Spain
- Department of Psychobiology and Methodology of Behavioral Sciences, Faculty of Psychology and Speech Therapy, University of Malaga, Malaga, Spain
- Language Neuroscience Research Laboratory, Faculty of Psychology and Speech Therapy, University of Malaga, Malaga, Spain
| | - Marcelo L Berthier
- Cognitive Neurology and Aphasia Unit, Centro de Investigaciones Médico-Sanitarias, University of Malaga, Marqués de Beccaria 3, 29010, Malaga, Spain.
- Instituto de Investigación Biomédica de Malaga-IBIMA, Malaga, Spain.
- Language Neuroscience Research Laboratory, Faculty of Psychology and Speech Therapy, University of Malaga, Malaga, Spain.
| |
Collapse
|
9
|
Berthier ML, Dávila G. Pharmacotherapy for post-stroke aphasia: what are the options? Expert Opin Pharmacother 2023; 24:1221-1228. [PMID: 37263978 DOI: 10.1080/14656566.2023.2221382] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 05/31/2023] [Indexed: 06/03/2023]
Abstract
INTRODUCTION Aphasia is a common, long-lasting aftermath of stroke lesions. There is an increased integration of pharmacotherapy as an adjunctive strategy to speech and language therapy (SLT) for post-stroke aphasia (PSA). Nevertheless, more research in pharmacotherapy for acute and chronic PSA is necessary, including the election of drugs that target different neurotransmitter systems and deficits in specific language domains. AREAS COVERED This article updates the role of pharmacotherapy for PSA, focusing the spotlight on some already investigated drugs and candidate agents deserving of future research. Refining the precision of drug election would require using multimodal biomarkers to develop personalized treatment approaches. There is a solid need to devise feasible randomized controlled trials adapted to the particularities of the PSA population. The emergent role of multimodal interventions combining one or two drugs with noninvasive brain stimulation to augment SLT is emphasized. EXPERT OPINION Pharmacotherapy can improve language deficits not fully alleviated by SLT. In addition, the 'drug-only' approach can also be adopted when administering SLT is not possible. The primary goal of pharmacotherapy is reducing the overall aphasia severity, although targeting language-specific deficits (i.e. naming, spoken output) also contributes to improving functional communication. Unfortunately, there is still little information for recommending a drug for specific language deficits.
Collapse
Affiliation(s)
- Marcelo L Berthier
- Cognitive Neurology and Aphasia Unit, Centro de Investigaciones Médico-Sanitarias, University of Malaga, Malaga, Spain
- Instituto de Investigación Biomédica de Malaga - IBIMA, Malaga, Spain
| | - Guadalupe Dávila
- Cognitive Neurology and Aphasia Unit, Centro de Investigaciones Médico-Sanitarias, University of Malaga, Malaga, Spain
- Instituto de Investigación Biomédica de Malaga - IBIMA, Malaga, Spain
- Language Neuroscience Research Laboratory, Faculty of Psychology and Speech Therapy, University of Malaga, Malaga, Spain
- Department of Psychobiology and Methodology of Behavioral Sciences, Faculty of Psychology and Speech Therapy, University of Malaga, Malaga, Spain
| |
Collapse
|
10
|
Treatments to improve recovery after stroke. Int J Stroke 2022; 17:1058-1060. [DOI: 10.1177/17474930221136176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|