Are People with Aphasia (PWA) Involved in the Creation of Quality of Life and Aphasia Impact-Related Questionnaires? A Scoping Review

The Communication Success Screener: A Preliminary Investigation of Perceived Communicative Success Across Modalities, Environments, and Demands

PURPOSE

Behavioral intervention targeting speech, language, and communication concerns is an established therapeutic approach for patients with communication concerns across a range of acquired neurogenic disorders. The multidimensional factors that contribute to a person's self-identified communication challenges and strengths in their daily communication needs must be considered to provide functional and person-centered care. While assessments grounded in clinician observation or client self-report exist, there is a direct need for a screening tool that comprehensively evaluates the roles of modality (verbal, text, gesture) and environment (in-person, virtual) on self-reported success across communicative demands. In this study, we describe a preliminary approach to monitoring the progression of receptive and expressive communication skills in people with chronic poststroke aphasia in the context of communication practices of the 21st century, culminating in the development and exploratory implementation of a novel clinical instrument: the Communication Success Screener (COMSS).

METHOD

Thirty-three participants with aphasia due to stroke were recruited to complete and evaluate the COMSS via an online survey. Quantitative responses and open-ended participant feedback were collected to validate and propose adaptations to the COMSS. Group-level analyses and case presentations were used to highlight COMSS features and outcomes.

RESULTS

Participant responses to the COMSS questionnaire suggest that this screening tool creates differentiated communicative success profiles based on self-report. Participant feedback also indicated that the COMSS appropriately evaluates self-reported success across modalities of verbal, text, and gesture in the context of in-person and virtual environments.

CONCLUSIONS

The communication concerns experienced by people with aphasia are often heterogeneous and vary as a function of their daily activities of living, preferred language modalities, and environmental supports. We present preliminary feasibility analyses of the COMSS as a potential tool to support the monitoring of functional change by evaluating self-reported communicative success across form, modality, environment, and task demand.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.24521044.

Therapies and Challenges in the Post-Stroke Aphasia Rehabilitation Arena: Current and Future Prospects

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.

The development of the People with Aphasia and Other Layperson Involvement (PAOLI) framework for guiding patient and public involvement (PPI) in aphasia research

BACKGROUND

Patient and Public Involvement (PPI) in aphasia research requires researchers to include people with aphasia as research partners from the beginning of the study. Yet the quality of reporting on the level and type of involvement is poorly documented in the absence of a framework to guide PPI in aphasia research. This study aimed to extract the items and statements relevant for the development of the People with Aphasia and Other Layperson Involvement (PAOLI) framework for designing and implementing PPI in aphasia research, in collaboration with people with aphasia.

METHOD

The method recommended by the EQUATOR network was followed. This involved: (1) evidence from a scoping review, (2) a thematic analysis of the in-depth interviews, of people with stroke and aphasia, on the topics to be included in the pilot draft, (3) a two round Delphi survey for item/statement selection and (4) an experts' consensus meeting. The research team involved two PPI partners with chronic stroke-induced aphasia. The research process involved co-design and was informed by the Dialogue model.

RESULTS

Twenty-three panellists, from 13 countries, voted in round one with 87% (20/23) responding in round two. The final PAOLI framework includes the following 17 items (with 66 descriptive statements): establish collaborations, recruit patients, gain informed consent, organize induction meetings, train patient partners, create communication links, engage communication partners, conceptualize topics, establish research priorities, reach consensus, work with co-design methods, develop proposals, assist with dissemination of results, promote implementation of the outcomes, support patient partners and promote self-evaluation, monitor progress and assess impact of the patient involvement. These items were considered by the panellists as the most relevant for the involvement of people with aphasia as research partners.

CONCLUSION

The PAOLI is the first international consensus framework for guiding patient involvement in aphasia research. Researchers are encouraged to adopt the framework to improve the quality of their research by promoting the meaningful involvement of people with aphasia within the research team from the start.

The impact of subcortical stroke-related aphasia on executive functions and working memory

Aphasia is a common post-stroke disorder characterized by impairments in speaking, listening, reading, and writing. Although cognitive impairments have been well studied in cortical aphasia, deficits associated with subcortical aphasia remain to be elucidated. The current study aimed to assess executive functions (EF) and working memory (WM) in patients with subcortical aphasia, and investigate the relationship between language abilities and cognition deficits. Participants of this research included patients with thalamus lesions (n = 9; mean age = 53.89 years) and healthy individuals (n = 9; mean age = 54.33 years). Assessment materials were the Mini-Mental State Examination (MMSE), Persian Western Aphasia Battery (P-WAB-1), digit span subtest of Adult Wechsler Test (WAIS-R), and Wisconsin Card Sorting Test (WCST). Obtained results revealed significant differences in all components of EF, as well as in WM forward and backward digit spans between patients and healthy individuals. However, investigating the relationship between MMSE and AQ scores and components of EF and WM revealed no significant difference. In conclusion, the findings of the present research indicated defects in cognitive functions, including WM and EF, in patients with subcortical stroke. Accordingly, it is crucial to provide optimal rehabilitation therapies for the improvement of language and cognitive problems upon subcortical aphasia.

Adaptation of the Aphasia Impact Questionnaire-21 into Greek: A Reliability and Validity Study

The impact of aphasia on the everyday life of Greek-speaking people with aphasia (PWA) is often underestimated by rehabilitation clinicians. This study explores the adaptation and psychometric properties of the Greek (GR) version of The Aphasia Impact Questionnaire-21 (AIQ-21-GR) to address this issue. The aim of this study is to determine the reliability and validity of the Greek version of the AIQ-21. The AIQ-21-GR was administered to 69 stroke survivors, 47 with aphasia and 22 without aphasia. The data were analyzed to determine reliability and validity. Content validity was based on the Consensus-based Standards for the selection of health Measurement Instruments guidelines. The AIQ-21-GR shows high levels of reliability and validity. The results confirmed high scores of internal consistency (Cronbach’s α = 0.91) and indicated good known—groups validity (Mann–Whitney U = 202, p < 001). Content validity achieved high scores with an overall median score of 4 [Q25 = 4, Q75 = 5]. The psychometric properties of the AIQ-21-GR support the reliability and validity of the tool for investigating the impact of aphasia on the quality of life of Greek-speaking PWA. The AIQ-21-GR can be used for setting functional goals in collaboration with PWA and as a patient reported outcome measure for functional communication training.

The views of people living with chronic stroke and aphasia on their potential involvement as research partners: a thematic analysis

BACKGROUND

Patient and Public Involvement (PPI) is the active partnership between researchers, patients and laypeople in the process of creating research. PPI in stroke aphasia research aims to ensure equal opportunities for informed decision-making and guarantee democratic representation of patient partners within the research team. Yet, little is known about the factors that hinder and/or promote the autonomous involvement of people with aphasia in stroke and aphasia PPI projects. This study aimed to explore the views and perspectives of people who live with chronic stroke, with and without aphasia, with experience in research prior to stroke, on their potential involvement as research partners.

METHODS

The research team included a PPI partner with chronic stroke-induced aphasia. Semi-structured interviews were conducted online with people with chronic stroke (n = 8), four with aphasia and four without. Interviews were subject to thematic analysis.

RESULTS

Inductive thematic analysis generated four themes: (1) the kinds of Restrictions that make involvement in research difficult, (2) the preferred levels and ways of Involvement during the research process, (3) the Support required for active and collaborative involvement, and (4) the Impact of their involvement and how it benefits the study's outcomes.

CONCLUSION

People experiencing chronic stroke and aphasia are willing to be involved as PPI partners if the research team provides the necessary support. Recommendations for researchers to consider before commencing co-produced research with people with stroke and aphasia are provided.

Adaptation of The Scenario Test for Greek-speaking people with aphasia: A reliability and validity study

BACKGROUND

Evidence-based assessments for people with aphasia (PWA) in Greek are predominantly impairment based. Functional communication (FC) is usually underreported and neglected by clinicians. This study explores the adaptation and psychometric testing of the Greek (GR) version of The Scenario Test. The test assesses the everyday FC of PWA in an interactive multimodal communication setting.

AIMS

To determine the reliability and validity of The Scenario Test-GR and discuss its clinical value.

METHODS & PROCEDURES

The Scenario Test-GR was administered to 54 people with chronic stroke (6+ months post-stroke): 32 PWA and 22 stroke survivors without aphasia. Participants were recruited from Greece and Cyprus. All measures were administered in an interview format. Standard psychometric criteria were applied to evaluate reliability (internal consistency, test-retest, and interrater reliability) and validity (construct and known-groups validity) of The Scenario Test-GR.

OUTCOMES & RESULTS

The Scenario Test-GR shows high levels of reliability and validity. High scores of internal consistency (Cronbach's α = 0.95), test-retest reliability (intra-class coefficients (ICC) = 0.99), and interrater reliability (ICC = 0.99) were found. Interrater agreement in scores on individual items ranged from good to excellent levels of agreement. Correlations with a tool measuring language function in aphasia, a measure of FC, two instruments examining the psychosocial impact of aphasia and a tool measuring non-verbal cognitive skills revealed good convergent validity (all ps < 0.05). Results showed good known-groups validity (Mann-Whitney U = 96.5, p < 0.001), with significantly higher scores for participants without aphasia compared with those with aphasia.

CONCLUSIONS & IMPLICATIONS

The psychometric qualities of The Scenario Test-GR support the reliability and validity of the tool for the assessment of FC in Greek-speaking PWA. The test can be used to assess multimodal FC, promote aphasia rehabilitation goal-setting at the activity and participation levels, and be used as an outcome measure of everyday communication abilities.

Internet+Continuing Nursing (ICN) Program Promotes Motor Function Rehabilitation of Patients With Ischemic Stroke

BACKGROUND AND PURPOSE

Ischemic stroke is a severe disorder with high rates of death and recurrence that causes disability in patients and for which there is currently no effective treatment. Internet-based rehabilitation helps patients with disability recover at home with the help of their household or family members in a nonclinical setting. However, the effects of the internet+continuing nursing (ICN) program on the recovery of patients after ischemic stroke remains unknown.

METHODS

In the present study, patients were treated with an ICN-based rehabilitation training program; subsequently, the Self-efficacy Scale for Chronic Disease, Questionnaire of Exercise Adherence, Motor Assessment Scale, Activities of Daily Living, and Stroke-specific Quality of Life were performed to evaluate the effects of the ICN program on patient self-confidence to persist with rehabilitation, functional exercise compliance, motor function, ability to live independently and quality of life following ischemic stroke.

RESULTS

We observed that, after the ICN intervention for 6 weeks and 3 months, the scores of Self-efficacy Scale for Chronic Disease, Questionnaire of Exercise Adherence, Motor Assessment Scale, Activities of Daily Living, and Stroke-specific Quality of Life in the ICN-treated group were significantly higher compared with those in the control group.

CONCLUSION

These results suggested that the ICN program may promote the recovery of patients after ischemic stroke.