Journal articles on the topic 'Aphasia and stroke care'
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Musser, Benjamin, Joanne Wilkinson, Thomas Gilbert, and Barbara G. Bokhour. "Changes in Identity after Aphasic Stroke: Implications for Primary Care." International Journal of Family Medicine 2015 (January 21, 2015): 1–8. http://dx.doi.org/10.1155/2015/970345.
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Background. Stroke survivors with aphasia experience difficulty associated with their communication disorder. While much has been written about aphasia’s impacts on partners/family, we lack data regarding the psychosocial adjustment of aphasic stroke survivors, with a paucity of data from the patients themselves. Methods. Qualitative study of lived experiences of individuals with poststroke aphasia. Each of the stroke survivors with aphasia completed 3-4 semistructured interviews. In most cases, patients’ partners jointly participated in interviews, which were transcribed and analyzed using techniques derived from grounded theory. Results. 12 patients were interviewed, with the total of 45 interviews over 18 months. Themes included poststroke changes in patients’ relationships and identities, which were altered across several domains including occupational identity, relationship and family roles, and social identity. While all these domains were impacted by aphasia, the impact varied over time. Conclusion. Despite the challenges of interviewing individuals with aphasia, we explored aphasia’s impacts on how individuals experience their identity and develop new identities months and years after stroke. This data has important implications for primary care of patients with aphasia, including the importance of the long-term primary care relationship in supporting psychosocial adjustment to life after aphasic stroke.
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STAN, Adina, Stefan STRILCIUC, Nicoleta GHERGHEL, Angela COZMA, Alexander CRISTIAN, Silvina ILUT, Alina BLESNEAG, et al. "Aphasia after acute ischemic stroke: epidemiology and impact on tertiary care resources." Balneo and PRM Research Journal, Vol.12, no.4 (December 14, 2021): 376–80. http://dx.doi.org/10.12680/balneo.2021.465.
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Introduction. This study aimed to reveal the disease burden of aphasia after acute ischemic stroke (AIS) at the national level and investigate the impact of aphasia on tertiary care resources and patient outcomes. We aimed to investigate the length of stay (LOS) and discharge modified Rankin Scale (mRS) score in aphasic, acute ischemic stroke (AIS) patients in order to estimate aphasia-related disease burden at a national level. Material and method. The local database from the Cluj-Napoca Emergency County Hospital (CNECH), the second largest stroke center in Romania was used to export demographics, baseline clinical and laboratory data, inpatient length of stay (LOS), NIH Stroke Scale (NIHSS), and discharge modified Rankin Scale (mRS) score data for all AIS patients admitted during March 2019. Results and discussions. Of 92 patients included in the study, 30 (32.6 %) had aphasia on admission. In a marginally significant unadjusted hierarchical multiple regression model, individuals with aphasia had a LOS of 1.86 days longer than stroke survivors without aphasia. In an adjusted version of the model, the NIHSS score at baseline was a significant predictor for LOS. In addition, the presence of aphasia was associated with a 1.49 increase in the mean mRS score. Aphasia was a marginally significant predictor for increased LOS. Presence of aphasia was more likely to produce a poor functional outcome. Conclusions. Considering an estimated impact of approximately EUR 3 million on direct medical expenditure annually, future policymaking efforts should improve prevention of stroke and improved access to post-stroke aphasia care in Romania. Keywords: aphasia; acute ischemic stroke; length of stay; disability, outcome,
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Whelan, K., M. Haarstad, B. Feldbruegge, A. Jacobi, C. Mayo, T. Hautz, C. Heyer, B. Graham, and G. Hunter. "P.092 Successful implementation of a supported conversation program on an acute stroke unit." Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques 48, s3 (November 2021): S45—S46. http://dx.doi.org/10.1017/cjn.2021.370.
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Background: Aphasia is a life alerting deficit that affects up to 40% of people living with stroke. Barriers to communication ultimately impacts the care aphasic patients receive, as well as functional recovery. The Canadian Stroke Best Practice Recommendations suggest early and frequent language interventions to improve patients with aphasia quality of life, mood, and social outcomes. Methods: A supported conversation (SC) program (colloquially named The Aphasia Club) was implemented on the Acute Stroke Unit (ASU). The program included aphasia awareness and assessment training, as well as creation of an aphasia tool kit and discipline specific aphasia-friendly resources. Staff were encouraged to complete a 1-hour independent course on SC through the Aphasia Institute. Speech and language pathologists (SLP) offered an additional 30-minute in-person teaching session with interdisciplinary practice professionals. Following SLP assessment, personalized communication profiles were created for patients with aphasia to help staff understand the most useful strategies for communication. Results: More then 50 interprofessional staff members took SC training. Staff reported increased levels of knowledge and confidence when communicating with aphasic patients. Conclusions: A supported communication program was successfully implemented on an ASU. Planning appropriate communication interventions can assist interdisciplinary professionals in their ability to support patients through their stroke journey.
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Gunawan, Pricilla Yani, and Kalista Ardelia Iswara. "Correlation Between Aphasia in Stroke Patients and Severe Depression of Family Members as Primary Caregivers." Medicinus 8, no. 3 (June 2, 2021): 94. http://dx.doi.org/10.19166/med.v8i3.3765.
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<p><strong>Background and Objective: </strong>Stroke is a disease with an increasing annual prevalence. One of the most frequent clinical manifestation seen in stroke patients is aphasia which greatly affects the patient’s ability to communicate. The burden and the pressure of taking care of the patient placed on the family members often results in psychological impacts such as depression. We intend to know the association between aphasia in stroke patients with severe depression on family members. </p><p><strong>Methodology:</strong> This was a cross sectional study, using an unpaired categorical comparative analysis. Inclusion criteria were family members of patients with and without aphasia. Patients and caregivers who gave their consent verbally were guided to fill in the Hamilton Depression Rating Scale questionnaire. The association between aphasia status and the depression scale was analyzed using Chi-Square.</p><p><strong>Results: </strong>Out of 54 respondents included in the study, there were 25 caregivers (46,3%) taking care stroke patients without aphasia, and 29 caregivers (53,7) taking care stroke patients with aphasia. As much as35 (64.8%) were categorized as normal- moderate level of depression and 19 (35.2%) categorized as major depression. From those with major depression, 14 (73.7%) were found in the aphasic group and 5 were in the non-aphasia group. Chi-Square analysis shows a significant correlation [P=0.03; OR=3.73 (1.1-12.7)] between aphasia in stroke patients and severe depression of the caregivers.</p><p><strong>Conclusion: </strong>There is a significant association between aphasia in stroke patients and the incidence of severe depression on their caregivers.</p>
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Febryanto, Dwi, Retnaningsih, and Fitria Handayani. "Assessment Of Afasia in Stroke Patients: Case Study." Journal Of Nursing Practice 3, no. 2 (April 29, 2020): 210–19. http://dx.doi.org/10.30994/jnp.v3i2.88.
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Introduction: Aphasia is understood as difficulty in understanding or producing language caused by disorders involving the brain hemispheres. Early assessment of aphasia is very important to prevent the emergence of telegraphic speech styles, improve welfare, independence, social participation, quality of life, reduce length of stay and care costs, but there is little literature on this subject, especially in stroke patients. Purpose: This study is to provide an overview of the assessment of aphasia in stroke patients. Methods: The design of a case study involving 6 participants and data collection was carried out by conducting an assessment using the Language Aphasia Screening Test (LAST) instrument which was monitored for 3 days, including monitoring errors for naming images, monitoring mismatches repeating words and sentences, monitoring spontaneous pronunciation, monitoring image comprehension, monitoring comprehension of verbal instructions.Results: A total of 6 ischemic stroke patients were found wrong in repeating words and sentences. Conclusion: In aphasic stroke patients all language modalities are impaired, ranging from spontaneous speech, repetition, naming, language comprehension, reading and writing
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Godecke, Erin, Elizabeth A. Armstrong, Tapan Rai, Sandy Middleton, Natalie Ciccone, Anne Whitworth, Miranda Rose, et al. "A randomized controlled trial of very early rehabilitation in speech after stroke." International Journal of Stroke 11, no. 5 (May 5, 2016): 586–92. http://dx.doi.org/10.1177/1747493016641116.
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Rationale The efficacy of rehabilitation therapy for aphasia caused by stroke is uncertain. Aims and hypothesis The Very Early Rehabilitation of Speech (VERSE) trial aims to determine if intensive prescribed aphasia therapy (VERSE) is more effective and cost saving than non-prescribed, intensive (usual care-plus) and non-intensive usual care (UC) therapy when started within 15 days of stroke onset and continued daily over four weeks. We hypothesize that aphasia therapy when started very early after stroke and delivered daily could enhance recovery of communication compared with UC. Sample size estimates A total of 246 participants (82 per arm) will provide 80% power to detect a 4.4% improvement on aphasia quotient between VERSE and UC plus at a significance level of α = 0.05. Setting Acute-care hospitals and accompanying rehabilitation services throughout Australia, 2014–2017. Design Three-arm, prospective, randomized, parallel group, open-label, blinded endpoint assessment (PROBE) trial. Participants Acute stroke in previous 14 days and aphasia diagnosed by aphasia quotient (AQ) of the Western Aphasia Battery (WAB). Randomization Computer-generated blocked randomization procedure stratified by aphasia severity according to Western Aphasia Battery, to one of three arms. Intervention All participants receive UC—usual ward-based aphasia therapy. Arm 1: UC—no additional therapy; Arm 2: UC-plus usual ward-based therapy; Arm 3: VERSE therapy—a prescribed and structured aphasia therapy program. Arms 2 and 3 receive a total of 20 additional sessions (45–60 min, provided daily) of aphasia therapy. The additional intervention must be provided before day 50 post stroke. Study outcome measures The aphasia quotient of Western Aphasia Battery at 12 weeks post stroke. Secondary outcomes include discourse measures, the Stroke and Aphasia Quality of Life Scale-39 and the Aphasia Depression Rating Scale at 12 and 26 weeks. Economic evaluation Incremental cost-effectiveness ratios at 26 weeks will be reported. Discussion This trial is designed to test whether the intensive and prescribed VERSE intervention is effective in promoting maximum recovery and preventing costly health complications in a vulnerable population of survivors of stroke. It will also provide novel, prospective, aphasia specific cost-effectiveness data to guide future policy development for this population.
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Bahia, Mariana Mendes, and Regina Yu Shon Chun. "Quality of life in aphasia: differences between fluent and non-fluent aphasic Augmentative and Alternative Communication users." Audiology - Communication Research 19, no. 4 (December 2014): 352–59. http://dx.doi.org/10.1590/s2317-64312014000300001353.
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Purpose To investigate and to compare quality of life (QOL) in fluent and non-fluent aphasics. Methods This is a prospective, quantitative, and transversal study. We included 11 stroke patients with aphasia (five non-fluent aphasics augmentative and alternative communication users and six fluent aphasics). Data was gathered from the Stroke Specific Quality of Life Scale (SS-QOL), a structure interview, and The Modified Rankin Scale. Results The non-fluent aphasics presented poorer Rankin and quality of life than the fluent aphasics. The major difference occurred in the fields of language and upper extremity function. The three most affected domains in non-fluent aphasics were language, social roles, and thinking, whereas in the fluent aphasics were personality, social roles, and thinking. All the subjects referred a worse quality of life after stroke. The domains of language and self-care were identified as the most affected after stroke. Conclusion This study demonstrated that, in general, non-fluent aphasics have lower quality of life than fluent aphasics. However, this difference is not homogeneous among the several quality of life domains. Additionally, this research evidences a relationship between aphasia severity and individual functionality, implying impairment in quality of life, especially for non-fluent aphasics.
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Macrae, Margaret, and Jacinta M. Douglas. "Communication Outcome 12 Months Following Left-Hemisphere Stroke in the Elderly." Brain Impairment 9, no. 2 (September 1, 2008): 170–78. http://dx.doi.org/10.1375/brim.9.2.170.
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AbstractWith increasing life expectancy and the changing age structure of the population, the health sector is experiencing increased demands on services associated with age-related diseases including stroke and Alzheimer's disease. The communication needs of older Australians in these disease groups need to be understood to enable adequate provision of speech pathology services. In this project we set out to make a preliminary investigation of 12-month communication outcome and discharge destination of aphasic stroke survivors over age 65 at onset of first ever in a lifetime stroke (FELS). The recruitment timeframe was a 6-month period of stroke admissions to a large metropolitan health network. Nearly 70% of stroke admissions were aged 65 years and over and 34% were ascertained retrospectively from medical records as having aphasia. Within this group, there was a 20% mortality rate. Sixteen left-hemisphere stroke survivors with aphasia were followed up at 12 months. More than half were living in residential care. Excluding the impact of recurrent stroke, 12-month reassessment of language demonstrated substantial improvement could occur in the old-very old stroke survivor. These findings highlight the need to develop systematic review and follow-up speech pathology services that operate effectively in residential care environments.
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Shankar, Shyam, Ishan Malhotra, Pavel Gozenput, Mangalore Amith Shenoy, Pavan Irukulla, Roman Bernstein, and Yizhak Kupfer. "1991: NOMINAL APHASIA: UTI, NOT STROKE?" Critical Care Medicine 44, no. 12 (December 2016): 573. http://dx.doi.org/10.1097/01.ccm.0000510663.98093.e9.
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Rose, Miranda L., David Copland, Lyndsey Nickels, Leanne Togher, Marcus Meinzer, Tapan Rai, Dominique A. Cadilhac, et al. "Constraint-induced or multi-modal personalized aphasia rehabilitation (COMPARE): A randomized controlled trial for stroke-related chronic aphasia." International Journal of Stroke 14, no. 9 (September 7, 2019): 972–76. http://dx.doi.org/10.1177/1747493019870401.
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Rationale The comparative efficacy and cost-effectiveness of constraint-induced and multi-modality aphasia therapy in chronic stroke are unknown. Aims and hypotheses In the COMPARE trial, we aim to determine whether Multi-Modal Aphasia Treatment (M-MAT) and Constraint-Induced Aphasia Therapy Plus (CIAT-Plus) are superior to usual care (UC) for chronic post-stroke aphasia. Primary hypothesis: CIAT-Plus and M-MAT will reduce aphasia severity (Western Aphasia Battery-Revised Aphasia Quotient (WAB-R-AQ)) compared with UC: CIAT-Plus superior for moderate aphasia; M-MAT superior for mild and severe aphasia. Sample size estimates A total of 216 participants (72 per arm) will provide 90% power to detect a 5-point difference on the WAB-R-AQ between CIAT-Plus or M-MAT and UC at α = 0.05. Methods and design Prospective, randomized, parallel group, open-label, assessor blinded trial. Participants: Stroke >6 months; aphasia severity categorized using WAB-R-AQ. Computer-generated blocked and stratified randomization by aphasia severity (mild, moderate, and severe), to 3 arms: CIAT-Plus, M-MAT (both 30 h therapy over two weeks); UC (self-reported usual community care). Study outcomes WAB-R-AQ immediately post-intervention. Secondary outcomes: WAB-R-AQ at 12-week follow-up; naming scores, discourse measures, Communicative Effectiveness Index, Scenario Test, and Stroke and Aphasia Quality of Life Scale-39 g immediately and at 12 weeks post-intervention; incremental cost-effectiveness ratios compared with UC at 12 weeks. Discussion This trial will determine whether CIAT-Plus and M-MAT are superior and more cost-effective than UC in chronic aphasia. Participant subgroups with the greatest response to CIAT-Plus and M-MAT will be described.
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Tippett, Donna C., and Argye E. Hillis. "Where are aphasia theory and management “headed”?" F1000Research 6 (July 3, 2017): 1038. http://dx.doi.org/10.12688/f1000research.11122.1.
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The sequelae of post-stroke aphasia are considerable, necessitating an understanding of the functional neuroanatomy of language, cognitive processes underlying various language tasks, and the mechanisms of recovery after stroke. This knowledge is vital in providing optimal care of individuals with aphasia and counseling to their families and caregivers. The standard of care in the rehabilitation of aphasia dictates that treatment be evidence-based and person-centered. Promising techniques, such as cortical stimulation as an adjunct to behavioral therapy, are just beginning to be explored. These topics are discussed in this review.
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Lui, Justin K., Lacey J. McIntosh, Jorge Escobar Valle, Thomas Stockl, and Stephen Summers. "Facial Drooping, Aphasia, and an Incidental Lung Mass in a Nonsmoker." Journal of Intensive Care Medicine 32, no. 3 (October 26, 2016): 228–30. http://dx.doi.org/10.1177/0885066616676044.
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Background: Atrial fibrillation and atrial flutter are atrial tachycardias associated with embolic strokes. To date, there have only been a few reports highlighting the incidence of these atrial tachycardias due to mechanical compression of myocardial structures and the pulmonary vasculature in certain mediastinal masses and cysts. Case: We present a case of a 75-year-old gentleman who is a nonsmoker with a history of hypertension who presents with an acute embolic stroke due to atrial flutter likely from mechanical compression from an underlying squamous cell carcinoma of the lung. Conclusion: This case represents, to the best of our knowledge, a rare case of squamous cell carcinoma of the lung in a nonsmoker likely leading to mechanical compression and a resultant atrial tachycardia with an embolic stroke.
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Kasparian, Laura, Olga Kaminski, Megan Schliep, Semra Koymen, and Sofia Vallila-Rohter. "Implementing a Standardized Assessment Battery for Aphasia in Acute Care." Seminars in Speech and Language 39, no. 01 (January 22, 2018): 037–52. http://dx.doi.org/10.1055/s-0037-1608857.
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AbstractIn this article, the implementation of a standardized assessment battery for the evaluation of language in an acute care setting is described. Following an institutional shift to adopt electronic medical records, researchers and clinicians worked together to develop a technology-assisted evaluation of aphasia that would be used to assess all patients admitted to our facility with stroke. The project goal was to devise a clinical process to improve aphasia diagnosis and evaluation while remaining feasible within constraints imposed by the acute care setting and the electronic medical record. Utilizing frameworks from implementation science, the four key phases were: (1) initial considerations of the host setting, (2) creation of a structure for implementation, (3) maintenance of this structure once implementation began, and (4) improvement for future applications. A pilot implementation demonstrated that establishing and executing a minimum standardized assessment for aphasia in acute care is feasible. Retrospective medical record review of 50 aphasia evaluations in the setting of first incidence of left hemisphere stroke affecting the middle cerebral artery (25 preimplementation and 25 postimplementation) revealed that information content of medical notes was more consistent and complete postimplementation than preimplementation. Clinical implications and future directions are discussed.
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Kuster, Judith Maginnis. "Internet Resources for Stroke and Aphasia." Topics in Stroke Rehabilitation 7, no. 2 (July 2000): 21–31. http://dx.doi.org/10.1310/edj3-0fty-5dt8-pl8x.
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Sandberg, Chaleece W., Joanne K. Niemkiewicz, Anne Marie Kubat, and Liza M. Conyers. "Impact of COVID-19 on People With Aphasia: Emerging Rehabilitation Needs." Rehabilitation Research, Policy, and Education 36, no. 4 (December 1, 2022): 264–75. http://dx.doi.org/10.1891/re-21-23.
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Purpose:The purpose of this article is to address an emerging issue in rehabilitation counseling: The effect of the COVID-19 pandemic on people with aphasia (PWA).Method:Based upon a review of the literature this article provides an overview of (a) COVID-19 and emergent aphasia-related disability, (b) COVID-19 effects on stroke and aphasia services, (c) COVID-19 effects on mental health and employment of PWA.Results:This review of the impact of COVID-19 on PWA highlights the increased and emerging needs for rehabilitation counseling services related to an anticipated increase in incidence of aphasia related to COVID-19 illness and secondary impact of medical care for this population.Conclusion:The impact of COVID-19 on aphasia care in rehabilitation settings underscores the need for increased interprofessional education and collaboration to address the many gaps in aphasia care. Likewise, interdisciplinary research focused on rehabilitation outcomes in aphasia is needed to provide a foundation for evidence-based practice that conforms to the WHO-ICF framework.
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Irwin, Billy. "Patient-Reported Outcome Measures in Aphasia." Perspectives on Neurophysiology and Neurogenic Speech and Language Disorders 22, no. 4 (December 2012): 160–66. http://dx.doi.org/10.1044/nnsld22.4.160.
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Patient-reported outcomes (PROs) for persons with aphasia offer a new method of obtaining subjective reports of social and psychological wellbeing subsequent to stroke and/or aphasia. Several instruments designed to elicit self-report in stroke patients, including those who have aphasia, have adopted aphasia-friendly formats and have included persons with all levels of severity in the development of the instrument. A brief overview of currently available tools is provided with comments regarding the primary focus of the tools and some of the reported psychometric properties. In addition, this article includes a discussion of the rationale and forces that are driving the development and use of these tools, including systematic health-care changes and an increased prominence of the social approach to aphasia. Also, the author discusses an overview of the current and future application of PROs.
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Lane, Kathleen. "“Are you going to come and see us again soon?” An intergenerational event between stroke survivors and school-children." Quality in Ageing and Older Adults 17, no. 4 (December 12, 2016): 246–52. http://dx.doi.org/10.1108/qaoa-09-2016-0037.
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Purpose A one-hour intergenerational event held at an infant school in Norfolk, England, aimed to increase the citizenship experience of young children and their awareness of what it means to live with stroke, and to address social isolation or self-confidence in communicating among stroke survivors with aphasia. It was also intended to gauge whether this activity might provide a basis for future research. The paper aims to discuss these issues. Design/methodology/approach Four community-dwelling stroke survivors with aphasia were recruited. In total, 12 pupils aged six and seven were selected by their Year 2 teacher and head-teacher. At the event, participants sat in groups of one adult and three pupils and engaged in writing, hand-tracing and talking about pictures. The author circulated among the groups to facilitate engagement. Findings All participants enjoyed interacting together in the activities. The pupils gained insights into the stroke survivors’ lived experience and wanted them to return to “see us again soon”; the adults valued being in the “real world” and practising their conversation in activities different from their usual routines. Feedback indicated the value of the engagement and that participants welcomed similar intergenerational opportunities. The author will develop a research application exploring enablers, barriers and benefits of this type of engagement. Originality/value The event gave a rare opportunity for stroke survivors with aphasia to participate in intergenerational activities and for children to engage with vulnerable older adults. It demonstrated the value of interactions in which learning and insights are obtained on both sides. It also provided evidence that pursuing research in this field is feasible.
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Flood, Chris, Nicholas Behn, Jane Marshall, Alan Simpson, Sarah Northcott, Shirley Thomas, Kimberley Goldsmith, Sally McVicker, Mireia Jofre-Bonet, and Katerina Hilari. "A pilot economic evaluation of a feasibility trial for SUpporting wellbeing through PEeR-Befriending (SUPERB) for post-stroke aphasia." Clinical Rehabilitation 36, no. 5 (February 2, 2022): 683–92. http://dx.doi.org/10.1177/02692155211063554.
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Objectives To explore the feasibility of a full economic evaluation of usual care plus peer-befriending versus usual care control, and potential cost-effectiveness of peer-befriending for people with aphasia. To report initial costs, ease of instruments’ completion and overall data completeness. Design Pilot economic evaluation within a feasibility randomised controlled trial Setting Community, England Participants People with post-stroke aphasia and low levels of psychological distress Intervention All participants received usual care; intervention participants received six peer-befriending visits between randomisation and four months Main measures Costs were collected on the stroke-adapted Client Service Receipt Inventory (CSRI) for health, social care and personal out-of-pocket expenditure arising from care for participants and carers at 4- and 10-months post-randomisation. Health gains and costs were reported using the General Health Questionnaire-12 and the EQ-5D-5L. Mean (CI) differences for costs and health gains were reported and uncertainty represented using non-parametric bootstrapping and cost-effectiveness acceptability curves. Results 56 participants were randomised. Mean age was 70.1 (SD 13.4). Most ( n = 37, 66%) had mild and many ( n = 14; 25%) severe aphasia. There was ≥94% completion of CSRI questions. Peer-befriending was higher in intervention arm ( p < 0.01) but there were no significant differences in total costs between trial arms. Peer-befriending visits costed on average £57.24 (including training and supervision costs). The probability of peer-befriending being cost-effective ranged 39% to 66%. Conclusions Economic data can be collected from participants with post-stroke aphasia, indicating a full economic evaluation within a definitive trial is feasible. A larger study is needed to demonstrate further cost-effectiveness of peer-befriending.
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Johnson, Jessie, Sarah Westgate, and Linda Oliver. "An interprofessional approach to promoting autonomous decision-making for clients who are aphasic." International Journal of Healthcare 5, no. 2 (June 11, 2019): 44. http://dx.doi.org/10.5430/ijh.v5n2p44.
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Often times interprofessional health care team members presume individuals with aphasia due to stroke lack the capacity to participate in and contribute to decision-making. This belief may hinder the client’s participation in the decision-making process. Two main impairments resulting from stroke, that impede communication and limit capacity for autonomous participation in decision-making, are aphasia and cognitive deficits. Reduced capacity for communication in the client with stroke, combined with complexity in health team dialogue and process, may further diminish the individual’s ability to engage in autonomous decision-making. Health team members need to use reliable methods and devise new methods which can more accurately measure capacity for autonomous decision-making. This review elucidates the necessity for (1) autonomous decision-making in persons with aphasia, (2) assessing the need for capacity, (3) concrete ways to assess cognitive function, and (4) interprofessional team decision-making.
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Rose, Tanya, Linda Worrall, Louise Hickson, and Tammy Hoffmann. "Do People With Aphasia Want Written Stroke and Aphasia Information? A Verbal Survey Exploring Preferences for When and How to Provide Stroke and Aphasia Information." Topics in Stroke Rehabilitation 17, no. 2 (March 2010): 79–98. http://dx.doi.org/10.1310/tsr1702-79.
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Prior, Sarah, Andrea Miller, Steven Campbell, Karen Linegar, and Gregory Peterson. "The Challenges of Including Patients With Aphasia in Qualitative Research for Health Service Redesign: Qualitative Interview Study." Journal of Participatory Medicine 12, no. 1 (February 7, 2020): e12336. http://dx.doi.org/10.2196/12336.
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Background Aphasia is an impairment of language, affecting the production or comprehension of speech and the ability to read or write. Aphasia is a frequent complication of stroke and is a major disability for patients and their families. The provision of services for stroke patients differs across health care providers and regions, and strategies directed at improving these services have benefited from the involvement of patients. However, patients with aphasia are often excluded from these co-design activities due to a diminished capacity to communicate verbally and a lack of health researcher experience in working with patients with aphasia. Objective The primary aim of this paper is to identify approaches appropriate for working with patients with aphasia in an interview situation and, more generally, determine the importance of including people with aphasia in health service improvement research. The secondary aim is to describe the experiences of researchers involved in interviewing patients with aphasia. Methods A total of 5 poststroke patients with aphasia participated in face-to-face interviews in their homes to gain insight into their in-hospital experience following their stroke. Interviews were audio-recorded, and thematic analysis was performed. The experiences of the researchers interviewing these patients were informally recorded postinterview, and themes were derived from these reflections. Results The interview technique utilized in this study was unsuitable to gain rich, qualitative data from patients with aphasia. The experience of researchers performing these interviews suggests that preparation, emotion, and understanding were three of the main factors influencing their ability to gather useful experiential information from patients with aphasia. Patients with aphasia are valuable contributors to qualitative health services research, and researchers need to be flexible and adaptable in their methods of engagement. Conclusions Including patients with aphasia in health service redesign research requires the use of nontraditional interview techniques. Researchers intending to engage patients with aphasia must devise appropriate strategies and methods to maximize the contributions and valuable communications of these participants.
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Eisner, Ashley, and Stephen Clum. "HYPONATREMIA-INDUCED EXPRESSIVE APHASIA: AN ATYPICAL STROKE MIMIC." Chest 156, no. 4 (October 2019): A1963. http://dx.doi.org/10.1016/j.chest.2019.08.1947.
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Northcott, Sarah, Alan Simpson, Shirley A. Thomas, Shashivadan P. Hirani, Chris Flood, and Katerina Hilari. "SOlution Focused brief therapy In post-stroke Aphasia (SOFIA Trial): protocol for a feasibility randomised controlled trial." AMRC Open Research 1 (May 21, 2019): 11. http://dx.doi.org/10.12688/amrcopenres.12873.1.
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Background: Around a quarter of people post stroke will experience aphasia, a language disability. Having aphasia places someone at risk of becoming depressed and isolated. There is limited evidence for effective interventions to enhance psychological well-being for this client group. A potential intervention is Solution Focused Brief Therapy (SFBT), which supports a person to build meaningful, achievable change through focusing on a person’s skills and resources rather than their deficits. The SOFIA Trial aims to explore the acceptability of SFBT to people with varying presentations of aphasia, including severe aphasia, and to assess the feasibility of conducting a future definitive trial investigating clinical and cost effectiveness. Methods: The trial is a single-blind, randomised, wait-list controlled feasibility trial with nested qualitative research and pilot economic evaluation comparing SFBT plus usual care to usual care alone. The study will recruit 32 participants with aphasia who are ≥6 months post stroke. All participants will be assessed on psychosocial outcome measures at baseline, three, and six months post randomisation by assessors blinded to treatment allocation. Participants will be randomly assigned to intervention group (start intervention immediately post randomisation) or wait-list group (start intervention six months post randomisation). Wait-list group will additionally be assessed nine months post randomisation. The intervention consists of up to six SFBT sessions delivered over three months by speech and language therapists. Participants and therapists will also take part in in-depth interviews exploring their experiences of the study. The pilot economic evaluation will use the EQ-5D-5L measure and an adapted Client Service Receipt Inventory. People with aphasia have been involved in designing and monitoring the trial. Discussion: Given the high levels of depression and isolation, there is a need to investigate effective interventions that enhance the psychological wellbeing of people with aphasia. Trial registration: ClinicalTrials.gov NCT03245060 10/08/2017.
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Northcott, Sarah, Alan Simpson, Shirley A. Thomas, Shashivadan P. Hirani, Chris Flood, and Katerina Hilari. "Solution Focused brief therapy In post-stroke Aphasia (SOFIA Trial): protocol for a feasibility randomised controlled trial." AMRC Open Research 1 (July 15, 2019): 11. http://dx.doi.org/10.12688/amrcopenres.12873.2.
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Background: Around a quarter of people post stroke will experience aphasia, a language disability. Having aphasia places someone at risk of becoming depressed and isolated. There is limited evidence for effective interventions to enhance psychological well-being for this client group. A potential intervention is Solution Focused Brief Therapy (SFBT), which supports a person to build meaningful, achievable change through focusing on a person’s skills and resources rather than their deficits. The SOFIA Trial aims to explore the acceptability of SFBT to people with varying presentations of aphasia, including severe aphasia, and to assess the feasibility of conducting a future definitive trial investigating clinical and cost effectiveness. Methods: The trial is a single-blind, randomised, wait-list controlled feasibility trial with nested qualitative research and pilot economic evaluation comparing SFBT plus usual care to usual care alone. The study will recruit 32 participants with aphasia who are ≥6 months post stroke. All participants will be assessed on psychosocial outcome measures at baseline, three, and six months post randomisation by assessors blinded to treatment allocation. Participants will be randomly assigned to intervention group (start intervention immediately post randomisation) or wait-list group (start intervention six months post randomisation). Wait-list group will additionally be assessed nine months post randomisation. The intervention consists of up to six SFBT sessions delivered over three months by speech and language therapists. Participants and therapists will also take part in in-depth interviews exploring their experiences of the study. The pilot economic evaluation will use the EQ-5D-5L measure and an adapted Client Service Receipt Inventory. People with aphasia have been involved in designing and monitoring the trial. Discussion: Given the high levels of depression and isolation, there is a need to investigate effective interventions that enhance the psychological wellbeing of people with aphasia. Trial registration: ClinicalTrials.gov NCT03245060 10/08/2017.
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Ulatowska, Hanna, Tricia Olea Santos, and Carla Krishan Cuadro. "Cultural Considerations to the Life Participation Approach in Aphasia:A Filipino Case Study." Innovation in Aging 5, Supplement_1 (December 1, 2021): 934. http://dx.doi.org/10.1093/geroni/igab046.3378.
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Abstract Stroke is among the common causes of chronic disability (Feigin, 2014). Around one-third of stroke survivors are affected by aphasia, a communication disorder affecting the ability to comprehend and express oneself (Dickey, et. al., 2010). Culture is essential to understanding aphasia and providing person-centered care. Philippine cultural identity is reflected via respect for older persons, collectivism in family and community, and devotion to religion (Pe Pua & Protacio-Marcelino, 2000). The Filipino family is a primary support system, and cultural values directly influence caregiving approaches in chronic disability. This single case study examines the life of a Filipino man who has successfully lived with aphasia for over 25 years. Having finished a doctorate from Harvard University, served as the youngest University president, and member of the Philippine government, he suddenly had a stroke and was able to communicate only via single words, gestures, and facial expressions. His life is discussed in the context of the unique, multi-modal communication system which developed through the years with his family. Music and symbolism via watercolor paintings also define his aphasia journey. The value of religion in Filipino culture (Cruz, et. al., 2019) and its role in fostering positivity in his aphasia journey is examined. This study also highlights Filipino collectivism through the support of family and community in addressing communication needs and facilitating meaningful relationships at various stages in life. Cultural values deeply rooted in Filipino caregiving, such as debt of gratitude and filial devotion to parents (Enriquez, 1992), are discussed.
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Loft, Mia Ingerslev, Cecilie Volck, and Lise Randrup Jensen. "Communicative and Supportive Strategies: A Qualitative Study Investigating Nursing Staff’s Communicative Practice With Patients With Aphasia in Stroke Care." Global Qualitative Nursing Research 9 (January 2022): 233339362211108. http://dx.doi.org/10.1177/23333936221110805.
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This study aimed to provide detailed descriptions of the influences on the nursing staff’s communicative practices with patients with aphasia in the context of usual stroke care interactions, and secondly to explore the nursing staff’s use or non-use of supportive techniques, including the SCATM method. A qualitative design was chosen, combining field observations and semi-structured interviews. Inductive and deductive qualitative content analysis was used. The results showed that the nursing staff’s interactions with patients with aphasia were influenced by organizational and environmental influences, nurses’ roles and functions and supporting patients with aphasia in communication. The role of the nursing staff in caring for the psychosocial well-being of patients is deprioritised in favor of other tasks. If there is no time or culture for prioritizing time for conversing with patients and supporting their psychosocial well-being, communication-partner training like SCATM is likely hindered.
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Øra, Hege Prag, Melanie Kirmess, Marian C. Brady, Iselin Partee, Randi Bjor Hognestad, Beate Bertheau Johannessen, Bente Thommessen, and Frank Becker. "The effect of augmented speech-language therapy delivered by telerehabilitation on poststroke aphasia—a pilot randomized controlled trial." Clinical Rehabilitation 34, no. 3 (January 5, 2020): 369–81. http://dx.doi.org/10.1177/0269215519896616.
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Objective: Pilot a definitive randomized controlled trial of speech-language telerehabilitation in poststroke aphasia in addition to usual care with regard to recruitment, drop-outs, and language effects. Design: Pilot single-blinded randomized controlled trial. Setting: Telerehabilitation delivered from tertiary rehabilitation center to participants at their home or admitted to secondary rehabilitation centers. Subjects: People with naming impairment due to aphasia following stroke. Intervention: Sixty-two participants randomly allocated to 5 hours of speech and language telerehabilitation by videoconference per week over four consecutive weeks together with usual care or usual care alone. The telerehabilitation targeted functional, expressive language. Main measures: Norwegian Basic Aphasia Assessment: naming (primary outcome), repetition, and auditory comprehension subtests; Verb and Sentence Test sentence production subtest and the Communicative Effectiveness Index at baseline, four weeks, and four months postrandomization. Data were analyzed by intention to treat. Results: No significant between-group differences were seen in naming or auditory comprehension in the Norwegian Basic Aphasia Assessment at four weeks and four months post randomization. The telerehabilitation group ( n = 29) achieved a Norwegian Basic Aphasia Assessment repetition score of 8.9 points higher ( P = 0.026) and a Verb and Sentence Test score 3 points higher ( P = 0.002) than the control group ( n = 27) four months postrandomization. Communicative Effectiveness Index was not significantly different between groups, but increased significantly within both groups. No adverse events were reported. Conclusion: Augmented telerehabilitation via videoconference may be a viable rehabilitation model for aphasia affecting language outcomes poststroke. A definitive trial with 230 participants is needed to confirm results.
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Sundin, Karin, Astrid Norberg, and Lilian Jansson. "The Meaning of Skilled Care Providers’ Relationships with Stroke and Aphasia Patients." Qualitative Health Research 11, no. 3 (May 2001): 308–21. http://dx.doi.org/10.1177/104973201129119127.
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D’Souza, Sarah, Erin Godecke, Natalie Ciccone, Deborah Hersh, Elizabeth Armstrong, Claire Tucak, and Heidi Janssen. "Investigation of the implementation of a Communication Enhanced Environment model on an acute/slow stream rehabilitation and a rehabilitation ward: A before-and-after pilot study." Clinical Rehabilitation 36, no. 1 (November 8, 2021): 15–39. http://dx.doi.org/10.1177/02692155211032655.
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Objectives: Develop and implement a Communication Enhanced Environment model and explore its effect on language activities for patients early after stroke. Method and design: Before-and-after pilot study. Setting: An acute/slow stream rehabilitation and a rehabilitation ward in a private hospital in Perth, Western Australia. Participants: Fourteen patients recruited within 21 days of stroke. Seven recruited during the before-phase (control group: patients with aphasia = 3, patients without aphasia = 4) and seven recruited in the after-phase (intervention group: patients with aphasia = 4, patients without aphasia = 3). Intervention: The intervention group exposed to a Communication Enhanced Environment model had access to equipment, resources, planned social activities and trained communication partners. Both groups received usual stroke care. Data collection: Hospital site champions monitored the availability of the intervention. Behavioural mapping completed during the first minute of each 5-minute interval over 12 hours (between 7 am and 7 pm) determined patient engagement in language activities. Results: Seventy-one percent of the Communication Enhanced Environment model was available to the intervention group who engaged in higher, but not significant (95% CI), levels of language activities (600 of 816 observation time points, 73%) than the control group (551 of 835 observation time points, 66%). Unforeseen reorganisation of the acute ward occurred during the study. Conclusions: Implementation of a Communication Enhanced Environment model was feasible in this specific setting and may potentially influence patients’ engagement in language activities. The unforeseen contextual challenges that occurred during the study period demonstrate the challenging nature of the hospital environment and will be useful in future research planning.
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Zhang, Hong, He Li, Ruojin Li, Guoxing Xu, and Zhenlan Li. "Therapeutic effect of gradual attention training on language function in patients with post-stroke aphasia: a pilot study." Clinical Rehabilitation 33, no. 11 (July 25, 2019): 1767–74. http://dx.doi.org/10.1177/0269215519864715.
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Objective: To investigate the effect of gradual attention training on language function with aphasia. Design: Randomized controlled trial. Participants: A total of 40 patients (mean age: 53.47 years) with post-stroke aphasia came from the stroke rehabilitation unit of rehabilitation department in the First Hospital of Jilin University, of which 13 (32.5%) had intracerebral hemorrhage, 28 inpatients and 12 outpatients, 11 women and 29 men, 34 within three-month stroke and 6 within three months to one year. Interventions: All participants were divided into control and experimental groups. Both groups received language treatment 20 minutes a day, six days/week, for five weeks, and the experimental group received gradual attention training 20 minutes a day, six days/week, for five weeks. Main measures: Language function was assessed pre- and post-treatment by components of the Western Aphasia Battery (WAB) which included spontaneous speech, auditory comprehension, repetition, and naming and then calculated the aphasia quotient (AQ). Results: The mean (SD) AQ of the experimental group and control group, respectively, was 25.71 (12.63) and 26.2 (12.31) at baseline. After treatment, the AQ mean (SD) was 43.08 (15.14) in the experimental group, which showed a significant improvement compared to 33.48 (14.04) in the control group ( P = 0.02).All items of WAB were higher in experimental group than those in control group, especially in auditory comprehension and naming ( P = 0.02, 0.01). Conclusion: Gradual attention training seemed to improve language function in post-stroke aphasia, specifically function of listening comprehension and naming.
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Hinckley, Jacqueline J. "Finding Messages in Bottles: Living Successfully with Stroke and Aphasia." Topics in Stroke Rehabilitation 13, no. 1 (January 2006): 25–36. http://dx.doi.org/10.1310/flj3-04dq-mg8w-89eu.
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Basirat, Anahita, Étienne Allart, Angèle Brunellière, and Yves Martin. "Audiovisual speech segmentation in post-stroke aphasia: a pilot study." Topics in Stroke Rehabilitation 26, no. 8 (August 1, 2019): 588–94. http://dx.doi.org/10.1080/10749357.2019.1643566.
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Laures-Gore, Jacqueline S., Matthew Farina, Elliot Moore, and Scott Russell. "Stress and depression scales in aphasia: relation between the aphasia depression rating scale, stroke aphasia depression questionnaire-10, and the perceived stress scale." Topics in Stroke Rehabilitation 24, no. 2 (June 27, 2016): 114–18. http://dx.doi.org/10.1080/10749357.2016.1198528.
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Aarnio, Karoliina, Jorge Rodríguez-Pardo, Bob Siegerink, Juliane Hardt, Jenna Broman, Lauri Tulkki, Elena Haapaniemi, Markku Kaste, Turgut Tatlisumak, and Jukka Putaala. "Return to work after ischemic stroke in young adults." Neurology 91, no. 20 (October 12, 2018): e1909-e1917. http://dx.doi.org/10.1212/wnl.0000000000006510.
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ObjectiveWe aimed to investigate the proportion of young patients not returning to work (NRTW) at 1 year after ischemic stroke (IS) and during follow-up, and clinical factors associated with NRTW.MethodsPatients from the Helsinki Young Stroke Registry with an IS occurring in the years 1994–2007, who were at paid employment within 1 year before IS, and with NIH Stroke Scale score ≤15 points at hospital discharge, were included. Data on periods of payment came from the Finnish Centre for Pensions, and death data from Statistics Finland. Multivariate logistic regression analyses assessed factors associated with NRTW 1 year after IS, and lasagna plots visualized the proportion of patients returning to work over time.ResultsWe included a total of 769 patients, of whom 289 (37.6%) were not working at 1 year, 323 (42.0%) at 2 years, and 361 (46.9%) at 5 years from IS. When adjusted for age, sex, socioeconomic status, and NIH Stroke Scale score at admission, factors associated with NRTW at 1 year after IS were large anterior strokes, strokes caused by large artery atherosclerosis, high-risk sources of cardioembolism, and rare causes other than dissection compared with undetermined cause, moderate to severe aphasia vs no aphasia, mild and moderate to severe limb paresis vs no paresis, and moderate to severe visual field deficit vs no deficit.ConclusionsNRTW is a frequent adverse outcome after IS in young adults with mild to moderate IS. Clinical variables available during acute hospitalization may allow prediction of NRTW.
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Yadav, Krishna Kumar, and Rajesh Kumar Mandal. "Clinical and Etiological Profile of Ischemic Stroke in a Tertiary Care Hospital of Nepal." International Journal of Health Sciences and Research 12, no. 6 (June 24, 2022): 214–17. http://dx.doi.org/10.52403/ijhsr.20220628.
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Background: Stroke is one of the most common neurological diseases, often leading to disability and death. Ischemic stroke accounts for 80-85% of all stroke cases. This Study aimed to evaluate the clinical and etiological profile of patients of ischemic cerebrovascular stroke. Materials and Methods: This was a cross sectional, observational study of 93 patients of ischemic cerebrovascular stroke, conducted at Bir Hospital, Kathmandu during January 2018 to December 2019. The patients detailed history, examinations, blood investigation, CT Scan head and Echocardiography was done. The data were recorded in Excel a sheet and analyzed by SPSS 20. Results: The mean age of ischemic stroke patients was 63.28 +_ 15.52 with a range from 30 to 94 years. The stroke was predominant in male with 52(55.91 %). The most common risk factors for stroke were hypertension 54(58.06%), followed by smoking 48(51.61%), LVH 45(48.38%), hypercholesterolemia 26(27.95%), diabetes mellitus 11(11.82%), atrial fibrillation 3(3.22%) and coronary artery disease 1(1.07%). Hemiplegia was present in all the patients. Other common symptoms included dysarthria due to facial deviation in 73.11%, speech aphasia in 6.45 % and altered sensorium/loss of consciousness in 1.07 % patients. Conclusion: Stroke is not limited to elderly population; younger adults are also vulnerable for stroke. Hypertension, smoking, hypercholesterolemia, diabetes mellitus are common risk factors which can be modified for prevention of stroke. Key words: Ischemic stroke; hemiplegia; risk factors..
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Godecke, Erin, Tapan Rai, Dominique A. Cadilhac, Elizabeth Armstrong, Sandy Middleton, Natalie Ciccone, Anne Whitworth, et al. "Statistical analysis plan (SAP) for the Very Early Rehabilitation in Speech (VERSE) after stroke trial: an international 3-arm clinical trial to determine the effectiveness of early, intensive, prescribed, direct aphasia therapy." International Journal of Stroke 13, no. 8 (October 2018): 863–80. http://dx.doi.org/10.1177/1747493018790055.
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Background Limited evidence exists to support very early intensive aphasia rehabilitation after stroke. VERSE is a PROBE trial designed to determine whether two types of intensive aphasia therapy, beginning within 14 days of acute stroke, provide greater therapeutic and cost-effectiveness than usual care. Objective To publish the detailed statistical analysis plan for the VERSE trial prior to unblinding. This statistical analysis plan was based on the published and registered VERSE trial protocol and was developed by the blinded steering committee and management team, led by the trial statistician. This plan was developed using outcome measures and trial data collection forms. Results The VERSE statistical analysis plan is consistent with reporting standards for clinical trials and provides for clear and open reporting. Conclusions Publication of a statistical analysis plan serves to reduce potential trial reporting bias and outlines transparent pre-specified analyses. Australian New Zealand Clinical Trials Registry (ANZCTR) Registration number: ACTRN12613000776707; Universal Trial Number (UTN) is U1111-1145-4130.
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Hilari, Katerina, Nicholas Behn, Kirsty James, Sarah Northcott, Jane Marshall, Shirley Thomas, Alan Simpson, et al. "Supporting wellbeing through peer-befriending (SUPERB) for people with aphasia: A feasibility randomised controlled trial." Clinical Rehabilitation 35, no. 8 (February 24, 2021): 1151–63. http://dx.doi.org/10.1177/0269215521995671.
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Objective: To determine the feasibility and acceptability of peer-befriending, for people with aphasia. Design: Single-blind, parallel-group feasibility randomised controlled trial comparing usual care to usual care + peer-befriending. Participants and setting: People with aphasia post-stroke and low levels of distress, recruited from 5 NHS Hospitals and linked community services; their significant others; and 10 befrienders recruited from community. Intervention: Six 1-hour peer-befriending visits over three months. Main measures: Feasibility parameters included proportion eligible of those screened; proportion consented; missing data; consent and attrition rates. Acceptability was explored through qualitative interviews. Outcomes for participants and significant others were measured at baseline, 4- and 10-months; for peer-befrienders before training and after one/two cycles of befriending. Results: Of 738 patients identified, 75 were eligible of 89 fully screened (84%), 62 consented (83% of eligible) and 56 randomised. Attrition was 16%. Adherence was high (93% attended ⩾2 sessions, 81% all six). The difference at 10 months on the GHQ-12 was 1.23 points on average lower/better in the intervention arm (95% CI 0.17, −2.63). There was an 88% decrease in the odds of GHQ-12 caseness (95% CI 0.01, 1.01). Fourty-eight significant others and 10 peer-befrienders took part. Procedures and outcome measures were acceptable. Serious adverse events were few ( n = 10, none for significant others and peer-befrienders) and unrelated. Conclusions: SUPERB peer-befriending for people with aphasia post-stroke experiencing low levels of distress was feasible. There was preliminary evidence of benefit in terms of depression. Peer-befriending is a suitable intervention to explore further in a definitive trial. Clinical trial registration-URL: http://www.clinicaltrials.gov Unique identifier: NCT02947776 Subject terms: Translational research, mental health, rehabilitation, quality and outcomes, stroke
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Gialanella, Bernardo, and Paola Prometti. "Rehabilitation Length of Stay in Patients Suffering from Aphasia After Stroke." Topics in Stroke Rehabilitation 16, no. 6 (November 2009): 437–44. http://dx.doi.org/10.1310/tsr1606-437.
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Brady, Marian C., Myzoon Ali, Kathryn VandenBerg, Linda J. Williams, Louise R. Williams, Masahiro Abo, Frank Becker, et al. "Complex speech-language therapy interventions for stroke-related aphasia: the RELEASE study incorporating a systematic review and individual participant data network meta-analysis." Health and Social Care Delivery Research 10, no. 28 (September 2022): 1–272. http://dx.doi.org/10.3310/rtlh7522.
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Background People with language problems following stroke (aphasia) benefit from speech and language therapy. Optimising speech and language therapy for aphasia recovery is a research priority. Objectives The objectives were to explore patterns and predictors of language and communication recovery, optimum speech and language therapy intervention provision, and whether or not effectiveness varies by participant subgroup or language domain. Design This research comprised a systematic review, a meta-analysis and a network meta-analysis of individual participant data. Setting Participant data were collected in research and clinical settings. Interventions The intervention under investigation was speech and language therapy for aphasia after stroke. Main outcome measures The main outcome measures were absolute changes in language scores from baseline on overall language ability, auditory comprehension, spoken language, reading comprehension, writing and functional communication. Data sources and participants Electronic databases were systematically searched, including MEDLINE, EMBASE, Cumulative Index to Nursing and Allied Health Literature, Linguistic and Language Behavior Abstracts and SpeechBITE (searched from inception to 2015). The results were screened for eligibility, and published and unpublished data sets (randomised controlled trials, non-randomised controlled trials, cohort studies, case series, registries) with at least 10 individual participant data reporting aphasia duration and severity were identified. Existing collaborators and primary researchers named in identified records were invited to contribute electronic data sets. Individual participant data in the public domain were extracted. Review methods Data on demographics, speech and language therapy interventions, outcomes and quality criteria were independently extracted by two reviewers, or available as individual participant data data sets. Meta-analysis and network meta-analysis were used to generate hypotheses. Results We retrieved 5928 individual participant data from 174 data sets across 28 countries, comprising 75 electronic (3940 individual participant data), 47 randomised controlled trial (1778 individual participant data) and 91 speech and language therapy intervention (2746 individual participant data) data sets. The median participant age was 63 years (interquartile range 53–72 years). We identified 53 unavailable, but potentially eligible, randomised controlled trials (46 of these appeared to include speech and language therapy). Relevant individual participant data were filtered into each analysis. Statistically significant predictors of recovery included age (functional communication, individual participant data: 532, n = 14 randomised controlled trials) and sex (overall language ability, individual participant data: 482, n = 11 randomised controlled trials; functional communication, individual participant data: 532, n = 14 randomised controlled trials). Older age and being a longer time since aphasia onset predicted poorer recovery. A negative relationship between baseline severity score and change from baseline (p < 0.0001) may reflect the reduced improvement possible from high baseline scores. The frequency, duration, intensity and dosage of speech and language therapy were variously associated with auditory comprehension, naming and functional communication recovery. There were insufficient data to examine spontaneous recovery. The greatest overall gains in language ability [14.95 points (95% confidence interval 8.7 to 21.2 points) on the Western Aphasia Battery-Aphasia Quotient] and functional communication [0.78 points (95% confidence interval 0.48 to 1.1 points) on the Aachen Aphasia Test-Spontaneous Communication] were associated with receiving speech and language therapy 4 to 5 days weekly; for auditory comprehension [5.86 points (95% confidence interval 1.6 to 10.0 points) on the Aachen Aphasia Test-Token Test], the greatest gains were associated with receiving speech and language therapy 3 to 4 days weekly. The greatest overall gains in language ability [15.9 points (95% confidence interval 8.0 to 23.6 points) on the Western Aphasia Battery-Aphasia Quotient] and functional communication [0.77 points (95% confidence interval 0.36 to 1.2 points) on the Aachen Aphasia Test-Spontaneous Communication] were associated with speech and language therapy participation from 2 to 4 (and more than 9) hours weekly, whereas the highest auditory comprehension gains [7.3 points (95% confidence interval 4.1 to 10.5 points) on the Aachen Aphasia Test-Token Test] were associated with speech and language therapy participation in excess of 9 hours weekly (with similar gains notes for 4 hours weekly). While clinically similar gains were made alongside different speech and language therapy intensities, the greatest overall gains in language ability [18.37 points (95% confidence interval 10.58 to 26.16 points) on the Western Aphasia Battery-Aphasia Quotient] and auditory comprehension [5.23 points (95% confidence interval 1.51 to 8.95 points) on the Aachen Aphasia Test-Token Test] were associated with 20–50 hours of speech and language therapy. Network meta-analyses on naming and the duration of speech and language therapy interventions across language outcomes were unstable. Relative variance was acceptable (< 30%). Subgroups may benefit from specific interventions. Limitations Data sets were graded as being at a low risk of bias but were predominantly based on highly selected research participants, assessments and interventions, thereby limiting generalisability. Conclusions Frequency, intensity and dosage were associated with language gains from baseline, but varied by domain and subgroup. Future work These exploratory findings require confirmatory study designs to test the hypotheses generated and to develop more tailored speech and language therapy interventions. Study registration This study is registered as PROSPERO CRD42018110947. Funding This project was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme and will be published in full in Health and Social Care Delivery Research; Vol. 10, No. 28. See the NIHR Journals Library website for further project information. Funding was also provided by The Tavistock Trust for Aphasia.
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Pohontsch, Nadine Janis, Thorsten Meyer, Yvonne Eisenmann, Maria-Inti Metzendorf, Verena Leve, and Veronika Lentsch. "Study protocol of a systematic review and qualitative evidence synthesis using two different approaches: Healthcare related needs and desires of older people with post-stroke aphasia." BMJ Open 11, no. 4 (April 2021): e039348. http://dx.doi.org/10.1136/bmjopen-2020-039348.
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IntroductionStroke is a frequent disease in the older population of Western Europe with aphasia as a common consequence. Aphasia is known to impede targeting treatment to individual patients’ needs and therefore may reduce treatment success. In Germany, the postacute care of patients who had stroke is provided by different healthcare institutions of different sectors (rehabilitation, nursing and primary care) with substantial difficulties to coordinate services. We will conduct two qualitative evidence syntheses (QESs) aiming at exploring distinct healthcare needs and desires of older people living with poststroke aphasia. We thereby hope to support the development of integrated care models based on needs of patients who are very restricted to communicate them. Since various methods of QESs exist, the aim of the study embedding the two QESs was to determine if findings differ according to the approach used.Methods and analysisWe will conduct two QESs by using metaethnography (ME) and thematic synthesis (ThS) independently to synthesise the findings of primary qualitative studies. The main differences between these two methods are the underlying epistemologies (idealism (ME) vs realism (ThS)) and the type of research question (emerging (ME) vs fixed (ThS)).We will search seven bibliographical databases. Inclusion criteria comprise: patients with poststroke aphasia, aged 65 years and older, studies in German/English, all types of qualitative studies concerning needs and desires related to healthcare or the healthcare system. The protocol was registered in the International Prospective Register of Systematic Reviews, follows Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols guidelines and includes three items from the Enhancing Transparency in Reporting the synthesis of Qualitative Research checklist.Ethics and disseminationEthical approval is not required. Findings will be published in a peer-reviewed journal and presented on national conferences.
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Guhacaj, Migena, and Mary Hildebrand. "OT in an Intensive Comprehensive Aphasia Program: Addressing Occupational Gaps Among People With Aphasia." American Journal of Occupational Therapy 76, Supplement_1 (July 1, 2022): 7610505074p1. http://dx.doi.org/10.5014/ajot.2022.76s1-po74.
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Abstract Date Presented 04/01/2022 Over the course of 5 years, a total of 31 people with aphasia (PWA) participated in an Intensive Comprehensive Aphasia Program (ICAP), which included 4 hours of OT a week. Using the Activity Card Sort, this research study examined what goals PWA chose to address. Of 151 goals, PWA most frequently chose high demand leisure (27%) and instrumental (27%) activities. This provides support for OT in ICAPs to address these occupations affected by stroke. Primary Author and Speaker: Migena Guhacaj Additional Authors and Speakers: Mary Hildebrand
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Sundin, Karin, Lilian Jansson, and Astrid Norberg. "Understanding between care providers and patients with stroke and aphasia: a phenomenological hermeneutic inquiry." Nursing Inquiry 9, no. 2 (June 2002): 93–103. http://dx.doi.org/10.1046/j.1440-1800.2002.00135.x.
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Brogan, Emily, Erin Godecke, and Natalie Ciccone. "Behind the therapy door: what is “usual care” aphasia therapy in acute stroke management?" Aphasiology 34, no. 10 (May 18, 2020): 1291–313. http://dx.doi.org/10.1080/02687038.2020.1759268.
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Souza, Regina Cláudia Silva, and Edna Apparecida Moura Arcuri. "Communication Strategies Of The Nursing Team In The Aphasia After Cerebrovascular Accident." Revista da Escola de Enfermagem da USP 48, no. 2 (April 2014): 292–98. http://dx.doi.org/10.1590/s0080-6234201400002000014.
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This is an exploratory, cross-sectional study of quantitative design that aimed to identify the communication strategies used and reported by the nursing staff in the care of aphasic patients after a stroke. The techniques used were the participant observation and interviews with 27 subjects of the nursing staff of neurological units in a general hospital. The most frequently mentioned strategies were gestures (100%), verbal communication (33.3%), written communication (29.6%) and the touch (18.5 %). Among the observed strategies, the gestures reached 40.7% and the touch was present in all situations, given its instrumental character essential to care. The findings show lack of knowledge of nonverbal, proxemics , kinesics and tacesics communication. No significant differences were observed among the professional categories depending on the length of experience with respect to the strategies reported by members of the nursing staff in the care for aphasic patients.
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Rao, Leela A., Angela C. Roberts, Rhiana Schafer, Alfred Rademaker, Erin Blaze, Marissa Esparza, Elizabeth Salley, et al. "The Reliability of Telepractice Administration of the Western Aphasia Battery–Revised in Persons With Primary Progressive Aphasia." American Journal of Speech-Language Pathology 31, no. 2 (March 10, 2022): 881–95. http://dx.doi.org/10.1044/2021_ajslp-21-00150.
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Purpose: The use of telepractice in the field of communication disorders offers an opportunity to provide care for those with primary progressive aphasia (PPA). The Western Aphasia Battery–Revised (WAB-R) is used for differential diagnosis, to assess severity of aphasia, and to identify a language profile of strengths and challenges. Telehealth administration of the WAB-R is supported for those with chronic aphasia due to stroke but has not yet been systematically explored in neurodegenerative dementia syndromes. To fill this gap, in-person and telehealth performance on the WAB-R from participants with mild to moderate PPA was compared. Method: Nineteen participants with mild to moderate PPA were administered the WAB-R in person and over videoconferencing. Videoconferencing administration included modifications to the testing protocol to ensure smooth completion of the assessment. Subtest and Aphasia Quotient (WAB-AQ) summary scores were compared using concordance coefficients to measure the relationship between the administration modes. Results: In-person and telehealth scores showed strong concordance for the WAB-AQ, Auditory Verbal Comprehension subtest, and Naming & Word Finding subtest. The Spontaneous Speech test summary score had slightly lower concordance, indicating the need for caution when comparing these scores across administration modes. Conclusion: These findings support extending the use of telehealth administration of the WAB-R via videoconferencing to those with mild to moderate PPA given appropriate modifications to testing protocol.
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Foley, Erin L., Marjorie L. Nicholas, Carolyn M. Baum, and Lisa Tabor Connor. "Influence of Environmental Factors on Social Participation Post-Stroke." Behavioural Neurology 2019 (January 16, 2019): 1–8. http://dx.doi.org/10.1155/2019/2606039.
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Objectives. For rehabilitation professionals to adequately address meaningful participation in social activities with their patients after a stroke, there must be a better understanding of neurobehavior, that is, how neurological impairment and its sequelae and environmental factors support or limit social participation. The current study examines how stroke severity (NIH Stroke Scale), its impact on perceived mobility (Stroke Impact Scale mobility domain), and the environment (MOS Social Support–Positive Social Interactions scale and Measure of Stroke Environment receptivity and built environment domains) influence social participation (Activity Card Sort: ACS). Methods. A correlational, cross-sectional design examined the relationships among neurological impairment, perceived limitations in activity, environmental factors, and social participation. Participants included 48 individuals who were at least 6 months post-stroke both with aphasia (N=22) and without aphasia (N=26) living in the community for whom all measures were available for analysis. Results. No differences in social participation were found between those with and without aphasia, though both groups reported a large (25-30%) decline in participating in their prestroke social activities. For the ACS Social Domain activities and ACS Partner to Do With activities (percent retained), 37% and 35% of the variance, respectively, was accounted for by the predictor variables, with only MOS Social Support making an independent contribution to social participation. In this sample, neurological impairment was not a significant correlate of social participation. Additionally, perceived mobility and the built environment were not found to independently predict participation in social activities. Conclusions. Perceived social support was found to predict social participation in individuals living in the community 6 months or greater post-stroke. Focusing on social support during post-stroke rehabilitation may provide an avenue for increased social participation and more successful community reintegration.
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Schindel, Daniel, Lena Mandl, Ralph Schilling, Andreas Meisel, and Liane Schenk. "Guideline adherence in speech and language therapy in stroke aftercare. A health insurance claims data analysis." PLOS ONE 17, no. 2 (February 3, 2022): e0263397. http://dx.doi.org/10.1371/journal.pone.0263397.
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Background Impairments to comprehension and production of speech (aphasia, dysarthria) and swallowing disorders (dysphagia) are common sequelae of stroke, reducing patients’ quality of life and social participation. Treatment oriented on evidence-based guidelines seems likely to improve outcomes. Currently, little is known about guideline adherence in stroke aftercare for the above-mentioned sequelae. This study aims to analyse guideline adherence in the treatment of aphasia, dysarthria and dysphagia after stroke, based on suitable test parameters, and to determine factors that influence the implementation of recommended therapies. Methods Six test parameters were defined, based on systematic study of guidelines for the treatment of speech impairments and swallowing disorders (e.g. comprehensive diagnostics, early initiation and continuity). Guideline adherence in treatment was tested using claims data from four statutory health insurance companies. Multivariate logistic and linear regression analyses were performed in order to test the outcomes. Results 4,486 stroke patients who were diagnosed with specific disorders or received speech therapy were included in the study. The median age was 78 years; the proportion of women was 55.9%. Within the first year after the stroke, 90.3% of patients were diagnosed with speech impairments and swallowing disorders. Overall, 44.1% of patients received outpatient speech and language therapy aftercare. Women were less frequently diagnosed with specific disorders (OR 0.70 [95%CI:0.55/0.88], p = 0.003) and less frequently received longer therapy sessions (OR 0.64 [95%CI:0.43/0.94], p = 0.022). Older age and longer hospitalization duration increased the likelihood of guideline recommendations being implemented and of earlier initiation of stroke aftercare measures. Conclusions Our observations indicate deficits in the implementation of guideline recommendations in stroke aftercare. At the same time, they underscore the need for regular monitoring of implementation measures in stroke aftercare to address group-based disparities in care.
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Pratiwi, Sri Hartati, Eka Afrima Sari, and Ristina Mirwanti. "Pasien Paska Stroke Pada Fase Subacute: Informasi Yang Dibutuhkan." Malahayati Nursing Journal 5, no. 2 (February 1, 2022): 362–70. http://dx.doi.org/10.33024/mnj.v5i2.5901.
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ABSTRACT: POST STROKE PATIENTS IN THE SUBACUTE PHASE: INFORMATION REQUIRED Introduction: Post-stroke patient care in the subacute phase is carried out independently by the patient and family at home. Post-stroke patients must have adequate knowledge to carry out self-care at home. The lack of information obtained by post-stroke patients can affect the patient's ability to carry out self-care so that his health status decreases. Therefore, nurses as educators must be able to provide information according to the needs of post-stroke patients.Purpose: This study was conducted to determine the information needs of post-stroke patients in the sub-acute phase so that the nursing care provided is in accordance with the patient's needs.Method: This study is a quantitative descriptive study conducted on post-stroke patients at the Neurology Polyclinic, one of the hospitals in Bandung. The sample technique used was consecutive sampling as many as 83 people. The inclusion criteria of post-stroke patients in this study were having full awareness and not experiencing aphasia. The instrument used in this study was based on the concept of the needs of post-stroke patients Kevitt (2009) and Moreland (2009) with a validity coefficient of 0.73 and an r of 0.75.Result: The information needs of post-stroke patients in a row include information about self-management to prevent recurrence or stroke recurrence ( = 1,59), nformation about nutrition that must be taken ( = 1,54), information about risks and side effects of treatment ( = 1,49), information about certainty of disease condition ( = 1,48), and information about stroke ( = 1,45).Conclusion: Post-stroke patients need all information related to stroke, especially regarding self-management. Therefore, health workers are expected to provide education according to patient needs. Education for stroke patients can be done using various media and focuses on the patient. Keywords: Informations needs, Subacute, Stroke Patients INTISARI: PASIEN PASKA STROKE PADA FASE SUBACUTE: INFORMASI YANG DIBUTUHKAN Latar Belakang: Perawatan pasien post stroke pada fase subacute dilakukan secara mandiri oleh pasien dan keluarga di rumah. Pasien paska stroke harus memiliki pengetahuan yang adekuat untuk menjalankan perawatan diri di rumah. Kurangnya informasi yang didapatkan pasien paska stroke dapat mempengaruhi kemampuan pasien menjalankan perawatan diri sehingga status kesehatannya menurun. Oleh karena itu, perawat sebagai edukator harus mampu memberikan informasi sesuai kebutuhan pasien paska stroke. Tujuan: Penelitian ini dilakukan untuk mengetahui kebutuhan informasi pasien paska stroke pada fase subacute agar asuhan keperawatan yang diberikan sesuai dengan kebutuhan pasien.Metoda Penelitian: Penelitian ini merupakan penelitian deskriptif kuantitatif yang dilakukan kepada pasien paska stroke di Poliklinik Saraf dua Rumah Sakit di Bandung. Teknik sample yang digunakan adalah consecutive sampling sebanyak 83 orang. Kriteria inklusi pasien paska stroke dalam penelitian ini adalah memiliki kesadaran penuh dan tidak mengalami aphasia. Instrumen yang digunakan dalam penelitian ini disusun berdasarkan konsep kebutuhan pasien paska stroke khususnya bagian kebutuhan informasi yang dikembangkan oleh Kevitt (2009) dan Moreland (2009) dengan koefisien validitas 0,73 dan r 0,75.Hasil: Kebutuhan informasi pasien paska stroke secara berturut-turut diantaranya adalah informasi mengenai manajemen diri untuk mencegah kekambuhan atau stroke ulang ( = 1,59), informasi mengenai nutrisi yang harus dijalani ( = 1,54), informasi mengenai resiko dan efek samping pengobatan ( = 1,49), informasi mengenai kepastian kondisi penyakit ( = 1,48), dan informasi mengenai penyakit stroke ( = 1,45).Kesimpulan: Pasien paska stroke membutuhkan semua informasi yang berkaitan dengan stroke khususnya mengenai manajemen diri. Oleh karena itu, petugas kesehatan diharapkan dapat memberikan edukasi sesuai dengan kebutuhan pasien. Edukasi pada pasien stroke dapat dilakukan dengan menggunakan berbagai media dan berfokus pada pasien. Kata Kunci : Kebutuhan informasi, Pasien Stroke, subacute
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Latimer, Nicholas R., Simon Dixon, and Rebecca Palmer. "COST-UTILITY OF SELF-MANAGED COMPUTER THERAPY FOR PEOPLE WITH APHASIA." International Journal of Technology Assessment in Health Care 29, no. 4 (October 2013): 402–9. http://dx.doi.org/10.1017/s0266462313000421.
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Objectives: The aim of this study was to examine the potential cost-effectiveness of self-managed computer therapy for people with long-standing aphasia post stroke and to estimate the value of further research.Methods: The incremental cost-effectiveness ratio of computer therapy in addition to usual stimulation compared with usual stimulation alone was considered in people with long-standing aphasia using data from the CACTUS trial. A model-based approach was taken. Where possible the input parameters required for the model were obtained from the CACTUS trial data, a United Kingdom-based pilot randomized controlled trial that recruited thirty-four people with aphasia and randomized them to computer treatment or usual care. Cost-effectiveness was described using an incremental cost-effectiveness ratio (ICER) together with cost-effectiveness acceptability curves. A value of information analysis was undertaken to inform future research priorities.Results: The intervention had an ICER of £3,058 compared with usual care. The likelihood of the intervention being cost-effective was 75.8 percent at a cost-effectiveness threshold of £20,000 per QALY gained. The expected value of perfect information was £37 million.Conclusions: Our results suggest that computer therapy for people with long-standing aphasia is likely to represent a cost-effective use of resources. However, our analysis is exploratory given the small size of the trial it is based upon and therefore our results are uncertain. Further research would be of high value, particularly with respect to the quality of life gain achieved by people who respond well to therapy.
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Tarrant, Mark, Mary Carter, Sarah Gerard Dean, Rod S. Taylor, Fiona C. Warren, Anne Spencer, Jane Adamson, Paolo Landa, Chris Code, and Raff Calitri. "Singing for people with aphasia (SPA): a protocol for a pilot randomised controlled trial of a group singing intervention to improve well-being." BMJ Open 8, no. 9 (September 2018): e025167. http://dx.doi.org/10.1136/bmjopen-2018-025167.
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IntroductionThe singing for people with aphasia (SPA) intervention aims to improve quality of life and well-being for people with poststroke aphasia. A definitive randomised controlled trial (RCT) is required to assess the clinical and cost effectiveness of SPA. The purpose of this pilot study is to assess the feasibility of such a definitive trial and inform its design.Methods and analysisA two-group, assessor-blinded, randomised controlled external pilot trial with parallel mixed methods process evaluation and economic evaluation. Forty-eight participants discharged from clinical speech and language therapy will be individually randomised 1:1 to SPA (10 group sessions plus a resource booklet) or control (resource booklet only). Outcome assessment at baseline, 3 and 6 months postrandomisation include: ICEpop CAPability measure for adults, Stroke and Aphasia Quality of Life, EQ-5D-5L, modified Reintegration into Normal Living Index, Communication Outcome After Stroke, Very Short Version of the Minnesota Aphasia Test, Service Receipt Inventory and Care Related Quality of Life. Feasibility, acceptability and process outcomes include recruitment and retention rates, with measurement burden and trial experiences being explored in qualitative interviews (15 participants, 2 music facilitators and 2 music champions). Analyses include: descriptive statistics, with 95% CIs where appropriate; qualitative themes; intervention fidelity from videos and session checklists; rehearsal of health economic analysis.Ethics and disseminationNHS National Research Ethics Service and the Health Research Authority confirmed approval in April 2017; recruitment commenced in June 2017. Outputs will include: pilot data to inform whether to proceed to a definitive RCT and support a funding application; finalised intervention manual for multicentre replication of SPA; presentations at conferences, public involvement events; internationally recognised peer reviewed journal publications, open access sources and media releases.Trial registration numberNCT03076736.