Dissertations / Theses on the topic 'Aphasia and stroke care'
To see the other types of publications on this topic, follow the link: Aphasia and stroke care.
Create a spot-on reference in APA, MLA, Chicago, Harvard, and other styles
Consult the top 50 dissertations / theses for your research on the topic 'Aphasia and stroke care.'
Next to every source in the list of references, there is an 'Add to bibliography' button. Press on it, and we will generate automatically the bibliographic reference to the chosen work in the citation style you need: APA, MLA, Harvard, Chicago, Vancouver, etc.
You can also download the full text of the academic publication as pdf and read online its abstract whenever available in the metadata.
Browse dissertations / theses on a wide variety of disciplines and organise your bibliography correctly.
1
Snook, Katherine Dorothy Ms. "Telephone-based Script Training and Generalization for Aphasia." The Ohio State University, 2013. http://rave.ohiolink.edu/etdc/view?acc_num=osu1372865259.
Full text
2
Dahné, Ylva, and Emma Thorin. "Sjuksköterskan och patienter med strokeinduceradafasi – En litteraturöversikt om kommunikation ochpersoncentrering." Thesis, Högskolan Dalarna, Omvårdnad, 2017. http://urn.kb.se/resolve?urn=urn:nbn:se:du-25249.
Full textAbstract:
Bakgrund: Stroke är ett samlingsbegrepp för hjärninfarkter och hjärnblödningar. Stroke ger ofta livslånga men, såsom afasi. Afasi innebär en reducerad förmåga att förstå talat/skrivet språk och/eller en reducerad förmåga att uttrycka sig adekvat. För att en god och personcentrerad vård ska kunna erbjudas patienter med stroke så är en fungerande kommunikation en förutsättning. Syfte: Syftet är att beskriva faktorer som påverkar personcentrerad vård och kommunikation mellan sjuksköterskan och patienter som drabbats av strokeinducerad afasi. Metod: Studien är en litteraturöversikt. Studien är baserad på 15 vetenskapliga artiklar som lästs och analyserats och där gemensamma teman identifierats. Resultat: Resultatet visade på ett antal strategier som främjade eller försvårade en god kommunikation mellan sjuksköterskan och patienter som drabbats av strokeinducerad afasi. Dessa strategier berörde sju områden: Verbal kommunikation, Icke verbal kommunikation, Att se patienten som en kompetent och unik individ, Uppmärksamhet och engagemang, Tidsaspekten vid kommunikation med afasidrabbade, Den omgivande miljöns betydelse för kommunikationen samt Personalens utbildning och kompetens. Konklusion: Det finns inget standardsvar på hur kommunikationen ska gå till, varje individ är unik och varje situation kräver sin unika lösning. Dock finns det ett antal aspekter och metoder som är betydelsefulla och användbara vid kommunikation med afasidrabbade. Dessa används i olika utsträckning inom vården.Background: Stroke is a collective term for cerebral infarction and cerebral hemorrhage. Stroke often causes lifelong detrimental effects, such as aphasia. Aphasia means a reduced ability to understand spoken/written language and/or a reduced ability to express oneself adequately. To enable a good and person-centred care for the patients, an effective communication is a prerequisite. Aim: The aim of this study is to describe the factors that influence the person-centred care and communication between the nurse and patients affected by stroke induced aphasia. Method: The study is a literature review on bachelor level. The study is based on 15 scientific articles that have been red and analyzed and where common themes have been identified. Result: The results revealed a number of strategies that promoted and hindered good communication between the nurse and people affected by stroke induced aphasia. These strategies concern seven areas: Verbal communication, Nonverbal communication, Seeing the patient as a competent and unique individual, Attention and involvement, The time aspect of communication with patients with aphasia, The importance of the surrounding environment for communication and The personnel's education and skills . Conclusion: There is no standard answer to how communication shall be achieved, each individual is unique and every situation requires a different solution. However, there are a number of aspects and methods that are important and useful when communicating with aphasic people. These are used to different degrees in health care.
3
Kjellberg, Katarina, and Linnéa Öhrström. "Livet för personer med afasi och deras närstående efter stroke : Personer med afasi och deras närståendes skattningar på COAST respektive Carer COAST i relation till en språklig bedömning med testet A-ning." Thesis, Uppsala universitet, Logopedi, 2016. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-312952.
Full textAbstract:
ABSTRACT Stroke can result in aphasia which is an acquired language disorder. It affects both the person with aphasia and the relatives. Previous studies have shown that people with aphasia consider themselves to have fewer difficulties with communication in comparison to their relatives’ opinions. The relatives rate the difficulties as less severe in comparison to the speech and language pathologists. The scales Communication Outcome after Stroke (COAST) and Carer Communication Outcome after Stroke (Carer COAST) can be used to investigate the experiences of the people with aphasia and their relatives regarding the language and communication ability of people with aphasia and the quality of life for both groups. By using COAST and Carer COAST this study aimed to investigate the experiences of people with aphasia and their relatives and to compare their experiences to the assessment of language. This study also aimed to start a validation of COAST and Carer COAST on a Swedish population. A qualitative and a quantitative analysis were used. Twenty people with aphasia and nineteen relatives were participating. The ratings between people with aphasia, their relatives and the speech and language pathologist did not differ a lot even though the relatives rated the difficulties as most severe. The quality of life was negatively affected for almost all participants. This study provided deeper insight in the different experiences which can be crucial in the clinical practice. The validation of COAST and Carer COAST can contribute to an extended use of the scales clinically and in research. Keywords: aphasia, stroke, relative, experiences, speech and language pathology, Communication Outcome after Stroke, Carer Communication Outcome after Stroke SAMMANFATTNING Afasi är en förvärvad språkstörning som kan uppkomma efter stroke och påverkar både personen som fått afasi och de närstående. Enligt tidigare studier anser personer med afasi att de har mindre kommunikationssvårigheter än vad de närstående upplever. De närstående upplever i sin tur svårigheterna som mindre än vad logopeder bedömer. Skattningsformulären Communication Outcome after Stroke (COAST) och Carer Communication Outcome after Stroke (Carer COAST) kan användas för att undersöka upplevelserna hos personer med afasi och deras närstående avseende den språkliga och kommunikativa förmågan hos personen med afasi samt livskvaliteten hos båda parter. Studien syftade till att med COAST och Carer COAST studera upplevelserna hos personer med afasi och deras närstående samt hur dessa förhöll sig till en språklig bedömning. Ytterligare ett syfte var att påbörja validering av COAST och Carer COAST på en svensk population. En kvalitativ och en kvantitativ analys gjordes. Tjugo personer med afasi och nitton närstående deltog. Det var inga större skillnader mellan skattningarna av deltagarna med afasi och deras närstående. Skattningarna stämde även till stor del överens med den språkliga bedömningen även om de närstående överlag skattade svårigheterna som störst. Livskvaliteten var negativt påverkad för de flesta deltagarna. Studiens resultat ökar insikten om de olika upplevelserna vilket kan vara av betydelse i den kliniska verksamheten. Valideringen av COAST och Carer COAST kan innebära att skattningsskalorna i större utsträckning kan användas kliniskt och inom forskning. Nyckelord: afasi, stroke, närstående, upplevelser, logopedi, Communication Outcome after Stroke, Carer Communication Outcome after Stroke
4
Laska, Ann Charlotte. "Aphasia in acute stroke /." Stockholm, 2007. http://diss.kib.ki.se/2007/978-91-7357-195-1/.
Full text
5
Kontou, Eirini. "Depression and aphasia after stroke." Thesis, University of Nottingham, 2010. http://eprints.nottingham.ac.uk/12841/.
Full textAbstract:
Background: Post-stroke depression (PSD) is a common phenomenon and has a negative impact on rehabilitation, recovery and quality of life. About one third of stroke patients suffer communication problems, including aphasia, which is a condition that mainly affects their ability in understanding and/or producing language. The frequency of depressive symptoms in post-stroke aphasia has been difficult to determine as most studies have excluded stroke patients with aphasia due to methodological limitations. As a result, depression remains often under-diagnosed and untreated in these patients. Objectives: The purpose of this thesis was 1) to develop and validate a revised version of the Visual Analogue Mood Scales (YAMS), and 2) to identify factors which may be associated with low mood in stroke patients with aphasia. Method: The items Happy and Energetic of the VAMS were reversed for a more consistent format. All participants completed a questionnaire including the revised version of the VAMS (VAMS-R), the Hospital & Anxiety Depression Scale (BADS), but also four key items of the VAMS-R which were repeated with and without verbal descriptors to assess their content and test-rest reliability. Aphasic stroke patients were recruited both from hospital and community settings and completed assessments at recruitment and at six months follow up. Participants were assessed on measures of communication, cognition, mood, activities of daily living, and disability associated with living with aphasia. Carers also completed assessments of caregiving strain and satisfaction with care at six months follow up. Results: The VAMS-R showed good evidence of validity and reliability in a community sample of 50 older adults and in 71 stroke patients with aphasia. In the main study, 132 aphasic stroke patients were invited to take part, 71 consented and completed baseline assessments and 63 were followed up at six months. Most participants (n=47) were recruited in the community, 38 were men, mean age was 70 years old and the mean time post-stroke was 15 months. Almost half of the aphasic stroke patients recruited had low mood at baseline (55%) and at follow up (44%) based either on their self-report or the observer-rated mood scores. Physical impairment, demographic and medical information, ADL and leisure activities were not shown to be significant predictors of depression. Communication impairment was significantly related to low mood, but was not predictive of self report mood outcomes at both end points. Disability and emotional consequences living with aphasia were predictive of low mood and accounted for 37% of the variance in self-report mood scores at recruitment and for 48% of the variance at follow up. Baseline language battery scores and follow up Carer Strain Index scores were predictive of the observer-rated mood scores at follow up. Conclusions: The VAMS-R, VASES and SADQ-21 could be used to screen for symptoms of low mood in aphasic stroke patients who cannot complete conventional mood assessments that rely on verbal communication. The main factors found to predict low mood in stroke patients with aphasia were disability associated with living with aphasia, carer strain and communication impairment. The factors identified are amenable to psychological intervention and future research should address interventions for the management of post-stroke depression in aphasia. The need to include people with aphasia in future post-stroke depression research is also highlighted.
6
Beeson, Pelagie Maritz. "Memory impairment associated with stroke and aphasia." Diss., The University of Arizona, 1990. http://hdl.handle.net/10150/185167.
Full textAbstract:
Brain structures in the perisylvian region that are critical for language also subserve verbal memory processes. Researchers have documented a reduction in verbal memory span in individuals with perisylvian stroke resulting in aphasia, but scant data are available regarding the integrity of long-term memory in such individuals. Whereas dissociated memory processes have been documented in nonaphasic populations, characteristic patterns of short- versus long-term memory have not typically been associated with specific lesion sites in aphasic individuals. The purpose of this study was to examine memory abilities of aphasic individuals in relation to site of neurological lesion resulting from cerebrovascular accident. Fourteen individuals with stroke and aphasia and fourteen demographically matched control subjects were given selected tests of short-term memory (STM) and long-term memory (LTM). The stroke patients represented two distinct groups with regard to site of neurological lesion: seven with anterior lesions, seven with posterior lesions. STM was assessed with Digits Forward and Tapping Forward subtests from the Wechsler Memory Scale-Revised (Wechsler, 1988). Verbal LTM was assessed using two multitrial free recall paradigms. One paradigm required free recall of a word list presented aurally with selective reminding of unrecalled items. The other required free and cued recall of a word list presented with guided semantic encoding. Stroke patients were impaired relative to normal control subjects on tests of verbal memory, with greater impairment of LTM associated with anterior lesions and greater impairment of STM associated with posterior lesions. Individuals with anterior lesions were deficient in the enactment of successful LTM encoding and retrieval strategies. The posterior aphasia group was most impaired for digit span, a task dependent upon subvocal rehearsal. There were no group differences on a test of visual short-term memory. Verbal memory performance did not correlate highly with language ability, and did not appear to be simply a consequence of language impairment. The memory impairments observed in aphasic stroke patients were interpreted as working memory impairments with distinct manifestations dependent upon lesion site.
7
Ford, Emma Jane. "Quality of life after stroke and aphasia : stroke survivors' and spouses' perspectives." Thesis, Staffordshire University, 2014. http://eprints.staffs.ac.uk/1997/.
Full textAbstract:
Having previously worked in research teams investigating the impact of stroke and aphasia upon individuals and spending two years working therapeutically with people with low mood and post-stroke aphasia, a passion for aiding this client group to achieve a good quality of life was developed. Furthermore, completing this work highlighted the paucity of good quality research including this population, despite having learned from personal experience that it was feasible to do so, given that the appropriate adaptations and considerations were made to accommodate communication difficulties. Subsequently, a need for further research regarding quality of life post-stroke and aphasia was acknowledged. An initial review of the existing literature regarding quality of life post-stroke and aphasia was conducted, to determine what was already known, and what remained to be found. The studies identified for review were subjected to evaluation. The outcome of the review suggested that quality of life was a complex, multifaceted concept, impacted by a number of factors, but that it was not possible to determine for certain what factors were important in achieving a good quality of life, primarily due to the methodological limitations of the studies forming the evidence base. Chiefly, the data collection methods used were seemingly inappropriate for people with communication difficulties. Thus it was proposed that the more aphasia friendly, Q methodology approach was utilised to gather the views of people with post-stroke aphasia about what factors were important to achieve a good quality of life. Six aphasic stroke survivors and five spouses completed a Q sort task, in which they were required to rank a number of statements depicting different factors related to quality of life, in terms of personal importance. Spouses did this task from the perspective of the stroke survivor. Ultimately, two factors were identified: ‘returning to the pre-stroke self’ which represented the stroke survivors of working age, and ‘life beyond stroke, what’s important now?’ which reflected the views of the older, retired participants. The two factors were considered in relation to Erikson’s (1968) psychosocial stages of development model and in terms of stroke recovery models (Holbrook, Quality of Life After Stroke and Aphasia 1982; Kirkevold, 2002). Significant, strong and positive pair-wise correlations between the Q sort outcomes of the stroke survivors’ and their respective spouses’ suggested that spouses could reliably report the stroke survivors’ views regarding quality of life. The importance of the findings in relation to the work of a clinical psychologist was subsequently considered.
8
Griffith, Julie. "Post-Stroke Language Remediation Through Constraint-Induced Aphasia Therapy." University of Cincinnati / OhioLINK, 2014. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1415615475.
Full text
9
Bethel, Susannah. "Functional magnetic resonance imaging of recovery from post-stroke aphasia." Thesis, University of Nottingham, 2009. http://eprints.nottingham.ac.uk/12635/.
Full textAbstract:
This thesis presents the design, development and application of a novel overt picture-naming paradigm through a series of exploratory behavioural and imaging experiments. The paradigm is subsequently used in a functional magnetic resonance imaging study of recovery from post-stroke aphasia. The possibility of comparing correct and error naming responses in aphasic patients and unimpaired subjects induced to make errors was investigated and successfully trialled. This research improves on techniques currently favoured in imaging studies to explore the processes involved in functional recovery in a more analytical way. The novel study design provides a new way to interrogate processing involved in the production of aphasic responses. The intentions of this project were to drive the research field of post-stroke aphasia recovery forward by suggesting and applying new methods of using functional imaging to investigate the current pertinent research questions. In addition to this, it was aimed that data collected from participants who have an aphasic deficit, and those with a healthy language system, would be analysed to provide evidence of how a stroke damaged brain may recover functional language. It was hypothesised that results from aphasic patients would show that successful language performance is associated with cortical activation of the patients' normal left hemispheric language areas, around their lesion site. Conversely, the hypotheses state that production of linguistic errors would correlate with an increase in activation in areas of the right hemisphere homologous to the left lateralised fronto-temporal language production network. It was thought that further investigation of successful and unsuccessful language performance in unimpaired speakers would echo this finding. The current debate in this research field centres on the role of the undamaged hemisphere in successful recovery. Five chronic stage aphasics were tested using the developed continuous scanning, event-related paradigm and their correct and error naming trials were compared. Results indicate that recruitment of cortical areas homologous to the stroke lesion can support successful language processing. This is contrary to the theory that disinhibition of non-dominant language areas may contribute to the production of aphasic errors. An investigation of forced errors in unimpaired speakers was also conducted to provide comparisons with the aphasic patient group. Imaging results showed that the naming-to-deadline paradigm used may provide a useful baseline for the normal processes involved in the monitoring and control of task performance.
10
DeMarco, Andrew Tesla, and Andrew Tesla DeMarco. "Neural Substrates of Phonological Processing in Chronic Aphasia from Stroke." Diss., The University of Arizona, 2016. http://hdl.handle.net/10150/622976.
Full textAbstract:
Deficits in phonology are among the most common and persistent impairments in aphasia after left hemisphere stroke, and can have significant functional consequences for spoken and written language. While many individuals make considerable gains through physiological restitution and in response to treatment, the neural substrates supporting phonological performance in the face of damage to critical language regions is poorly understood. To address this issue, we used BOLD fMRI to measure regional brain activation in a case series of individuals with aphasia after left MCA stroke during a phonological task. The results of this study support the idea that damage to even a portion of the phonological network results in impaired phonological processing. We found that individuals with left perisylvian damage tend to rely on the residual left-hemisphere language network, and typically recruit regions associated with domain-general cognitive processing which fall outside of the left-hemisphere language network. However, recruitment of these regions did not necessarily enhance phonological processing. Rather, more successful phonological processing outside the scanner was associated with recruitment of a language region in right posterior middle temporal gyrus and a region in left occipital pole. More successful phonological processing inside the scanner was associated with additional recruitment of the left supramarginal gyrus within the healthy control network, engagement of bilateral intraparietal sulcus from the multi-demand network, and up-regulation of the right-hemisphere network of regions homotopic to the left-hemisphere language network seen in the healthy control group. These findings emphasize the contributions of residual components of the left-hemisphere language network, engagement of a non-linguistic domain-general multi-demand network, and the participation of the non-dominant right-hemisphere language network in successful phonological processing in chronic aphasia after stroke.
11
Martin, Paula Irene. "MRI neuroimaging: language recovery in adult aphasia due to stroke." Thesis, Boston University, 2013. https://hdl.handle.net/2144/11133.
Full textAbstract:
Thesis (Ph.D.)--Boston UniversityThis research focuses on the contribution of magnetic resonance imaging (MRI) to understanding recovery and treatment of aphasia in adults who have suffered a stroke. There are three parts. Part 1 presents the feasibility of the application of an overt, picture-naming, functional MRI (fMRI) paradigm to examine neural activity in chronic, nonfluent aphasia (four mild-moderate and one severe nonfluent/global patient). The advantages and disadvantages of an overt, object picture-naming, fMRI block-design paradigm are discussed. An overt naming fMRI design has potential as a method to provide insight into recovery from adult aphasia including plasticity of the brain after left hemisphere stroke and response to treatment. Part 2 uses the overt naming fMRI paradigm to examine changes in neural activity (neural plasticity) after a two-week series of repetitive transcranial magnetic stimulation (rTMS) treatments to improve picture naming in chronic nonfluent aphasia. An overview of rTMS and rationale for use of rTMS as a clinical treatment for aphasia is provided. Patterns of fMRI activation are examined in two patients with chronic nonfluent aphasia following a two-week series of 1 Hz rTMS treatments to suppress the right pars triangularis portion of the right hemisphere, Broca's homologue. One patient responded well, and the other did not. Differences in fMRI activation in response to the rTMS treatment for the two patients may be due to differences in the patients' lesion sites and extent of damage within each lesion site. Part 3 examines the area of the corpus callosum (CC) in 21 chronic nonfluent aphasia patients and 13 ageequivalent controls using structural MRI. Understanding brain morphology and potential atrophy of the CC in chronic stroke patients may shed light on alterations in the interhemispheric dynamics after stroke, especially patterns of brain reorganization during post-stroke language recovery. A decrease in interhemispheric connections has implications for mechanisms of language recovery and potential success with specific treatment methods. Future directions of both structural and functional neuroimaging to study language recovery in adult aphasia are discussed.
12
Bartels-Tobin, Lori R. "Naming and inhibition in aphasia." [Tampa, Fla.] : University of South Florida, 2007. http://purl.fcla.edu/usf/dc/et/SFE0001959.
Full text
13
Geva, Sharon. "Inner speech in post-stroke aphasia : a behavioural and imaging study." Thesis, University of Cambridge, 2010. https://www.repository.cam.ac.uk/handle/1810/243908.
Full textAbstract:
Patients with aphasia often complain that there is a poor correlation between the words they think (inner speech) and the words they say (overt speech). Previous studies show that there are some cases in which inner speech is preserved while overt speech is impaired, and vice versa. However, these studies have various methodological and theoretical drawbacks. In cognitive models of language processing, inner speech is described as either dependent on both speech production and speech comprehension, or on the speech production system alone. Lastly, imaging studies show that inner speech is correlated with activation in various language areas. However, these studies are sparse and many have methodological caveats. Moreover, studies looking at inner speech in stroke patients are rare. This study examined inner speech in post-stroke aphasia using three different methodological approaches. Using cognitive behavioural methods, inner speech was characterised in healthy participants and stroke patients with aphasia. Using imaging, the brain structures which support inner speech were investigated. Two different methods were employed in this instance: Voxel based Lesion Symptom Mapping (VLSM) and Voxel Based Morphometry (VBM). Lastly, functional magnetic resonance imaging (fMRI) was used to study the dynamics of functional activations supporting inner speech production. The study showed that inner speech can remain intact while there is a marked deficit in overt speech. Structural studies suggested an involvement of the dorsal language route in inner speech processing, together with systems supporting motor feedback and executive functions. Functional imaging showed that inner speech processing in stroke is correlated with compensatory peri-lesional and contra-lesional activations. Activations outside the language network might reflect increase in effort or attention, or the use of feed forward and feedback mechanisms to support inner speech production. These results have implications for diagnosis, prognosis and therapy of certain patients with post-stroke aphasia.
14
Naeslund, Elin. "Stroke Lesion Segmentation for tDCS." Thesis, Linköpings universitet, Medicinsk informatik, 2011. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-71472.
Full textAbstract:
Transcranial direct current stimulation (tDCS), together with speech therapy, is known to relieve the symptoms of aphasia. Knowledge about amount of current to apply and stimulation location is needed to ensure the best result possible. Segmented tissues are used in a finite element method (FEM) simulation and by creating a mesh, information to guide the stimulation is gained. Thus, correct segmentation is crucial. Manual segmentation is known to produce the most accurate result, although it is not useful in the clinical setting since it currently takes weeks to manually segment one image volume. Automatic segmentation is faster, although both acute stroke lesions and nectrotic stroke lesions are known to cause problems. Three automatic segmentation routines are evaluated using default settings and two sets of tissue probability maps (TPMs). Two sets of stroke patients are used; one set with acute stroke lesions (which can only be seen as a change in image intensity) and one set with necrotic stroke lesions (which are cleared out and filled with cerebrospinal fluid (CSF)). The original segmentation routine in SPM8 does not produce correct segmentation result having problems with lesion and paralesional areas. Mohamed Seghier’s ALI, an automatic segmentation routine developed to handle lesions as an own tissue class, does not produce satisfactory result. The new segmentation routine in SPM8 produces the best results, especially if Chris Rorden’s (professor at The Georgia Institute of Technology) improved TPMs are used. Unfortunately, the layer of CSF is not continuous. The segmentation result can still be used in a FEM simulation, although the result from the simulatation will not be ideal. Neither of the automatic segmentation routines evaluated produce an acceptable result (see Figure 5.7) for stroke patients. Necrotic stroke lesions does not affect the segmentation result as much as the acute dito, especially if there is only a small amount of scar tissue present at the lesion site. The new segmentation routine in SPM8 has the brightest future, although changes need to be made to ensure anatomically correct segmentation results. Post-processing algorithms, relying on morphological prior constraints, can improve the segmentation result further.
15
Glader, Eva-Lotta. "Stroke care in Sweden : Hospital care and patient follow-up based on Riks-Stroke, the National Quality Register for Stroke Care." Doctoral thesis, Umeå universitet, Medicin, 2003. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-94114.
Full text
16
Casilio, Marianne, and Marianne Casilio. "An Auditory-Perceptual Rating of Connected Speech in Aphasia." Thesis, The University of Arizona, 2017. http://hdl.handle.net/10150/624122.
Full textAbstract:
Purpose: The goal of this study was to develop a novel tool for connected speech analysis in aphasia, so that spoken output can be characterized in a data-driven and explanatory manner.
Method: We designed a multidimensional rating scheme called the Auditory-Perceptual Rating of Connected Speech in Aphasia (APROCSA), in which 27 common features were each rated on a 5-point scale. Three researchers and twelve student clinicians rated 24 connected speech samples from the AphasiaBank database.
Results: Ratings conducted by both researchers and student clinicians demonstrated good-to-excellent reliability and strong concurrent validity with AphasiaBank measures derived from transcriptions, clinical measures, and subscores from the Western Aphasia Battery (WAB). Factor analysis revealed that four underlying factors—Paraphasia, Logopenia, Agrammatism, and Motor speech—accounted for 79% of the variance in the connected speech profiles. Examination of individual patient scores showed considerable diversity of factor scores among patients of any given aphasia subtype.
Conclusions: The APROCSA proved to be a reliable, valid, and efficient tool for research or clinical purposes. The preliminary findings of the factor analysis suggest a parcellation of non-fluency into three distinct profiles—Logopenia, Agrammatism, and Motor speech—which may occur in conjunction with other non-fluent profiles or with the fluent profile
17
Robson, Holly. "Investigating the comprehension impairment in Wernicke's aphasia." Thesis, University of Manchester, 2011. https://www.research.manchester.ac.uk/portal/en/theses/investigating-the-comprehension-impairment-in-wernickesaphasia(ed866bcc-714f-496a-bf1b-1f5681850bb1).html.
Full textAbstract:
Wernicke’s aphasia (WA), an acquired impairment of language comprehension and word repetition, results from a cerebrovascular accident to the left temporoparietal junction. The disorder has been important to the development of neurobiological models of language, however neuropsychological investigations into the nature of the comprehension impairment have been limited. This thesis presents a series of four experiments, investigating the comprehension impairment in WA. Chapter 3, a behavioural neuropsychological study, investigates existing hypotheses of the comprehension impairment in WA: a phonological breakdown, a semantic breakdown, a dual phonological-semantic breakdown. A case series comparison methodology is utilised. Participants with WA are compared to participants from two other clinical, comprehension impaired groups: semantic dementia and semantic aphasia. Semantic dementia and semantic aphasia provide neuropsychological models of semantic breakdown, affecting semantic representations and semantic control respectively. Individuals with WA showed disrupted non-verbal semantic analysis of a similar magnitude to that in semantic dementia and semantic aphasia and of a qualitatively similar nature to that in semantic aphasia. A significantly greater impairment on assessments which required acoustic-phonological analysis was found for individuals with WA compared to semantic aphasia. Overall a dual breakdown in acoustic-phonological and semantic control best accounted for the comprehension impairment in WA. In Chapter 4, direct evidence was sought for a link between acoustic-phonological non-word analysis and auditory comprehension in WA. A novel test of non-word discrimination was created which was perceptually graded so as to provide a sensitive measure in severely impaired participants. Individuals with WA were significantly impaired at non-word discrimination compared to age and hearing matched control participants who performed at ceiling. The degree of non-word discrimination/acoustic-phonological analysis impairment correlated with auditory comprehension in WA. Chapter 5 investigated the extent to which the established acoustic-phonological impairment in WA was grounded in a more fundamental deficit in non-verbal auditory analysis. The capacity to detect structural changes in non-verbal auditory stimuli was measured. Participants with WA had an impaired capacity to detect differences in all but the most structurally simple auditory stimuli, compared to control participants. The degree of this impairment correlated with the degree of auditory comprehension impairment in the WA group. Chapter 6 revisits the semantic impairment observed in WA. Functional magnetic resonance imaging was used to investigate the residual neural networks recruited by individuals with WA, when performing a semantic animate-inanimate judgment task. Large portions of the inferior and anterior temporal lobes bilaterally were activated, regions remote from the lesion in WA. Age matched control participants recruited similar regions; however the activation in WA participants was significantly stronger. This indicated greater reliance on the residual semantic network in WA in response to damage to posterior temporoparietal semantic regions. The results from this series of studies indicated that the primary deficit in WA is one of impaired acoustic analysis and co-morbid damage to a phonological system. Additional disruption occurs to the semantic control network, which regulates the task directed use of semantic representations. A combination of all three factors accounts for the comprehension impairment in WA and it is the relative contributions of each factor that accounts for behavioural variation between individuals.
18
Butler, Rebecca. "Using diffusion weighted imaging to map changes in white matter connectivity in chronic stroke aphasia." Thesis, University of Manchester, 2013. https://www.research.manchester.ac.uk/portal/en/theses/using-diffusion-weighted-imaging-to-map-changes-in-white-matter-connectivity-in-chronic-stroke-aphasia(287f2b2a-3bdd-492a-ab90-ca9cb7c9ad90).html.
Full textAbstract:
The role of white matter pathways in language networks has received much attention inrecent years. This is largely due to advances in diffusion imaging techniques, which haveenabled exploration of white matter properties in vivo. The emergent model from suchwork proposes that language processing is underpinned by a dorsal and a ventral pathwayconnecting anterior and posterior regions involved in language. This thesis aimed toexplore whether consideration of white matter measures could aid understanding ofperformance profiles in chronic stroke aphasia. To this end, a group of participants withchronic stroke aphasia were recruited and their performance on a large battery oflanguage assessments was related to their neuroimaging data. The neuroimaging datacomprised high resolution T1-weighted structural scans, fractional anisotropy (FA) maps,and data generated using a tractography-based technique called Anatomical ConnectivityMapping (ACM) which provides an index of long-range connectivity that has not yetbeen applied to chronic stroke aphasia.Chapter 3 established, in a small series of case examples, that connectivityinformation from ACM can help explain variations in performance in chronic strokeaphasia. Chapter 4 extended this work to a larger group of participants. Differencesbetween aphasic participants and controls, and between groups with different aphasicsubtypes and controls, were calculated and compared across imaging methods. ACMoffered insights into connectivity differences that were complementary to informationfrom T1-weighted and FA data. In addition to revealing areas where connectivity wasreduced relative to controls, ACM revealed an increase in connectivity in the righthemisphere dorsal route homologue of aphasic participants.Chapter 5 aimed to improve our ability to capture aphasic performance and torelate it to neuroimaging data. Principal components analysis (PCA) was used to derivefactors underlying performance on the language battery. Phonological, semantic, andcognitive factors emerged from the PCA and participants’ factor scores were used ascontinuous regressors in a voxel-level analysis of their T1-weighted images. Regions thatemerged as significantly related to language abilities aligned with those found usingother methodologies. Chapter 6 brought together work from the previous chapters byrelating PCA-derived factor scores to FA maps and ACM, in order to assess therelationship between behavioural performance and the status of key white matterpathways. In line with recent characterisations of the dual route system, phonologicalperformance related to dorsal route measures and semantic performance related to ventralroute measures. Better cognitive performance was found to relate to increasedconnectivity relative to controls in the right frontal lobe. Overall these results suggest thatconsideration of white matter abnormalities, both reductions and increases, can helpexplain patterns of performance in chronic stroke aphasia and that ACM can be a usefulsource of such information given its sensitivity to connectivity remote from the lesion.These findings both provide hypotheses for future research and could be used to informtherapeutic interventions.
19
Al, Jadaan Adel Fahad. "Assessing the quality of life among Saudi patients with aphasia after stroke." Thesis, University of Newcastle upon Tyne, 2015. http://hdl.handle.net/10443/2788.
Full textAbstract:
Although there is a growing literature on the impact of aphasia on quality of life (QoL), this has focused on western Christian rather than Arabic cultures. While a few QoL studies have been conducted in Arabic countries, employing translated, culturally unadapted assessment tools, none have considered people with aphasia (PWA). Given the cultural and religious context, this gap needs to be redressed and so this study explored the factors affecting QoL for Saudi PWA, developed a tool to assess QoL, and explored other predictors affecting it. A three-stage qualitative and quantitative approach was used. First, a QoL questionnaire was developed by reviewing existing measures of QoL for aphasia in the light of cross-cultural adaptation, and surveying opinions on QoL and aphasia. Thematic analysis was then employed to produce a questionnaire, which was piloted and then revised. Second, another pilot test was implemented and its properties were examined by factor analysis, producing a shorter version. Third, this version was also piloted and its psychometric properties, accessibility and acceptability were examined. Potential predictors of QoL for demographic and health-related factors for Saudi PWA were then measured. After the review, three main measures were used to develop the questions. Thematic analysis resulted in a developed scale containing 58 items, covering areas such as physical and daily life activities, and communication. This scale was valid and reliable (r 0.992; α=0.896). For the potential predictors, it was found that QoL became worse as factors such as age and severity of aphasia increased. However, gender, post-onset time and employment variables seemed to have no significant effect. The QoL of Saudi PWA centred on mobility, communication, and social participation. Contrary to predictions, religion did not affect QoL despite its importance in Saudi culture, so further research could be conducted on the questionnaire’s psychometric properties, and its clinical implications.
20
Thompson, Hannah Elizabeth. "Deficits of semantic cognition in stroke aphasia : underlying causes and ameliorating factors." Thesis, University of York, 2012. http://etheses.whiterose.ac.uk/3721/.
Full textAbstract:
Research suggests that semantic memory deficits can occur in at least three ways. Patients can (1) show amodal degradation of concepts within the semantic store itself, such as in semantic dementia (SD), (2) have an impairment of semantic control, leading to difficulty accessing appropriate knowledge in line with current goals or context, as in semantic aphasia (SA), and (3) experience a semantic deficit in only one modality following degraded input from sensory cortex. Patients with SA show damage to prefrontal cortex which extends posteriorly (PF+), or damage restricted to temporoparietal regions (TP-only), and have deficits of semantic control and ‘access’ across word and picture tasks, consistent with the view that their problems arise from impaired multimodal control processes. This thesis aims to explore the nature of these deficits, in four themes. (1) “Refractory effects” in SA patients are explored across modalities – i.e., these patients are shown to experience declining accuracy in cyclical matching tasks when semantically-related sets are presented rapidly and repeatedly. (2) We studied one case study with ‘verbal-only’ refractory effects, to investigate an apparent anomaly in the literature – the existence of patients who have ‘access’ deficits which are restricted to a single modality. These patients challenge the notion that semantic control processes are modality-general. We assessed the hypothesis that multimodal semantic control/ access impairments can follow a modality-specific pattern if paired with an input deficit of a single modality. (3) We explore the effect of lesion location on behavioural performance of semantic aphasia (SA) patients, who have PF+ or TP-only lesions by bringing together data published previously in different papers, together with some new SA cases. Past research suggests SA patients with these two lesions may show similar deficits of semantic control, yet the functional neuroimaging literature proposes a unique role for the prefrontal cortex. PF+ patients were less fluent, showed more associative picture naming errors, and overall somewhat stronger SA characteristics (e.g., they were more inconsistent, and less affected by frequency). (4) Semantic control recruits a wide cortical network, in both the left hemisphere (LH) and right hemisphere (RH). Semantic representations in the RH are partially distinct from the LH, including specialised knowledge of faces and metaphors. Our aim was to test whether damage to RH control regions would negatively affect performance on semantic control tasks which use items stored in the RH, in a similar way to our SA patients in the LH. Overall, the results suggest that semantic control operates in an amodal fashion, with deficits found across modalities. There was evidence to suggest a wide network involved in semantic control beyond the prefrontal cortex – including left posterior cortex and right hemisphere regions. However, these regions are subtly distinct in their role in semantic control.
21
Dangerfield, Lynn. "An in-depth exploration of an aphasia care pathway." Thesis, University of Portsmouth, 2018. https://researchportal.port.ac.uk/portal/en/theses/an-indepth-exploration-of-an-aphasia-care-pathway(3df8b2b9-5936-4fa4-ba3c-f4e306c4135a).html.
Full textAbstract:
Introduction: Clinical or care pathways are increasingly being employed in health care settings, as a structured plan of care, to share with clients and their families and to implement clinical guidelines. Studies have explored the value of generic care pathways, yet there is limited evidence for the use of an aphasia care pathway. This research aimed to review and contribute to the theory and evidence-base for an aphasia care pathway, from a range of the key stakeholders including people with aphasia (PWA) carers and health care professionals (HCPs) including Speech and Language Therapists (SLTs). The aim was to illuminate their experiences and to measure the extent to which practising SLTs referred to an aphasia care pathway in their clinical practice, in order to address the research “Is there a need for an aphasia specific care pathway”? Methods and procedures: Qualitative research techniques were used initially, PWA participated in focus groups and carers and HCPs in interviews, all were purposively selected. Focus groups and interviews were transcribed verbatim and the data analysed using the thematic based framework. A survey was distributed to SLTs working with PWA, to collect quantitative data. A sequential mixed methods analysis identified similarities and differences in the data sets which were then synthesised. Outcomes and results: Thematic framework analysis illuminated four themes: experiences of care pathways within the NHS, characteristics and value of an aphasia care pathway, provision of aphasia related information and psychosocial factors that influence response to an aphasia care pathway. Descriptive statistics identified 42% of SLTs used an aphasia care pathway. 88% of all respondents agreed that an accessible version of an aphasia care pathway should be developed. Conclusions and implications: This study highlights that, whilst the key stakeholders had awareness of an aphasia care pathway, modifications are required, including a description of the core elements of an aphasia care pathway, clear timescales for interventions, the provision of information in a timelier manner. In addition, the need for the key stages of a care pathway to be provided by a registered SLT and for an accessible representation of an aphasia care pathway to be available, were identified as priorities.
22
Campbell, Sarah E. "THROMBOLYSIS AND EARLY SPEECH AND LANGUAGE RECOVERY AFTER STROKE." UKnowledge, 2018. https://uknowledge.uky.edu/rehabsci_etds/49.
Full textAbstract:
Speech and language impairments after left hemisphere stroke are life altering. Neuroprotective interventions, such as tissue plasminogen activator, or tPA, are utilized to diminish the impact of the stroke on functional ability.
The purpose of this study was to examine speech and language recovery in the first three months after stroke in individuals with aphasia and to further investigate any differences between individuals who did and individuals who did not receive tPA, using objective speech and language measures.
Twenty-six individuals, thirteen of whom received tPA and thirteen who did not, suffering from first-ever left hemisphere stroke with resulting aphasia were enrolled and completed repeated speech and language assessments within 24 hours after stroke, at one and two weeks after stroke. A three month assessment also included an additional quality of life measure.
Findings indicate that both individuals who did and those who did not receive tPA demonstrated significant gains in language skills. Results also suggest that the individuals who received tPA have better outcomes at three months compared to those who did not. This is clinically significant as it helps provide prognostic information about the use of tPA and informs decision making for speech pathologists within the acute care hospital.
23
Warburton, Elizabeth. "Mechanisms for the recovery of aphasia following stroke : a positron emission tomography study." Thesis, University of Oxford, 1998. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.299261.
Full text
24
Rohter, Sofia Vallila. "Learning ability in post-stroke aphasia : success, strategy use and implications for therapy." Thesis, Massachusetts Institute of Technology, 2014. http://hdl.handle.net/1721.1/87502.
Full textAbstract:
Thesis: Ph. D. in Speech and Hearing Biosciences and Technology, Harvard-MIT Program in Health Sciences and Technology, 2014.Cataloged from PDF version of thesis.
Includes bibliographical references (pages 103-111).
Aphasia is an impairment in the expression or comprehension of language that results from stroke, traumatic brain injury or progressive neurological disease. Approximately one million people in the United States suffer from aphasia, with the prevalence projected to increase to two million by 2020. Research has shown that speech-language therapy, the treatment for aphasia, can significantly improve people's ability to communicate. However, a major limitation in the field of aphasia rehabilitation is the lack of predictability in patients' response to therapy and the inability to tailor treatment to individuals. We hypothesize that learning represents a critical, underexplored factor in aphasia rehabilitation. Predicting whether a patient will improve following therapy may depend more upon that individual's ability to learn new information in general than upon a specific ability to relearn and master language. In this thesis I report a series of experiments that introduce a new approach that looks beyond language, proposing that the answer to developing efficacious, individually tailored therapies lies in a better understanding of the mechanisms of nonverbal learning in individuals with aphasia. We first explore learning success on a test of nonlinguistic category learning to examine whether learning differences arise among individuals with aphasia and non-aphasic controls. In Experiment 2, we probe the impact of stimulus manipulations on learning success. Experiment 3 presents an investigation into the relationship between learning score and language therapy outcomes. Finally, in Experiment 4, we examine the strategies used to perform our task in order to better understand how information is processed during probabilistic category learning. Results support the hypothesis that aphasia differentially affects language and learning networks. Instruction method and stimulus complexity were found to impact learning success and strategy use in individuals with aphasia. Furthermore, a positive correlation was found between learning scores and success with language therapy, suggesting that there is an informative relationship between learning ability and therapy outcomes. Findings draw attention to underlying processes that have not yet been the focus of research in aphasia, yet likely contribute to outcomes with therapy and present a gateway towards individualizing therapy and improving the predictability of patient outcomes.
by Sofia Vallila Rohter.
Ph. D. in Speech and Hearing Biosciences and Technology
25
McGurk, Rhona. "Coping and psychological well-being in informal carers of stroke survivors with aphasia." Thesis, University of Southampton, 2010. https://eprints.soton.ac.uk/162805/.
Full textAbstract:
This dissertation considers coping and psychological well-being in informal carers of stroke survivors with aphasia. Firstly, a literature review examines the main problems reported by this group of carers, the coping strategies they use to manage these problems, and the links between coping and psychological well-being. This is followed by an empirical paper which reports on a study investigating how informal carers of stroke survivors with aphasia cope with communication problems, and examining the links between coping and an aspect of psychological well-being - depressive symptoms. Further, this study also explores the question of how best to measure how carers cope with communication problems, by including questions specifically developed for this topic alongside a traditional coping inventory. As expected, the results demonstrated a relationship between coping strategies and depressive symptoms in this group of carers. The use of avoidant coping strategies was associated with increased symptoms of depression. No links were found between problem-focused coping strategies and depressive symptoms, however it was shown that coping by ‘positive reframing’ was linked with reduced levels of depressive symptoms. The study also found that a traditional style coping inventory gives a useful assessment of the pertinent coping strategies used by informal carers of stroke survivors with aphasia to manage communication problems. However this is usefully supplemented by more specific questioning about the use of avoidance and withdrawal. The study concludes with a discussion of the clinical implications of the results and where future research in this area would be beneficially directed.
26
Eccles, Alicia. "Validation of behavioural outcomes of anxiety (BOA) questionnaire in stroke survivors with aphasia." Thesis, Cardiff University, 2015. http://orca.cf.ac.uk/75642/.
Full textAbstract:
Aims: Anxiety disorders and aphasia are common following stroke. This study investigated the psychometric properties of the Behavioural Outcomes of Anxiety scale (BOA) in a sample of aphasic stroke survivors. The BOA relies upon the observations of a carer to rate the anxiety of the stroke survivor. The Generalised Anxiety Disorder-7 measure (GAD-7) is a brief screen for general anxiety which has not been investigated in stroke. A secondary aim of this study was to evaluate the performance of an observational version of the GAD-7 for aphasic stroke survivors. Design: Cross-sectional questionnaires, with repeated measures and a relaxation intervention for a subsample. Correlational and ROC analysis to assess psychometric properties, repeated measures MANOVA to assess the outcome of the intervention. Method: One hundred and eleven stroke survivor-carer dyads were recruited through voluntary sector organisations. All survivors completed a visual self-report anxiety screen, the Tension Rating Circles (TRCs), and the Frenchay Aphasia Severity Test (FAST). Carers completed the BOA and adapted versions of the anxiety subscale of the Hospital Anxiety and Depression Scale (HADS-A) and GAD-7. A sub-group of 29 survivor-carer dyads repeated the measures two weeks later to assess test-retest reliability. Within this sub-group, stroke survivors were randomly allocated to a relaxation training or control group. Results: 41.4% of these aphasic stroke survivors were identified as anxious which is higher than prevalence rates in general stroke samples. The BOA and the GAD-7 correlated significantly with each other and with all the other measures of anxiety. When using the HADS-A (≥7) as a criterion standard against the BOA, the area under the ROC curve (AUC) was 0.90 (excellent range of accuracy). A cut-off score on the BOA >16 achieved recommended levels of sensitivity (0.85) and specificity (0.85). For the GAD-7, using the same criterion standard, the AUC (0.94) also fell within the excellent range of accuracy, and was significantly greater than an AUC of 0.50. Optimal cut-off for identifying anxiety was a score of >4 (sensitivity: 0.91, specificity: 0.83). Significantly greater reductions in the BOA scores occurred in survivors who completed relaxation training than in the controls, providing evidence of construct validity. The BOA and the GAD-7 both showed good test-retest reliability of 0.91 and 0.67 respectively. Feedback from carers revealed that the BOA was easy and quick to use and prompted further reflection on the emotional status of the survivors. Conclusions: The carer-completed BOA appears to be a valid and reliable screen for anxiety in stroke survivors with aphasia. Preliminary support for the validity of the GAD-7 is provided and further studies are warranted. Clinical and theoretical implications of the study findings are discussed and recommendations for future research are outlined.
27
Jönsson, Lina, and Sandra Ruiz. "Att leva med afasi efter stroke." Thesis, Malmö högskola, Fakulteten för hälsa och samhälle (HS), 2014. http://urn.kb.se/resolve?urn=urn:nbn:se:mau:diva-24587.
Full textAbstract:
Bakgrund: Nästan hälften av alla människor som drabbats av stroke får någon form av talhandikapp till följd som har stor påverkan på deras fortsatta livskvalitet. Varje år får ca 12 000 personer i Sverige afasi, vilket innebär avsaknad av en språklig funktion på grund av skador i hjärnan. Det är ovanligt med en total avsaknad av språk istället brukar det variera mellan att glömma bort ord, upprepningar, ha ett oförståeligt tal och felaktig grammatisk ordföljd. Sjuksköterskan har en stor roll i patientens rehabiliteringsprocess efter en stroke och kunskaper kring afasi och hur det påverkar individen och dess närstående är betydande för att kunna ge adekvat omvårdnad och ett bra bemötande. Syfte: Syftet med studien var att utifrån tidigare forskning beskriva hur afasi efter stroke påverkar vuxna personers sociala liv. Metod: En litteraturstudie som inkluderade tio artiklar varav åtta var kvalitativa och två var kvantitativa. Resultat: Resultatet visade att många afasipatienter upplevde svårigheter i kommunikationen med sina närstående och kände att både de och deras anhöriga behövde mer kunskap kring kommunikationsstrategier. Anhöriga spelade en viktig roll i rehabiliteringsprocessen och behövde göras delaktiga i ett tidigt skede för ett bättre resultat av rehabiliteringen. Graden av belastning hos närstående påverkades av hur den anhörige upplevde den afatiskes begränsningar och det var störst påfrestning för de som bodde ihop med den som drabbats av afasi. Vårdpersonal har möjligheten göra anhöriga delaktiga och och ge både den afatiske och dess närstående de instrument som krävs för att de ska kunna utveckla nya kommunikationsstrategier. Slutsatser: En bibehållen god relation med familj och vänner var en mycket viktig faktor för de afatiska personernas välbefinnande och dessa relationer bör stärkas bland annat genom större kunskaper om afasi med hjälp av vårdpersonal.Background: Almost 50 percent of all people affected by stroke get some form of speech and language disability that will have a major impact on their continued quality of life. Every year about 12 000 people in Sweden are diagnosed with aphasia, which means the lack of a linguistic function due to damage of the brain. Total absence of language is rare, usually the severity varies between forgetting and repeating words, incomprehensible speech and incorrect grammar. The nurse has a major role in the patient's rehabilitation process after a stroke. Knowledge of aphasia and how it affects the individual and their relatives are important to provide adequate care and good treatment. Aim: The purpose of the study was to based on previous research describe how aphasia after stroke affects social life of adults persons. Method: Literature study that included ten articles, of which eight were qualitative and two was quantitative. Results: The results showed that many patients with aphasia experienced difficulties in communicating with their family and felt that both they and their families needed more knowledge about communication strategies. Family members played an important role in the rehabilitation process and needed to be involved at an early stage for better rehabilitation results. The degree of strain on the relative was influenced by how they experienced the new limitations of the person suffering from aphasia and it was hardest on those living with the relative suffering from aphasia. Nurses should make families involved and give both the person with aphasia and their relatives instruments required to enable them to develop new communication strategies. Conclusion: Maintaining a good relationship with family and friends was a very important factor for the aphasic person’s well-being and these relations should be strengthened through greater knowledge of aphasia with the help of medical professionals.
28
Wade, Tracy Katherine. "Stroke care mapping : a study of the development and application of the dementia care mapping tool in stroke care." Thesis, City University London, 2000. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.340342.
Full text
29
Zhao, Ying. "Structural and functional networks for components of language : network analysis of stroke aphasia patients." Thesis, University of Manchester, 2018. https://www.research.manchester.ac.uk/portal/en/theses/structural-and-functional-networks-for-components-of-language-network-analysis-of-stroke-aphasia-patients(9f552ac8-adfa-4092-9460-c0a75d03a244).html.
Full textAbstract:
The PhD project used a multimodality imaging database, which included T1, resting-state fMRI (rs-fMRI), and DTI images of stroke aphasia, to explore the relationships between the brain and behaviours. As network approaches for language processing have become popular, the current project was especially interested in functional and structural connections that are related to behavioural variations in post-stroke aphasia. Chapter 1 reviewed the findings and methods that are used in language network studies. Chapter 2 analysed patients' T1 images with principal component analysis with varimax rotation and uncovered the hidden vascular structure behind the lesions. On the behaviour side, four behavioural principal components were extracted: phonology, semantics, executive, and fluency. The behavioural components were used across Chapters, as this pattern is stable and replicated previous results found in the literature. When using the lesion components to predict the behavioural components in a regression model, the lesion component approach implicated additional regions that explained the extra behavioural variance. Chapter 3 analysed the patients' rs-fMRI data with regards to variation in the timing of the BOLD response. Researchers have previously reported that there can be regionally-specific hemodynamic time shifts in resting-state MRI. The chapter discovered that these time shifts (positive and negative) can be related to the patients' variation across the PCA-derived behavioural components, reflecting possible diaschisis or hemodynamic compensation of the brain post stroke. Finally, Chapter 4 and Chapter 5 analysed the functional connections in rs-fMRI and white matter connections in DTI, respectively. There were significant regularised regression models for predicting the behavioural components, which might suggest that the connections were an important aspect in explaining the behavioural variance. However, when regressing out the variance that can be explained by the lesion, there were no significant models. This indicated that, in stroke, the lesion is the dominating modality. Chapter 6 reports an explorative investigation which combined imaging modalities (T1 and FC data) using joint independent component analysis. The resultant joint components were biased by the covariance in T1 data as it had larger covariance among its features. The T1 components were similar to the vascular structure while the FC patterns were less interpretable. In conclusion, multimodality neuroimaging data helps to understand language mechanisms post-stroke from different angles. Nevertheless, the lesion itself is the predominant modality in explaining behavioural variation in stroke aphasia.
30
Pound, Carole. "An exploration of the friendship experiences of working-age adults with aphasia." Thesis, Brunel University, 2013. http://bura.brunel.ac.uk/handle/2438/7696.
Full textAbstract:
Aphasia impairs using and understanding language, and thus impacts on communication, identity and relationships. However, little research has investigated how people with aphasia understand friends and friendship. This Participatory Action Research (PAR) study explored how younger adults with aphasia experience friendship. Participants were 28 people with aphasia, some of whom were members of the Research Group. Data from 12 initial interviews in Phase 1 of the study led to a model of friendship and aphasia. This underpinned development of peer-led Friendship Events in Phase 2 of the study, after which 16 additional participants with aphasia were interviewed, contributing to elaboration of the model. Within the context of living with aphasia, which was central for all participants, eight inter-connected themes emerged. Friends could be anchors in a time of change and trusted stabilising influences while reconfiguring identity. Participants described the hard work of friendship, the place of communication in supporting friendship, and the challenge of equality within post-aphasia friendships. Time, humour and two-way flexibility were crucial in developing new kinds of friendship. Participants categorised a wide variety of relationships as friendship. These findings elucidate understandings of friendship loss and change as well as strategies to maintain friendship post-onset of aphasia. The study sheds new light on social connectedness and social support provided by friends, family and peers with aphasia. It emphasises the role of friendship in reconfiguring identity, and offers practical recommendations for harnessing the benefits of friends and friendship in life with aphasia. PAR methodology facilitated creation of accessible tools to support conversations and awareness-raising about friendship. The study highlights the strengths of relational methods for researching friendship and the transformative potential of doing PAR with marginalised groups such as people with aphasia.
31
Pike, Caitlin. "Social participation in working-age adults with aphasia : an updated systematic review." Diss., University of Pretoria, 2017. http://hdl.handle.net/2263/61355.
Full textAbstract:
Background: A previous systematic review found limited data regarding social participation in working-age people with aphasia (PWA). This population has many roles to fulfill, that are negatively affected by aphasia. A review of recent studies may reveal more information on the challenges in re-establishing social roles and thus may inform treatment thereof.
Method: The aim was to provide an updated systematic review on social participation in PWA under 65 years of age. Studies from 2005-2017 were searched from Scopus, Pubmed and Psychinfo. Search terms were derived from the International Classification of Functioning, Disability and Health (ICF) and the Aphasia- Framework for Outcomes Measures (A-FROM). Aspects of domestic life, interpersonal relations and interactions, education and employment and community, civic and social life were investigated.
Results: From 2,864 initial hits, 11 studies were identified, all of which were on the American Speech-Language-Hearing Association (ASHA) Level III of evidence. The studies indicated that participation in domestic life is reduced and PWA showed reduced social networks, loss of friendships and changes in the quality of marital relations. Few PWA returned to work or spent time on education. Limitations in community, civic and social life were noted and there were contradictory findings on the impact of contextual factors on social participation. There was an increase in research into contextual factors impacting on social participation in PWA and in the use of conceptual frameworks in the last decade.
Conclusions: Social participation in working-age adults is limited across the social domains. While the ICF conceptual framework is increasingly used, no studies used the A-FROM. There is greater use of standardised assessments and larger sample sizes.Dissertation (MA)--University of Pretoria, 2017.
Speech-Language Pathology and Audiology
MA
Unrestricted
32
Vanhook, Patricia M. "State Stroke Systems of Care-Tennessee." Digital Commons @ East Tennessee State University, 2007. https://dc.etsu.edu/etsu-works/7449.
Full text
33
Ljung, Fanny, and Anna Åkesson. "Följden av en bristande kommunikation : En litteraturstudie om personers upplevelse av att leva med afasi till följd utav stroke." Thesis, Högskolan i Halmstad, Akademin för hälsa och välfärd, 2017. http://urn.kb.se/resolve?urn=urn:nbn:se:hh:diva-35899.
Full textAbstract:
Stroke är en vanlig orsak till att människor drabbas av afasi. Att drabbas av afasi innebär en stor påverkan på det psykiska måendet och det är vanligt att personer med afasi isoleras från omvärlden. Eftersom personer med afasi har svårigheter att själva uttrycka sin vilja är det viktigt att som sjuksköterska ha en insikt i hur de upplever sin situation. Syftet med studien är därför att belysa personers upplevelse av att leva med afasi till följd utav en stroke. Studien genomfördes som en allmän litteraturstudie. Systematiska sökningar utfördes i tre databaser vilket genererade tio vetenskapliga artiklar som var relevanta för syftet. Resultatet presenterades i två huvudkategorier: förändrat levnadssätt och förändrade sociala relationer. I resultatet beskrivs det att personer med afasi värdesatte att känna sig självständiga och delaktiga. De uppskattade även att engagera sig i olika typer av aktiviteter och känna tillhörighet till andra personer med afasi. Det uppmärksammades dock att personerna med afasi ofta upplevde att människor i deras omgivning var oförstående gällande deras kommunikationssvårigheter vilket orsakade en känsla av exkludering. En ytterligare ökad kunskap om upplevelsen av att leva med afasi kan bidra till en förbättrad vård för personer som drabbats av afasi till följd av en stroke.Stroke is a common cause of people suffering from aphasia. Suffering from aphasia has a major impact on the mental well-being and it is common for persons with aphasia to get isolated from the rest of the world. It is important that nurses has knowlegde about how people with aphasia experience their own sitaution, since they have difficulty expressing it themselves. The aim of this study was to highlight the experience of living with aphasia as a result of a stroke. The study was conducted as a general litterature study. A systematic research was made, which generated ten articles relevant to the study. The result was presented in two categories: a changed way of living and changed social relationships. The result describes that people with aphasia valued the feeling of being independent and involved in things. They also appreciated to engage in different types of activities and having a sense of belonging together with other people suffering from aphasia. However, it was noticed that people with aphasia often experienced that other people were uncomprehending concerning their communication difficulties which caused a feeling of exclusion. Further research of the experience of living with aphasia can contribute to an improved care for people suffering from aphasia due to a stroke.
34
Geranmayeh, Fatemeh. "Using fMRI to investigate speech production in healthy adults and patients with post-stroke aphasia." Thesis, Imperial College London, 2015. http://hdl.handle.net/10044/1/25126.
Full textAbstract:
This thesis presents an investigation of brain networks mediating both language-specific and domain-general control of propositional speech production in health and following left hemisphere stroke. The research used univariate and multivariate analyses of functional magnetic resonance imaging data as participants produced sentential speech in response to stimuli (Speech). The activity of specific brain networks during Speech was compared against different baseline conditions. Two studies on healthy participants confirmed a language-specific role for a left fronto-temporo-parietal (LFTP) network. Propositional speech was accompanied by a relative suppression of activity in domain-general networks including a right fronto-temporo-parietal (RFTP) network, default mode network (DMN), and cingulo-opercular (CingOper) network. A separate study investigated alterations in the activity of these networks following a chronic left hemisphere stroke. The network measures in patients were related to those from the healthy participants. There was an up-regulation of the CingOper network during Speech, a task the patients found difficult. Although the activity within individual networks was not predictive of speech production in patients, the relative activity between networks was a predictor of both within-scanner and out-of-scanner performance, over and above that predicted from lesion volume and various demographic factors. Specifically, the robust functional imaging predictors were the differential activity between the DMN and both the left and right fronto-temporo-parietal networks. The patients also demonstrated an altered speech-related between-networks functional connectivity. A further study of cerebrovascular reactivity measurements suggested that signal changes in the healthy tissue remote from the infarct were unlikely to be confounded by cerebrovascular reactivity changes following stroke. The results of the thesis indicate that recovery of speech production after stroke, is not adequately captured by notions of brain regions 'taking over' lost domain-specific functions. Rather it is best considered as the interaction between what remains of domain-specific networks and the domain-general systems that regulate behaviour.
35
Barrows, Paul David. "The development and validation of mood scales suitable for use with stroke patients with aphasia." Thesis, University of Nottingham, 2016. http://eprints.nottingham.ac.uk/37568/.
Full textAbstract:
About a third of stroke survivors have some degree of depression. Depression has a significant impact on recovery after stroke, and identification is important so it can be treated. A common symptom of stroke is aphasia, where comprehension or expression of language is significantly impaired. Communication problems following stroke have been shown to be a major predictor of depression after stroke, yet these problems often make assessment of mood using conventional, language-based measures difficult or impossible. Though some non-verbal, self report mood measures exist, their utility is limited and evidence base lacking. The aim of this study was to design, create and validate a non-verbal mood assessment instrument suitable both as a general outcome measure and as a screening measure for depression in stroke patients with aphasia. A series of four judgement experiments were conducted based on 22 photographic sittings, and a series of scales were developed. The resulting prototype instrument Dynamic Visual Analogue Mood Scales (D-VAMS) is a tablet/computer-based instrument consisting of seven bipolar scales comprising images of human faces whose expressions are modulated by sliders. The instrument was then validated in a sample of 46 stroke survivors recruited from online, from stroke clubs and via NHS rehabilitation services. Good construct validity was demonstrated by high correlations between word and face versions of the seven D-VAMS scales (r=.73 to r=.79), however discriminant validity was poor, with substantial cross-correlations between scores for all of the face scales (r=.58 to r=.88). Internal consistency of D-VAMS was very high, with a Cronbach’s α of 0.95. A Principal Components Analysis revealed one factor accounting for 80% of the variance, corresponding to pleasantness or unpleasantness of mood. Excellent criterion validity was evidenced by strong correlations between D-VAMS and Hospital Anxiety and Depression Scale (HADS) depression subscale (HADS-D) scores (r=.73). Excellent test-retest reliability (r=.89), and high sensitivity and specificity against HADS-D cut-offs of 4–7 were also found. The findings suggest that the D-VAMS is a valid, brief measure of pleasantness of mood in a range of 0–100 which is suitable for use as a general outcome measure for stroke survivors with aphasia, and which may serve as an indirect, simplified measure of depression. Though D-VAMS may also be useful as a screening measure for depression following stroke, further validation is needed to examine how it performs in people during the acute stage after stroke. Some supervision may be required for people unfamiliar with using a tablet or PC interface.
36
Bennett, Kristen. "The Effects of Bilingualism in Post-Stroke Aphasia Patients: Clinical Implications Within the United States." Digital Commons @ East Tennessee State University, 2020. https://dc.etsu.edu/honors/518.
Full textAbstract:
The consistent increase of cultural diversity and immigration within the United States over the last fifty years has contributed to a societal shift towards a growing bilingual population. The growth of this population has generated a need to evaluate current assessment and treatment plans for bilingual post-stroke aphasia patients within the United States to ensure that these individuals are receiving effective healthcare. This study aims to investigate the current knowledge gap surrounding appropriate methods of assessing and treating bilingual post-stroke aphasia patients within the United States and suggest potential approaches based on existing research. In order to synthesize information regarding current methods of assessing and treating bilingual post-stroke aphasia patients and to suggest areas for future research, a review of previously published literature was conducted. To illustrate the association between bilingualism and approaches to healthcare, potential and previously studied assessment and treatment plans for bilingual post-stroke aphasia patients within the United States were evaluated based on the likelihood of their success in a physical clinical setting. Because minimal research currently exists concerning intervention in bilingual aphasic adults, SLPs in the United States are forced to provide services without the knowledge necessary to provide efficacious healthcare to this population. As a result, there is currently a critical need for the development of consistent, culturally relevant assessments and treatment approaches for bilingual post-stroke aphasia patients and for large-scale empirical studies to be conducted in the United States that examine the validity of these assessment and treatment protocols.
37
McGrane, Helen. "An investigation into the ability of adults with post-stroke aphasia to learn new vocabulary." Thesis, Queen Margaret University, 2006. https://eresearch.qmu.ac.uk/handle/20.500.12289/7449.
Full textAbstract:
Recent studies have established that adults with post-stroke aphasia can learn to establish connections between familiar words and abstract images, and nonwords with familiar objects. What has not been investigated was whether adults with aphasia could learn non-words with abstract images/ novel meanings i.e. new vocabulary. The main objective of this study was to investigate whether adults with post-stroke aphasia could learn ‘novel’ word forms with ‘novel’ word meanings, despite phonological and/or semantic impairment. Specific research questions included: Can post-stroke adults with aphasia learn new vocabulary? If so, what factors affect their capacity to learn? Is it possible to predict which individuals will learn most successfully? The methodology was developed using preliminary studies both with adults of normal language and cognitive functioning and post-stroke non-aphasic and aphasic adults. It incorporated learning theory and a cognitive neuropsychological model of language. A range of assessments was used to facilitate the capture of new learning. ‘New learning’ was measured not only in terms of the accurate production of the new stimuli but also the recognition and knowledge of the word forms and meanings of this new vocabulary. In the main investigation twenty novel word forms with 20 novel meanings were taught to 12 aphasic adults (< 65 years), over a four day period, using an errorless learning paradigm. Immediate recall of these newly learnt representations was investigated as well as delayed recall. Quantitative and qualitative results from a case series of 12 participants are presented and discussed. Despite semantic and phonological difficulties, all but three participants demonstrated substantial learning of the new vocabulary. The participants’ range of learning ability (from both immediate and delayed recall data) was analysed in relation to severity of aphasia, cognitive factors (including attention, memory and executive function), as well as variables such as age, months post-stroke and number of years in education. With an intensive training period, these participants with aphasia demonstrate varying degrees of ability for new learning. Possible influencing factors and implications for speech and language therapy rehabilitation are discussed.
38
Bände, Sandra, and Joel Jansson. "Patienters upplevelser av att leva med afasi efter en stroke : En litteraturbaserad studie." Thesis, Högskolan Väst, Avdelningen för omvårdnad - grundnivå, 2020. http://urn.kb.se/resolve?urn=urn:nbn:se:hv:diva-15365.
Full textAbstract:
Background: Each year, approximately 25,000 are affected by stroke in Sweden. As a result of a stroke, the person may also suffer from various types of disabilities, including aphasia. Aphasia means impairment of communication, where the affected person has difficulties in the spoken or written language. There is a lack of knowledge regarding how people with aphasia experience their condition, both at a community level and in the health care system. Aim: The purpose of the study was to describe patients experiences of aphasia after a stroke. Method: A literature-based study based on an analysis of eight scientific articles. Results: Two main themes emerged: Negative experiences and positive experiences. The results show that people with aphasia often suffer from mental illness related to their condition. Submerged mood and depression where the most common experiences of psychological effect, which can adversely affect patient's social life and daily activities. The results also show that the support from the environment can motivate the patient to want to improve their condition and give the patient an increased well-being. Conclusion: Caregivers need an increased understanding and knowledge of experiences regarding patients with aphasia. This can contribute to preventive actions related to mental illness. The support of the environment is important for patient's recovery and the nurse can, with an increased understanding and knowledge contribute to patient's well-being and rehabilitation.Afasi är en sekundärskada till följd av en stroke, som innebär en nedsättning av kommunikationsförmågan. Detta sker då vissa delar av hjärnan drabbas av syrebrist, vilket leder till att celler skadas eller dör. Tillståndet kan påverka patienters vardag och detta präglas av patienters upplevelser av deras tillstånd. Negativa upplevelser kan vara frustration, nedstämdhet, ångest och depression, men även upplevelser av att omgivningen är oförstående och saknar insikt i vad afasi innebär. Negativa upplevelser kan leda till att patienter isolerar sig och att de inte fullföljer sin rehabiliteringsplan. Sjuksköterskan behöver mer kunskap angående patienters upplevelser av att leva med afasi – för att kunna förebygga psykisk ohälsa. Patienter med afasi kan dock erfara positiva upplevelser trots sitt tillstånd. Genom att acceptera sitt tillstånd, samt genom stöd från omgivning och vårdpersonal kan patienter med afasi känna tillhörighet och välbefinnande. Detta kan leda till att patienter som är drabbade av afasi upplever motivation till att fullfölja sin rehabilitering. För att effektivisera återhämtningen kan närstående bjudas in av sjuksköterskan och bli mer delaktiga i patientens kommunikativa rehabilitering, då närståendes stöd och uppmuntran är en viktig aspekt i att patienter upplever motivation till återhämtning. Patienter med afasi upplever ett sjukdomslidande till följd av att ha insjuknat i en stroke och afasi. Upplevelser av detta leder till ett själsligt lidande för patienten. Sjuksköterskans ansvar är att lindra lidande, samt att återställa och främja hälsa inom ramen för hens kompetensområde – omvårdnad. Sjuksköterskan behöver en ökad kunskap och förståelse för den psykiska påverkan som afasi kan medföra, så att hen kan uppmärksamma symtom på och förebygga psykisk ohälsa hos patienter med afasi. Det här är en litteraturstudie, med avsikt att bidra till evidensbaserad vård med grund i kvalitativ forskning. Resultatet är baserat på kvalitativ analys av åtta vetenskapliga artiklar, som beskriver patienters upplevelser av att leva med afasi.
39
Sonnentheil, Frida, and Anna Österberg. "Evidensbaserad logopedisk intervention vid strokeorsakad afasi hos vuxna : En verksamhetsknuten litteraturstudie." Thesis, Uppsala universitet, Logopedi, 2014. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-217394.
Full textAbstract:
Background: The speech- and language deficit aphasia affects 12 000 persons annually in Sweden. Aphasia is caused by injury in the brain and the most common etiology is stroke. According to the tool for describing and assessing aphasia, A-FROM (Kagan et al., 2008), the four following aspects of aphasia need to be considered: severity of aphasia, participation in life situations, communication and language environment and personal factors. Several different interventions and treatments can be performed in every domain. There is scientific evidence for interventions performed by speech and language pathologists; however, the question is yet being discussed since results are unambiguous. Purpose: The main purpose of this study is to investigate which aphasia interventions performed by speech and language pathologists that are supported by evidence. A further purpose is to visit clinical practices to obtain data concerning how speech and language pathologists work with persons with aphasia. Method: Systematic search for literature was executed in seven medical databases. Articles that met certain criteria were graded regarding evidence. The authors additionally made visits to speech and language pathologists at a hospital Svealand, Sweden, for observation and interviewing of speech and language pathologists. Results and conclusions: The level of evidence for interventions varies. No intervention is investigated in more than three included studies and the number of participants is often small. Recommendations for clinical work can be given based on evidence from the included studies. The one intervention that was being studied by the most studies is CIAT/CILT. Interventions targeting expressive language, in particular word retrieval, have the strongest support in evidence.Bakgrund: Språkstörningen afasi drabbar 12 000 personer årligen i Sverige. Afasi är en förvärvad språkstörning och orsakas av en skada i hjärnan, vanligaste orsaken är stroke. Enligt ett verktyg för att beskriva och bedöma afasi, A-FROM (Kagan et al. 2008), kan man se till fyra aspekter av afasin: afasisvårigheter, delaktighet i vardagliga situationer, språklig och kommunikativ omgivning samt personliga faktorer. Inom varje domän kan flera olika typer av logopedisk intervention och behandling genomföras. Vetenskaplig evidens stödjer effekt av logopedisk intervention men diskussion pågår då resultaten inte är entydiga. Forskning på området är inte heller entydig kring vilken typ av intervention som har mest evidens att ge effekt. Syfte: Studiens huvudsyfte är att genom granskning av de senaste årens forskning besvara vilka logopediska afasiinterventioner som stöds av evidens. Ett ytterligare syfte är att göra besök i klinisk verksamhet för att inhämta data kring hur logopeder arbetar med personer med afasi. Metod: Systematiska litteratursökningar genomfördes i sju medicinska databaser. Artiklar som uppfyllde uppsatta inklusionskriterier evidensgraderades. Vidare besöktes ett sjukhus i Svealand för auskultation på och intervjuer med legitimerade logopeder. Resultat och slutsats: Studien visade på att afasiinterventioner har varierande grad av evidens. Varje typ av intervention behandlades av endast en eller ett fåtal inkluderade artiklar som ofta hade få försöksdeltagare. Förslag på rekommendationer för kliniskt arbete kan utfärdas utifrån inkluderade studier och deras evidensgrad. Den enskilda interventionen som studerats av flest inkluderade studier (tre studier) är CIAT/CILT. Starkast stöd i evidens har träning av expressiva förmågor, främst ordmobilisering.
40
Dahllöf, Oliver, Oliver Dahllöf, Felix Hofwimmer, and Felix Hofwimmer. "Optimal placement of a Mobile Stroke Unit (MSU) to achieve improved stroke care." Thesis, Malmö universitet, Fakulteten för teknik och samhälle (TS), 2018. http://urn.kb.se/resolve?urn=urn:nbn:se:mau:diva-20525.
Full textAbstract:
Tid till behandling är livsviktigt för människor som får en stroke. På olika platser i världen har man därför sett värdet i att införskaffa en specialambulans för stroke (stroke-ambulans) som har specialutrustning och specialpersonal som kan utföra intravenös behandling (trombolys). Då det är uppenbart att dess involvering i vården skulle hjälpa åtminstone en viss andel patienter används ofta ingen utvecklad metod eller analys av var och hur denna stroke-ambulans ska placeras. Genom att noggrant undersöka läget i Skåne län om hur denna placeringen kan gå till, är vårt mål att genom vår metod, som bygger på optimering av förväntade transporttider, upplysa beslutstagare om olika perspektiv man bör ta hänsyn till. Vår metod kan användas över olika geografiska områden.Vi föreslår en optimeringsmetod som utgår från två olika perspektiv: effektivitet och jämlikhet. Metoden visar att beroende på vilket perspektiv man väljer, kan den optimala placeringen för ett givet område variera kraftigt. Det är därför viktigt att beslutstagare av placering för stroke-ambulanser har tydliga och väl genomtänkta mål. Dessa mål bör även innefatta de lokala sjukhusens mål när det kommer till förbättring av behandlingstiden för strokepatienter, s.k. door-to-needle-time (DTN) då dessa i vissa fall kan göra större förbättringar än vad en införskaffning av en stroke-ambulans skulle göra.Tid till behandling är livsviktigt för människor som får en stroke. På olika platser i världen har man därför sett värdet i att införskaffa en specialambulans för stroke (stroke-ambulans) som har specialutrustning och specialpersonal som kan utföra intravenös behandling (trombolys). Då det är uppenbart att dess involvering i vården skulle hjälpa åtminstone en viss andel patienter används ofta ingen utvecklad metod eller analys av var och hur denna stroke-ambulans ska placeras. Genom att noggrant undersöka läget i Skåne län om hur denna placeringen kan gå till, är vårt mål att genom vår metod, som bygger på optimering av förväntade transporttider, upplysa beslutstagare om olika perspektiv man bör ta hänsyn till. Vår metod kan användas över olika geografiska områden.Vi föreslår en optimeringsmetod som utgår från två olika perspektiv: effektivitet och jämlikhet. Metoden visar att beroende på vilket perspektiv man väljer, kan den optimala placeringen för ett givet område variera kraftigt. Det är därför viktigt att beslutstagare av placering för stroke-ambulanser har tydliga och väl genomtänkta mål. Dessa mål bör även innefatta de lokala sjukhusens mål när det kommer till förbättring av behandlingstiden för strokepatienter, s.k. door-to-needle-time (DTN) då dessa i vissa fall kan göra större förbättringar än vad en införskaffning av en stroke-ambulans skulle göra.
The time to treatment is vital for people who suffer from a stroke. Therefore, in different places in the world, the value of acquiring a specially developed ambulance for a stroke (i.e., a Mobile Stroke Unit, MSU) with special equipment and specialists who can perform intravenous treatment (thrombolysis) has been identified. Since it is clear that an MSU’s involvement in health care would aid at least a certain proportion of the patients, the MSU is often purchased and placed without any developed method or analysis of where and how this MSU is to be placed. By carefully examining the situation in Skåne Municipality of how this placement could be performed, we will inform decision makers about different perspectives that should be taken into consideration, including other areas than Skåne.Our optimization method showed that depending on what perspective you are investing, efficiency or equality, the optimal placement for any given area can vary greatly. It is therefore importantthat decision-makersofMSUpurchaseshaveclearandwell-thought-outgoals.These goals should also include the goals of the local hospitals when it comes to improving the treatment time for stroke patients, door-to-needle (DTN), as the DTN may in some cases make greater improvements than a purchase of an MSU would.
The time to treatment is vital for people who suffer from a stroke. Therefore, in different places in the world, the value of acquiring a specially developed ambulance for a stroke (i.e., a Mobile Stroke Unit, MSU) with special equipment and specialists who can perform intravenous treatment (thrombolysis) has been identified. Since it is clear that an MSU’s involvement in health care would aid at least a certain proportion of the patients, the MSU is often purchased and placed without any developed method or analysis of where and how this MSU is to be placed. By carefully examining the situation in Skåne Municipality of how this placement could be performed, we will inform decision makers about different perspectives that should be taken into consideration, including other areas than Skåne.Our optimization method showed that depending on what perspective you are investing, efficiency or equality, the optimal placement for any given area can vary greatly. It is therefore importantthat decision-makersofMSUpurchaseshaveclearandwell-thought-outgoals.These goals should also include the goals of the local hospitals when it comes to improving the treatment time for stroke patients, door-to-needle (DTN), as the DTN may in some cases make greater improvements than a purchase of an MSU would.
41
Teale, Elizabeth Ann. "Development of a minimum stroke dataset for electronic collection in routine stroke care." Thesis, University of Leeds, 2011. http://etheses.whiterose.ac.uk/3095/.
Full textAbstract:
Improving stroke care is a national priority and adherence to national policy and guidelines is closely monitored by numerous organisations using a considerable number of overlapping indicators of stroke care processes. Demonstration that the processes of stroke care are linked to patient outcomes in empirical post-stroke populations is confounded by the complexities of patient case-mix. Electronic, real-time, point of care data capture of care processes that are demonstrably linked to appropriately case-mix adjusted patient reported outcomes would increase confidence that the important aspects of patients’ care are measured, monitored, and improved. This thesis aims to determine the best available case-mix adjuster, process measures and preferred patient reported outcome instruments and, through exploration of the relationships between these factors, to develop a dataset for use within an electronic data system. The best available case-mix adjuster was identified through a systematic literature review as the Six Simple Variable (SSV) model. Through group decision making workshops, and informed by a previous systematic review, the Subjective Index of physical and Social Outcome (SIPSO) was identified as the preferred postal outcome measure. I demonstrate how existing process markers for stroke lack variability, such that when recorded in their current format, their relative impact on patient outcome is difficult to discern. Process measures which feature as important predictors of patient outcome are shown to act as proxy measures of stroke severity. The SSV case-mix adjustment model is overshadowed by a simple univariable predictor (length of stay) which is also likely to be acting as a proxy for stroke severity. In this context, length of stay may offer a pragmatic alternative to more complex case-mix adjustment models to examine the relationships between processes of care and outcome in populations of stroke survivors.
42
Fridriksson, Julius. "Cerebral perfusion and diffusion in stroke: Association with aphasia severity in the early phases of recovery." Diss., The University of Arizona, 2002. http://hdl.handle.net/10150/279956.
Full textAbstract:
The purpose of this study was to investigate the relationship between aphasia severity and cerebral perfusion and lesion size in stroke. Nine subjects with acute ischemic stroke were examined within 24 hours of symptom onset and six were reexamined at one-month post-stroke. Examination included aphasia testing, testing of face discrimination ability, administration of the National Institutes of Health Stroke Scale, and perfusion MRI (PI), diffusion MRI (DWI), and T2-weighted MRI (T2-MRI). Subjects with a variety of aphasia types and a large range of aphasia severity participated in the study. MR images were visually inspected to verify perfusion and diffusion abnormalities. Perfusion abnormality was quantified by calculating a perfusion signal ratio of the affected hemisphere over the whole image (left/whole = ratio). Lesion volume was calculated from the DWI and T2-MRI. A perfusion abnormality larger than a DWI lesion was observed in 8 of 9 subjects. Minimal lesions were observed on DWI in three of the subjects while their PI revealed significant perfusion abnormality. Correlation coefficients (Spearman) between aphasia severity and hypoperfusion were significant in the acute stage and again at one-month post-stroke. Five of six subjects that were reexamined at one-month post-stroke experienced significant aphasia recovery. Visual inspection of their PI scans suggests that aphasia recovery was accompanied by increase in cerebral perfusion. The correlation between aphasia severity and lesion size was not statistically significant in the acute stage or at one-month post-stroke. Consequently, it is probable that cerebral hypoperfusion is a better predictor of aphasia severity and recovery in early stroke than lesion volume.
43
Hartelius, Ebba, and Lisa Mattsson. "Constraint-Induced Aphasia Therapy (CIAT) : effekt på en grupp individer med kronisk afasi." Thesis, Linköping University, Linköping University, Department of Clinical and Experimental Medicine, 2008. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-15862.
Full textAbstract:
Constraint-Induced Therapy (CI) is based on the theory that constraining operationalfunctions will increase the usage and at the same time the recovery of impaired functions. Constraint-Induced Aphasia Therapy (CIAT) is a variant of CI, aimed at people with chronicaphasia. The purpose of this study was to examine whether CIAT would affect the linguisticabilities of eleven individuals with chronic aphasia. The linguistic abilities of each participant were tested before and after the therapy which consisted of thirty hours intensive trainingduring two weeks in accordance with CIAT. Abilities that were examined included namingability, informative speech, listening comprehension and everyday use of language. Measurements of the participants’ length of utterances and speech-rate were also implemented. The test results were analyzed using Wilcoxon signed ranks tests and dependent t-tests. Significant improvements were ascertained in the areas of length ofutterances, naming ability and informative speech. The conclusion of the study was that CIAT has a positive effect on individuals suffering from chronic aphasia, in regards tospeech production. It is unclear whether the method has any effect on language comprehension.
Constraint-Induced Therapy (CI) bygger på teorin att hämmande av välfungerande funktionerökar användningen och därmed återhämtningen av nedsatta funktioner. Constraint-InducedAphasia Therapy (CIAT) är en variant av CI som riktas mot personer med kronisk afasi. Syftet med föreliggande studie var att undersöka om CIAT påverkade språkförmågan för elva personer med kronisk afasi. Deltagarnas språkförmåga testades före och efter behandlingen, vilken utgjordes av trettio timmar intensiv träning under två veckor i enlighet med CIAT. Delförmågor som testades var benämningsförmåga, informativt tal, hörförståelse samt språkanvändning i vardagen. Mätningar gjordes också av deltagarnas taltempo och genomsnittliga yttrandelängd. Deltagarnas resultat från språktesten analyserades med Wilcoxon signed ranks test och beroende t-test. Signifikanta förbättringar kunde ses inomområdena yttrandelängd, benämningsförmåga samt informativt tal. Slutsatsen var att CIAT har en positiv effekt på personer med kronisk afasi vad gäller talproduktion. Det är dockoklart huruvida metoden påverkar språkförståelse.
44
Sundström, Markus, and Emelie Backman. "Vårdpersonals upplevelse av att vårda patientermed diagnosen afasi efter stroke : En litteraturstudie." Thesis, Umeå universitet, Institutionen för omvårdnad, 2015. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-99917.
Full textAbstract:
Background: Stroke is one of the leading causes for longlasting sequelae, among them loss in cognitive function, like aphasia. Aphasia effects the patients ability to understand and express themselves in speaking and writing. To be able to reach a good level of care, the careproviders and patients ought to have the same goals and values. This requires a good communication between the careproviders and patients. Which can be problematic for the caregivers when they don't feel secure in their way of getting close to these patients. Aim: The purpose of this study was to illuminate caregivers experience of caring for patients with the diagnosis aphasia following stroke. Method: This is a literature study where nine studies, with qualitative design, has been analyzed and compiled. Inclusion- and exclusioncritera were used to limit the result. All the studies have been qualitychecked. Result: There are varied experiences for the caregivers when it comes to care for patients with the diagnosis aphasia after stroke. The result is presented with three categories; “Caregivers experience of time and resources for god care”, “Caregivers methods and aids in the care” and “Relationships and feelings connected to the care of patients who suffered aphasia after stroke”. Conclusion: Based on the caregivers experiences in the result, more research is needed in this area, partly to be able to develop strategies that will help the caregivers and save time, and also to be able to map how caregivers feel in the care of these patients.Bakgrund: Stroke är en av de ledande orsakerna till långvariga följdsjukdomar, däribland kognitiva nedsättningar som afasi. Afasi kan påverka patientens förmåga att förstå och uttrycka sig i tal och skrift. För att uppnå god omvårdnad bör vårdpersonal och patient ha samma mål och värderingar, vilket ställer krav på kommunikationen mellan patient och vårdare. Det kan vara problematiskt för vårdpersonal då de inte alltid känner sig säkra på hur de ska närma sig dessa patienter. Syfte: Syftet med litteraturstudien var att belysa vårdpersonals upplevelser av att vårda patienter med diagnosen afasi efter stroke. Metod: Det här är en litteraturstudie där nio studier, med kvalitativ ansats, har analyserats och sammanställts. Inklusions- och exklusionskriterier har använts för att avgränsa resultatet. Alla studier har kvalitetsgranskats. Resultat: Det finns varierande upplevelser hos vårdpersonal när det kommer till att vårda patienter som diagnostiserats med afasi efter stroke. Resultatet presenteras i tre huvudkategorier; “Vårdpersonals upplevelse av tid och resurser för att ge god omvårdnad”, “Vårdpersonals metoder och hjälpmedel i omvårdnaden” och “Relationer och känslor kopplade till omvårdnaden av patienter med diagnosen afasi efter stroke”. Konklusion: Baserat på vårdpersonals upplevelser behövs mer forskning inom detta område dels för att utveckla strategier som kan hjälpa i kommunikationen och spara tid, men också för att kunna kartlägga hur vårdpersonal känner inför omvårdnaden av dessa patienter.
45
Alvarado, Natasha. "The LoTS (Longer-Term Stroke) care system of care : an evaluation of its local implementation at two community stroke services." Thesis, University of Leeds, 2013. http://etheses.whiterose.ac.uk/5413/.
Full textAbstract:
The longer-term problems of stroke are well documented but are often poorly addressed by community services. The Longer-Term Stroke (LoTS) care system of care aimed to address this gap through enhancing the practice of health care professionals termed ‘Stroke Care Coordinators’. The system was evaluated in a Randomised Controlled Trial (RCT) that measured patient and carer outcomes in comparison to usual care. These outcomes do not reveal how, why or to what extent the system enhanced the practice of the Stroke Care Coordinators. This study was designed to complement the RCT using a theory-driven approach to explore the implementation and the impact of the system at two community stroke services (both multidisciplinary teams). The theory of change (how and why the system was expected to work) was elicited for comparison against service practice. The study drew on the principles of realist evaluation, which hypothesise that successful outcomes (O) will be realised if appropriate ideas and opportunities (mechanisms (M)) are introduced into appropriate contexts (C). CMO propositions were drawn out from the wider theory for testing at the two research sites. Qualitative methods were employed for data collection including observations of service practice, interviews with stakeholder groups and a review of service documentation. The findings revealed that local facilitators and barriers shaped how the system was implemented, resulting in two distinct applications of the intervention that deviated from the theory of change. The extent to which the system enhanced the Stroke Care Coordinators’ practice was dependent on context e.g. their background and experience. Further to this, the system’s impact was mediated by the information and support available from within the multidisciplinary teams. For this reason, the extent to which the service enhancements realised in practice impacted on the patient and carer outcomes measured was hard to discern.
46
Mapulanga, Miriam. "Exploration and determination of the process of care of stroke in Zambia." University of the Western Cape, 2016. http://hdl.handle.net/11394/4976.
Full textAbstract:
Magister Scientiae (Physiotherapy) - MSc(Physio)Zambia is undergoing epidemiological changes from communicable diseases to NCDs as a result of demographic transition and hence Stroke is an emerging NCD in the country. The process of care of stroke in Zambia as country is unknown. Exploring the process of care of stroke in Zambia, could help understand the gaps in service delivery thereby helping to create interventions to improve stroke service delivery. The purpose of this study was to determine and explore the process of care of stroke in Zambia. As there is no information regarding stroke care in Zambia, the study aimed to explore and determine the process of care and explore the conditions under which diagnosis and management of stroke is done in Zambia and are the factors influencing stroke diagnosis and management in Zambia. The study was conducted in Zambia’s five general hospitals which were selected conveniently. The study consisted of both quantitative and qualitative methods. The quantitative part consisted of stroke patients’ medical records reviews, who were admitted to general hospitals between 1st January to 3oth October 2014. A sample of 80 medical records was selected randomly from each general hospital, making the total of 400 medical records from all the hospitals. Data was collected using a checklist which was specifically design for the study after literature review and contained stroke care processes including diagnosis, medical management, rehabilitation, lifestyle management and community linkage. Analysis of quantitative data was done using Statistical Package for Social Science (SPSS) version 22. The qualitative part consisted of individual in-depth interviews with a purposefully selected sample of three health workers from each hospital making 15 health workers. The in-depth interviews were based on predetermined themes including staffing levels, multidisciplinary team action, treatment guidelines, clinical capacity, planning and budgeting and technical environment. All the interviews were audio-taped, transcribed verbatim and the predetermined themes were analysed using content analysis. Ethical clearance to conduct the study was obtained from the University of the Western Cape Faculty Board Research and Ethics Committees and Senate Research Committee and ERES Converge in Zambia. Permission to conduct the study in Zambia was obtained from the Ministry of Health, Zambia. Informed consent was obtained from the health workers who took part in the study. The study found that the stroke process of care in Zambia ranged from diagnosis through to physical rehabilitation and lifestyle management. The stroke process of care was challenged in the area of diagnosis using biochemistry, haematology, CT scan, MRI and Angiography etc. The process of care in rehabilitation was challenged by lack of gadgets and space to use in rehabilitation. Community linkage, speech therapy and social welfares services were not part of the stroke process of care in Zambia as the study as established. Staff shortages, busy schedules, no treatment guidelines, poor clinical capacity, lack of resources and poor technical environment impacted negatively on the stroke process of care according to this study. Diagnosis and management of stroke was made with no treatment guidelines, poor clinical capacity and poor technical environment. The same were the factors which were influencing diagnosis and management namely staff shortages, no multidisciplinary teams due to busy schedules of health workers, lack of treatment guidelines, poor clinical capacity by health workers, lack of resources for stroke and poor technical environment. Using the Chi-square association of variables, the study showed that CT scan was associated with definitive diagnosis with the p-value of 0.000. Equally, Chi-Square test showed that Diagnosis was not associated with medical management (p value=0.058).
47
Hill, Kate Mary. "Understanding and Measuring Continuity of Care in Stroke." Thesis, University of Leeds, 2009. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.515343.
Full text
48
Pillay, Bhavani S. "Semantic feature analysis for word retrieval in a small aphasia-group setting." Diss., University of Pretoria, 2016. http://hdl.handle.net/2263/58976.
Full textAbstract:
Background: Word retrieval deficits are a common, pervasive feature of aphasia. Semantic feature analysis (SFA) is a popular treatment technique for word retrieval impairment. Preliminary evidence of its use in small aphasia-group settings suggests improved word retrieval in discourse-based tasks with improvements in communicative informativeness (Antonucci, 2009; Falconer & Antonucci, 2012).
Objective: The aim of this study was to investigate the training of SFA within discourse during a small (two-member) aphasia group treatment to ascertain if gains would be made in word retrieval abilities and communicative informativeness.
Method: Two female participants with chronic aphasia, aged seventy seven and sixty eight, participated weekly in group treatment for five consecutive weeks where stimuli were used to elicit increasingly naturalistic discourse. A multiple-baseline design was used and a case series analysis conducted. Baseline measures, treatment data and data from the six week follow-up (SWFU) session were analysed using the protocols developed by Nicholas and Brookshire (1993) and Mayer and Murray (2003).
Results: Both participants demonstrated certain modest gains in overall communicative informativeness but these were not maintained at the SWFU session. Gains in informativeness ranged from 12% to 13.4% for participants, which agree with improvements in other studies (Antonucci, 2009; Boyle & Coelho, 1995; Falconer & Antonucci, 2012). P2 (presented with anomic aphasia) performed better than P1 (presented with Broca’s aphasia and a component of apraxia of speech [AOS]) with regards to communicative informativeness (%CIUs) and had greater access to semantic knowledge (i.e. could access lexical forms at an improved rate).
Conclusion: The small group setting may offer advantages to facilitate communication skills and increase participation in everyday conversation. Further research is needed to identify benefits for individuals with differing aphasia types and severity, optimal intensity and frequency of group treatment and the role of peer support during group interaction.
Key Words
Aphasia, stroke rehabilitation, word retrieval, semantic feature analysis, connected speech, discourse, group therapy, communicative informativeness, functional communication.Dissertation (MA)--University of Pretoria, 2016.
Speech-Language Pathology and Audiology
MA
Unrestricted
49
Oudghiri, Jamila, and Johanna Taflin. "Hur kommunicerar sjuksköterskan med patienter som drabbats av afasi efter stroke? : En litteraturöversikt." Thesis, Ersta Sköndal högskola, Institutionen för vårdvetenskap, 2012. http://urn.kb.se/resolve?urn=urn:nbn:se:esh:diva-2068.
Full textAbstract:
Bakgrund: Varje år drabbas runt 30 000 svenskar av stroke och nästan en tredjedel av dem får afasi. Afasi innebär en förlust eller försämring av språksystemet som förekommer efter en hjärnskada. Patienter med afasi upplever detta tillstånd som en förlust av sin autonomi vilket påverkar livskvaliteten negativt. Att vårda någon som drabbats av afasi ställer särskilda krav på sjuksköterskan, både för att hitta nya vägar till kommunikation och för att kunna ge en så god vård som möjligt. Syfte: Syftet med denna studie är att beskriva komponenter som kan påverka kommunikationen med patienter som drabbats av afasi efter stroke utifrån sjuksköterskans perspektiv. Metod: Uppsatsen är en litteraturstudie där åtta kvalitativa artiklar, publicerade mellan åren 2000- 2012, ingår. Valda artiklar berör kommunikation mellan sjuksköterskan och patienter som drabbats av afasi efter stroke. Som teoretisk utgångspunkt används Joyce Travelbees teori med fokus på utveckling av relationen mellan sjuksköterska och patient. Resultat: Utifrån valda artiklar framkom två huvudteman: Grunder för en effektiv kommunikation och Möjligheter och hinder i kommunikation. Att använda sig av den icke- verbala kommunikationen har visat sig vara mycket effektivt när talförmågan är nedsatt. Samtidigt kan en anpassad miljö och tillräckligt med tid göra det möjligt att uppnå en effektiv kommunikation med patienter som drabbats av afasi. Diskussion: Genom att hjälpa patienter att vara delaktiga i sin vård samt att använda sig av den icke- verbala kommunikationen kan man nå patienter med afasi. Detta kan resultera i en rättvisare vård och det skulle troligtvis också kunna öka livskvaliteten för individen.Background: Each year about 30,000 Swedes suffer a stroke and almost one third of them experience aphasia. Aphasia is a loss or impairment of the language system that occurs after a brain injury. Patients with aphasia experience this condition as a loss of their autonomy which worsens their quality of life. To care for someone affected by aphasia requires specific skills for nurse, both to find new ways to communicate, and also to be able to provide as good care as possible. Aim: The aim of this study is to describe components that affect communication with patients suffering from aphasia after a stroke from a nurse perspective. Method: The study is a literature review including eight qualitative articles published between the years 2000 - 2012. Selected articles involve communication between the nurse and patients suffering from aphasia after a stroke. As a theoretical frame, Joyce Travelbee’s theory focusing on the development of the relationship between nurse and patient is used. Results: Based on the selected articles, two main themes arose: Fundamentals for effective communication, and the Opportunities and barriers in communication. Making use of the non-verbal communication has proven to be very effective when speech is impaired. Meanwhile, adapted surroundings and enough time can make it possible to achieve effective communication with patients suffering from aphasia. Discussion: By helping patients to be involved in their care, and to make use of non-verbal communication, it is possible to reach patients with aphasia. This can result in fairer healthcare and it would also probably increase the quality of life for the individual.
50
Sribus, Sinjai, and Suzan Geries. "Sjuksköterskans kommunikation och bemötande av personer med kognitiv nedsättning orsakad av stroke." Thesis, Högskolan i Gävle, Avdelningen för hälso- och vårdvetenskap, 2013. http://urn.kb.se/resolve?urn=urn:nbn:se:hig:diva-15744.
Full textAbstract:
Syfte: Att identifiera och beskriva sjuksköterskans kommunikation och bemötande av personer med kognitiv nedsättning, i form av afasi orsakad av stroke. Syftet var även att undersöka vilken betydelse datainsamlingsmetoden har för de inkluderade artiklarna.Metod: Beskrivande litteraturstudie baserad på 14 vetenskapliga artiklar som publicerats år 2000-2012 via databaserna PubMed och Cinahl. En metodologisk granskning av artiklarnas datainsamlingsmetod genomfördes. Resultat: Sjuksköterskans bemötande och kommunikation hade en påverkan på patientens upplevelse av vården. Det framkom både möjligheter och hinder som påverkade kommunikationen i mötet. Brist på kompetens, personalresurser och tid samt stress ansågs vara de faktorer som hindrade kommunikationen. Användning av verbal och icke- verbal kommunikation, bra vårdmiljö, en trygg, lugn och ödmjuk sjuksköterska förbättrade möjligheten till att kunna uppnå ett gott bemötande och en framgångsrik kommunikation. Ostrukturerade intervjuer, djupintervjuer, videoinspelningar och frågeformulär förekom i de valda vetenskapliga artiklarna.Slutsats: En fungerande relation mellan sjuksköterskan och patienten utgör en grund i omvårdnaden och förbättrar omvårdnadskvalitén. Sjuksköterskan behöver ha kompetens, självinsikt och förståelse av mänskligt beteende i mötet med patienter som har en kognitiv nedsättning orsakad av stroke. Sjuksköterskan bör ha ett genomtänkt förhållande till sina egna värderingar och förhållningssätt i mötet och kunna ha förmågan att förutse både eget och patientens beteende. Vald datainsamlingsmetod ger djupare förståelse i det valda omvårdnadsämnet.Aim: To identify and describe how nursing staff communication and treatment of patients with cognitive impairment such as aphasia caused by stroke and to examine the significance of the included article’s data collection methods.Method: A descriptive literature review based on 14 articles which was published between 2000-2012 in the databases PubMed and Cinahl. A detailed inspection of the articles’ data collection methods was conducted.Result: The nurse communication and treatment had an impact on the patient’s experience of care. It emerged both opportunities and barriers that affected the communication. Lack of staff resources and competence as well as stress were factors that hindered communication. The use of verbal and non-verbal communication, good health environment, a secure, calm and humble nurse improved the possibility to achieve a good treatment and successful communication. Unstructured interviews, in-depth interviews, video recordings and questionnaires occurred in the selected articles.Conclusion: A functional relationship between the nurse and patients is a basis in nursing and improves its quality. Nurses need to have skills, self-awareness and understanding of the human behavior when meeting patients with cognitive impairment caused by stroke. Nurses ought to have a deliberate relation to their own values and attitudes in meetings and be able to anticipate both their own and patient’s behavior. The selected data collection methods give a deeper understanding of the chosen nursing substance.