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Mooney AR, Bravo M, Roberts A, Salley E, Blaze E, Esparza M, Fried-Oken M, Khayum B, Rao L, Rademaker A, Rogalski E. Use and Perceived Effectiveness of Communication Modes Reported by Persons With Primary Progressive Aphasia. Am J Speech Lang Pathol 2023; 32:298-305. [PMID: 36472941 PMCID: PMC10023145 DOI: 10.1044/2022_ajslp-21-00386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 03/22/2022] [Accepted: 08/11/2022] [Indexed: 06/17/2023]
Abstract
PURPOSE Primary progressive aphasia (PPA) is a clinical neurodegenerative dementia syndrome characterized by early, selective, and progressive language impairment. PPA onset is gradual, providing time to potentially identify additional or alternative expressive communication modes; however, reports of communication mode use and effectiveness by persons with PPA have not been described. This study characterized the use, frequency, and perceived effectiveness of communication modes reported by individuals with PPA. METHOD Forty-one participants with mild-to-moderate PPA completed a structured interview detailing the type, frequency, and perceived effectiveness of 12 potential communication modes, categorized by technology required (no-tech, low-tech, and high-tech). The ratio of modes used was compared across technology categories with a repeated-measures generalized linear model assuming a binomial distribution with an overall Wald chi-square statistic, followed by pairwise post hoc t-test comparisons. RESULTS Of the 12 communication modes assessed, participants reported using a median of eight (range: 5-10). All participants affirmed using speech, facial expressions, and talking on the phone. Frequency and perceived effectiveness ratings for these three modes were endorsed at the "some/most of the time" level for more than 80% of the participants. No-tech mode use was significantly higher than reported high-tech and low-tech modes (p = .004 and p < .0001, respectively). Even so, while some high-tech modes (apps) and some low-tech modes (nonelectronic augmentative and alternative communication) had fewer users, effectiveness ratings were moderate to high for all but one user. CONCLUSIONS Persons with mild-to-moderate language impairment due to PPA report using a range of communication modes with moderate-to-high frequency and perceived effectiveness. These outcomes provide practical information when considering mode refinement or expansion during intervention to maximize communication participation. Barriers to modality use may include low awareness or access, which could be queried by future studies and supported by speech and language interventions. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.21614262.
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Affiliation(s)
| | - Megan Bravo
- Oregon Health & Science University, Portland
| | - Angela Roberts
- School of Communication Sciences and Disorders and Department of Computer Science, Western University, London, Ontario, Canada
| | - Elizabeth Salley
- Mesulam Center for Cognitive Neurology and Alzheimer's Disease, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Erin Blaze
- Mesulam Center for Cognitive Neurology and Alzheimer's Disease, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Marissa Esparza
- Mesulam Center for Cognitive Neurology and Alzheimer's Disease, Northwestern University Feinberg School of Medicine, Chicago, IL
| | | | - Becky Khayum
- Mesulam Center for Cognitive Neurology and Alzheimer's Disease, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Leela Rao
- Mesulam Center for Cognitive Neurology and Alzheimer's Disease, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Alfred Rademaker
- Mesulam Center for Cognitive Neurology and Alzheimer's Disease, Northwestern University Feinberg School of Medicine, Chicago, IL
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Emily Rogalski
- Mesulam Center for Cognitive Neurology and Alzheimer's Disease, Northwestern University Feinberg School of Medicine, Chicago, IL
- Department of Psychiatry & Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
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Rogalski E, Roberts A, Salley E, Saxon M, Fought A, Esparza M, Blaze E, Coventry C, Mesulam MM, Weintraub S, Mooney A, Khayum B, Rademaker A. Communication partner engagement: A relevant factor for functional outcomes in speech language therapy for aphasic dementia. J Gerontol B Psychol Sci Soc Sci 2021; 77:1017-1025. [PMID: 34528692 DOI: 10.1093/geronb/gbab165] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Previous reports established the feasibility of a telehealth model for delivering speech-language therapy via Internet videoconferencing, which connects individuals with primary progressive aphasia (PPA) to an expert speech and language pathologist for treatment. This study reports feasibility of the same telehealth intervention in a larger set of progressive aphasia participants and explores factors potentially influencing functional intervention outcomes. METHODS Participants with PPA or progressive aphasia in the context of a neurodegenerative dementia syndrome and their communication partners were enrolled into an 8-session intervention, with 3 evaluations (Baseline, 2- and 6-months post-enrollment). Half of the participants were randomized into a "check-in" group and received three monthly half-hour sessions post-intervention. Mixed linear models with post hoc testing and percent change in area under the curve (AUC) were used to examine communication confidence over time, the primary patient reported outcome, as well as the influence of check-in sessions and role of communication partner engagement on communication confidence. RESULTS Communication confidence improved at the 2-month evaluation and showed no significant decline at the 6-month evaluation. Item-level analysis revealed gains in communication confidence across multiple communication contexts. Gains and maintenance of communication confidence were only present for the engaged communication partner group and were not bolstered by randomization to the check-in group. DISCUSSION Internet-based, person-centered interventions demonstrate promise as a model for delivering speech-language therapy to individuals living with PPA. Maintenance is possible for at least 6-months post-enrollment and is better for those with engaged communication partners, which supports the use of dyadic interventions.
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Affiliation(s)
- Emily Rogalski
- Mesulam Center for Cognitive Neurology and Alzheimer's Disease Northwestern University, Chicago, IL, USA.,Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Angela Roberts
- Department of Communication Sciences and Disorders, Northwestern University, Evanston, IL, USA
| | - Elizabeth Salley
- Mesulam Center for Cognitive Neurology and Alzheimer's Disease Northwestern University, Chicago, IL, USA
| | - Marie Saxon
- Mesulam Center for Cognitive Neurology and Alzheimer's Disease Northwestern University, Chicago, IL, USA
| | - Angela Fought
- Mesulam Center for Cognitive Neurology and Alzheimer's Disease Northwestern University, Chicago, IL, USA.,Department of Biostatistics and Informatics, University of Colorado Denver Anschutz Medical Campus, Aurora, CO, USA.,Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Marissa Esparza
- Mesulam Center for Cognitive Neurology and Alzheimer's Disease Northwestern University, Chicago, IL, USA
| | - Erin Blaze
- Mesulam Center for Cognitive Neurology and Alzheimer's Disease Northwestern University, Chicago, IL, USA
| | - Christina Coventry
- Mesulam Center for Cognitive Neurology and Alzheimer's Disease Northwestern University, Chicago, IL, USA
| | - Marek-Marsel Mesulam
- Mesulam Center for Cognitive Neurology and Alzheimer's Disease Northwestern University, Chicago, IL, USA
| | - Sandra Weintraub
- Mesulam Center for Cognitive Neurology and Alzheimer's Disease Northwestern University, Chicago, IL, USA.,Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Aimee Mooney
- Department of Biostatistics and Informatics, University of Colorado Denver Anschutz Medical Campus, Aurora, CO, USA.,Oregon Health & Science University, Portland, OR, USA
| | - Becky Khayum
- Mesulam Center for Cognitive Neurology and Alzheimer's Disease Northwestern University, Chicago, IL, USA
| | - Alfred Rademaker
- Mesulam Center for Cognitive Neurology and Alzheimer's Disease Northwestern University, Chicago, IL, USA.,Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Abstract
Primary progressive aphasia (PPA) is a clinical neurodegenerative dementia syndrome characterized by deficits in spoken and written word retrieval, word usage, and/or word comprehension. Currently, there are no effective treatments to reverse or halt the underlying disease process; however, speech-language therapy may be helpful. The Communication Bridge Care Model was developed to address the unique communication and quality of life needs of individuals living with PPA. The core elements include person-centered care with dyadic instruction for disease education, and counseling, along with tailored levels of impairment- and compensatory-based communication strategy training. Our multicomponent approach incorporates guidance from the Life Participation Approach for Aphasia, including client-directed assessment and interventions that aim to maximize functional communication and participation in desired life activities. The direct and indirect use of technology is integrated into our tailored model of care to facilitate achievement of the client's functional goals. Here, we describe how to practically apply the Communication Bridge Care Model across treatment settings, including case examples from the Communication Bridge research study. This approach to care provides an opportunity to maximize communication effectiveness and quality of life for individuals living with PPA throughout the course of disease.
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Affiliation(s)
- Emily J Rogalski
- Cognitive Neurology and Alzheimer's Disease Center, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Becky Khayum
- Cognitive Neurology and Alzheimer's Disease Center, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- MemoryCare Corporation, Aurora, Illinois
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Hickey EM, Kinder R, Khayum B, Douglas NF, Bourgeois MS. Setting the Stage for Person-Centered Care. Dementia 2017. [DOI: 10.4324/9781315103891-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Hickey EM, Khayum B, Bourgeois MS. Assessment of Cognition, Communication, and Behavior. Dementia 2017. [DOI: 10.4324/9781315103891-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Rogalski EJ, Saxon M, McKenna H, Wieneke C, Rademaker A, Corden ME, Borio K, Mesulam MM, Khayum B. Communication Bridge: A pilot feasibility study of Internet-based speech-language therapy for individuals with progressive aphasia. Alzheimers Dement (N Y) 2016; 2:213-221. [PMID: 28503656 PMCID: PMC5423699 DOI: 10.1016/j.trci.2016.08.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Introduction Individuals with aphasia symptoms due to neurodegenerative disease are under-referred for speech–language therapy (SLT) services. We sought to determine the feasibility of utilizing telepractice, via Internet videoconferencing, to connect individuals with progressive aphasia to a speech–language pathologist (SLP) for treatment. Methods Participants received an initial evaluation, 8 person-centered Internet-based SLT sessions, and 2 post-therapy evaluations. The feasibility of providing Web-based SLT, strategies used and their compliance, functional gains, and the duration of benefit were assessed. Results Thirty-four participants from 21 states and Canada were enrolled. Thirty-one participants completed the 6-month evaluation. SLP-assessed and self-reported functional gains and increased confidence in communication were documented at 2 months and maintained at 6 months postenrollment. Discussion Internet-based SLT using person-centered interventions provides a feasible model for delivering care to individuals with dementia and mild and/or moderate aphasia symptoms who have an engaged care-partner and prior familiarity with a computer.
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Affiliation(s)
- Emily J Rogalski
- Cognitive Neurology and Alzheimer's Disease Center, Northwestern University Feinberg School of Medicine (NU FSM), Chicago, IL
| | - Marie Saxon
- Cognitive Neurology and Alzheimer's Disease Center, Northwestern University Feinberg School of Medicine (NU FSM), Chicago, IL
| | - Hannah McKenna
- Cognitive Neurology and Alzheimer's Disease Center, Northwestern University Feinberg School of Medicine (NU FSM), Chicago, IL
| | - Christina Wieneke
- Cognitive Neurology and Alzheimer's Disease Center, Northwestern University Feinberg School of Medicine (NU FSM), Chicago, IL
| | | | - Marya E Corden
- Center for Behavioral Intervention Technologies, NU FSM, Chicago, IL
| | | | - M-Marsel Mesulam
- Cognitive Neurology and Alzheimer's Disease Center, Northwestern University Feinberg School of Medicine (NU FSM), Chicago, IL.,Department of Neurology, NU FSM, Chicago, IL
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Morhardt D, Weintraub S, Khayum B, Robinson J, Medina J, O'Hara M, Mesulam M, Rogalski EJ. The CARE pathway model for dementia: psychosocial and rehabilitative strategies for care in young-onset dementias. Psychiatr Clin North Am 2015; 38:333-52. [PMID: 25998120 PMCID: PMC4635684 DOI: 10.1016/j.psc.2015.01.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The goal of the Care Pathway Model for Dementia (CARE-D) is to improve quality of life and daily functioning both for individuals diagnosed with dementia and for their families or other caregivers. This is accomplished by developing individualized recommendations focused on a person's strengths and weaknesses as determined by formal neurocognitive and psychosocial evaluations. Careful attention is given to the stage of illness and an individual's stage in life, to connecting families with services that target an individual's cognitive and behavioral symptoms, and to providing education and emotional support specific to symptoms, clinical diagnosis, and prognosis.
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Affiliation(s)
- Darby Morhardt
- Cognitive Neurology and Alzheimer's Disease Center, Northwestern University Feinberg School of Medicine, 320 East Superior Street, Searle Building 11th Floor, Chicago, IL 60611, USA
| | - Sandra Weintraub
- Cognitive Neurology and Alzheimer's Disease Center, Northwestern University Feinberg School of Medicine, 320 East Superior Street, Searle Building 11th Floor, Chicago, IL 60611, USA, Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, 446 East Ontario, Chicago, IL 60611, USA, Department of Neurology, Northwestern University Feinberg School of Medicine, 710 North Lake Shore Drive, Chicago, IL 60611, USA
| | - Becky Khayum
- MemoryCare Corporation, 634 Brooklyn Drive, Aurora, IL 60502, USA
| | - Jaimie Robinson
- Christ Hospital Cancer Center, 2139 Auburn Avenue, Cincinnati, OH 45219, USA
| | - Jennifer Medina
- Cognitive Neurology and Alzheimer's Disease Center, Northwestern University Feinberg School of Medicine, 320 East Superior Street, Searle Building 11th Floor, Chicago, IL 60611, USA
| | - Mary O'Hara
- Cognitive Neurology and Alzheimer's Disease Center, Northwestern University Feinberg School of Medicine, 320 East Superior Street, Searle Building 11th Floor, Chicago, IL 60611, USA
| | - Marsel Mesulam
- Cognitive Neurology and Alzheimer's Disease Center, Northwestern University Feinberg School of Medicine, 320 East Superior Street, Searle Building 11th Floor, Chicago, IL 60611, USA, Department of Neurology, Northwestern University Feinberg School of Medicine, 710 North Lake Shore Drive, Chicago, IL 60611, USA
| | - Emily J. Rogalski
- Cognitive Neurology and Alzheimer's Disease Center, Northwestern University Feinberg School of Medicine, 320 East Superior Street, Searle Building 11th Floor, Chicago, IL 60611, USA, Corresponding author.
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Khayum B, Wieneke C, Rogalski E, Robinson J, O'Hara M. Thinking Outside the Stroke: Treating Primary Progressive Aphasia (PPA). ACTA ACUST UNITED AC 2012; 17:37-49. [PMID: 26500714 DOI: 10.1044/gero17.2.37] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
In this article, we explore the symptoms, cause, treatment potential, and supportive services for individuals diagnosed with Primary Progressive Aphasia (PPA). Although it is possible to regain certain cognitive abilities with stroke or brain injury, in PPA, language abilities worsen and other symptoms emerge with time, shortening the lifespan. The goal of speech therapy for PPA is not to regain lost language, but rather to maximize communication for as long as possible. In this article, we offer information and tools for speech-language pathologists to help people living with PPA achieve these goals and improve overall quality of life.
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Affiliation(s)
- Becky Khayum
- Cognitive Neurology and Alzheimer's Disease Center, Northwestern University Chicago, IL
| | - Christina Wieneke
- Cognitive Neurology and Alzheimer's Disease Center, Northwestern University Chicago, IL
| | - Emily Rogalski
- Cognitive Neurology and Alzheimer's Disease Center, Northwestern University Chicago, IL
| | - Jaimie Robinson
- Cognitive Neurology and Alzheimer's Disease Center, Northwestern University Chicago, IL
| | - Mary O'Hara
- Cognitive Neurology and Alzheimer's Disease Center, Northwestern University Chicago, IL
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