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Watanabe M, Cartwright J, Pierce JE. Positive effects of speech and language therapy group interventions in primary progressive aphasia: A systematic review. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2024. [PMID: 38602276 DOI: 10.1111/1460-6984.13031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 03/08/2024] [Indexed: 04/12/2024]
Abstract
BACKGROUND Primary progressive aphasia (PPA) is a neurodegenerative condition characterised by a prominent and progressive deterioration in language abilities, which significantly impacts quality of life and interpersonal relationships. Speech and language therapy plays a crucial role in offering interventions. Group intervention is one mode of delivery that could benefit communication functioning and overall wellbeing of people with PPA (pwPPA) and their care partners. Group interventions are also more efficient than one-to-one intervention and may facilitate peer support. AIMS The aim of this review was to systematically evaluate the current evidence for the effectiveness of speech and language therapy groups for pwPPA and their care partners. Specifically, this paper considered three questions: 1.What evidence-based speech and language therapy groups for pwPPA and their care partners have been reported to date? 2.Are group communication interventions effective in improving quality of life and communication function for pwPPA and their care partners? 3.Are group communication interventions that are designed for people with communication difficulties of other aetiologies (such as stroke) effective for pwPPA? In addition, this review aimed to describe the structure and content of groups, including aims, disciplines involved, size and frequency of group meetings, and outcome measures. METHODS MEDLINE, CINAHL and PsycINFO were used to retrieve articles of interest. A total of 10 studies published between 2009 and 2022 met the eligibility criteria and therefore were included in this study. Data were extracted from the articles regarding the structure and content of groups. MAIN CONTRIBUTION Although evidence is currently limited, results suggest that speech and language therapy group intervention can improve specific linguistic processes, the use of communication strategies and psychosocial well-being. The importance of multidisciplinary input and care partners' involvement in groups was highlighted, along with the benefits of creative non-verbal activities as tools for self-expression. There is also initial evidence that telehealth group provision and one-off group sessions may be feasible and can benefit psychosocial well-being. Lastly, intentional recruitment and explicit education on different aphasia types are described as important when pwPPA participate in groups with mixed diagnoses. CONCLUSIONS The literature on speech and language therapy group interventions for PPA shows promise of positive effects on communication function and psychosocial well-being of both pwPPA and their care partners. Speech and language therapists can consider these published interventions when designing and implementing similar groups, but more robust evidence is required to confirm the relative effectiveness of this approach. WHAT THIS PAPER ADDS What is already known on this subject Speech pathology led group intervention shows some promise in benefitting communication functioning and overall well-being of pwPPA and their carers, but there has been no systematic evaluation of all the evidence regarding the efficacy of speech and language therapy led groups. Establishing feasibility, acceptability and efficacy of speech and language therapy group interventions for pwPPA and their carers may present a valuable addition for managing this progressive language disability. What this paper adds to existing knowledge Although evidence is currently limited, results from this systematic review suggest that speech and language therapy led group intervention can improve specific linguistic processes, the use of communication strategies and psychosocial well-being for pwPPA and their carers. The importance of multidisciplinary input and carers' involvement in groups was highlighted, along with the benefits of creative non-verbal activities as tools for self-expression. There is also initial evidence that telehealth group provision for carers may be feasible and can benefit psychosocial wellbeing. Lastly, intentional recruitment and explicit education on different aphasia types are described as important when pwPPA participate in groups with mixed diagnoses. What are the potential or actual clinical implications of this work? A synthesis of the evidence base for speech and language therapy led PPA groups, as well as a description of the group components and formats, will be valuable for clinical service planning, and will guide future examination of group options for pwPPA and their carers. Speech and language therapists can also consider the research findings from this systematic review when designing and implementing similar groups in their local context.
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Affiliation(s)
| | - Jade Cartwright
- School of Health Sciences, College of Health and Medicine, University of Tasmania, Launceston, Australia
| | - John E Pierce
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University, Melbourne, Victoria, Australia
- Speech Pathology, La Trobe University, Melbourne, Victoria, Australia
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Georgiou AM, Kambanaros M. Therapies and Challenges in the Post-Stroke Aphasia Rehabilitation Arena: Current and Future Prospects. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1674. [PMID: 37763793 PMCID: PMC10537631 DOI: 10.3390/medicina59091674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 09/11/2023] [Accepted: 09/14/2023] [Indexed: 09/29/2023]
Abstract
Aphasia is a serious consequence of stroke that results in a breakdown in communication. The course of aphasia recovery differs between afflicted individuals, and responsiveness to treatment cannot be predicted. Aphasiologists continue to investigate numerous behavioral treatment protocols that have shifted their focus to complimentary rehabilitation strategies. The aim of this study is threefold. First, to summarize the different categories of aphasia interventions post-stroke, considering their respective protocols, and present available evidence on the effectiveness of those protocols. Second, to document the challenges regarding the prediction of aphasia treatment response post-stroke in individual patients. Third, to report the challenges faced by researchers in recruiting people with aphasia (PWA) for treatment studies, and provide recommendations on how to increase participant recruitment and retention. This study provides up-to-date information on (i) effective therapies and aphasia recovery processes, and (ii) research recruitment hurdles together with potential strategies for overcoming them.
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Affiliation(s)
- Anastasios M. Georgiou
- The Brain and Neurorehabilitation Lab, Department of Rehabilitation Sciences, Cyprus University of Technology, 3041 Limassol, Cyprus;
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Sandberg CW, Niemkiewicz JK, Kubat AM, Conyers LM. Impact of COVID-19 on People With Aphasia: Emerging Rehabilitation Needs. REHABILITATION RESEARCH, POLICY, AND EDUCATION 2022. [DOI: 10.1891/re-21-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Purpose:The purpose of this article is to address an emerging issue in rehabilitation counseling: The effect of the COVID-19 pandemic on people with aphasia (PWA).Method:Based upon a review of the literature this article provides an overview of (a) COVID-19 and emergent aphasia-related disability, (b) COVID-19 effects on stroke and aphasia services, (c) COVID-19 effects on mental health and employment of PWA.Results:This review of the impact of COVID-19 on PWA highlights the increased and emerging needs for rehabilitation counseling services related to an anticipated increase in incidence of aphasia related to COVID-19 illness and secondary impact of medical care for this population.Conclusion:The impact of COVID-19 on aphasia care in rehabilitation settings underscores the need for increased interprofessional education and collaboration to address the many gaps in aphasia care. Likewise, interdisciplinary research focused on rehabilitation outcomes in aphasia is needed to provide a foundation for evidence-based practice that conforms to the WHO-ICF framework.
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Caute A, Cruice M, Devane N, Patel A, Roper A, Talbot R, Wilson S, Marshall J. Delivering group support for people with aphasia in a virtual world: experiences of service providers. Disabil Rehabil 2022; 44:8264-8282. [PMID: 34962849 DOI: 10.1080/09638288.2021.2011436] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
PURPOSE This study explored the acceptability to service providers of delivering a novel group support intervention for people with aphasia (PWA) in a virtual world. MATERIALS AND METHODS The service providers were six group coordinators and 10 volunteers. Fourteen of the service providers participated in a semi-structured qualitative interview and 15 took part in a consensus group discussion. Qualitative interviews were analysed using framework analysis. For consensus group discussions, nominal group rankings were analysed and semantically similar responses were identified. RESULTS Service providers described the virtual world as a safe space in which to communicate, connect, and experiment. The key barriers were technical, particularly relating to sound and connectivity issues. Service providers suggested a range of improvements to the virtual world and intervention programme. They reported that PWA benefitted from accessing a support group in a virtual world, with opportunities to connect socially and to develop their communication skills. CONCLUSIONS Service providers found delivery of group support intervention in a virtual world to be acceptable. The use of a bespoke virtual world to deliver group support intervention may enhance the experience and increase its accessibility, enabling more PWA to benefit from this type of intervention.Implications for rehabilitationPeople with aphasia benefit from group support intervention but may find it difficult to access face-to-face groups.Delivery of group support intervention in a virtual world is acceptable to service providers, can enhance the experience and increase accessibility of groups.Technical challenges present potential barriers when delivering group support in a virtual world, relating particularly to sound and connectivity.Potential benefits of this model of delivery, as perceived by service providers, include opportunities to connect socially and to develop communication skills plus specific and strong levels of enjoyment of the virtual context.
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Affiliation(s)
- Anna Caute
- School of Health and Social Care, University of Essex, Colchester, UK.,Centre for Language and Communication Science Research, City, University of London, London, UK
| | - Madeline Cruice
- Centre for Language and Communication Science Research, City, University of London, London, UK
| | - Niamh Devane
- Centre for Language and Communication Science Research, City, University of London, London, UK
| | - Anita Patel
- Anita Patel Health Economics Consulting Ltd, London, UK
| | - Abi Roper
- Centre for Language and Communication Science Research, City, University of London, London, UK
| | - Richard Talbot
- Centre for Language and Communication Science Research, City, University of London, London, UK.,Sussex Community NHS Foundation Trust, Brighton, UK
| | - Stephanie Wilson
- Centre for Human-Computer Interaction Design, City, University of London, London, UK
| | - Jane Marshall
- Centre for Language and Communication Science Research, City, University of London, London, UK
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Pettigrove K, Lanyon LE, Attard MC, Vuong G, Rose ML. Characteristics and impacts of community aphasia group facilitation: a systematic scoping review. Disabil Rehabil 2022; 44:6884-6898. [PMID: 34632891 DOI: 10.1080/09638288.2021.1971307] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
PURPOSE Community aphasia groups (CAGs) can provide a range of benefits to people with aphasia and support long-term psychosocial wellbeing. However, the dominant speech-pathologist-led service delivery model is inherently limited in scope. Peer-led groups hold potential as a sustainable and empowering extension of this traditional model. The implementation of peer-led models likely requires targeted training and support, however little is known about the characteristics and impacts of CAG facilitation. This study reviews the literature on CAGs and their facilitation. MATERIALS AND METHODS We conducted a scoping review on this topic. RESULTS One hundred and seventy-seven texts were included, reporting on a heterogeneous range of activities. Most texts reported on speech-pathologist-led groups, however, a range of alternative models were also represented. While no studies directly compared the impacts of different facilitation models, some comparative benefits could be drawn from the literature. Facilitation was perceived as complex and challenging, and significant gaps were identified in the training of facilitators. Ten qualitative studies investigated characteristics and impacts of facilitator behaviours, providing a useful foundation for future development of training and evaluation tools. CONCLUSIONS Further investigation into alternative facilitation models and facilitator training needs will likely support the proliferation of high-quality CAGs.Implications for RehabilitationCommunity aphasia groups (CAGs) play an important role in supporting identity and wellbeing for individuals with chronic aphasia.The traditional speech-pathology led model of group service delivery is limited in scope; the addition of peer- and volunteer-led CAGs may facilitate access to groups and meet a range of different needs for individuals with aphasia.CAG facilitation is a complex and challenging task, likely requiring specialised training, however, this has not been widely available to facilitators.The development of specialised facilitator training will likely support the proliferation of sustainable and high-quality CAGs.
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Affiliation(s)
- Kathryn Pettigrove
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia.,Centre of Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University, Melbourne, Australia
| | - Lucette E Lanyon
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia.,Centre of Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University, Melbourne, Australia
| | - Michelle C Attard
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia.,Centre of Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University, Melbourne, Australia
| | - Genevieve Vuong
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University, Melbourne, Australia.,School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Australia
| | - Miranda L Rose
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia.,Centre of Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University, Melbourne, Australia
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Edmonds LA, Morgan J. Two-Year Longitudinal Evaluation of Community Aphasia Center Participation on Linguistic, Functional Communication, and Quality of Life Measures Across People With a Range of Aphasia Presentations. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2022; 31:2378-2394. [PMID: 36260759 DOI: 10.1044/2022_ajslp-21-00308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
PURPOSE The purpose of this study was to evaluate potential changes on a hierarchy of language tasks and measures of functional communication and quality of life in a group of people with aphasia (PWA) who attended a community aphasia center for 2 years. A secondary purpose was to determine whether there were any predictors of change. METHOD Twenty-seven PWA who attended Brooks Rehabilitation Aphasia Center (BRAC) were evaluated on an aphasia battery, confrontation naming, and structured discourse in addition to completing self-reported measures of functional communication and quality of life at three time points: before attending BRAC and after 1 (N = 27) and 2 (N = 20) years of BRAC participation. Twenty-six communication partners who communicated regularly with the PWA completed a questionnaire about their functional communication at the same time points. A mixed linear model was conducted for all dependent variables to determine change over time. Tau-b correlations were conducted between demographic and aphasia-related variables and difference scores for outcome measures that exhibited significant improvements. RESULTS At 1-year testing, significant improvements were observed on the aphasia battery, object and action naming, and all self- and communication partner-reported measures. At 2-year testing, all improvements were maintained except for the self-reported measure of functional communication. Structured discourse showed increases in average number of words, percentage of meaningful words and utterances, and efficiency of meaningful word production after 2 years. No significant correlations were observed between predictor variables and difference scores. CONCLUSIONS Participation in aphasia centers can result in significant changes in language, functional communication, and quality of life in people with chronic aphasia. These findings support the importance of aphasia centers in the continuum of care for PWA. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.21313689.
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Affiliation(s)
- Lisa A Edmonds
- Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY
| | - Jodi Morgan
- Brooks Rehabilitation Aphasia Center, Jacksonville, FL
- Department of Communication Sciences and Disorders, Jacksonville University, FL
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Kristensson J, Saldert C, Östberg P, Smith SR, Åke S, Longoni F. Naming vs. non-naming treatment in aphasia in a group setting-A randomized controlled trial. JOURNAL OF COMMUNICATION DISORDERS 2022; 97:106215. [PMID: 35367876 DOI: 10.1016/j.jcomdis.2022.106215] [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: 03/15/2021] [Revised: 03/07/2022] [Accepted: 03/15/2022] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Anomia affects numerous persons with aphasia. Treatment effects of anomia group therapy have been reported, but the evidence is not comprehensive. This study aimed to explore treatment effects of a naming treatment compared with a non-naming treatment delivered in a group setting. METHODS In a randomized controlled trial, 17 participants with chronic poststroke aphasia underwent group therapy, 2 hours a session, 3 times per week, for a total of 20 hours. The treatment given in the naming group was modified semantic feature analysis (SFA). Treatment content in the non-naming group comprised auditory comprehension, copying text, and reading. The primary outcome measure was accuracy in confrontation naming of participant-selected trained nouns and verbs. Generalization effects were evaluated in single-word naming, connected speech, and everyday communication. RESULTS Participants in both groups significantly improved their naming of trained items. There were no differences between the groups. The treatment effect did not remain at follow-up 10 weeks after therapy. No other statistically significant changes occurred in either group. CONCLUSIONS Group intervention can improve naming ability in individuals with chronic aphasia. However, similar treatment effects can be achieved using a non-naming treatment as using a naming treatment, such as modified SFA. Further research is warranted to identify the most important elements of anomia group therapy.
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Affiliation(s)
- Joana Kristensson
- Speech and Language Pathology Unit, Department of Health and Rehabilitation at the Institute of Neuroscience and Physiology, Sahlgrenska Academy at Gothenburg University, PO Box 452, SE-405 30 Gothenburg, Sweden.
| | - Charlotta Saldert
- Speech and Language Pathology Unit, Department of Health and Rehabilitation at the Institute of Neuroscience and Physiology, Sahlgrenska Academy at Gothenburg University, PO Box 452, SE-405 30 Gothenburg, Sweden
| | - Per Östberg
- Division of Speech and Language Pathology, Department of Clinical Science, Intervention, and Technology, Karolinska Institutet, Stockholm, Sweden; Medical Unit Speech and Language Pathology, Karolinska University Hospital, Stockholm, Sweden
| | - Signe Rödseth Smith
- Speech and Language Pathology Unit, Department of Health and Rehabilitation at the Institute of Neuroscience and Physiology, Sahlgrenska Academy at Gothenburg University, PO Box 452, SE-405 30 Gothenburg, Sweden
| | - Sabina Åke
- Speech and Language Pathology Unit, Department of Health and Rehabilitation at the Institute of Neuroscience and Physiology, Sahlgrenska Academy at Gothenburg University, PO Box 452, SE-405 30 Gothenburg, Sweden
| | - Francesca Longoni
- Speech and Language Pathology Unit, Department of Health and Rehabilitation at the Institute of Neuroscience and Physiology, Sahlgrenska Academy at Gothenburg University, PO Box 452, SE-405 30 Gothenburg, Sweden
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Cherney LR, Carpenter J. Behavioral interventions for poststroke aphasia. HANDBOOK OF CLINICAL NEUROLOGY 2022; 185:197-220. [PMID: 35078599 DOI: 10.1016/b978-0-12-823384-9.00010-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
There is a long history of behavioral interventions for poststroke aphasia with hundreds of studies supporting the benefits of aphasia treatment. However, interventions for aphasia are complex with many interacting components, and no one treatment is appropriate for all persons with aphasia. We present a novel, simple framework for classifying aphasia interventions. The framework is incorporated within the overarching International Classification of Functioning, Disability, and Health (ICF) model and is consistent with the commonly-held definition that aphasia is a multimodality disorder that impairs, in varying degrees, the understanding and expression of both oral and written language modalities. Furthermore, within the language impairment level, it distinguishes between the linguistic areas of phonology, semantics, and syntax that may be impaired individually or in combination. We define the terminology of the proposed framework and then categorize some common examples of behavioral interventions for post-stroke aphasia. We describe some of these interventions in greater detail to illustrate the extensive toolbox of evidence-based treatments for aphasia. We address some key issues that clinicians, usually speech-language pathologists, consider when selecting interventions for their specific patients with aphasia, including dose. Finally, we address various models of service delivery for persons with aphasia such as Intensive Comprehensive Aphasia Programs (ICAPs) and Aphasia Centers.
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Affiliation(s)
- Leora R Cherney
- Center for Aphasia Research and Treatment, Shirley Ryan AbilityLab, Chicago, IL, United States; Department of Physical Medicine & Rehabilitation, Northwestern University, Chicago, IL, United States; Department of Communication Sciences & Disorders, Northwestern University, Chicago, IL, United States.
| | - Julia Carpenter
- Center for Aphasia Research and Treatment, Shirley Ryan AbilityLab, Chicago, IL, United States
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Escher AA, McKinnon S, Berger S. Effective interventions within the scope of occupational therapy practice to address participation for adults with aphasia: A systematic review. Br J Occup Ther 2021. [DOI: 10.1177/03080226211057835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction Occupational therapists work with clients with impaired communication to re-engage in valued occupations. This systematic review seeks to answer the question: What are effective interventions within the scope of occupational therapy practice to address participation for adults with aphasia? Method A systematic review of the literature was completed using PubMed, PsychInfo, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Embase, Cochrane Database of Systematic Reviews, and OT Seeker databases. Intervention studies within the scope of occupational therapy practice with a participation outcome, and published in peer reviewed journals from 2000 to 2019, were included. The quality of each study was assessed using the Mixed Methods Appraisal Tool. Findings Thirteen articles fit the inclusion criteria. Categories of interventions that emerged from the data include community-based groups, individually tailored programs, adaptation/presentation of materials, interprofessional interventions, and psychoeducation. Conclusion There is evidence to support the use of interventions within the scope of occupational therapy practice to increase participation for people with aphasia. Specifically, the use of community-based groups and adaptation of materials are effective to facilitate participation. Most of the studies were pre-post one group design; however, they demonstrated positive results for participation outcomes. More research is needed on people with aphasia that focuses on participation in meaningful occupations.
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Affiliation(s)
- Anne A Escher
- Department of Occupational Therapy, Boston University, Boston, MA, USA
| | - Sarah McKinnon
- Post-Professional OTD Program, Department of Occupational Therapy, MGH Institute of Health Professions, Boston, MA, USA
| | - Sue Berger
- Department of Occupational Therapy, Boston University, Boston, MA, USA
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Semantic Variant Primary Progressive Aphasia: Practical Recommendations for Treatment from 20 Years of Behavioural Research. Brain Sci 2021; 11:brainsci11121552. [PMID: 34942854 PMCID: PMC8699306 DOI: 10.3390/brainsci11121552] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 11/15/2021] [Accepted: 11/16/2021] [Indexed: 12/01/2022] Open
Abstract
People with semantic variant primary progressive aphasia (svPPA) present with a characteristic progressive breakdown of semantic knowledge. There are currently no pharmacological interventions to cure or slow svPPA, but promising behavioural approaches are increasingly reported. This article offers an overview of the last two decades of research into interventions to support language in people with svPPA including recommendations for clinical practice and future research based on the best available evidence. We offer a lay summary in English, Spanish and French for education and dissemination purposes. This paper discusses the implications of right- versus left-predominant atrophy in svPPA, which naming therapies offer the best outcomes and how to capitalise on preserved long-term memory systems. Current knowledge regarding the maintenance and generalisation of language therapy gains is described in detail along with the development of compensatory approaches and educational and support group programmes. It is concluded that there is evidence to support an integrative framework of treatment and care as best practice for svPPA. Such an approach should combine rehabilitation interventions addressing the language impairment, compensatory approaches to support activities of daily living and provision of education and support within the context of dementia.
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Monnelly K, Marshall J, Cruice M. Intensive Comprehensive Aphasia Programmes: a systematic scoping review and analysis using the TIDieR checklist for reporting interventions. Disabil Rehabil 2021; 44:6471-6496. [PMID: 34445900 DOI: 10.1080/09638288.2021.1964626] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE Aphasia is an acquired language disorder that typically occurs as a result of a stroke. People with aphasia experience communication difficulties and risk secondary impacts, for example, affecting social and work life and mental health. Intensive Comprehensive Aphasia Programmes (ICAPs) aims to address the multiple consequences of aphasia using intensive intervention and a wide range of therapy approaches. Although basic parameters of ICAP intervention have been defined, a fuller characterisation is needed. This systematic scoping review aimed to determine what constitutes an ICAP. METHODS Peer-reviewed and Grey databases were searched for articles on ICAPs using Joanna Brigg's Institute methodology. Data was extracted following the Template for Intervention Description and Replication (TIDieR) checklist for reporting interventions and synthesised using a narrative synthesis. RESULTS AND CONCLUSIONS 17 ICAPs were reported in 20 peer-reviewed literature sources (9 ICAPs supplemented by Grey literature sources). There were high degrees of variation in dose, professionals involved, and no qualitative data from participants. Of note, ICAP intervention was highly tailored to individual participants on the same ICAP, and intervention content varied between ICAPs. ICAPs appear to be rationalised as intensive impairment-based programmes with other components added for comprehensiveness. Stronger rationale and a logic model are required to justify the core components of ICAPs. The input of stakeholders into designing future ICAP interventions is recommended.IMPLICATIONS FOR REHABILITATIONThe ICAP model is in its infancy when it comes to mainstream clinical application as only the intensity component of the ICAP has clear theoretical underpinning as reported in the peer-reviewed literature.There have been clinical uptakes of the ICAP model which is likely to continue and is valid in the context of an under-researched area of aphasia therapy and on a background of a less than perfect relationship between evidence base and practice.Aspects of the ICAP model are valid for clinicians to implement, for example, intensive evidence-based aphasia therapy in combination with therapy which addresses some of the broader implications of aphasia, for example, social isolation.Clinicians can use the ICAP model to review their existing service provision and explore whether their service provides aphasia therapy that addresses the multiple aspects of aphasia (i.e., ensuring the focus is not only on impairment-based therapy).
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Affiliation(s)
- Katie Monnelly
- Division of Language and Communication Science, University of London, London, UK
| | - Jane Marshall
- Division of Language and Communication Science, University of London, London, UK
| | - Madeline Cruice
- Division of Language and Communication Science, University of London, London, UK
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Armstrong E, Coffin J, Hersh D, Katzenellenbogen JM, Thompson SC, Ciccone N, Flicker L, Woods D, Hayward C, Dowell C, McAllister M. "You felt like a prisoner in your own self, trapped": the experiences of Aboriginal people with acquired communication disorders. Disabil Rehabil 2021; 43:1903-1916. [PMID: 31692386 DOI: 10.1080/09638288.2019.1686073] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 10/23/2019] [Accepted: 10/24/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE Aboriginal Australians are under-represented in brain injury rehabilitation services despite a high incidence of both stroke and traumatic brain injury in this population. This study aimed to explore the experiences of Aboriginal Australian adults with acquired communication disorders (ACDs) after brain injury for the first time to inform the development of accessible and culturally secure service delivery models. METHODS AND MATERIALS Semi-structured interviews were undertaken with 32 Aboriginal people who had experienced a brain injury resulting in ACDs (aged 35-79 years) and 18 family members/carers across Western Australia. Thematic analysis identified common themes across participants. RESULTS Overall themes related to communication (both related to the communication disorder and general healthcare interactions), health and social contexts, recovery, and support, being away from family and country, knowledge and beliefs about brain injury, and follow-up. CONCLUSIONS An increase in healthcare staff's appreciation of the health and social contexts of Aboriginal people after brain injury is needed in order to improve communication with Aboriginal patients and the ability to offer accessible rehabilitation services. Ongoing support is required, with cultural identity noted as key to ensuring cultural security and ultimately recovery. Involvement of family and other Aboriginal people in recovery processes, as well as access to relevant Aboriginal languages and proximity to ancestral lands is central.Implications for rehabilitationAcknowledgment of cultural identity and strengths through involvement of extended family and Aboriginal Hospital Liaison Officers, access to language and proximity to country all central to rehabilitation planning for Aboriginal people after brain injury.Cultural security training for rehabilitation staff is recommended focusing on clear two-way communication skills to make medical information accessible for Aboriginal patients and to listen to patients' concerns in a way that respects cultural context.Information regarding practical support and implications for ongoing management of life after brain injury (for the person and their family) is essential, and should supplement the medical-related information provided.Follow-up post discharge from hospital best facilitated through establishing contact with local Aboriginal community through Aboriginal community controlled health services, community elders, and Aboriginal health workers across organisations.
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Affiliation(s)
- Elizabeth Armstrong
- School of Medical & Health Sciences, Edith Cowan University, Perth, Australia
| | | | - Deborah Hersh
- School of Medical & Health Sciences, Edith Cowan University, Perth, Australia
| | - Judith M Katzenellenbogen
- School of Population and Global Health, University of Western Australia, Perth, Australia
- Telethon Kids Institute, Perth, Australia
| | - Sandra C Thompson
- Western Australian Centre for Rural Health, University of Western Australia, Geraldton, Australia
| | - Natalie Ciccone
- School of Medical & Health Sciences, Edith Cowan University, Perth, Australia
| | - Leon Flicker
- Centre for Medical Research, University of Western Australia, Perth, Australia
| | - Deborah Woods
- Geraldton Regional Aboriginal Medical Service, Geraldton, Australia
| | - Colleen Hayward
- Kurongkurl Katitjin, Centre for Indigenous Australian Education and Research, Edith Cowan University, Perth, Australia
| | - Catelyn Dowell
- School of Medical & Health Sciences, Edith Cowan University, Perth, Australia
| | - Meaghan McAllister
- School of Medical & Health Sciences, Edith Cowan University, Perth, Australia
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Taylor-Rubin C, Croot K, Nickels L. Speech and language therapy in primary progressive aphasia: a critical review of current practice. Expert Rev Neurother 2021; 21:419-430. [PMID: 33641570 DOI: 10.1080/14737175.2021.1897253] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Primary progressive aphasia (PPA) is a complex language-led dementia syndrome whereby disproportionate deterioration of speech and language occurs subsequent to neurodegenerative disease in the early to mid-stages of the condition. As no effective pharmacotherapies are currently available, speech and language therapies are the optimum treatment to maximize communication for as long as possible. AREAS COVERED The authors present an overview of current speech-language therapy practices in PPA, highlighting recent research on effective treatments. EXPERT OPINION The challenges in this complex field of practice are described. We highlight the challenge of improving access to speech-language therapy by advocating for increased referral rates. The authors also suggest effective incorporation of innovative technologies in treatment and an enhanced evidence base for the utility of lexical retrieval treatment in improving everyday communication as challenges for the future. Finally, increased provision of PPA-specific education and support for individuals and their families is required.
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Affiliation(s)
- Cathleen Taylor-Rubin
- Department of Cognitive Science, Faculty of Medicine, Health and Human Sciences, Macquarie University, Level 3, Australian Hearing Hub, 16 University Road, Macquarie University, Sydney, NSW, Australia.,Department of Speech Pathology, Uniting War Memorial Hospital, South Eastern Sydney Local Health District War Memorial Hospital, Waverley, NSW, Australia
| | - Karen Croot
- Department of Cognitive Science, Faculty of Medicine, Health and Human Sciences, Macquarie University, Level 3, Australian Hearing Hub, 16 University Road, Macquarie University, Sydney, NSW, Australia.,Faculty of Science, School of Psychology, Brennan MacCallum Building, Camperdown, NSW, Australia
| | - Lyndsey Nickels
- Department of Cognitive Science, Faculty of Medicine, Health and Human Sciences, Macquarie University, Level 3, Australian Hearing Hub, 16 University Road, Macquarie University, Sydney, NSW, Australia
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Do caregivers who connect online have better outcomes? A systematic review of online peer-support interventions for caregivers of people with stroke, dementia, traumatic brain injury, Parkinson’s disease and multiple sclerosis. BRAIN IMPAIR 2021. [DOI: 10.1017/brimp.2021.5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
AbstractBackground and Objectives:This systematic review aimed to identify and appraise the evidence for online peer-support interventions for caregivers of stroke survivors (with and without aphasia), and people with dementia, traumatic brain injury (TBI), Parkinson’s disease and multiple sclerosis.Research Design and Methods:Systematic review conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Five databases were systematically searched up until September 2020: EMBASE, PubMed, CINAHL, Scopus and Web of Science. Two reviewers independently screened titles, abstracts and full-text articles. The methodological quality of included studies was assessed using Physiotherapy Evidence Database (PEDro) and Mixed-Methods Appraisal Tool (MMAT) scales. Interventions were described using the Template for Intervention Description and Replication (TIDieR) checklist.Results:A total of 3026 records were identified from database searches. Following screening, 18 studies reporting 17 interventions were included in this review. Most studies (n = 13) reported interventions for caregivers of people with dementia. All studies incorporated an element of peer support as part of the intervention, however, most interventions (n = 15) comprised both psychosocial and educational elements. Statistically significant changes were reported for 11 interventions in one or more of the following domains: caregiver knowledge, mental health, stress, depression, distress, burden, self-efficacy, mastery, helplessness and perceived support. Qualitative outcomes included perceived reductions in stress and increased emotional and informational support.Discussion and Implications:Positive changes in caregiver outcomes were identified in response to multi-component online interventions (i.e., peer support in addition to education). Peer support was often poorly described, limiting the conclusions that could be drawn about the intervention components which result in better outcomes. Online interventions may provide an accessible and effective means of supporting caregivers.
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Whillans C, Lawrie M, Cardell EA, Kelly C, Wenke R. A systematic review of group intervention for acquired dysarthria in adults. Disabil Rehabil 2020; 44:3002-3018. [PMID: 33356634 DOI: 10.1080/09638288.2020.1859629] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PURPOSE This review aimed to evaluate the evidence for group therapy in improving speech production in adults with acquired dysarthria. Secondary outcomes included communication effectiveness and/or wellbeing. MATERIALS AND METHODS A review protocol was prospectively published on PROSPERO. Fourteen electronic databases were searched to identify experimental studies investigating adults with acquired dysarthria participating in group intervention with outcomes related to communication and/or wellbeing. The quality of included studies was assessed using the Mixed Methods Appraisal Tool (MMAT) or the McMaster University's Critical Review Form, and the TIDieR template for intervention description and replication. RESULTS 21 studies were identified involving 330 individuals with dysarthria, from mostly Parkinson's disease (PD) (97%; n = 321). Treatment approaches included singing therapy (n = 10), loudness therapy (n = 5) and multi-components therapy (including a combination of impairment and/or compensatory approaches) (n = 4). Studies varied in intensity and outcome measures used. Statistically significant improvements to speech production and/or wellbeing were reported following most approaches. CONCLUSION There is some preliminary moderate-quality evidence to suggest that group therapy may improve speech production and in some cases communication effectiveness or wellbeing in people with dysarthria following PD, with more consistent improvements being found for loudness approaches. Singing approaches were frequently studied in PD with some improvements to intelligibility evident. Further well-designed controlled studies including individuals with non-progressive aetiologies is warranted to establish the effectiveness of group treatment.IMPLICATIONS FOR REHABILITATIONGroup therapy may be an effective means of improving speech production and/or wellbeing in individuals with dysarthria following Parkinson's disease.Studies' employing loudness-based group therapy for PD demonstrated more consistent improvements to intensity measures.Some controlled studies utilising singing group therapy resulted in improved intelligibility in PD.PROSPERO registration number: CRD42015029374.
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Affiliation(s)
- Chelsea Whillans
- Speech Pathology & Audiology Services, Gold Coast Health, Southport, Australia
| | - Melissa Lawrie
- Speech Pathology & Audiology Services, Gold Coast Health, Southport, Australia.,School of Allied Health Sciences, Griffith University, Southport, Australia
| | - Elizabeth A Cardell
- School of Allied Health Sciences, Griffith University, Southport, Australia.,Menzies Institute Queensland, Southport, Australia
| | - Crystal Kelly
- School of Allied Health Sciences, Griffith University, Southport, Australia
| | - Rachel Wenke
- Speech Pathology & Audiology Services, Gold Coast Health, Southport, Australia.,School of Allied Health Sciences, Griffith University, Southport, Australia
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Marshall J, Devane N, Talbot R, Caute A, Cruice M, Hilari K, MacKenzie G, Maguire K, Patel A, Roper A, Wilson S. A randomised trial of social support group intervention for people with aphasia: A Novel application of virtual reality. PLoS One 2020; 15:e0239715. [PMID: 32970784 PMCID: PMC7514104 DOI: 10.1371/journal.pone.0239715] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 08/31/2020] [Indexed: 11/18/2022] Open
Abstract
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.
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Affiliation(s)
- Jane Marshall
- Centre for Language and Communication Science Research, City, University of London, London, United Kingdom
| | - Niamh Devane
- Centre for Language and Communication Science Research, City, University of London, London, United Kingdom
| | - Richard Talbot
- Centre for Language and Communication Science Research, City, University of London, London, United Kingdom
| | - Anna Caute
- Centre for Language and Communication Science Research, City, University of London, London, United Kingdom
- School of Health and Social Care, University of Essex, Colchester, United Kingdom
| | - Madeline Cruice
- Centre for Language and Communication Science Research, City, University of London, London, United Kingdom
| | - Katerina Hilari
- Centre for Language and Communication Science Research, City, University of London, London, United Kingdom
| | - Gillian MacKenzie
- Centre for Language and Communication Science Research, City, University of London, London, United Kingdom
| | - Kimberley Maguire
- Centre for Language and Communication Science Research, City, University of London, London, United Kingdom
| | - Anita Patel
- Anita Patel Health Economics Consulting Ltd, Queen Mary University of London, London, United Kingdom
| | - Abi Roper
- Centre for Language and Communication Science Research, City, University of London, London, United Kingdom
| | - Stephanie Wilson
- Centre for Human Computer Interaction Design, City, University of London, London, United Kingdom
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Lee JB, Azios JH. Facilitator Behaviors Leading to Engagement and Disengagement in Aphasia Conversation Groups. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2020; 29:393-411. [PMID: 31419150 DOI: 10.1044/2019_ajslp-cac48-18-0220] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Purpose Researchers have identified features of successful aphasia conversation groups and clinician behaviors leading to engagement and group cohesion. There has been less focus in the literature on facilitator behaviors that hinder participation or result in disengagement. This study aims to explore the behaviors of graduate student facilitators that contribute to and detract from engagement in aphasia conversation groups. Method Data were drawn from 4 conversation group sessions from 2 different university settings. Groups included 1 graduate student facilitator and 3 or more persons with aphasia. Sociolinguistic discourse analysis was applied to transcripts of group sessions. Results Three broad patterns detailing facilitator behaviors were identified. Several facilitator actions contributing to engagement were noted, including strategic use of topic elicitors, multimodal communication supports, and techniques to avoid interactional asymmetry. Behaviors associated with participant disengagement were also noted across sessions, including restricted discourse behaviors and difficulty managing the competing needs of participants. Engagement and disengagement were the product of several coordinating actions of the facilitator and group members that together influenced participation in conversation. Conclusion Results suggest that novice facilitators exhibit behaviors that contribute to and detract from participant engagement in aphasia conversation groups. Findings, discussed within the context of the literature on well-managed groups, highlight the skill required in managing the needs of participants with aphasia and knowing how and when to employ clinician-led strategies.
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Affiliation(s)
- Jaime B Lee
- Communication Sciences & Disorders, James Madison University, Harrisonburg, VA
| | - Jamie H Azios
- Speech & Hearing Sciences, Lamar University, Beaumont, TX
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18
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Wood LL, Bryant D, Scirocco K, Datta H, Alimonti S, Mowers D. Aphasia Park: A pilot study using the co-active therapeutic theater model with clients in aphasia recovery. ARTS IN PSYCHOTHERAPY 2020. [DOI: 10.1016/j.aip.2019.101611] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Taylor-Rubin C, Azizi L, Croot K, Nickels L. Primary Progressive Aphasia Education and Support Groups: A Clinical Evaluation. Am J Alzheimers Dis Other Demen 2020; 35:1533317519895638. [PMID: 32096652 PMCID: PMC10691435 DOI: 10.1177/1533317519895638] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To evaluate the benefits of a primary progressive aphasia (PPA) education and support session for people with PPA (pwPPA) and their caregivers. METHOD Thirty-eight individuals (20 pwPPA, 18 caregivers) were invited to participate in the study. Twenty-five individuals (12 pwPPA, 13 caregivers) completed questionnaires before and after an education and support group session provided by a speech pathologist and a clinical psychologist. Seven individuals (2 pwPPA, 5 caregivers) participated in follow-up interviews. RESULTS After one attendance, caregivers reported significant improvement in knowledge of PPA, strategies to manage worry and low mood, and opportunities to meet peers. Themes at interview were reduced feelings of isolation, increased feelings of support, increased knowledge of coping strategies, and improved understanding of PPA. Caregivers who had attended previous sessions reported increased feelings of well-being and support. IMPLICATIONS Primary progressive aphasia education and support group sessions in the postdiagnostic period constitute a valuable component of comprehensive care for PPA.
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Affiliation(s)
- Cathleen Taylor-Rubin
- Speech Pathology Department, War Memorial Hospital, Sydney, New
South Wales, Australia
- Department of Cognitive Science, Macquarie University, Sydney, New
South Wales, Australia
- ARC Centre of Excellence in Cognition and Its Disorders, Sydney, New
South Wales, Australia
| | - Lisa Azizi
- Psychology Department, War Memorial Hospital, Sydney, New South
Wales, Australia
| | - Karen Croot
- Department of Cognitive Science, Macquarie University, Sydney, New
South Wales, Australia
- ARC Centre of Excellence in Cognition and Its Disorders, Sydney, New
South Wales, Australia
- School of Psychology, University of Sydney, New South Wales,
Australia
| | - Lyndsey Nickels
- Department of Cognitive Science, Macquarie University, Sydney, New
South Wales, Australia
- ARC Centre of Excellence in Cognition and Its Disorders, Sydney, New
South Wales, Australia
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Abstract
OBJECTIVE Group treatment enables people with aphasia to practise communication skills outside the typical clinician-patient dyad. While there is evidence that this treatment format can improve participation in everyday communication, there is little evidence it impacts linguistic abilities. This project aimed to investigate the effects of 'typical' group treatment on the communication skills of people with aphasia with a focus on word retrieval in discourse. METHODS Three people with aphasia took part in a 6-week group therapy programme. Each week focused on a different topic, and three topics also received a home programme targeting word retrieval. The six treated topics were compared with two control topics, with regard to language production in connected speech. Semistructured interviews were collected twice prior to treatment and twice following the treatment and analysed using (a) word counts; (b) the profile of word errors and retrieval in speech; (c) a measure of propositional idea density, and (d) perceptual discourse ratings. RESULTS Two participants showed no significant improvements; one participant showed significant improvement on discourse ratings. CONCLUSIONS This study provides limited support for group treatment, leading to improved communication as measured by semistructured interviews, even when supplemented with a home programme. We suggest that either group treatment, as implemented here, was not an effective approach for improving communication for our participants and/or that outcome measurement was limited by difficulty assessing changes in connected speech.
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21
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Kristinsson S, Yourganov G, Xiao F, Bonilha L, Stark BC, Rorden C, Basilakos A, Fridriksson J. Brain-Derived Neurotrophic Factor Genotype-Specific Differences in Cortical Activation in Chronic Aphasia. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2019; 62:3923-3936. [PMID: 31756156 PMCID: PMC7203521 DOI: 10.1044/2019_jslhr-l-rsnp-19-0021] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 06/02/2019] [Accepted: 07/29/2019] [Indexed: 05/04/2023]
Abstract
Purpose The brain-derived neurotrophic factor (BDNF) gene has been shown to be important for synaptic plasticity in animal models. Human research has suggested that BDNF genotype may influence stroke recovery. Some studies have suggested a genotype-specific motor-related brain activation in stroke recovery. However, recovery from aphasia in relation to BDNF genotype and language-related brain activation has received limited attention. We aimed to explore functional brain activation by BDNF genotype in individuals with chronic aphasia. Consistent with findings in healthy individuals and individuals with poststroke motor impairment, we hypothesized that, among individuals with aphasia, the presence of the Met allele of the BDNF gene is associated with reduced functional brain activation compared to noncarriers of the Met allele. Method Eighty-seven individuals with chronic stroke-induced aphasia performed a naming task during functional magnetic resonance imaging scanning and submitted blood or saliva samples for BDNF genotyping. The mean number of activated voxels was compared between groups, and group-based activation maps were directly compared. Neuropsychological testing was conducted to compare language impairment between BDNF genotype groups. The Western Aphasia Battery Aphasia Quotient (Kertesz, 2007) was included as a covariate in all analyses. Results While lesion size was comparable between groups, the amount of activation, quantified as the number of activated voxels, was significantly greater in noncarriers of the Met allele (whole brain: 98,500 vs. 28,630, p < .001; left hemisphere only: 37,209 vs. 7,000, p < .001; right hemisphere only: 74,830 vs. 30,630, p < .001). This difference was most strongly expressed in the right hemisphere posterior temporal area, pre- and postcentral gyrus, and frontal lobe, extending into the white matter. Correspondingly, the atypical BDNF genotype group was found to have significantly less severe aphasia (Western Aphasia Battery Aphasia Quotient of 64.2 vs. 54.3, p = .033) and performed better on a naming task (Philadelphia Naming Test [Roach, Schwartz, Martin, Grewal, & Brecher, 1996] score of 74.7 vs. 52.8, p = .047). A region of interest analysis of intensity of activation revealed no group differences, and a direct comparison of average activation maps across groups similarly yielded null results. Conclusion BDNF genotype mediates cortical brain activation in individuals with chronic aphasia. Correspondingly, individuals carrying the Met allele present with more severe aphasia compared to noncarriers. These findings warrant further study into the effects of BDNF genotype in aphasia. Supplemental Material https://doi.org/10.23641/asha.10073147 Presentation Video https://doi.org/10.23641/asha.10257581.
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Affiliation(s)
- Sigfus Kristinsson
- Department of Communication Sciences & Disorders, University of South Carolina, Columbia
| | | | - Feifei Xiao
- Department of Epidemiology and Biostatistics, University of South Carolina, Columbia
| | - Leonardo Bonilha
- Department of Neurology, Medical University of South Carolina, Charleston
| | - Brielle C. Stark
- Department of Speech and Hearing Sciences, Indiana University, Bloomington
| | - Chris Rorden
- Department of Psychology, University of South Carolina, Columbia
| | - Alexandra Basilakos
- Department of Communication Sciences & Disorders, University of South Carolina, Columbia
| | - Julius Fridriksson
- Department of Communication Sciences & Disorders, University of South Carolina, Columbia
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Pitt R, Theodoros D, Hill AJ, Russell T. The impact of the telerehabilitation group aphasia intervention and networking programme on communication, participation, and quality of life in people with aphasia. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2019; 21:513-523. [PMID: 30200788 DOI: 10.1080/17549507.2018.1488990] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2017] [Revised: 04/16/2018] [Accepted: 06/07/2018] [Indexed: 06/08/2023]
Abstract
Purpose: Aphasia group therapy can result in improvements in communication, participation and quality of life (QOL). However, evidence for aphasia group interventions with combined aims across the International Classification of Functioning, Disability and Health (ICF) is limited. TeleGAIN is a holistic aphasia group intervention that can be delivered via telepractice. This study builds on prior pilot work and addresses the need for additional research into the effectiveness of TeleGAIN. The aim of this study was to describe changes in aphasia severity, communication related QOL and participation, for people with chronic aphasia following TeleGAIN. Method: Nineteen participants with aphasia were assessed on a range of outcome measures before and after a twelve-week block of TeleGAIN delivered via web based videoconferencing. Treatment provided opportunities to participate in conversation, engage with others with aphasia and complete functional communication activities. Result: Statistical analyses revealed statistically significant improvements in communication related QOL, increased engagement in communicative activities, and decreased aphasia severity. Conclusion: Results from this study suggest that the online delivery of a multi-purpose group intervention for people with aphasia can result in improved communication, communicative participation, and QOL. It also highlights the potential for intervention provided via telepractice to offer an alternative to face-to-face services.
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Affiliation(s)
- Rachelle Pitt
- School of Health and Rehabilitation Sciences, University of Queensland , Australia
- Centre for Research in Telerehabilitation, University of Queensland , Australia , and
| | - Deborah Theodoros
- School of Health and Rehabilitation Sciences, University of Queensland , Australia
- Centre for Research in Telerehabilitation, University of Queensland , Australia , and
- RECOVER Injury Research Centre, University of Queensland , Australia
| | - Anne J Hill
- School of Health and Rehabilitation Sciences, University of Queensland , Australia
- Centre for Research in Telerehabilitation, University of Queensland , Australia , and
| | - Trevor Russell
- School of Health and Rehabilitation Sciences, University of Queensland , Australia
- Centre for Research in Telerehabilitation, University of Queensland , Australia , and
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Worrall L. The seven habits of highly effective aphasia therapists: The perspective of people living with aphasia. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2019; 21:438-447. [PMID: 31500463 DOI: 10.1080/17549507.2019.1660804] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Purpose: Influential value-driven approaches to aphasia rehabilitation have been proposed previously, but have emphasised how service providers need to deliver their services. The aim of this article is to extract a set of values or habits that define effective aphasia therapists, from a 16-year programme of research that has sought to capture the perspectives of people with aphasia, their family and speech-language pathologists. Method: The findings of 58 studies published by members of our team which have sought the views of people with aphasia (38 studies), speech-language pathologists (11 studies) and family members (5 studies), and those which compared all stakeholder's perspectives (2 studies), were synthesised into seven themes. Presented as habits, these were subsequently described in the same manner as the popular "Seven Habits of Highly Effective People". Result: The seven habits of highly effective aphasia therapists described by people with aphasia and their family were (1) Prioritise relationships; (2) Find a rope team; (3) Begin with the end in mind; (4) Practise SMARTER therapy; (5) Leave no person behind; (6) Look behind the mask and (7) Find a voice. Conclusion: While there are similarities to other value-based approaches to aphasia rehabilitation, these seven habits are detailed using our published research that has privileged the voices of people with aphasia. The seven habits therefore reflect what people with aphasia view as the features of highly effective aphasia therapists. The next steps are to identify how to evaluate evidence-based practices in these areas and ensure their implementation into practice. Effective aphasia therapists are at the heart of effective aphasia rehabilitation.
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Affiliation(s)
- Linda Worrall
- School of Health and Rehabilitation Sciences, University of Queensland , Brisbane , Australia
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Knollman-Porter K, Julian SK. Book Club Experiences, Engagement, and Reading Support Use by People With Aphasia. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2019; 28:1084-1098. [PMID: 31251670 DOI: 10.1044/2019_ajslp-18-0237] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Background People with chronic aphasia often exhibit a decrease in social engagement and reading ability that negatively influences quality of life. Book clubs can provide a supportive environment that facilitates both socialization and reading. However, limited data exist examining the use of book clubs for individuals with chronic aphasia. Purpose The purpose of this qualitative descriptive study was to describe the experiences, engagement, and reading supports used by people with aphasia participating for the 1st time in a book club. Method and Procedure Ten people with chronic aphasia and co-occurring reading deficits engaged in 7 book club sessions. Participants first completed a questionnaire about pre- and poststroke reading experiences. Individualized interviews with participants during and post-book club explored the experiences, preferences, and reading comprehension strategies used within the structure of the book club. Results Three main categories of findings emerged from the data analysis: (a) perceived changes in attitudes regarding reading and club participation post-book club, (b) variations in use of reading supports and strategies across participants, and (c) perceived social benefits of the book club. Conclusion The current study provides evidence that people with varying types and severities of chronic aphasia and reading comprehension challenges can successfully increase reading and social engagement through book club participation. The results from this study highlight the need to provide evidence to support services that extend beyond standard rehabilitation protocols and identify engaging ways to facilitate active participation in functional reading activities for people with chronic aphasia.
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Affiliation(s)
| | - Samantha K Julian
- Department of Speech Pathology and Audiology, Miami University, Oxford, OH
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Pauranik A, George A, Sahu A, Nehra A, Paplikar A, Bhat C, Krishnan G, Kaur H, saini J, Suresh PA, Ojha P, Singh P, Sancheti P, Karanth P, Mathuranath PS, Goswami S, Chitnis S, Sundar N, Alladi S, Faroqi-Shah Y. Expert Group Meeting on Aphasia: A Report. Ann Indian Acad Neurol 2019; 22:137-146. [PMID: 31007423 PMCID: PMC6472241 DOI: 10.4103/aian.aian_330_18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
A multidisciplinary team of experts took stock of the current state of affairs about many aspects of aphasia in India, including community burden, diagnostic assessment, therapy, rehabilitation, research, education, and advocacy. The broad spectrum of aphasiology was matched by the types of participants ranging from neurologists, speech-language pathologists, clinical psychologists, linguists, to experts in neuroimaging and computer sciences. Threadbare discussion in 16 sessions over 3 days leads to the identification of pressing problems and possible solutions. Many action plans have been envisaged and recommendations made. A few examples with high priority are community-based and hospital-based study incidence and prevalence of aphasia, development of test batteries for the assessment of many components of speech and communication in Indian languages which are validated on rigorous psychometric, and linguistic criteria, national registry for aphasia, educational modules about aphasia for different target groups, resources for advocacy and its training, a bank of research questions and outlines of research protocols for young professionals to pursue. The expert group will continue to oversee execution of some of the actionable plans in short and long term.
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Affiliation(s)
- Apoorva Pauranik
- Professor, Deaprtment of Neurology, M.G.M. Medical College, Indore, Madhya Pradesh, India
| | | | - Aparna Sahu
- Scientist, Psyneuronics, Banglore, Karnataka, India
| | - Ashima Nehra
- Professor, Deapartment of Clinical Neuropsychology, AIIMS, New Delhi, India
| | | | - Chitralekha Bhat
- Scientist, TCS Research and Innovations, Mumbai, Maharashtra, India
| | - Gopee Krishnan
- Professor, Speech Language Pathology, School of Allied Health sciences, Manipal, Karnataka, India
| | - Harsimar Kaur
- Research Officer, Clinical Neuropsychology, AIIMS, New Delhi, India
| | - Jitendra saini
- Professor, Neuro-Radiology, NIMHANS, Banglore, Karnataka, India
| | - P. A. Suresh
- Professor, Neurologist, Director, ICCONS, Trichur, Kerala, India
| | - Pawan Ojha
- Consultant, Neurology, Fortis Hospital, Vashi, Mumbai, Maharashtra, India
| | - Pinky Singh
- Speech Language Pathology, AIIMS, Bhopal, Madhya Pradesh, India
| | | | - Prathibha Karanth
- Speech Language Pathologist, Director, Communication DEALL Trust, Banglore, Karnataka, India
| | | | - Satyapal Goswami
- Professor, Speech Language Pathology, AIISH, Mysore, Karnataka, India
| | - Sonal Chitnis
- Assistant Professor, Speech Language Pathology, Bharti Vidyapeeth, Pune, India
| | - N Sundar
- Scientist, Psyneuronics, Banglore, Karnataka, India
| | - Suvarna Alladi
- Professor, Neurology, NIMHANS, Banglore, Karnataka, India
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Keegan LC, Murdock M, Suger C, Togher L. Improving natural social interaction: Group rehabilitation after Traumatic Brain Injury. Neuropsychol Rehabil 2019; 30:1497-1522. [DOI: 10.1080/09602011.2019.1591464] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Louise C. Keegan
- Department of Rehabilitation Sciences, Moravian College, Bethlehem, PA, USA
| | - Macy Murdock
- Carolinas Rehabilitation, Atrium Health, Charlotte, NC, USA
| | - Caitlin Suger
- Westwood Hills Nursing and Rehabilitation Center, RehabCare, Wilkesboro, NC, USA
| | - Leanne Togher
- Speech Pathology, The University of Sydney, Sydney, Australia
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Pitt R, Theodoros D, Hill AJ, Russell T. The development and feasibility of an online aphasia group intervention and networking program - TeleGAIN. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2019; 21:23-36. [PMID: 28868932 DOI: 10.1080/17549507.2017.1369567] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 05/31/2017] [Accepted: 08/16/2017] [Indexed: 06/07/2023]
Abstract
PURPOSE Aphasia group therapy offers many benefits, however people with aphasia report difficulty accessing groups and speech-language pathologists are faced with many challenges in providing aphasia group therapy. Telerehabilitation may offer an alternative service delivery option. An online aphasia group therapy program - Telerehabilitation Group Aphasia Intervention and Networking (TeleGAIN) - has been developed according to the guidelines of the Medical Research Council (MRC) framework for complex interventions. The purpose of this paper is to describe the development of TeleGAIN and the results of a pilot trial to determine feasibility and acceptability. METHOD The development of TeleGAIN was informed through literature reviews in relevant topic areas, consideration of expert opinion and application of the social cognitive theory. TeleGAIN was then modelled through a feasibility pilot trial with four people with aphasia. RESULT TeleGAIN appeared to be feasible and acceptable to participants and able to be implemented as planned. Participant satisfaction with treatment was high and results suggested some potential for improvements in language functioning and communication-related quality of life. CONCLUSION TeleGAIN appeared to be feasible and acceptable, however the study highlighted issues related to technology, clinical implementation and participant-specific factors that should be addressed prior to a larger trial.
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Affiliation(s)
- Rachelle Pitt
- a School of Health and Rehabilitation Sciences , University of Queensland , Queensland , Australia and
- b Centre for Research in Telerehabilitation , University of Queensland , Queensland , Australia
| | - Deborah Theodoros
- a School of Health and Rehabilitation Sciences , University of Queensland , Queensland , Australia and
- b Centre for Research in Telerehabilitation , University of Queensland , Queensland , Australia
| | - Anne J Hill
- a School of Health and Rehabilitation Sciences , University of Queensland , Queensland , Australia and
- b Centre for Research in Telerehabilitation , University of Queensland , Queensland , Australia
| | - Trevor Russell
- a School of Health and Rehabilitation Sciences , University of Queensland , Queensland , Australia and
- b Centre for Research in Telerehabilitation , University of Queensland , Queensland , Australia
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Attard MC, Loupis Y, Togher L, Rose ML. Experiences of people with severe aphasia and spouses attending an Interdisciplinary Community Aphasia Group. Disabil Rehabil 2019; 42:1382-1396. [PMID: 30652928 DOI: 10.1080/09638288.2018.1526336] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Background: Community aphasia groups are recognized as an area of need and value for people with chronic aphasia and their significant others. However, our understanding of attendees' experiences is limited by the small amount of qualitative research available. The present study aimed to describe participant experiences of an Interdisciplinary Community Aphasia Group, as part of a better understanding of its underlying processes and value.Methods: Four people with chronic, severe aphasia and their spouses attended an Interdisciplinary Community Aphasia Group held at a university speech clinic for 2 h once weekly over 12 weeks. The group was co-facilitated by a speech-language pathologist and a social worker, with the support of two aides (one a person with aphasia, and the other a member of the general community). The group addressed the following areas: communication therapy, conversation, participation in meaningful and accessible activities, psychological and social support, and aphasia information and education. Following the program, the people with aphasia (via multimodal communication) and spouses participated in separate semi-structured interviews with an independent interviewer. The interviews addressed members' perceptions of the program (both in relation to themselves and their spouse) along with recommendations for improvement. The interviews were analyzed using Framework Analysis.Results: Members shared preferences for program activities and group format, with some experiences leading to suggestions for improvement. The group dynamics and environment were considered positive overall, and members highlighted a range of positive impacts for both themselves and their spouse. Together, these elements informed members' evaluation that the model contained something for everyone, but may not be a "one-stop shop" given ongoing needs for therapy. An overarching theme for spouses addresses therapy and recovery in relation to the impact of peers, views and beliefs, and adjustment.Conclusions: The Interdisciplinary Community Aphasia Group model has overall acceptability for people with chronic, severe aphasia and their spouses, and can be adapted to ensure feasibility in clinical practice. Ongoing research is required to best tailor community groups for people with aphasia and significant others, and to reinforce the need for their proliferation.Implications for rehabilitationPeople with aphasia and their spouses can benefit from a wide range of programming, including participation in meaningful and accessible non-verbal activitiesAn interdisciplinary staff team can contribute positively to member experience and impacts, with peer staff offering valuable mentoring roles. Various aspects of member identity and life narrative impact on community aphasia group participation; understanding members' needs in the context of previous experiences can improve tailoring of program content.
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Affiliation(s)
| | - Yasmine Loupis
- Department of Social Work, St. Vincent's Hospital, Sydney, Australia
| | - Leanne Togher
- Faculty of Health Sciences, University of Sydney, Sydney, Australia
| | - Miranda L Rose
- School of Allied Health, La Trobe University, Melbourne, Australia
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Kong APH, Tse CWK. Clinician Survey on Speech Pathology Services for People with Aphasia in Hong Kong. ACTA ACUST UNITED AC 2018. [DOI: 10.21849/cacd.2018.00409] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Keegan LC, Togher L. An Innovative Clinical Training Model for Students Using the Context of a Cognitive Communication Skills Group. ACTA ACUST UNITED AC 2018. [DOI: 10.1044/persp3.sig2.21] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Priorities for Closing the Evidence-Practice Gaps in Poststroke Aphasia Rehabilitation: A Scoping Review. Arch Phys Med Rehabil 2017; 99:1413-1423.e24. [PMID: 28923500 DOI: 10.1016/j.apmr.2017.08.474] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2016] [Revised: 07/16/2017] [Accepted: 08/14/2017] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To identify implementation priorities for poststroke aphasia management relevant to the Australian health care context. DATA SOURCES Using systematized searches of databases (CINAHL and MEDLINE), guideline and stroke websites, and other sources, evidence was identified and extracted for 7 implementation criteria for 13 topic areas relevant to aphasia management. These 7 priority-setting criteria were identified in the implementation literature: strength of the evidence, current evidence-practice gap, clinician preference, patient preference, modifiability, measurability, and health effect. STUDY SELECTION Articles were included if they were in English, related to a specific recommendation requiring implementation, and contained information pertaining to any of the 7 prioritization criteria. DATA EXTRACTION The scoping review methodology was chosen to address the broad nature of the topic. Evidence was extracted and placed in an evidence matrix. After this, evidence was summarized and then aphasia rehabilitation topics were prioritized using an approach developed by the research team. DATA SYNTHESIS Evidence from 100 documents was extracted and summarized. Four topic areas were identified as implementation priorities for aphasia: timing, amount, and intensity of therapy; goal setting; information, education, and aphasia-friendly information; and constraint-induced language therapy. CONCLUSIONS Closing the evidence-practice gaps in the 4 priority areas identified may deliver the greatest gains in outcomes for Australian stroke survivors with aphasia. Our approach to developing implementation priorities may be useful for identifying priorities for implementation in other health care areas.
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Baker C, Worrall L, Rose M, Hudson K, Ryan B, O'Byrne L. A systematic review of rehabilitation interventions to prevent and treat depression in post-stroke aphasia. Disabil Rehabil 2017; 40:1870-1892. [PMID: 28420284 DOI: 10.1080/09638288.2017.1315181] [Citation(s) in RCA: 78] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE Stepped psychological care is the delivery of routine assessment and interventions for psychological problems, including depression. The aim of this systematic review was to analyze and synthesize the evidence of rehabilitation interventions to prevent and treat depression in post-stroke aphasia and adapt the best evidence within a stepped psychological care framework. METHOD Four databases were systematically searched up to March 2017: Medline, CINAHL, PsycINFO and The Cochrane Library. RESULTS Forty-five studies met inclusion and exclusion criteria. Level of evidence, methodological quality and results were assessed. People with aphasia with mild depression may benefit from psychosocial-type treatments (based on 3 level ii studies with small to medium effect sizes). For those without depression, mood may be enhanced through participation in a range of interventions (based on 4 level ii studies; 1 level iii-3 study and 6 level iv studies). It is not clear which interventions may prevent depression in post-stroke aphasia. No evidence was found for the treatment of moderate to severe depression in post-stroke aphasia. CONCLUSIONS This study found some interventions that may improve depression outcomes for those with mild depression or without depression in post-stroke aphasia. Future research is needed to address methodological limitations and evaluate and support the translation of stepped psychological care across the continuum. Implications for Rehabilitation Stepped psychological care after stroke is a framework with levels 1 to 4 which can be used to prevent and treat depression for people with aphasia. A range of rehabilitation interventions may be beneficial to mood at level 1 for people without clinically significant depression (e.g., goal setting and achievement, psychosocial support, communication partner training and narrative therapy). People with mild symptoms of depression may benefit from interventions at level 2 (e.g., behavioral therapy, psychosocial support and problem solving). People with moderate to severe symptoms of depression require specialist mental health/behavioral services in collaboration with stroke care at levels 3 and 4 of stepped psychological care.
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Affiliation(s)
- Caroline Baker
- a School of Health and Rehabilitation Sciences, The University of Queensland , Brisbane , Australia
| | - Linda Worrall
- a School of Health and Rehabilitation Sciences, The University of Queensland , Brisbane , Australia
| | - Miranda Rose
- b School of Allied Health, La Trobe University , Melbourne , Australia
| | - Kyla Hudson
- a School of Health and Rehabilitation Sciences, The University of Queensland , Brisbane , Australia
| | - Brooke Ryan
- a School of Health and Rehabilitation Sciences, The University of Queensland , Brisbane , Australia
| | - Leana O'Byrne
- a School of Health and Rehabilitation Sciences, The University of Queensland , Brisbane , Australia
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Jokel R, Meltzer J, D R J, D M L, J C J, A N E, D T C. Group intervention for individuals with primary progressive aphasia and their spouses: Who comes first? JOURNAL OF COMMUNICATION DISORDERS 2017; 66:51-64. [PMID: 28412599 DOI: 10.1016/j.jcomdis.2017.04.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2016] [Revised: 03/23/2017] [Accepted: 04/05/2017] [Indexed: 06/07/2023]
Abstract
Primary progressive aphasia (PPA) is a neurodegenerative dementia in which language impairment is the first and most dominant symptom. There is a considerable dearth of interventions for PPA although language rehabilitation has made headway in managing the disorder. Thus far, no comprehensive services have been proposed for PPA clients and/or their spouses. This paper describes the first structured group intervention program designated exclusively for people with PPA and their caregivers. This pilot project originates from a clinical service and presents supporting evidence for initiation of a larger study to establish an evidence-based intervention for PPA. A 10-week intervention program comprised working on language activities, learning communication strategies, counselling and education. Outcome measures administered to participants and their spouses before and after the intervention were compared showed improvements in quality of communication and coping skills in the PPA group compared to controls. Qualitative comments from all 10 participants in the active treatment group highlighted the necessity of intervention that is tailored specifically to the PPA population and addresses the needs of both individuals with PPA and their caregivers. All participants in the intervention group contributed to the study and are also co-authors of this paper.
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Affiliation(s)
- Regina Jokel
- Rotman Research Institute, Baycrest Health Sciences, University of Toronto, Toronto, Canada.
| | - Jed Meltzer
- Rotman Research Institute, University of Toronto, Toronto, Canada
| | - J D R
- Baycrest Health Sciences, Toronto, Canada
| | - L D M
- Baycrest Health Sciences, Toronto, Canada
| | - J J C
- Baycrest Health Sciences, Toronto, Canada
| | - E A N
- Baycrest Health Sciences, Toronto, Canada
| | - C D T
- Baycrest Health Sciences, Toronto, Canada
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Affiliation(s)
- Seung Nam Yang
- Department of Physical Medicine and Rehabilitation, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
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Kim DY, Kim YH, Lee J, Chang WH, Kim MW, Pyun SB, Yoo WK, Ohn SH, Park KD, Oh BM, Lim SH, Jung KJ, Ryu BJ, Im S, Jee SJ, Seo HG, Rah UW, Park JH, Sohn MK, Chun MH, Shin HS, Lee SJ, Lee YS, Park SW, Park YG, Paik NJ, Lee SG, Lee JK, Koh SE, Kim DK, Park GY, Shin YI, Ko MH, Kim YW, Yoo SD, Kim EJ, Oh MK, Chang JH, Jung SH, Kim TW, Kim WS, Kim DH, Park TH, Lee KS, Hwang BY, Song YJ. Clinical Practice Guideline for Stroke Rehabilitation in Korea 2016. BRAIN & NEUROREHABILITATION 2017. [DOI: 10.12786/bn.2017.10.e11] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
- Deog Young Kim
- Department of Rehabilitation Medicine, Yonsei University College of Medicine, Korea
| | - Yun-Hee Kim
- Department of Physical and Rehabilitation Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Korea
| | - Jongmin Lee
- Department of Rehabilitation Medicine, Konkuk University School of Medicine, Korea
| | - Won Hyuk Chang
- Department of Physical and Rehabilitation Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Korea
| | - Min-Wook Kim
- Department of Rehabilitation Medicine, College of Medicine, The Catholic University of Korea, Korea
| | - Sung-Bom Pyun
- Department of Physical Medicine and Rehabilitation, Korea University College of Medicine, Korea
| | - Woo-Kyoung Yoo
- Department of Physical Medicine and Rehabilitation, Hallym University College of Medicine, Korea
| | - Suk Hoon Ohn
- Department of Physical Medicine and Rehabilitation, Hallym University College of Medicine, Korea
| | - Ki Deok Park
- Department of Rehabilitation Medicine, Gachon University College of Medicine, Korea
| | - Byung-Mo Oh
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Korea
| | - Seong Hoon Lim
- Department of Rehabilitation Medicine, College of Medicine, The Catholic University of Korea, Korea
| | - Kang Jae Jung
- Department of Physical Medicine and Rehabilitation, Eulji University Hospital & Eulji University School of Medicine, Korea
| | - Byung-Ju Ryu
- Department of Physical Medicine and Rehabilitation, Sahmyook Medical Center, Korea
| | - Sun Im
- Department of Rehabilitation Medicine, College of Medicine, The Catholic University of Korea, Korea
| | - Sung Ju Jee
- Department of Rehabilitation Medicine, Chungnam National University College of Medicine, Korea
| | - Han Gil Seo
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Korea
| | - Ueon Woo Rah
- Department of Physical Medicine and Rehabilitation, Ajou University School of Medicine, Korea
| | - Joo Hyun Park
- Department of Rehabilitation Medicine, College of Medicine, The Catholic University of Korea, Korea
| | - Min Kyun Sohn
- Department of Rehabilitation Medicine, Chungnam National University College of Medicine, Korea
| | - Min Ho Chun
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Korea
| | - Hee Suk Shin
- Department of Rehabilitation Medicine and Institute of Health Sciences, Gyeongsang National University College of Medicine, Korea
| | - Seong Jae Lee
- Department of Rehabilitation Medicine, College of Medicine Dankook University, Korea
| | - Yang-Soo Lee
- Department of Rehabilitation Medicine, Kyungpook National University School of Medicine, Korea
| | - Si-Woon Park
- Department of Rehabilitation Medicine, Catholic Kwandong University International St Mary's Hospital, Korea
| | - Yoon Ghil Park
- Department of Rehabilitation Medicine, Yonsei University College of Medicine, Korea
| | - Nam Jong Paik
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Korea
| | - Sam-Gyu Lee
- Department of Physical and Rehabilitation Medicine, Chonnam National University Medical School, Korea
| | - Ju Kang Lee
- Department of Rehabilitation Medicine, Gachon University College of Medicine, Korea
| | - Seong-Eun Koh
- Department of Rehabilitation Medicine, Konkuk University School of Medicine, Korea
| | - Don-Kyu Kim
- Department of Physical Medicine and Rehabilitation, College of Medicine, Chung-Ang University, Korea
| | - Geun-Young Park
- Department of Rehabilitation Medicine, College of Medicine, The Catholic University of Korea, Korea
| | - Yong Il Shin
- Department of Rehabilitation Medicine, Pusan National University Hospital, Korea
| | - Myoung-Hwan Ko
- Department of Physical Medicine and Rehabilitation, Chonbuk National University Medical School, Korea
| | - Yong Wook Kim
- Department of Rehabilitation Medicine, Yonsei University College of Medicine, Korea
| | - Seung Don Yoo
- Department of Physical Medicine and Rehabilitation, Kyung Hee University College of Medicine, Korea
| | - Eun Joo Kim
- Department of Physical Medicine and Rehabilitation, National Rehabilitation Hospital, Korea
| | - Min-Kyun Oh
- Department of Rehabilitation Medicine and Institute of Health Sciences, Gyeongsang National University College of Medicine, Korea
| | - Jae Hyeok Chang
- Department of Rehabilitation Medicine, Pusan National University Hospital, Korea
| | - Se Hee Jung
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Korea
| | - Tae-Woo Kim
- TBI rehabilitation center, National Traffic Injury Rehabilitation Hospital, College of Medicine, The Catholic University of Korea, Korea
| | - Won-Seok Kim
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Korea
| | - Dae Hyun Kim
- Department of Physical Medicine and Rehabilitation, Veterans Health Service Medical Center, Korea
| | - Tai Hwan Park
- Department of Neurology, Seoul Medical Center, Korea
| | - Kwan-Sung Lee
- Department of Neurosurgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Korea
| | - Byong-Yong Hwang
- Department of Physical Therapy, Yong-In University College of Health & Welfare, Korea
| | - Young Jin Song
- Department of Rehabilitation Medicine, Asan Medical Center, Korea
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Rotherham A, Howe T, Tillard G. Perceived Benefits for Family Members of Group Participation by Their Relatives with Aphasia. ACTA ACUST UNITED AC 2016. [DOI: 10.21849/cacd.2016.00059] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Wallace SJ, Worrall L, Rose T, Le Dorze G. Core Outcomes in Aphasia Treatment Research: An e-Delphi Consensus Study of International Aphasia Researchers. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2016; 25:S729-S742. [PMID: 27997949 DOI: 10.1044/2016_ajslp-15-0150] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2015] [Accepted: 04/07/2016] [Indexed: 06/06/2023]
Abstract
PURPOSE The purpose of this article is to identify outcome constructs that aphasia researchers consider essential to measure in all aphasia treatment research. METHOD Purposively sampled researchers were invited to participate in a 3-round e-Delphi exercise. In Round 1, an open-ended question was used to elicit important outcome constructs; responses were analyzed using inductive content analysis. In Rounds 2 and 3, participants rated the importance of each outcome using a 9-point rating scale. Outcomes reaching predefined consensus criteria were further analyzed using International Classification of Functioning, Disability and Health coding. RESULTS Eighty researchers commenced Round 1, with 72 completing the entire survey. High response rates (≥ 85%) were achieved in subsequent rounds. Consensus was reached on 6 outcomes: (a) language functioning in modalities relevant to study aims, (b) impact of treatment from the perspective of the person with aphasia (PWA), (c) communication-related quality of life, (d) satisfaction with intervention from the perspective of the PWA, (e) satisfaction with ability to communicate from the perspective of the PWA, and (f) satisfaction with participation in activities from the perspective of the PWA. CONCLUSIONS Consensus was reached that it is essential to measure language function and specific patient-reported outcomes in all aphasia treatment research. These results will contribute to the development of a core outcome set.
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Nickels L, McDonald B, Mason C. The impact of group therapy on word retrieval in people with chronic aphasia. NeuroRehabilitation 2016; 39:81-95. [DOI: 10.3233/nre-161340] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Lyndsey Nickels
- ARC Centre of Excellence in Cognition and its Disorders (CCD), Department of Cognitive Science, Macquarie University, Sydney, NSW, Australia
| | - Belinda McDonald
- ARC Centre of Excellence in Cognition and its Disorders (CCD), Department of Cognitive Science, Macquarie University, Sydney, NSW, Australia
- Speech Pathology Service, St. Joseph’s Hospital, Sydney, NSW, Australia
| | - Catherine Mason
- ARC Centre of Excellence in Cognition and its Disorders (CCD), Department of Cognitive Science, Macquarie University, Sydney, NSW, Australia
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Winstein CJ, Stein J, Arena R, Bates B, Cherney LR, Cramer SC, Deruyter F, Eng JJ, Fisher B, Harvey RL, Lang CE, MacKay-Lyons M, Ottenbacher KJ, Pugh S, Reeves MJ, Richards LG, Stiers W, Zorowitz RD. Guidelines for Adult Stroke Rehabilitation and Recovery: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke 2016; 47:e98-e169. [PMID: 27145936 DOI: 10.1161/str.0000000000000098] [Citation(s) in RCA: 1548] [Impact Index Per Article: 193.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE The aim of this guideline is to provide a synopsis of best clinical practices in the rehabilitative care of adults recovering from stroke. METHODS Writing group members were nominated by the committee chair on the basis of their previous work in relevant topic areas and were approved by the American Heart Association (AHA) Stroke Council's Scientific Statement Oversight Committee and the AHA's Manuscript Oversight Committee. The panel reviewed relevant articles on adults using computerized searches of the medical literature through 2014. The evidence is organized within the context of the AHA framework and is classified according to the joint AHA/American College of Cardiology and supplementary AHA methods of classifying the level of certainty and the class and level of evidence. The document underwent extensive AHA internal and external peer review, Stroke Council Leadership review, and Scientific Statements Oversight Committee review before consideration and approval by the AHA Science Advisory and Coordinating Committee. RESULTS Stroke rehabilitation requires a sustained and coordinated effort from a large team, including the patient and his or her goals, family and friends, other caregivers (eg, personal care attendants), physicians, nurses, physical and occupational therapists, speech-language pathologists, recreation therapists, psychologists, nutritionists, social workers, and others. Communication and coordination among these team members are paramount in maximizing the effectiveness and efficiency of rehabilitation and underlie this entire guideline. Without communication and coordination, isolated efforts to rehabilitate the stroke survivor are unlikely to achieve their full potential. CONCLUSIONS As systems of care evolve in response to healthcare reform efforts, postacute care and rehabilitation are often considered a costly area of care to be trimmed but without recognition of their clinical impact and ability to reduce the risk of downstream medical morbidity resulting from immobility, depression, loss of autonomy, and reduced functional independence. The provision of comprehensive rehabilitation programs with adequate resources, dose, and duration is an essential aspect of stroke care and should be a priority in these redesign efforts. (Stroke.2016;47:e98-e169. DOI: 10.1161/STR.0000000000000098.).
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Power E, Thomas E, Worrall L, Rose M, Togher L, Nickels L, Hersh D, Godecke E, O'Halloran R, Lamont S, O'Connor C, Clarke K. Development and validation of Australian aphasia rehabilitation best practice statements using the RAND/UCLA appropriateness method. BMJ Open 2015; 5:e007641. [PMID: 26137883 PMCID: PMC4499686 DOI: 10.1136/bmjopen-2015-007641] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2015] [Revised: 05/05/2015] [Accepted: 06/03/2015] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES To develop and validate a national set of best practice statements for use in post-stroke aphasia rehabilitation. DESIGN Literature review and statement validation using the RAND/UCLA Appropriateness Method (RAM). PARTICIPANTS A national Community of Practice of over 250 speech pathologists, researchers, consumers and policymakers developed a framework consisting of eight areas of care in aphasia rehabilitation. This framework provided the structure for the development of a care pathway containing aphasia rehabilitation best practice statements. Nine speech pathologists with expertise in aphasia rehabilitation participated in two rounds of RAND/UCLA appropriateness ratings of the statements. Panellists consisted of researchers, service managers, clinicians and policymakers. MAIN OUTCOME MEASURES Statements that achieved a high level of agreement and an overall median score of 7-9 on a nine-point scale were rated as 'appropriate'. RESULTS 74 best practice statements were extracted from the literature and rated across eight areas of care (eg, receiving the right referrals, providing intervention). At the end of Round 1, 71 of the 74 statements were rated as appropriate, no statements were rated as inappropriate, and three statements were rated as uncertain. All 74 statements were then rated again in the face-to-face second round. 16 statements were added through splitting existing items or adding new statements. Seven statements were deleted leaving 83 statements. Agreement was reached for 82 of the final 83 statements. CONCLUSIONS This national set of 82 best practice statements across eight care areas for the rehabilitation of people with aphasia is the first to be validated by an expert panel. These statements form a crucial component of the Australian Aphasia Rehabilitation Pathway (AARP) (http://www.aphasiapathway.com.au) and provide the basis for more consistent implementation of evidence-based practice in stroke rehabilitation.
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Affiliation(s)
- Emma Power
- Speech Pathology, Faculty of Health Sciences, The University of Sydney, Lidcombe, New South Wales, Australia
- Centre for Clinical Research Excellence in Aphasia Rehabilitation
| | - Emma Thomas
- Centre for Clinical Research Excellence in Aphasia Rehabilitation
- School of Health and Rehabilitation Sciences, the University of Queensland, St Lucia, Queensland, Australia
| | - Linda Worrall
- Centre for Clinical Research Excellence in Aphasia Rehabilitation
- School of Health and Rehabilitation Sciences, the University of Queensland, St Lucia, Queensland, Australia
| | - Miranda Rose
- Centre for Clinical Research Excellence in Aphasia Rehabilitation
- Department of Human Communication Sciences, School of Allied Health, La Trobe University, Bundoora, Victoria, Australia
| | - Leanne Togher
- Speech Pathology, Faculty of Health Sciences, The University of Sydney, Lidcombe, New South Wales, Australia
- Centre for Clinical Research Excellence in Aphasia Rehabilitation
| | - Lyndsey Nickels
- Centre for Clinical Research Excellence in Aphasia Rehabilitation
- Department of Cognitive Science, ARC Centre of Excellence in Cognition and its Disorders, Macquarie University, Sydney, New South Wales, Australia
| | - Deborah Hersh
- Centre for Clinical Research Excellence in Aphasia Rehabilitation
- Speech Pathology, School of Psychology and Social Science, Edith Cowan University, Perth, Western Australia, Australia
| | - Erin Godecke
- Centre for Clinical Research Excellence in Aphasia Rehabilitation
- Speech Pathology, School of Psychology and Social Science, Edith Cowan University, Perth, Western Australia, Australia
| | - Robyn O'Halloran
- Centre for Clinical Research Excellence in Aphasia Rehabilitation
- Department of Human Communication Sciences, School of Allied Health, La Trobe University, Bundoora, Victoria, Australia
| | - Sue Lamont
- Department of Speech Pathology, Monash Health, Melbourne, Victoria, Australia
| | - Claire O'Connor
- NSW Agency for Clinical Innovation, Chatswood, New South Wales, Australia
| | - Kim Clarke
- Speech Pathology, Country Health SA Local Health Network, Strathalbyn, South Australia, Australia
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Sekhon JK, Douglas J, Rose ML. Current Australian speech-language pathology practice in addressing psychological well-being in people with aphasia after stroke. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2015; 17:252-262. [PMID: 25936387 DOI: 10.3109/17549507.2015.1024170] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
PURPOSE Psychological well-being is essential to overall health; however, there is a paucity of research on how to address psychological well-being in stroke survivors with aphasia. This study describes the current beliefs, attitudes and practices of Australian speech-language pathologists in addressing psychological well-being in people with aphasia after stroke. METHOD A 26-item web-based survey consisting of open and closed questions was distributed to Australian speech-language pathologists through four electronic databases. RESULT Australian speech-language pathologists (n = 111) utilized counselling and clinical approaches to address psychological well-being in people with post-stroke aphasia. The majority of speech-language pathologists did not feel comfortable with addressing psychological well-being in people with aphasia and sought support from other health professionals in this practice. Self-perception of being under-skilled was the main barrier identified to adequate practice in this domain, followed by inadequate time, inadequate staffing and people with aphasia declining referral to counselling. The main facilitators reported by speech-language pathologists to address psychological well-being included personal interest, personal and professional experience and availability of counselling health professionals for people with aphasia. There were small-to-medium statistically significant correlations between speech-language pathologists reporting additional training in counselling and perceived knowledge of, confidence in and satisfaction with managing psychological well-being in people with aphasia. CONCLUSION This study identifies factors requiring attention in order to enable speech-language pathologists to facilitate improved psychological well-being in people with aphasia.
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Affiliation(s)
- Jasvinder K Sekhon
- School of Allied Health, La Trobe University , Bundoora, Melbourne , Australia
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Rose ML, Attard MC. Practices and challenges in community aphasia groups in Australia: Results of a national survey. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2015; 17:241-251. [PMID: 25739326 DOI: 10.3109/17549507.2015.1010582] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
PURPOSE This study reports on practices and challenges in developing community aphasia groups in Australia. METHOD A 24-item web-based survey addressed the structure of existing community aphasia groups, funding models, group activities, facilitator satisfaction, challenges to group development and maintenance and suggestions for improvement. A total of 156 surveys were completed, mostly by speech-language pathologists (SLPs), with 66% urban and 34% regional/rural/remote participants representing all Australian states/territories consistent with their populations. RESULT Seventy respondents indicated running a total of 86 groups, reflecting a substantial under-representation of service in proportion to the population of people with aphasia. Further, 23.6% of respondents reported dissatisfaction with aspects of their groups. The primary barriers to achieving satisfaction relate to limited resources and staffing, inability to run sufficient numbers of groups and to tailor them effectively, dispersed populations beyond major cities, group dynamics and a lack of group promotion and referral to groups. Respondents suggested means for improvement including changes to group structure, improved SLP training, dedicated funding and staffing, development of specific resources and better liaison and promotion. CONCLUSION The major features differentiating the community aphasia groups run in Australia from those running overseas are discussed and practical ways to achieve service improvement are suggested.
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Affiliation(s)
- Miranda L Rose
- School of Allied Health, La Trobe University , Melbourne , Australia
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Page SJ, Wallace SE. Speech Language Pathologists’ Opinions of Constraint-Induced Language Therapy. Top Stroke Rehabil 2014; 21:332-8. [DOI: 10.1310/tsr2104-332] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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