Karen Eleanor Gracey Sage

Manchester Metropolitan University | MMU · Faculty of Health, Psychology and Social Care

Background People who have communication difficulties may benefit from using augmentative and alternative communication (AAC). Understanding and measuring outcomes from the use of AAC is an important part of evaluating the impact of devices and services. Outcome measurement needs to reflect the changing nature of the impact of using AAC on an indiv...

Background Digital advancement of power assisted exercise equipment will advance exercise prescription for people with stroke (PwS). This article reports on the remote usability evaluation of a co-designed graphical user interface (GUI) and denotes an example of how video-conference software can increase reach to participants in the testing of reha...

Background: Evidence-based recommendations for a core outcome set (COS; minimum set of outcomes) for aphasia treatment research have been developed (the Research Outcome Measurement in Aphasia-ROMA, COS). Five recommended core outcome constructs: communication, language, quality of life, emotional well-being and patient-reported satisfaction/impac...

Stroke survivors and informal caregivers experience high levels of stress and anxiety, linked to heightened risk of secondary stroke in survivors. Relaxation and mindfulness could reduce stress and anxiety; being most effective when tailored to the target populations. Aims of the PPI include to: (1) consult on possible alterations to an existing re...

As speech and language therapists, we explored theories of communication and voice that are familiar to our profession and found them an inadequate basis on which to generate deep and rich analysis of the qualitative data from people who have communication difficulties and who use augmentative and alternative communication. Expanding our conceptual...

Background Multi-parameter risk assessment is recommended to aid treatment decisions in patients with pulmonary arterial hypertension. The 1-minute sit-to-stand test has been validated for use in other respiratory illnesses. The aim of this study was to evaluate its safety in the hospital setting and potential utility in remote assessment in patien...

Power assisted exercise equipment designed to assist multi-directional movements represent an exercise solution for people with stroke. Users identified digitization of the equipment through a new Graphical User Interface (GUI) to display feedback on exercise performance as a development priority. The Medical Device Technology (MDT) framework was a...

Background: We require high-quality information on the current burden, the types of therapy and resources available, methods of delivery, care pathways and long-term outcomes for people with aphasia. Aim: To document and inform international delivery of post-stroke aphasia treatment, to optimise recovery and reintegration of people with aphasia. Me...

Background: Stroke is the leading cause of chronic physical disability in Western industrialised nations. Despite clear guidelines for exercise in individuals with many non-communicable diseases, the guidance for people with stroke (PwS) who frequently present with multiple comorbidities is less clear. A systematic review of exercise guidelines wa...

Introduction: Stroke-associated pneumonia (SAP) is a common complication associated with poor outcomes. Early dysphagia screening and specialist assessment is associated with a reduced risk of SAP. Evidence about oral care and nasogastric tube (NGT) placement is equivocal. This study aimed to expose variations in dysphagia management practices and...

Purpose Seated Power Assisted Exercise (PAE) equipment is an accessible exercise mode for people with limited mobility following stroke and is available at a small number of community-based venues. The purpose of this qualitative study was to understand the lived experience of using PAE amongst PwS in a community venue and identify recommendations...

Plain English Summary Seated power assisted exercise machines assist different combinations of movement and can help people with stroke to take part in exercise programmes. Nine seated machines are manufactured in the UK. It was identified that the machines could be improved through development of technology to detect and display the user’s physica...

Background: Stroke is one of the major causes of chronic physical disability in the United Kingdom, typically characterized by unilateral weakness and a loss of muscle power and movement coordination. When combined with pre-existing comorbidities such as cardiac disease and diabetes, it results in reductions in cardiovascular (CV) fitness, physical...

Background Power assisted exercise is accessible and acceptable for people with stroke. The potential for technological advancement of the equipment to improve the user experience has been identified. Involvement of end users and service providers in the design of health technologies is essential in determining how said technology is perceived and...

Background The role of public involvement (PI) in healthcare research is growing in importance and it is imperative that researchers continuously reflect on how to promote the inclusion of patients and service users in the design and delivery of research. PI offers a mechanism for end-users to be involved planning, executing, and reporting research...

Background There has been growing interest in rehabilitation in patients with pulmonary hypertension in the last 15 years. Questions remain, however, over the most suitable rehabilitation interventions for this patient group, as well as optimal models for delivery. Addressing these questions relies on a clear understanding of the outcomes used in s...

Background: The role of public involvement (PI) in healthcare research is growing in importance and it is imperative that researchers continuously reflect on how to promote the inclusion of patients and service users in the design and delivery of research. PI offers a mechanism for end-users to be involved planning, executing, and reporting researc...

Dysphagia is associated with increased risk of stroke-associated pneumonia (SAP). However, it is unclear what other factors contribute to that risk or which measures may reduce it. This systematic review aimed to provide evidence on interventions and care processes associated with SAP in patients with dysphagia. Studies were screened for inclusion...

Rationale: The evidence base for rehabilitation in pulmonary hypertension is expanding but adoption in clinical practice is limited. Objectives: The World Health Organisation International Classification for Functioning, Disability and Health (ICF) identifies 3 health domains; Body Functions/Structures, Activity and Participation in society. To...

This short report presents a small-scale explorative study about children with Autism Spectrum Disorder (ASD) interaction with robots during clinical interactions. This is part of an ongoing project, which aims at defining a robotic service for supporting children with developmental disabilities and increase the efficiency of routine procedures tha...

(1) Background: Swallowing difficulties (dysphagia) after stroke are not uncommon and is a consistent risk factor for stroke-associated pneumonia. This interview study explores the perspectives of stroke survivors, who had their swallowing assessed in the first few days of admission to hospital, and their informal caregivers. (2) Methods: A partici...

Background Highly structured, supervised exercise training has been shown to be beneficial in patients with pulmonary hypertension. Despite evidence of the effectiveness of community-based rehabilitation in other cardiopulmonary diseases, there are limited data in patients with pulmonary hypertension. Methods This prospective study evaluated the i...

(1) Background: Patients with dysphagia are at increased risk of stroke-associated pneumonia. There is wide variation in the way patients are screened and assessed. The aim of this study is to explore staff opinions about current practice of dysphagia screening, assessment and clinical management in acute phase stroke. (2) Methods: Fifteen intervie...

Jargon aphasia is a language disorder characterised by phonological and nonword error. Errors are thought to arise when target segments are insufficiently activated, allowing non-target or recently used phonology to intrude. Words which are more frequent and familiar reside with greater degrees of activation and therefore should be less susceptible...

A presentation of the preliminary results of a systematic review.

Purpose People who have complex communication needs (CCN), and who use augmentative and alternative communication (AAC) to help them express themselves, can be difficult to engage in decision making about their healthcare. The purpose of this review was to identify what patient-reported outcome measures (PROMs) have been employed with people who us...

Purpose: The therapeutic alliance, also known as the therapeutic relationship, may influence treatment process and outcome in aphasia rehabilitation; however, we currently lack a reliable tool to measure this relationship. This study aimed to develop a novel measure of the therapeutic alliance applicable to this population and provide preliminary e...

Speech perception impairments are a universal feature of Wernicke’s aphasia (WA) and are systematically related to the Wernicke’s-type language comprehension impairment. However, speech perception is not absent; phonological changes can be identified with sufficient acoustic difference between stimuli. This study used a measure of non-instantaneous...

Background: This NIHR-funded research study aims to develop a PROM for people who use AAC. People with CCN, usually resulting from a neurological condition, have difficulties with speaking or writing. AAC are tools used by some people with CCN to help them communicate and range from basic, paper-based resources to complex computer systems. Generati...

Background The physical benefits of exercise following stroke are research evidenced and the UK stroke population is increasingly encouraged to engage with exercise interventions. A synthesis of qualitative research is required to further understand the perceived experience and psychosocial effect of exercise for people with stroke. Objectives To...

Purpose: To identify which elements of the therapeutic alliance are important to people with aphasia (PWA) attending speech-language pathology post-stroke. Method: A Q methodology design was adopted to explore which elements of the therapeutic alliance were valued by PWA. Statements (n = 453) relevant to the research question were extrapolated from...

Jargon aphasia is an acquired language disorder characterised by high proportions of nonword error production, rendering spoken language incomprehensible. There exist two major hypotheses relating to the source of nonword error; one implicates disruption to phonological processing and the other suggests both phonological and lexical contributions....

Background: Jargon aphasia is a complex acquired language disorder which is characterised by fluent verbal output and usually accompanied by poor error monitoring. Written or graphemic jargon may or may not co-occur with spoken jargon. Intervention to address jargon behaviour is difficult to design due to the presence of poor self-monitoring of err...

Background: A core outcome set (COS; an agreed, minimum set of outcomes) was needed to address the heterogeneous measurement of outcomes in aphasia treatment research and to facilitate the production of transparent, meaningful, and efficient outcome data. Objective: The Research Outcome Measurement in Aphasia (ROMA) consensus statement provides...

Introduction The NHS is placing increased value on patient centred care. There is a risk that relying on conventional, language-based methods for communication between patients and providers excludes populations who find it difficult to engage with written and spoken words. Co-design principles enable users to have a voice without relying on words,...

Background: Patients with dysphagia are at an increased risk of stroke-associated pneumonia. There is wide variation in the way patients are screened and assessed during the acute phase. The aim of this review was to identify the methods of assessment and management in acute stroke that influence the risk of stroke-associated pneumonia. Studies of...

The results of a systematic review into what patient reported outcome measures are used with people who rely on augmentative and alternative communication.

Background: The therapeutic alliance has been found to be a critical component of treatment delivery in mental health interventions. This construct may have the potential to inform both treatment efficacy and adherence in aphasia rehabilitation. However, little is known about how people with aphasia perceive therapeutic alliance construction in the...

Background Aphasia assessment is traditionally divided into formal and informal approaches. Informal assessment is useful in developing a rich understanding of the person with aphasia's performance, e.g., describing performance in the context of real‐world activities, and exploring the impact of environmental and/or partner supports upon communicat...

Background: Therapeutic alliance refers to the interactional and relational processes operating during therapeutic interventions. It has been shown to be a strong determinant of treatment efficacy in psychotherapy, and evidence is emerging from a range of healthcare and medical disciplines to suggest that the construct of therapeutic alliance may...

Background: Simmons-Mackie et al. (2010) stress the importance of the relationship between the environment and the person with aphasia and the key role of the communication partner. Intervention programmes for communication partners are based on the identification of barrier behaviours in conversation and the use of facilitating strategies for comm...

Background: Simmons-Mackie et al. (2010) stress the importance of the relationship between the environment and the person with aphasia and the key role of the communication partner. Intervention programmes for communication partners are based on the identification of barrier behaviours in conversation and the use of facilitating strategies for comm...

Dysphagia in acute stroke significantly increases risk of stroke-associated pneumonia (SAP). There are large variations in dysphagia assessment and management during the first 72 hours when patients are most susceptible. This Stroke Association funded study will investigate how these variations and organisational factors systemic to this patient gr...

Awake craniotomy often results in postoperative aphasia. Over the last several decades, neurosurgical technologies have evolved, increasing resection precision for the surgeon (e.g., intraoperative fMRI). However, one ongoing concern reported by surgical teams is delineating the extent of tissue that can be safely resected – remove too little and o...

Dysphagia increases the risk of pulmonary complications. This poster describes how the proposed Stroke Association funded study will examine variations in assessment and management during the first 72 hours of admission post stroke and how this impacts on development of stroke-association pneumonia. The potential impact of this research on practice...

Background: Semantic dementia is a rarer dementia, classified as a type of frontotemporal dementia and a variant of primary progressive aphasia. Studies examining conversation in this condition and interventions to enhance participation in family life present as gaps in the research literature. Methods: Working with one family on a longitudinal bas...

This study examined patterns of neologistic and perseverative errors during word repetition in fluent Jargon aphasia. The principal hypotheses accounting for Jargon production indicate that poor activation of a target stimulus leads to weakly activated target phoneme segments, which are outcompeted at the phonological encoding level. Voxel-lesion s...

This paper outlines the clinical doctoral research plan (funded by HEE/NIHR Integrated Clinical Academic Programme) to engage the wide range of people who use alternative and augmentative communication (AAC) to understand the perspectives of users in order to develop a Patient Reported Outcome Measure (PROM) to evaluate equipment and services.

Purpose: Exploration of the clinical uptake of a novel conversation partner training (CPT) programme in aphasia in 10 Dutch rehabilitation facilities and identification of its perceived facilitators and barriers in service providers, and the evaluation of the implementation methods used. Method: Ten rehabilitation centres took part in a multifacete...

Behavioural impairment post-stroke is a consequence of structural damage and altered functional network dynamics. Hypoperfusion of intact neural tissue is frequently observed in acute stroke, indicating reduced functional capacity of regions outside the lesion. However, cerebral blood flow (CBF) is rarely investigated in chronic stroke. This study...

Background There has been increasing interest in dementia care in recent years, including how practitioners, service providers and society in general can help individuals to live well with the condition. An important aspect to this is provision of advice to ensure conversation partners effectively support the person with dementia in conversation....

En el presente capítulo tratamos de describir la valoración e intervención de las afasias desde un enfoque funcional en el que se tiene en cuenta a la persona con afasia pero también a las personas con las que se comunica, las situaciones a las que se enfrenta o las actitudes de sus interlocutores cercanos. Nuestro objetivo es acercar al lector a c...

Background: Improving email writing in people with aphasia could enhance their ability to communicate, promote interaction and reduce isolation. Spelling therapies have been effective in improving single-word writing. However, there has been limited evidence on how to achieve changes to everyday writing tasks such as email writing in people with a...

Background: The increase in the number of reported conversation partner programmes for conversation partners of people with aphasia demonstrates increased awareness of partner needs and the positive effect of trained partners on the communicative abilities of the person with aphasia. Predominantly small-scale studies describe the effectiveness of...

Background: Bromocriptine has been used in previous studies to treat people with non-fluent aphasia with varying levels of success. Aims: This single case study set out to describe the effect of a 30 mgdose of bromocriptine on the behaviour, cognition and linguistic skills of a person with aphasia post-cerebrovas- cular accident. Methods and Proced...

Objective: To synthesise qualitative studies exploring patients' and professionals' perspectives and experiences of developing and maintaining therapeutic alliances in stroke rehabilitation. Data source: A systematic literature search was conducted using the following electronic databases: PsychInfo, CINAHL, EMBASE, Medline, AMED, ASSIA, ComDisD...

Purpose: Improving writing in people with aphasia could improve ability to communicate, reduce isolation and increase access to information. One area that has not been sufficiently explored is the effect of impairment based spelling therapies on functional writing. A multiple case study was conducted with eight participants with aphasia subsequent...

Background: Aphasia rehabilitation should comprise a family-centred approach, involving main conversation partners in the rehabilitation process as soon as possible. A standardised approach to conversation partner training (CPT) became available in the Netherlands with the release of Partners of Aphasic clients Conversation Training (PACT). PACT wa...

Purpose – The purpose of this paper is to gain consensus regarding the clinical priorities and tasks required in supporting communication needs in those living with semantic dementia and their families, by specialist speech and language therapists (SLTs), working in clinical practice within dementia care settings in the UK. Design/methodology/appr...

This dataset includes emails from forty two control participants ranging from 16 to 88 years of age (mean = 46) and 9 to 24 years of education (mean = 13). Three emails were produced by each participant (between 2011 and 2014), each within a time limit of three minutes. It is expected that this normative data will be useful for clinicians and resea...

Writing therapy studies have been predominantly uni-modal in nature; i.e., their central therapy task has typically been either writing to dictation or copying and recalling words. There has not yet been a study that has compared the effects of a uni-modal to a multi-modal writing therapy in terms of improvements to spelling accuracy. A multiple-ca...

Background: Acquired dysgraphia (impaired writing/spelling skills) can significantly restrict people from participating in social, professional, and educational life. Using writing in order to access the Internet via computers, tablets, and mobile phones has become an important part of everyday life for people of all ages. Improving writing in peop...

Background: Capturing evidence of the effects of therapy within everyday communication is the holy grail of aphasia treatment design and evaluation. Whilst impaired sentence production is a predominant symptom of Broca's-type aphasia, the effects of sentence production therapy on everyday conversation have not been investigated. Given the context-...

Background: Therapy for people with aphasia (PWA) can encompass a wide range of aims and methodologies from targeting the linguistic impairment to strategic compensation to optimise communication, interaction, and vocational rehabilitation. Aphasia rehabilitation ultimately has a social goal of optimising the communication of PWA within their typic...

Background Auditory discrimination is significantly impaired in Wernicke’s aphasia (WA) and thought to be causatively related to the language comprehension impairment which characterises the condition. This study used mismatch negativity (MMN) to investigate the neural responses corresponding to successful and impaired auditory discrimination in WA...

Wernicke's aphasia occurs after a stroke to classical language comprehension regions in the left temporoparietal cortex. Consequently, auditory-verbal comprehension is significantly impaired in Wernicke's aphasia but the capacity to comprehend visually presented materials (written words and pictures) is partially spared. This study used functional...

Semantic dementia is a variant of frontotemporal dementia and is a recently recognized diagnostic condition. There has been some research quantitatively examining care partner stress and burden in frontotemporal dementia. There are, however, few studies exploring the subjective experiences of family members caring for those with frontotemporal deme...