No full-text available
To read the full-text of this research,
you can request a copy directly from the authors.
An Umbrella Review of Aphasia Intervention descriPtion In Research: the AsPIRE project
Aphasiology
Abstract
Background: Recent reviews conclude that aphasia intervention is effective. However, replication and implementation require detailed reporting of intervention is and a specification of participant profiles. To date, reviews concentrate more on efficacy than on intervention reporting quality.
Aims : The aim of this project is to review the descriptions of aphasia interventions and participants appearing in recent systematic reviews of aphasia intervention effectiveness. The relationship between the quality of these descriptions and the robustness of research design is explored, and the replicability of aphasia interventions is evaluated.
Methods and Procedures : The scope of our search was an analysis of the aphasia intervention studies included in the and EBRSR 2018 systematic reviews, and in the RCSLT 2014 literature synthesis. Intervention descriptions published separately from the intervention study (i.e. published online, in clinical tools, or a separate trial protocols) were not included. The criteria for inclusion were that participants had aphasia, the intervention involved language and/or communication, and included the following research designs: Randomised Controlled Trial (RCT), comparison or control, crossover design, case series. Exclusion criteria included non-SLT interventions, studies involving fewer than four participants, conference abstracts, studies not available in English. Studies were evaluated for completeness of intervention description using the TIDieR Checklist. Additionally, we rated the quality of patient and intervention description, with particular reference to replicability.
Outcomes and Results: Ninety-three studies were included. Only 14 studies (15%) had >50 participants. Fifty-six studies (60%) did not select participants with a specific aphasia profile, and a further 10 studies only described participants as non-fluent. Across the studies, an average of eight (of 12) TIDieR checklist items were given but information on where, tailoring, modification and fidelity items was rarely available. Studies that evaluated general aphasia intervention approaches tended to use RCT designs, whereas more specific intervention studies were more likely to use case series designs.
Conclusions: Group studies were generally under-powered and there was a paucity of research looking at specific aphasia interventions for specific aphasia profiles. There was a trade-off between the robustness of the design and the level of specificity of the intervention described. While the TIDieR framework is a useful guide to information which should be included in an intervention study, it is insufficiently sensitive for assessing replicability. We consider possible solutions to the challenges of making large-scale trials more useful for determining effective aphasia intervention.
... The Aphasia Intervention description In Research (AsPIRE) project (Dipper et al., 2022) outlines several considerations for aphasia intervention studies. These include the use of the Template for Intervention Description and Replication (TIDieR) framework (Hoffman et al., 2014), with additional reporting items developed by the authors to assist with research replicability (Dipper et al., 2022;Behn et al., 2022). ...
... The Aphasia Intervention description In Research (AsPIRE) project (Dipper et al., 2022) outlines several considerations for aphasia intervention studies. These include the use of the Template for Intervention Description and Replication (TIDieR) framework (Hoffman et al., 2014), with additional reporting items developed by the authors to assist with research replicability (Dipper et al., 2022;Behn et al., 2022). The AsPIRE project recommends that research should state how intervention is provided, session duration and intensity, modifications made, stimulus materials used, target response required, type of feedback provided, and fidelity and adherence to a program protocol (Dipper et al., 2022). ...
... These include the use of the Template for Intervention Description and Replication (TIDieR) framework (Hoffman et al., 2014), with additional reporting items developed by the authors to assist with research replicability (Dipper et al., 2022;Behn et al., 2022). The AsPIRE project recommends that research should state how intervention is provided, session duration and intensity, modifications made, stimulus materials used, target response required, type of feedback provided, and fidelity and adherence to a program protocol (Dipper et al., 2022). Adequate reporting of these add to the validity of the research, provides opportunity for study replication, generalisation to the acute clinical setting and facilitates future synthesis and meta-analysis (Brady et al., 2020;Dipper et al., 2022). ...
... In a recent review of 93 studies, less than 30% reported actual or planned fidelity in aphasia treatment studies with information on where the treatment was provided, individual treatment tailoring, and modification rarely reported [9]. Reviews of treatment fidelity processes confirm limited treatment fidelity reporting in aphasia treatment studies [10][11][12]. ...
... In complex behavioural interventions, the multiple planned elements of the intervention are interconnected, such that isolating and describing the therapeutic elements of a complex behavioural intervention is challenging. While study design and treatment tasks are frequently reported in aphasia trials, the theoretical underpinnings and potential active ingredients within the intervention are reported much less often [9,11]. When delivering and evaluating an intervention such as aphasia therapy, conceptualising and developing the therapeutic elements into a measurable protocol can seem overwhelming. ...
Background
Treatment fidelity is inconsistently reported in aphasia research, contributing to uncertainty about the effectiveness of types of aphasia therapy following stroke. We outline the processes and outcomes of treatment fidelity monitoring in a pre-specified secondary analysis of the VERSE trial.
Methods
VERSE was a 3-arm, single-blinded RCT with a 12-week primary endpoint comparing Usual Care (UC) to two higher intensity treatments: Usual Care-Plus (UC-Plus) and VERSE, a prescribed intervention. Primary outcome results were previously reported. This secondary analysis focused on treatment fidelity. Video-recorded treatment sessions in the higher intensity study arms were evaluated for treatment adherence and treatment differentiation. Treatment components were evaluated using a pre-determined fidelity checklist. Primary outcome: prescribed amount of therapy time (minutes); secondary outcomes: (i) adherence to therapy protocol (%) and (ii) treatment differentiation between control and high intensity groups.
Results
Two hundred forty-six participants were randomised to Usual Care (n=81), Usual Care-Plus (n=82), and VERSE (n=83). One hundred thirty-five (82%) participants in higher intensity intervention arms received the minimum prescribed therapy minutes. From 10,805 (UC 7787; UC-Plus 1450; VERSE 1568) service events, 431 treatment protocol deviations were noted in 114 participants. Four hundred thirty-seven videos were evaluated. The VERSE therapists achieved over 84% adherence to key protocol elements. Higher stroke and aphasia severity, older age, and being in the UC-Plus group predicted more treatment deviations.
Conclusions
We found high levels of treatment adherence and differentiation between the intervention arms, providing greater confidence interpreting our results. The comprehensive systems for intervention fidelity monitoring and reporting in this trial make an important contribution to aphasia research and, we argue, should set a new standard for future aphasia studies.
Trial registration
ACTRN 12613000776707
... Even after gathering information from a secondary source (e.g., correspondence with the authors), only 28% of the interventions fulfilled all TIDieR checklist items. Dipper et al. (2022) found that, on average, authors only provided eight of the 12 TIDieR checklist items (66.6%) in the primary papers included in their umbrella review of aphasia interventions. In a systematic search and review of phonological interventions, Baker et al. (2022) found that the mean fulfillment of TIDieR items was 61%. ...
Purpose
The speech-language-hearing sciences (SLHS) field relies on rigorous research to inform clinical practice and improve outcomes for individuals with communication, swallowing, and hearing needs. However, a significant challenge in our field is the lack of accessibility, transparency, and reproducibility of this research. Such insufficiencies limit the generalizability and impact of study findings, particularly intervention research, as it becomes difficult to replicate and use the interventions in both clinical practice and research. In this tutorial, we highlight one particularly useful tool, the Template for Intervention Description and Replication (TIDieR; Hoffmann et al., 2014) checklist, which researchers can follow to improve reproducibility practices in SLHS.
Conclusions
We provide an overview and guide on using the TIDieR checklist with a practical example of its implementation. Additionally, we discuss the potential benefits of increased transparency and reproducibility for SLHS, including improved clinical outcomes and increased confidence in the effectiveness of interventions. We also provide specific recommendations for scientists, journal reviewers, editors, and editorial boards as they seek to adopt, implement, and encourage using the TIDieR checklist.
... The introduction of the Template for Intervention Description and Replication (TIDieR) checklist and guide [14] has both encouraged researchers to provide more detail about their interventions but also acted as an evaluation tool to demonstrate how infrequently intervention details are reported. Intervention reporting has been found wanting in both aphasia [15] and telehealth research [16]. ...
Background
Aphasia is a communication disorder affecting more than one-third of stroke survivors. Computerized Speech and Language Therapy (CSLT) is a complex intervention requiring computer software, speech and language therapists, volunteers, or therapy assistants, as well as self-managed practice from the person with aphasia. CSLT was found to improve word finding, a common symptom of aphasia, in a multicenter randomized controlled trial (Clinical and Cost Effectiveness of Computer Treatment for Aphasia Post Stroke [Big CACTUS]).
Objective
This study provides a detailed description of the CSLT intervention delivered in the Big CACTUS trial and identified the active ingredients of the intervention directly associated with improved word finding for people with aphasia.
Methods
We conducted a multiple methods study within the context of a randomized controlled trial. In study 1, qualitative interviews explored key informants’ understanding of the CSLT intervention, how the components interacted, and how they could be measured. Qualitative data were transcribed verbatim and analyzed thematically. Qualitative findings informed the process measures collected as part of a process evaluation of the CSLT intervention delivered in the Big CACTUS trial. In study 2, quantitative analyses explored the relationship between intervention process measures (length of computer therapy access; therapists’ knowledge of CSLT; degree of rationale for CSLT tailoring; and time spent using the software to practice cued confrontation naming, noncued naming, and using words in functional sentences) and change in word-finding ability over a 6-month intervention period.
Results
Qualitative interviews were conducted with 7 CSLT approach experts. Thematic analysis identified four overarching components of the CSLT approach: (1) the StepByStep software (version 5; Steps Consulting Ltd), (2) therapy setup: tailoring and personalizing, (3) regular independent practice, and (4) support and monitoring. Quantitative analyses included process and outcome data from 83 participants randomized to the intervention arm of the Big CACTUS trial. The process measures found to be directly associated with improved word-finding ability were therapists providing a thorough rationale for tailoring the computerized therapy exercises and the amount of time the person with aphasia spent using the computer software to practice using words in functional sentences.
Conclusions
The qualitative exploration of the CSLT approach provided a detailed description of the components, theories, and mechanisms underpinning the intervention and facilitated the identification of process measures to be collected in the Big CACTUS trial. Quantitative analysis furthered our understanding of which components of the intervention are associated with clinical improvement. To optimize the benefits of using the CSLT approach for word finding, therapists are advised to pay particular attention to the active ingredients of the intervention: tailoring the therapy exercises based on the individual’s specific language difficulties and encouraging people with aphasia to practice the exercises focused on saying words in functional sentences.
Trial Registration
ISRCTN Registry ISRCTN68798818; https://www.isrctn.com/ISRCTN68798818
... The completeness of the intervention description in this review was comparable to an umbrella review of intervention descriptions in aphasia [118]. The umbrella review, 50% of studies scored 8 out of a possible 12 items, and in this review 9/14 (64%) studies scored 8 or more out of the possible 12 items. ...
Purpose
This systematic review explored how virtual reality (VR) has been used to rehabilitate aphasia.
Materials and methods
Empirical studies were included where VR was used to target language, well-being, or quality of life in adults with acquired language impairment. Degenerative communication disabilities were excluded. Seven health databases were searched in October 2021. Risk of Bias was assessed using published checklists and completeness of intervention reporting evaluated. Narrative synthesis described forms of VR, rationales given, outcome measures, communication functions targeted, characteristics of interventions, and outcomes achieved within the framework of impairment, activity, and participation.
Results
Fourteen studies, involving 229 participants, met the criteria. The studies employed four forms of VR with various rationales given. Interventions used published and novel protocols. Primary outcomes targeted language impairment (12/14), activity (1/14), and well-being (1/14) and achieved positive outcomes in impairment and activity. All studies were exploratory. Risk of bias was high. Findings are discussed in the context of gains achieved by VR in other health contexts and the multi-user gaming literature.
Conclusions
Uses of VR in aphasia rehabilitation described in the literature are limited. Most applications target the remediation of language impairments. Opportunities to address activity, participation, and wider aspects of well-being are rare.
•
IMPLICATIONS FOR REHABILITATION
• Research documenting the use of virtual reality (VR) to rehabilitate aphasia is limited and exploratory, so does not yet offer clear guidance for clinicians.
• Many of the identified studies have used known published protocols (e.g., naming therapy or scripts therapy) delivered through the novel VR format and focus on language impairment outcomes.
• VR offers clinicians a unique opportunity to address communication activity and participation through the use of multi-user virtual worlds, but this has only been explored by only two research teams.
... Future research needs to focus on: 1. a systematic review and meta-analysis of existing interventions conducted in the first 90 days post-stroke identified within this scoping review with an appraisal of study methodologies; 2. a broader scope of the nature and extent of the research into communication difficulties in addition to aphasia, that often co-occurs after stroke such as dysarthria, cognitivecommunication disability, apraxia of speech and sensory loss; 3. interventions that address (a) environmental and personal factors; and (b) increasing engagement in participation in healthcare and everyday activities; 4. a coordinated, integrated approach towards managing communication disability, globally. Initiatives such as the Collaboration of Aphasia Triallists (www.aphasiatrials.org) is an example of work towards this goal; 5. recruitment of participants to intervention studies in acute and early subacute phases of recovery; 6. the clear and standardised description of therapeutic intervention and participants profiles (see Dipper et al. for a comprehensive review) [184]; 7. consideration and action on factors that influence whether or not the management of communication disability is prioritised (e.g., cultural, social, economic, stroke care structures and clinical pathways); 8. updating clinical guidelines and research priorities to address the perspectives and preferences of survivors of stroke, family members and healthcare providers; 9. updating clinical practice guidelines to include best available evidence across communication-related domains that align with the ICF framework in acute and early subacute phases after stroke. ...
Introduction
People with communication disability after stroke need interventions to optimise healthcare communication and rehabilitation outcomes. Current evidence syntheses do not adequately inform the management of communication disability during the first 90 days post-stroke.
Purpose
To explore the scope of literature for the management of communication disability in the first 90 days after stroke.
Materials and methods
A scoping review was conducted using a systematic keyword search of six databases. A descriptive synthesis was generated using communication-related domains related to the biopsychosocial framework of the International Classification of Functioning, Disability, and Health (ICF).
Results
A total of 129 studies met eligibility criteria. Aphasia was the most frequently addressed communication disability after stroke (76/129 studies) with a paucity of evidence investigating other acquired neurogenic communication impairments. Management predominantly focused on communication-related: body functions and structures (62 studies) (e.g., linguistic-behavioural therapies), followed by environmental factors (39 studies) (e.g., communication partner training/support); activities and participation (15 studies) (e.g., augmentative and alternative communication); and personal factors (13 studies) (e.g., assessment of depression after aphasia).
Conclusion
A coordinated, integrated approach to developing and testing acute and subacute interventions for all communication disabilities across all communication-related domains is required.
•
IMPLICATIONS FOR REHABILITATION
• Interdisciplinary stroke clinicians need to manage communication disabilities in the first 90 days after stroke to optimise healthcare communication and rehabilitation outcomes.
• There is some evidence to guide clinicians in aphasia management but less in other disabilities of speech and cognitive functioning.
• Most interventions to inform clinical practice address communication-related body functions and structures (e.g., linguistic and speech therapies). Clinicians need to address all domains and more evidence is needed to address environmental factors (e.g., communication support); activities and participation (e.g., person-centred goal setting); and personal factors (e.g., psychological care).
... complex interventions 30 and the more recently updated guidelines 31 highlight these challenges and call for stronger theoretical underpinning and more detailed reporting of interventions Credibility in the field has also been reduced by mostly relying on single-case design studies or underpowered group studies. 32 Whereas phase I studies are crucial for early development and proof of concept of treatment, it is difficult to see how best practice approaches can be determined without larger, properly powered, phase II and phase III trials. This notion is certainly not specific to aphasia treatment but generally applies to all rehabilitation practice. ...
A considerable body of research supports the use of behavioral communication treatment as the standard of care for aphasia. In spite of robust progress in clinical aphasiology, many questions regarding optimal care remain unanswered. One of the major challenges to progress in the field is the lack of a common framework to adequately describe individual treatments, which, if available, would allow comparisons across studies as well as improved communication among researchers, clinicians, and other stakeholders. Here, we describe how aphasia treatment approaches can be systematically characterized using the Rehabilitation Treatment Specification System (RTSS). At the core of the RTSS is a tripartite structure that focuses on targets (the behavior that is expected to change as a result of treatment), ingredients (what a clinician does to affect change in the target), and mechanism(s) of action (why a given treatment works by linking the ingredients to the target). Three separate papers in the current issue specifically describe how the RTSS can be used to describe different kinds of aphasia treatment approaches: functional approaches, cognitive-linguistic approaches, and biological approaches. It is our hope that the application of the RTSS in clinical aphasiology will improve communication in published studies, grant proposals, and in the clinical care of persons with aphasia.
... A 2017 review of 162 RCTs in the field of SLT found that none completely reported TIDieR items, but when authors were contacted for additional detail, 28% fulfilled all TIDieR criteria [74]. Since this study, the TIDieR checklist has been used to categorise SLT treatment approaches in aphasia [75,76], to explore documentation of communication partner training interventions in aphasia [77], to specify treatment content in RCTs [78,79], and to review descriptions of aphasia interventions [80]. ...
Purpose
Aphasia is an acquired language disorder that typically occurs as a result of a stroke. People with aphasia experience communication difficulties and risk secondary impacts, for example, affecting social and work life and mental health. Intensive Comprehensive Aphasia Programmes (ICAPs) aims to address the multiple consequences of aphasia using intensive intervention and a wide range of therapy approaches. Although basic parameters of ICAP intervention have been defined, a fuller characterisation is needed. This systematic scoping review aimed to determine what constitutes an ICAP.
Methods
Peer-reviewed and Grey databases were searched for articles on ICAPs using Joanna Brigg’s Institute methodology. Data was extracted following the Template for Intervention Description and Replication (TIDieR) checklist for reporting interventions and synthesised using a narrative synthesis.
Results and conclusions
17 ICAPs were reported in 20 peer-reviewed literature sources (9 ICAPs supplemented by Grey literature sources). There were high degrees of variation in dose, professionals involved, and no qualitative data from participants. Of note, ICAP intervention was highly tailored to individual participants on the same ICAP, and intervention content varied between ICAPs. ICAPs appear to be rationalised as intensive impairment-based programmes with other components added for comprehensiveness. Stronger rationale and a logic model are required to justify the core components of ICAPs. The input of stakeholders into designing future ICAP interventions is recommended.
•
IMPLICATIONS FOR REHABILITATION
• The ICAP model is in its infancy when it comes to mainstream clinical application as only the intensity component of the ICAP has clear theoretical underpinning as reported in the peer-reviewed literature.
• There have been clinical uptakes of the ICAP model which is likely to continue and is valid in the context of an under-researched area of aphasia therapy and on a background of a less than perfect relationship between evidence base and practice.
• Aspects of the ICAP model are valid for clinicians to implement, for example, intensive evidence-based aphasia therapy in combination with therapy which addresses some of the broader implications of aphasia, for example, social isolation.
• Clinicians can use the ICAP model to review their existing service provision and explore whether their service provides aphasia therapy that addresses the multiple aspects of aphasia (i.e., ensuring the focus is not only on impairment-based therapy).
Aphasia research has traditionally been considered a (unidisciplinary) niche topic in medical science. The international Collaboration of Aphasia Trialists (CATs) is a global collaboration of multidisciplinary aphasia researchers. Over the past 10 years, CATs has collectively taken a rigorous approach to systematically address persistent challenges to aphasia research quality. This article summarizes the achievements over the past decade. CATs’ achievements include: standardizing terminology, advancing aphasia research design by aphasia expert consensus recommendations, developing a core data set and intervention descriptors, facilitating the involvement of people with the language impairment aphasia in the research process, translating, and adapting assessment tools into global languages, encouraging data sharing, developing innovative secondary data analysis methodologies and promoting the transparency and accessibility of high quality aphasia research reports. CATs’ educational and scientific achievements over the past 10 years far exceed what individual researchers in the field could have ever achieved.
The purpose of the current study was to evaluate treatment fidelity (i.e., the extent to which an intervention is provided as intended) in the Family-Centered Function-Focused Care (Fam-FFC) intervention. This was a descriptive study using data collected during intervention activities throughout the course of the Fam-FFC study. Specific measures included Environment and Policy Assessments, Fam-FFC Knowledge Test, Goal Attainment Scale, Function-Focused Care Behavior Checklist, and completion of the FamPath Audit. Delivery was provided as intended. Staff demonstrated intervention skills with only one Fam-FFC research nurse needing retraining. Receipt was based on Fam-FFC Knowledge Test scores >80%, with the majority of participants reporting goal achievement as expected or higher than expected and slight improvement in environments and policies to better support Fam-FFC. Lastly, enactment was based on evidence that in 67% of observations staff provided at least one function-focused care intervention. Findings from this study will be used to adapt the intervention to reach all staff, increase ways to change environments and policies, consider ways to more comprehensively evaluate enactment of function-focused care during real-world interactions, and consider the characteristics of nursing staff and whether a relationship exists between staff characteristics and providing function-focused care. [Research in Gerontological Nursing, xx(x), xx-xx.].
The effect of treatment dose on recovery of post-stroke aphasia is not well understood. Inconsistent conceptualisation, measurement, and reporting of the multiple dimensions of dose hinders efforts to evaluate dose-response relationships in aphasia rehabilitation research. We review the state of dose conceptualisation in aphasia rehabilitation and compare the applicability of three existing dose frameworks to aphasia rehabilitation research - the Frequency, Intensity, Time, and Type principle (FITT), the Cumulative Intervention Intensity (CII) framework, and the Multidimensional Dose Articulation Framework (MDAF). The MDAF specifies dose in greater detail than the CII framework and the FITT principle. On this basis we selected the MDAF to be applied to three diverse examples of aphasia rehabilitation research. We next critically examined applicability of the MDAF to aphasia rehabilitation research and identified the next steps needed to systematically conceptualise, measure, and report the multiple dimensions of dose, which together can progress understanding of the effect of treatment dose on outcomes for people with aphasia following stroke. Further consideration is required to enable application of this framework to aphasia interventions that focus on participation, personal, and environmental interventions and to understand how the construct of episode difficulty applies across therapeutic activities used in aphasia interventions.
Purpose
This review article synthesizes and evaluates the evidence for sentence production treatments in aphasia, systematically charting impairment-based and functional communication outcomes. It reports (a) the level of evidence and fidelity of sentence treatments; (b) the impact of treatment on production of trained and untrained verbs and sentences, functional communication, and discourse; and (c) the potential active ingredients of treatment.
Method
The search included studies from January 1980 to June 2019. The level of evidence of each study was documented, as was fidelity in terms of treatment delivery, enactment, and receipt. Studies were also categorized according to treatment methods used.
Results
Thirty-three studies were accepted into the review and predominantly constituted Level 4 evidence (e.g., case control studies and case series). Thirty studies (90%) described treatment in sufficient detail to allow replication, but dosage was poorly reported, and fidelity of treatment was rarely assessed. The most commonly reported treatment techniques were mapping (10 studies: 30%), predicate argument structure treatment (six studies: 18%), and verb network strengthening treatment (five studies: 15%). Production of trained sentences improved for 83% of participants, and improvements generalized to untrained sentences for 59% of participants. Functional communication was rarely assessed, but discourse production improved for 70% of participants.
Conclusions
The evidence for sentence treatments is predominantly generated from Level 4 studies. Treatments were effective for the majority of participants regarding trained sentence and discourse production. However, there is inconsistent use of statistical analysis to verify improvements, and diverse outcome measures are used, which makes interpretation of the evidence difficult. The quality of sentence treatment research would be improved by agreeing a core set of outcome measures and extended by ascertaining the views of participants on sentence treatments.
Purpose
The purpose of this review was to examine the effects of aphasia therapy on language and/or communication outcome measures when treatment was initiated within four months post-onset. The review evaluated the methodological quality of relevant studies and summarised the findings of the high-quality studies according to three clinical questions about the provision of aphasia treatment in the early period of recovery: (1) Is treatment better than no treatment? (2) Is one type of treatment more effective than another? (3) Do different treatment intensities result in different outcomes?
Methods
A literature search was performed for articles in which aphasia treatments were initiated fewer than four months post-aphasia onset and evaluated with a control or comparison group. Two authors rated the studies on defined methodological quality criteria and extracted data for addressing the clinical questions.
Results
A total of 23 studies met the inclusion criteria. Sixteen of the studies received high-quality ratings. Nine studies provided data addressing clinical question 1; however, only four of them were considered as high-quality studies. Results from the high-quality studies were mixed: two studies demonstrated treatment efficacy for early aphasia therapy, and two studies found no differences in outcome measures between participants who received treatment and a no-treatment control. Eleven studies provided data addressing clinical question 2; six of them were considered as high-quality. None of the eleven treatment-comparison studies found that one type of treatment resulted in greater gains compared to another type of treatment on primary outcome measures. Finally, six studies contributed data for addressing clinical question 3; all of them were considered as high-quality studies. Five studies found no significant difference in outcomes between participants assigned to lower- and higher-intensive weekly treatment schedules, and one study reported superior findings in outcomes when participants received less intensive treatment.
Conclusion
This review found mixed results across studies that examined whether early aphasia treatment improved language/communication outcomes more than no treatment. The review also found that when different types of aphasia treatments were compared, no treatment was more efficacious than another treatment and that increasing the weekly intensity of treatment beyond 2–5 hours did not improve outcomes on language/communication measures. The review highlights the need for additional research on the effects of early aphasia therapy. We suggest that future research considers participant characteristics that might influence how a person will respond to a specific therapeutic approach and intensity.
Purpose: Speech and language pathology (SLP) for aphasia is a complex intervention delivered to a heterogeneous population within diverse settings. Simplistic descriptions of participants and interventions in research hinder replication, interpretation of results, guideline and research developments through secondary data analyses. This study aimed to describe the availability of participant and intervention descriptors in existing aphasia research datasets.
Method: We systematically identified aphasia research datasets containing ≥10 participants with information on time since stroke and language ability. We extracted participant and SLP intervention descriptions and considered the availability of data compared to historical and current reporting standards. We developed an extension to the Template for Intervention Description and Replication checklist to support meaningful classification and synthesis of the SLP interventions to support secondary data analysis.
Result: Of 11, 314 identified records we screened 1131 full texts and received 75 dataset contributions. We extracted data from 99 additional public domain datasets. Participant age (97.1%) and sex (90.8%) were commonly available. Prior stroke (25.8%), living context (12.1%) and socio-economic status (2.3%) were rarely available. Therapy impairment target, frequency and duration were most commonly available but predominately described at group level. Home practice (46.3%) and tailoring (functional relevance 46.3%) were inconsistently available.
Conclusion : Gaps in the availability of participant and intervention details were significant, hampering clinical implementation of evidence into practice and development of our field of research. Improvements in the quality and consistency of participant and intervention data reported in aphasia research are required to maximise clinical implementation, replication in research and the generation of insights from secondary data analysis.
Systematic review registration: PROSPERO CRD42018110947
We lack guidance on how to describe population health and policy (PHP) interventions in reports of evaluation studies. PHP interventions are legal, fiscal, structural, organisational, environmental, and policy interventions such as the regulation of unhealthy commodities, health service reorganisation, changes in welfare policy, and neighbourhood improvement schemes. Many PHP interventions have characteristics that are important for their implementation and success but are not adequately captured in the original Template for Intervention Description and Replication (TIDieR) checklist. This article describes the development of a revised reporting template for PHP interventions (TIDieR-PHP) and presents the checklist with examples for each item.
Background:
The Template for Intervention Description and Replication (TIDieR) checklist and guide was developed by an international team of experts to promote full and accurate description of trial interventions. It is now widely used in health research. The aim of this paper is to describe the experience of using TIDieR outside of trials, in a range of applied health research contexts, and make recommendations on its usefulness in such settings.
Main body:
We used the TIDieR template for intervention description in six applied health research projects. The six cases comprise a diverse sample in terms of clinical problems, population, settings, stage of intervention development and whether the intervention was led by researchers or the service deliverers. There was also variation in how the TIDieR description was produced in terms of contributors and time point in the project. Researchers involved in the six cases met in two workshops to identify issues and themes arising from their experience of using TIDieR. We identified four themes which capture the difficulties or complexities of using TIDieR in applied health research: (i) fidelity and adaptation: all aspects of an intervention can change over time; (ii) voice: the importance of clarity on whose voice the TIDieR description represents; (iii) communication beyond the immediate context: the usefulness of TIDieR for wider dissemination and sharing; (iv) the use of TIDieR as a research tool.
Conclusion:
We found TIDieR to be a useful tool for applied research outside the context of clinical trials and we suggest four revisions or additions to the original TIDieR which would enable it to better capture these complexities in applied health research: An additional item, 'voice' conveys who was involved in preparing the TIDieR template, such as researchers, service users or service deliverers. An additional item, 'stage of implementation' conveys what stage the intervention has reached, using a continuum of implementation research suggested by the World Health Organisation. A new column, 'modification' reminds authors to describe modifications to any item in the checklist. An extension of the 'how well' item encourages researchers to describe how contextual factors affected intervention delivery.
Aphasia is a significant cause of disability and reduced quality of life. Two speech pathology treatment approaches appear efficacious: multimodal and constraint-induced aphasia therapies. In constraint-induced therapies, non-verbal actions (e.g., gesture, drawing) are believed to interfere with treatment and patients are therefore constrained to speech. In contrast, multimodal therapies employ non-verbal modalities to cue word retrieval. Given the clinical and theoretical implications, a comparison of these two divergent treatments was pursued. This systematic review investigated both approaches in chronic aphasia at the levels of impairment, participation and quality of life. After a systematic search, the level of evidence and methodological quality were rated. Meta-analysis was conducted on 14 single case experimental designs using Tau-U, while heterogeneity in the four group designs precluded meta-analysis. Results showed that high-quality research was limited; however, findings were broadly positive for both approaches with neither being judged as clearly superior. Most studies examined impairment-based outcomes without considering participation or quality of life. The application and definition of constraint varied significantly between studies. Both constraint and multimodal therapies are promising for chronic post-stroke aphasia, but there is a need for larger, more rigorously conducted studies. The interpretation of “constraint” also requires clearer reporting.
Purpose
Intensive language action therapy (ILAT) can be effective in overcoming learned nonuse in chronic aphasia. It is suggested that all three guiding principles (constraint, communication embedding, massed practice) are essential to ILAT's success. We examined whether one of these, guidance by constraint, is critical.
Method
Twenty-four participants with aphasia (PWAs) were assigned to ILAT or a modified version of promoting aphasic communicative effectiveness (PACE) in a randomized block, single-blind, parallel-group treatment study. Blocking was by severity (mild/moderate, moderate to severe, severe). Both groups received intensive treatment in the context of therapeutic language action games. Whereas the ILAT group was guided toward spoken responses, the PACE group could choose any response modality.
Results
All participants, whether assigned to ILAT or PACE groups, improved on the primary outcome measure, picture naming. There was a Severity × Treatment interaction, with the largest effects estimated for PWAs with mild/moderate and moderate to severe aphasia. Regardless of severity, the ILAT group outperformed the PACE group on untrained pictures, suggesting some benefit of ILAT to generalization. However, this difference was not statistically significant.
Conclusion
Although the groups differed in subtle ways, including better generalization to untrained pictures for ILAT, the study was inconclusive on the influence of guidance by constraint.
Melodic Intonation Therapy (MIT) is a language production therapy for severely non-fluent aphasic patients using melodic intoning and rhythm to restore language. Although many studies have reported its beneficial effects on language production, randomized controlled trials (RCT) examining the efficacy of MIT are rare. In an earlier publication, we presented the results of an RCT on MIT in subacute aphasia and found that MIT was effective on trained and untrained items. Further, we observed a clear trend in improved functional language use after MIT: subacute aphasic patients receiving MIT improved considerably on language tasks measuring connected speech and daily life verbal communication. Here, we present the results of a pilot RCT on MIT in chronic aphasia and compare these to the results observed in subacute aphasia. We used a multicenter waiting-list RCT design. Patients with chronic (>1 year) post-stroke aphasia were randomly allocated to the experimental group (6 weeks MIT) or to the control group (6 weeks no intervention followed by 6 weeks MIT). Assessments were done at baseline (T1), after 6 weeks (T2), and 6 weeks later (T3). Efficacy was evaluated at T2 using univariable linear regression analyses. Outcome measures were chosen to examine several levels of therapy success: improvement on trained items, generalization to untrained items, and generalization to verbal communication. Of 17 included patients, 10 were allocated to the experimental condition and 7 to the control condition. MIT significantly improved repetition of trained items (β = 13.32, p = 0.02). This effect did not remain stable at follow-up assessment. In contrast to earlier studies, we found only a limited and temporary effect of MIT, without generalization to untrained material or to functional communication. The results further suggest that the effect of MIT in chronic aphasia is more restricted than its effect in earlier stages post stroke. This is in line with studies showing larger effects of aphasia therapy in earlier compared to later stages post stroke. The study was designed as an RCT, but was underpowered. The results therefore have to be interpreted cautiously and future larger studies are needed.
Clinical Trial Registration: www.ClinicalTrials.gov, identifier NTR 1961.
Introduction:
Clinical research highlights the importance of massed practice in the rehabilitation of chronic post-stroke aphasia. However, while necessary, massed practice may not be sufficient for ensuring progress in speech-language therapy. Motivated by recent advances in neuroscience, it has been claimed that using language as a tool for communication and social interaction leads to synergistic effects in left perisylvian eloquent areas. Here, we conducted a crossover randomized controlled trial to determine the influence of communicative language function on the outcome of intensive aphasia therapy.
Methods:
Eighteen individuals with left-hemisphere lesions and chronic non-fluent aphasia each received two types of training in counterbalanced order: (i) Intensive Language-Action Therapy (ILAT, an extended form of Constraint-Induced Aphasia Therapy) embedding verbal utterances in the context of communication and social interaction, and (ii) Naming Therapy focusing on speech production per se. Both types of training were delivered with the same high intensity (3.5 h per session) and duration (six consecutive working days), with therapy materials and number of utterances matched between treatment groups.
Results:
A standardized aphasia test battery revealed significantly improved language performance with ILAT, independent of when this method was administered. In contrast, Naming Therapy tended to benefit language performance only when given at the onset of the treatment, but not when applied after previous intensive training.
Conclusions:
The current results challenge the notion that massed practice alone promotes recovery from chronic post-stroke aphasia. Instead, our results demonstrate that using language for communication and social interaction increases the efficacy of intensive aphasia therapy.
Background: Demographic and clinical predictors of aphasia recovery have been identified in the literature. However, little attention has been devoted to identifying and distinguishing predictors of improvement for different outcomes, e.g., production of treated vs. untreated materials. These outcomes may rely on different mechanisms, and therefore be predicted by different variables. Furthermore, treatment features are not typically accounted for when studying predictors of aphasia recovery. This is partly due to the small numbers of cases reported in studies, but also to limitations of data analysis techniques usually employed.
Method: We reviewed the literature on predictors of aphasia recovery, and conducted a meta-analysis of single-case studies designed to assess the efficacy of treatments for verb production. The contribution of demographic, clinical, and treatment-related variables was assessed by means of Random Forests (a machine-learning technique used in classification and regression). Two outcomes were investigated: production of treated (for 142 patients) and untreated verbs (for 166 patients).
Results: Improved production of treated verbs was predicted by a three-way interaction of pre-treatment scores on tests for verb comprehension and word repetition, and the frequency of treatment sessions. Improvement in production of untreated verbs was predicted by an interaction including the use of morphological cues, presence of grammatical impairment, pre-treatment scores on a test for noun comprehension, and frequency of treatment sessions.
Conclusion: Improvement in the production of treated verbs occurs frequently. It may depend on restoring access to and/or knowledge of lexeme representations, and requires relative sparing of semantic knowledge (as measured by verb comprehension) and phonological output abilities (including working memory, as measured by word repetition). Improvement in the production of untreated verbs has not been reported very often. It may depend on the nature of impaired language representations, and the type of knowledge engaged by treatment: it is more likely to occur where abstract features (semantic and/or grammatical) are damaged and treated.
Speech production impairment is a frequent deficit observed in aphasic patients and rehabilitation programs have been extensively developed. Nevertheless, there is still no agreement on the type of rehabilitation that yields the most successful outcomes. Here, we ran a detailed meta-analysis of 39 studies of word production rehabilitation involving 124 patients. We used a model-driven approach for analyzing each rehabilitation task by identifying which levels of our model each task tapped into. We found that (1) all rehabilitation tasks are not equally efficient and the most efficient ones involved the activation of the two levels of the word production system: the phonological output lexicon and the phonological output, and (2) the activation of the speech perception system as it occurs in many tasks used in rehabilitation is not successful in rehabilitating word production. In this meta-analysis, the effect of the activation of the phonological output lexicon and the phonological output cannot be assessed separately. We further conducted a rehabilitation study with DPI, a patient who suffers from a damage of the phonological output lexicon. Our results confirm that rehabilitation is more efficient, in terms of time and performance, when specifically addressing the impaired level of word production.
Background: Developing effective interventions for people with aphasia, which both ameliorate impaired language and directly impact on real-life communication, is a key focus of aphasia research. While single-word and sentence-level models of language processing have informed effective interventions, there is limited evidence of intervention approaches that extend the principles from these models to discourse. Aims: This pilot randomised controlled trial (RCT) aimed to compare a novel multilevel intervention, a Novel Approach to Real-life communication: Narrative Intervention in Aphasia (NARNIA), with usual care (UC), with a view to assess the feasibility and acceptability of the approach and estimate effect sizes to design and power a definitive trial. Methods & Procedures: In a prospective, single-blind, RCT, 14 people with mild to moderate aphasia, between 2 and 165 months following stroke, were randomised to the two interventions. Both therapy conditions were delivered four times weekly over 5 weeks. The NARNIA intervention specifically combined word retrieval, sentence production, and discourse macrostructure across a range of everyday discourse (ED) genres. UC comprised any speech-language therapy routinely used in clinical practice, individually tailored to meet the assessed needs of the participant. The Curtin University Discourse Protocol (CUDP) was used to measure verb access, sentence production, and discourse structure. Outcomes & Results: Eight participants were assigned to the NARNIA intervention and six participants to UC. No significant differences were present in baseline prognostic factors between the two groups prior to intervention. Following intervention, orientation aspects of macrostructure were significantly greater in the NARNIA group on ED measures than in the UC group, with no other between-group differences found. Significant changes were, however, seen within groups across ED genres. The NARNIA group made significant gains across all language levels, while the UC made isolated gains in sentence production. Few changes were seen in narrative discourse for either group. While single-word processing was not significantly different between groups, significant within-group differences were seen. While both groups significantly improved in retrieving nouns in isolation, only the NARNIA group made significant improvement in verb processing. No change was seen in constrained sentence production for either group. Conclusions: These findings are highly promising in demonstrating the use of macrostructure to scaffold production of words and sentences and improve discourse organisation. The significantly greater within-group gains for the NARNIA participants will provide a platform to power a larger trial to evaluate the effectiveness of this integrated multilevel intervention for aphasia.
Background: Communication outcomes following stroke are improved when treatments for aphasia are administered early, within the first 3 months after stroke, and provided for more than 2 hours per week. However, uncertainty remains about the optimal type of aphasia therapy.
Aims: We compared constraint-induced aphasia therapy (CIAT) with individual, impairment-based intervention, both administered early and daily after acute stroke.
Methods & Procedures: This prospective, single-blinded, randomised, controlled trial recruited participants with mild to severe aphasia within 10 days of an acute stroke from acute/subacute Perth metropolitan hospitals (n = 20). Participants were allocated by computer-generated block randomisation method to either the CIAT (n = 12) or individual, impairment-based intervention group (n = 8) delivered at the same intensity (45–60 min, 5 days a week) for 20 sessions over 5 weeks (15–20 hours total). The primary outcome, measured after completing the intervention, was the Aphasia Quotient (AQ) from the Western Aphasia Battery. Secondary outcomes were the AQ at 12 and 26 weeks post stroke, a Discourse Analysis (DA) score and the Stroke and Aphasia Quality of Life Scale (SAQoL), measured at therapy completion, 12 and 26 weeks post stroke. There was a 10% (n = 2) dropout at the primary end point, both participants were in the CIAT group. The estimates for each treatment group were compared using repeated measures ANOVAs. Data from the 26-week follow-up assessment are presented, however, were not included in the between-group comparisons due to the low number of data points in each group.
Outcomes & Results: Within groups analyses comparing performance at baseline, therapy completion, and 12 weeks post stroke revealed a statistically significant treatment effect for the AQ (p < .001), DA (p = .002), and SAQoL (p < .001). Between groups analysis found there was no significant difference between the CIAT and individual therapy groups on any outcome measure.
Conclusions: CIAT and individual therapy produced comparable amounts of change in the very early phase of recovery suggesting a standard, intensive daily dose of therapy within this period of recovery is feasible and beneficial. There were no significant differences between the two groups demonstrating that CIAT, which is provided in a group format, may be a viable option in the very early phase of aphasia recovery. The study highlights the need for further research into the impact of therapy type in very early aphasia therapy.
Background: In the existing literature, verb therapy studies take one of two approaches regarding verb retrieval: (1) the single-word level, in which verbs are treated similarly to nouns, and (2) the sentence level, which emphasises the relationship between verbs and nouns in a sentence. Few studies have directly compared the efficacy of both the approaches.
Aims: The primary aim of this article is, first, to compare the efficacy of single-word therapy versus sentence therapy for verb retrieval and, second, to examine the impact of each type of therapy on single-word and sentence production in connected speech.
Methods & Procedures: Using a single-subject crossover within-subjects design, six participants with Broca’s aphasia were trained to retrieve verbs under two therapy conditions: single-word therapy and sentence therapy. Additionally, a connected speech task was administered in the baseline phase and after each therapy condition. The impact of the two therapies on sentence production was measured using the samples derived from the connected speech.
Outcomes & Results: At the group level, all six participants showed highly significant and equal improvement in verb retrieval after receiving both the types of therapy. However, at the individual level, participants were found to show different results compared with the overall group tendency. One participant benefited more from single-word therapy than sentence therapy, while another showed the reverse pattern. At the group level, in connected speech the number of grammatical sentences, especially single-argument structure sentences, and the number of verbs increased significantly after single-word therapy. After sentence therapy, however, there was no significant change in mean length of utterance (MLU), the number of grammatical sentences and the number of verbs.
Conclusions: At the group level, verb retrieval in participants with Broca’s aphasia improved significantly after both the types of therapy. For connected speech, however, only single-word therapy brought about significant changes.
In this study, we examined regions in the left and right hemisphere language network that were altered in terms of the underlying neural activation and effective connectivity subsequent to language rehabilitation. Eight persons with chronic post-stroke aphasia and eight normal controls participated in the current study. Patients received a 10 week semantic feature-based rehabilitation program to improve their skills. Therapy was provided on atypical examples of one trained category while two control categories were monitored; the categories were counterbalanced across patients. In each fMRI session, two experimental tasks were conducted: (a) picture naming and (b) semantic feature verification of trained and untrained categories. Analysis of treatment effect sizes revealed that all patients showed greater improvements on the trained category relative to untrained categories. Results from this study show remarkable patterns of consistency despite the inherent variability in lesion size and activation patterns across patients. Across patients, activation that emerged as a function of rehabilitation on the trained category included bilateral IFG, bilateral SFG, LMFG, and LPCG for picture naming; and bilateral IFG, bilateral MFG, LSFG, and bilateral MTG for semantic feature verification. Analysis of effective connectivity using Dynamic Causal Modeling (DCM) indicated that LIFG was the consistently significantly modulated region after rehabilitation across participants. These results indicate that language networks in patients with aphasia resemble normal language control networks and that this similarity is accentuated by rehabilitation.
Objective
To test the feasibility of a randomised controlled trial comparing face to face and remotely delivered word finding therapy for people with aphasia.
Design
A quasi-randomised controlled feasibility study comparing remote therapy delivered from a University lab, remote therapy delivered from a clinical site, face to face therapy and an attention control condition.
Setting
A University lab and NHS outpatient service.
Participants
Twenty-one people with aphasia following left hemisphere stroke.
Interventions
Eight sessions of word finding therapy, delivered either face to face or remotely, were compared to an attention control condition comprising eight sessions of remotely delivered supported conversation. The remote conditions used mainstream video conferencing technology.
Outcome measures
Feasibility was assessed by recruitment and attrition rates, participant observations and interviews, and treatment fidelity checking. Effects of therapy on word retrieval were assessed by tests of picture naming and naming in conversation.
Results
Twenty-one participants were recruited over 17 months, with one lost at baseline. Compliance and satisfaction with the intervention was good. Treatment fidelity was high for both remote and face to face delivery (1251/1421 therapist behaviours were compliant with the protocol). Participants who received therapy improved on picture naming significantly more than controls (mean numerical gains: 20.2 (remote from University); 41 (remote from clinical site); 30.8 (face to face); 5.8 (attention control); P <.001). There were no significant differences between groups in the assessment of conversation.
Conclusions
Word finding therapy can be delivered via mainstream internet video conferencing. Therapy improved picture naming, but not naming in conversation.
Objective
The authors compared the effectiveness of 2 intensive therapy methods: Constraint-Induced Aphasia Therapy (CIAT; Pulvermüller et al., 2001) and semantic therapy (BOX; Visch-Brink & Bajema, 2001).
Method
Nine patients with chronic fluent aphasia participated in a therapy program to establish behavioral treatment outcomes. Participants were randomly assigned to one of two groups (CIAT or BOX).
Results
Intensive therapy significantly improved verbal communication. However, BOX treatment showed a more pronounced improvement on two communication—namely, a standardized assessment for verbal communication, the Amsterdam Nijmegen Everyday Language Test (Blomert, Koster, & Kean, 1995), and a subjective rating scale, the Communicative Effectiveness Index (Lomas et al., 1989). All participants significantly improved on one (or more) subtests of the Aachen Aphasia Test (Graetz, de Bleser, & Willmes, 1992), an impairment-focused assessment. There was a treatment-specific effect. BOX treatment had a significant effect on language comprehension and semantics, whereas CIAT treatment affected language production and phonology.
Conclusion
The findings indicate that in patients with fluent aphasia, (a) intensive treatment has a significant effect on language and verbal communication, (b) intensive therapy results in selective treatment effects, and (c) an intensive semantic treatment shows a more striking mean improvement on verbal communication in comparison with communication-based CIAT treatment.
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-sensitive nature of spoken production by people with aphasia, it is difficult to extrapolate implications for everyday conversation based on results from task-based assessment (such as picture description, story retell or interview). Thus, there are strong theoretical and clinical motivations to investigate generalization from sentence production treatment to everyday conversation.
Aims:
To evaluate a theoretically driven treatment focused on the language production skills of participants with post-stroke Broca's aphasia and to track outcomes from psycholinguistic assessment tasks to everyday conversation.
Methods & procedures:
A case series design was utilized with pragmatic selection of participants with chronic aphasia undergoing the same assessment and treatment procedures. Nine participants with Broca's aphasia and their main conversation partners took part in the study. Treatment was implemented once weekly over 8 weeks and targeted production of basic syntax-two, three and four constituent constructions-through principles of mapping and reduced syntax treatment. Use of different possible exemplars for nouns, particularly pronouns, was trained together with use of both light and heavy verbs. Participants had the opportunity to 'top-up' therapy practise by completely a homework task that mirrored the therapy task.
Outcomes & results:
Syntactic well-formedness was assessed in samples of constrained sentence production, narrative retell and naturally occurring conversations at baseline, 1 week post-treatment, and 1 month post-treatment. Treatment showed strong direct effects in trained and untrained sentence construction tasks, with some generalization to narrative retell tasks. There was little evidence of change in everyday conversation.
Conclusions & implications:
Improvement in language production in constrained assessment tasks may not impact on everyday conversations. Implications for further research are discussed, e.g. the need for bridging interventions between constrained and unconstrained contexts of language production. Clinical implications include the potential to streamline therapy planning and delivery by making use of rich, hybrid therapies to treat individuals with similar symptom profiles but with a range of underlying deficits.
Background: There is an urgent need for treatment comparison studies for chronic aphasia. Two different treatments, Constraint-Induced Aphasia Therapy Plus (CIAT Plus) and Multi-Modality Aphasia Therapy (M-MAT) aim to improve spoken language production through intensive shaping of responses, and social-mediated repetitive practice. CIAT Plus constrains responses to the verbal modality, while M-MAT includes gesture, drawing, writing and reading-based cues to assist production. Aims: This Phase 1 study compared the efficacy of CIAT Plus and M-MAT. The study also aimed to investigate the relationship between treatment responsiveness and participant's aphasia severity and cognitive variables. Methods however, order effects are likely to have played a significant role. Treatment potency was demonstrated with generalisation to noun (8 participants) and verb production (1 participant) in discourse. Overall , CIAT Plus and M-MAT were equally efficacious for these 11 individuals, although six participants expressed preference for M-MAT and three for CIAT Plus. Delayed treatment effects were present in some participants. Future large-scale studies are required to deal with order effects and a participant's variability.
The delivery of tablet-based rehabilitation for individuals with post-stroke aphasia is relatively new, therefore, this study examined the effectiveness of an iPad-based therapy to demonstrate improvement in specific therapy tasks and how the tasks affect overall language and cognitive skills. Fifty-one individuals with aphasia due to a stroke or traumatic brain injury (TBI) were recruited to use an iPad-based software platform, Constant Therapy, for a 10 week therapy program. Participants were split into an experimental (N = 42) and control (N = 9) group. Both experimental and control participants received a 1 h clinic session with a clinician once a week, the experimental participants additionally practiced the therapy at home. Participants did not differ in the duration of the therapy and both groups of participants showed improvement over time in the tasks used for the therapy. However, experimental participants used the application more often and showed greater changes in accuracy and latency on the tasks than the control participants; experimental participants' severity level at baseline as measured by standardized tests of language and cognitive skills were a factor in improvement on the tasks. Subgroups of task co-improvement appear to occur between different language tasks, between different cognitive tasks, and across both domains. Finally, experimental participants showed more significant and positive changes due to therapy in their standardized tests than control participants. These results provide preliminary evidence for the usefulness of a tablet-based platform to deliver tailored language and cognitive therapy to individuals with aphasia.
Outcomes & Results: All the individuals demonstrated a significant treatment effect immediately post-treatment and at a 4-week follow-up and four of the five participants at an 8-week follow-up. Three also demonstrated generalisation to untrained items. Unfortunately, no clear-cut patterns emerged to allow us to make claims about the influence of choice, per se, on the behavioural manifestations of improved naming. Interestingly, the participant from the Choice condition showed neural activation changes post-treatment in frontal and parietal regions that were not evident for the participant in the No Choice condition. Moreover, these changes were accompanied by a larger treatment effect for that individual and generalisation to a novel naming task.
Using a pre-post design, eleven chronic stroke patients with large left hemisphere lesions and nonfluent aphasia underwent diffusion tensor imaging and language testing before and after receiving 15weeks of an intensive intonation-based speech therapy. This treated patient group was compared to an untreated patient group (n=9) scanned twice over a similar time period. Our results showed that the treated group, but not the untreated group, had reductions in fractional anisotropy in the white matter underlying the right inferior frontal gyrus (IFG, pars opercularis and pars triangularis), the right posterior superior temporal gyrus, and the right posterior cingulum. Furthermore, we found that greater improvements in speech production were associated with greater reductions in FA in the right IFG (pars opercularis). Thus, our findings showed that an intensive rehabilitation program for patients with nonfluent aphasia led to structural changes in the right hemisphere, which correlated with improvements in speech production.
Anomia, a word-finding difficulty, is a frequent consequence of poststroke linguistic disturbance, associated with fluent and nonfluent aphasia that needs long-term specific and intensive speech rehabilitation.
The present study explored the feasibility of telerehabilitation as compared to a conventional face-to-face treatment of naming, in patients with poststroke anomia.
Five aphasic chronic patients participated in this study characterized by: strictly controlled crossover design; well-balanced lists of words in picture-naming tasks where progressive phonological cues were provided; same kind of the treatment in the two ways of administration. ANOVA was used to compare naming accuracy in the two types of treatment, at three time points: baseline, after treatment, and followup. The results revealed no main effect of treatment type (P = 0.844) indicating that face-to-face and tele-treatment yielded comparable results. Moreover, there was a significant main effect of time (P = 0.0004) due to a better performance immediately after treatment and in the followup when comparing them to baseline. These preliminary results show the feasibility of teletreatment applied to lexical deficits in chronic stroke patients, extending previous work on telerehabilitation and opening new vistas for future studies on teletreatment of language functions.
Background: Semantic and word form cues have been shown to have long‐term effects on naming in aphasia. Multicue is a computer program that offers a variety of cues for improving word finding. It stimulates the users' independence by encouraging them to discover themselves which cues are most helpful. Aims: We investigated the effects of Multicue on naming and verbal communication. Methods & Procedures: A total of 18 individuals with aphasia caused by stroke, who had completed intensive impairment‐oriented treatment, were randomised to 10–11 hours of Multicue (n = 8) or no treatment (n = 10). Outcomes & Results: Only the Multicue group improved on the Boston Naming Test. However, mean improvement did not differ significantly between the treated and untreated groups, neither for the BNT (95% CI: −4.5 to 26.1), nor for the ANELT‐A (95% CI: −2.4 to 9.4). Conclusions: In the chronic phase of aphasia, following impairment‐oriented treatment, Multicue may have a beneficial effect on word finding in picture naming, but not on verbal communication. The effect of Multicue may be the result either of self‐cueing or of improved access. The lack of generalisation to verbal communication is discussed.
Purpose
Verb Network Strengthening Treatment (VNeST) is an aphasia treatment that targets verbs (e.g., measure) and their related thematic roles (e.g., carpenter–lumber). Previous studies reported encouraging results in a number of participants using single-subject design with improvements observed on naming, sentence production, and discourse. The purpose of the current study was to conduct a group analysis evaluating the effect of VNeST on similar outcomes.
Method
A multiple baseline design across participants was conducted with 11 persons with aphasia due to stroke. Wilcoxon signed-ranks tests were used to evaluate potential improvement from pre- to posttreatment and maintenance. Individual effect sizes were also calculated to evaluate magnitude of change within and across participants.
Results
Results showed significant improvement at posttreatment and maintenance on trained and untrained sentence probes and object and action naming. Improvement in the production of sentences not targeted in treatment was nonsignificant at posttreatment assessment but significant at maintenance. Moderate increases in percentage of complete utterances and overall informativeness were observed on discourse.
Conclusion
The results of this study replicate previous findings and provide evidence that VNeST may promote specific and generalized lexical retrieval abilities and affect basic syntax production in both constrained and discourse production tasks.
Supplemental Material
https://doi.org/10.23641/asha.6170219
Purpose
Recent investigations into effects of intensity or distribution of aphasia therapy have provided moderate evidence supporting intensive therapy schedules on aphasia treatment response. The purpose of the present study was to investigate the feasibility of creating an intensive therapy session without extending the amount of daily time a person spends in treatment.
Method
Individuals who presented with chronic anomia poststroke (N = 8) participated in 2 weeks of a computerized, therapist-delivered, cued, picture-naming treatment. Dosing parameters for each session were 8 presentations of 50 pictures, totaling 400 teaching episodes per session.
Results
Of the 8 participants, 6 achieved significant increases from baseline on trained items after 400 teaching episodes (i.e., 1 treatment hr), and the remaining 2 participants achieved significant increases from baseline after 1200 teaching episodes (i.e., 3 treatment hr). Maintenance data from 7 of the participants indicated that 6 participants maintained significant improvement from baseline on trained items.
Conclusions
Given an intensive and saturated context, anomic individuals were surprisingly quick at relearning to produce problematic words successfully. Most participants demonstrated retention of the gains 2 months after treatment ended. The high density of teaching episodes within the treatment session (i.e., the intensive treatment schedule) may have contributed to the behavioral gains.
Model-oriented therapies of aphasic word production have been shown to be effective, with item-specific therapy effects being larger than generalisation effects for untrained items. However, it remains unclear whether semantic versus phonological therapy lead to differential effects, depending on type of lexical impairment. Functional imaging studies revealed that mainly left-hemisphere, perisylvian brain areas were involved in successful therapy-induced recovery of aphasic word production. However, the neural underpinnings for model-oriented therapy effects have not received much attention yet.
Without a complete published description of interventions, clinicians and patients cannot reliably implement interventions that are shown to be useful, and other researchers cannot replicate or build on research findings. The quality of description of interventions in publications, however, is remarkably poor. To improve the completeness of reporting, and ultimately the replicability, of interventions, an international group of experts and stakeholders developed the Template for Intervention Description and Replication (TIDieR) checklist and guide. The process involved a literature review for relevant checklists and research, a Delphi survey of an international panel of experts to guide item selection, and a face-to-face panel meeting. The resultant 12-item TIDieR checklist (brief name, why, what (materials), what (procedure), who intervened, how, where, when and how much, tailoring, modifications, how well (planned), how well (actually carried out)) is an extension of the CONSORT 2010 statement (item 5) and the SPIRIT 2013 statement (item 11). While the emphasis of the checklist is on trials, the guidance is intended to apply across all evaluative study designs. This paper presents the TIDieR checklist and guide, with a detailed explanation of each item, and examples of good reporting. The TIDieR checklist and guide should improve the reporting of interventions and make it easier for authors to structure the accounts of their interventions, reviewers and editors to assess the descriptions, and readers to use the information.
© Georg Thieme Verlag KG Stuttgart · New York.
. Little is known about the efficacy of language production treatment in subacute severe nonfluent aphasia. Although Melodic Intonation Therapy (MIT) is a language production treatment for this disorder, until now MIT effect studies have focused on chronic aphasia.
. This study examines whether language production treatment with MIT is effective in subacute severe nonfluent aphasia.
. A multicenter, randomized controlled trial was conducted in a waiting-list control design: patients were randomly allocated to the experimental group (MIT) or the control group (control intervention followed by delayed MIT). In both groups, therapy started at 2 to 3 months poststroke and was given intensively (5 h/wk) during 6 weeks. In a second therapy period, the control group received 6 weeks of intensive MIT. The experimental group resumed their regular treatment. Assessment was done at baseline (T1), after the first intervention period (T2), and after the second intervention period (T3). Efficacy was evaluated at T2. The impact of delaying MIT on therapy outcome was also examined.
. A total of 27 participants were included: n = 16 in the experimental group and n = 11 in the control group. A significant effect in favor of MIT on language repetition was observed for trained items, with mixed results for untrained items. After MIT there was a significant improvement in verbal communication but not after the control intervention. Finally, delaying MIT was related to less improvement in the repetition of trained material.
. In these patients with subacute severe nonfluent aphasia, language production treatment with MIT was effective. Earlier treatment may lead to greater improvement.
. An aphasia treatment was designed to shift laterality from the left to right lateral frontal lobe during word production by initiating word-finding trials with complex left-hand movements. Previous findings indicated successful relateralization.
. The current study was designed to ascertain whether the shift was attributable to the left-hand movement.
. Using stratified random sampling, 14 subjects were equally divided between Intention (IT) and Control (CT) treatments. CT was identical to IT, except with no left-hand movements. Both treatments trained picture naming (phases 1 and 2) and category-member generation (phase 3), each phase lasting 10 sessions. Functional magnetic resonance imaging of category member generation occurred at pretreatment, posttreatment, and 3-month follow-up.
. IT shifted lateral frontal activity rightward compared with pretreatment both at posttreatment (t = -2.602, df = 6, P < .05) and 3-month follow-up (t = -2.332, df = 5, P < .05), but CT did not. IT and CT yielded similar changes for all picture-naming and category probes. However, IT patients showed gains for untrained category (t = 3.33, df = 6, P < .01) and picture-naming probes (t = 3.77, df = 5, P < .01), but CT patients did not.
. The rightward shift in lateral frontal activity for IT was because of the left-hand movements. IT evoked greater generalization than CT.
Purpose
In this study, the authors assessed how the addition of intentional left-hand gestures to an intensive treatment for anomia affects 2 types of discourse: picture description and responses to open-ended questions.
Method
Fourteen people with aphasia completed treatment for anomia comprising 30 treatment sessions over 3 weeks. Seven subjects also incorporated intentional left-hand gestures into each treatment trial.
Results
Both groups demonstrated significant changes in trained items and improved naming of untrained items but no change in Western Aphasia Battery—Aphasia Quotient (WAB–AQ; Kertesz, 1982) scores. Changes in discourse were limited to the 3-month follow-up assessment. Several discourse measures showed significant improvements in the picture description task and declines during question responses. Additionally, the gesture group produced more words at each assessment, whereas the no gesture group produced fewer words at each assessment. These patterns led to improvements in picture descriptions and minimal declines in question responses in the gesture group. In contrast, the no gesture group showed minimal improvements in picture descriptions and production declines in question responses relative to pretreatment levels.
Conclusion
The intensive treatment protocol is a successful method for improving picture naming even of untrained items. Further, the authors conclude that the intentional left-hand gesture contributed significantly to the generalization of treatment to discourse.
Despite often impressive improvements on linguistic assessments, there is a lack of evidence of significant generalisation from impairment-focused aphasia therapy to everyday communication. The aim of the current study was to investigate the effect of a verb retrieval therapy across a range of levels of language production. Nine participants with chronic non-fluent stroke aphasia were recruited into this case series. Baseline assessment included naming a range of verbs (i.e., action verbs, semantically light verbs and personally relevant verbs) and sentence production. Multiple samples of conversation were collected from each participant and his/her partner. Consecutively failed verbs were divided across treatment and control sets; these sets were matched for salient psycholinguistic variables such as frequency, imageability and argument structure. A multi-component verb retrieval therapy was delivered, consisting of semantic feature analysis, gesture production and phonemic cueing. Following therapy, participants demonstrated significant and sustained gains in naming treated verbs; more modest effects were seen in untreated verbs. Mixed patterns of generalisation were evident in assessment of sentence production. In conversation, while group analysis suggested a lack of change, individual analyses indicated increased verb retrieval for three participants and qualitative changes related to the syntactic contexts of verbs retrieved.
To investigate the therapeutic effect of neurologic music therapy (NMT) and speech language therapy (SLT) through improvement of the aphasia quotient (AQ) in post-stroke aphasic patients.
Twenty-one post-stroke, nonfluent aphasia patients who had ischemic/hemorrhagic stroke on radiologic evaluation were divided into the NMT and SLT groups. They received NMT and SLT for 1 month. Language function was assessed by Korean version-Western Aphasia Battery before and after therapy. NMT consisted of therapeutic singing and melodic intonation therapy, and SLT consisted of language-oriented therapy.
Significant improvements were revealed in AQ, repetition, and naming after therapy in the NMT group and improvements in repetition in the SLT group of chronic stroke patients (p<0.05). There were significant improvements in language ability in the NMT group of subacute stroke patients. However, there was no significant improvement in the SLT group of subacute stroke patients.
We concluded that the two therapies are effective treatments in the chronic stage of stroke and NMT is effective in subacute post-stroke aphasic patients.
Background: The aphasiological literature has provided an extensive body of research on verb impairments but many fewer verb therapy studies. Verbs display particular complexity at various levels of linguistic analysis: phonological, morphological, semantic, and syntactic. Verb impairments can arise at any of these processing levels as well as from cognitive sources. Verb-naming therapies may therefore be relatively more vulnerable to errors, which could reduce their effectiveness. Errorless learning has been used with positive results for noun therapies.Aims: Given the high linguistic and cognitive demands of verb processing, this study investigated whether errorless therapy would be more effective for verb naming than more traditional hierarchical cueing (relatively errorful) therapy.Methods & Procedures: Nine participants with word-finding difficulties as a part of their chronic aphasia took part in the study.Outcomes & Results: For the dependent variable of naming accuracy, as in previous studies, we found that errorless therapy was as effective as errorful therapy for both verb and noun naming. Three participants with most severe aphasia showed significantly greater gains in noun as opposed to verb naming. The remaining participants exhibited comparable gains in both nouns and verb naming. There was no lasting generalisation from treated to untreated therapy items. The prediction that errorless therapy would be more effective for verb naming was not upheld; errorless and errorful approaches were as effective as one another.Conclusions: An errorless-learning approach to verb and noun naming was a time-efficient therapy, and one that was as effective as an errorful/hierarchical cueing method in improving naming accuracy, for a range of participants with varying naming skills and types of aphasia.
Research into intervention with people with speech and language needs often takes the form of single-case/case series experimental studies (SCEDs) or randomized controlled trials (RCTs). This paper explores the nature of these designs, including their strengths/weaknesses and highlights the value of understanding the intervention outcomes for individual participants. An online survey gathered information on speech and language therapists’ views on their use of the different research designs. We conclude that both research designs are used to inform practice. SCEDs, in particular, are used in developing theories of intervention and informing therapy with individuals. Sound experimental intervention studies of both designs are needed.
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 evidence-based recommendations for the measurement of outcomes for adults with post-stroke aphasia within phases I-IV aphasia treatment studies.
Methods:
This statement was informed by a four-year program of research, which comprised investigation of stakeholder-important outcomes using consensus processes, a scoping review of aphasia outcome measurement instruments, and an international consensus meeting. This paper provides an overview of this process and presents the results and recommendations arising from the international consensus meeting.
Results:
Five essential outcome constructs were identified: Language, communication, patient-reported satisfaction with treatment and impact of treatment, emotional wellbeing, and quality of life. Consensus was reached for the following measurement instruments: Language: The Western Aphasia Battery Revised (WAB-R) (74% consensus); emotional wellbeing: General Health Questionnaire (GHQ)-12 (83% consensus); quality of life: Stroke and Aphasia Quality of Life Scale (SAQOL-39) (96% consensus). Consensus was unable to be reached for measures of communication (where multiple measures exist) or patient-reported satisfaction with treatment or impact of treatment (where no measures exist).
Discussion:
Harmonization of the ROMA COS with other core outcome initiatives in stroke rehabilitation is discussed. Ongoing research and consensus processes are outlined.
Conclusion:
The WAB-R, GHQ-12, and SAQOL-39 are recommended to be routinely included within phases I-IV aphasia treatment studies. This consensus statement has been endorsed by the Collaboration of Aphasia Trialists, the British Aphasiology Society, the German Society for Aphasia Research and Therapy, and the Royal College of Speech Language Therapists.
Background: Pollock et al. (2014, Top 10 research priorities relating to life after stroke – Consensus from stroke survivors, caregivers, and health professionals, International Journal of Stroke, 9, 313–320) applied the James Lind Alliance methodology to derive the top 10 priorities for research relating to life after stroke. Many of the initial Treatment Uncertainties related to aphasia.
Aim: The current study uses these Treatment Uncertainties to derive the shared top 10 research priorities of people with aphasia (PWA), their carers and speech and language therapists (SLTs)
Methods & Procedures: Treatment Uncertainties relating to aphasia were identified from the 226 unique unanswered questions relating to life after stroke generated by Pollock et al. Using these 34 Treatment Uncertainties relating to aphasia, the last two stages of the JLA method (survey followed by consensus meeting) were carried out with PWA, their carers and SLTs. Participants ranked the top 10 priorities from the 34 given in the survey. Communication ramps were used with the PWA. The 16 highest ranked uncertainties were presented at the consensus meeting, where the final shared top 10 priorities were agreed, merging some statements and refining the wording in others.
Outcomes & Results: Participants included PWA with severely affected communication. The methodology produced consensus on a range of priorities including the best treatments and most effective service delivery, management of psychosocial issues, helping volunteers and carers, and research into treating severe forms of aphasia.
Conclusions: PWA are able to participate fully in research priority setting. These shared research priorities represent an excellent base for the development of clinically important research in aphasia, addressing issues which are of greatest importance to key stakeholders.
Without a complete published description of interventions, clinicians and patients cannot reliably implement interventions that are shown to be useful, and other researchers cannot replicate or build on research findings. The quality of description of interventions in publications, however, is remarkably poor. To improve the completeness of reporting, and ultimately the replicability, of interventions, an international group of experts and stakeholders developed the Template for Intervention Description and Replication (TIDieR) checklist and guide. The process involved a literature review for relevant checklists and research, a Delphi survey of an international panel of experts to guide item selection, and a face-to-face panel meeting. The resultant 12-item TIDieR checklist (brief name, why, what (materials), what (procedure), who intervened, how, where, when and how much, tailoring, modifications, how well (planned), how well (actually carried out)) is an extension of the CONSORT 2010 statement (item 5) and the SPIRIT 2013 statement (item 11). While the emphasis of the checklist is on trials, the guidance is intended to apply across all evaluative study designs. This paper presents the TIDieR checklist and guide, with a detailed explanation of each item, and examples of good reporting. The TIDieR checklist and guide should improve the reporting of interventions and make it easier for authors to structure the accounts of their interventions, reviewers and editors to assess the descriptions, and readers to use the information.
Evidence-based practice involves physical therapists incorporating high-quality clinical research on treatment efficacy into their clinical decision-making.1 However, if clinical interventions are not adequately reported in the literature, physical therapists face an important barrier to using effective interventions for their patients. Previous studies have reported that incomplete description of interventions is a problem in reports of randomized controlled trials in many health areas.2–4 One of these studies examined 133 trials of nonpharmacological interventions.4 The experimental intervention was inadequately described in over 60% of the trials, and descriptions of the control interventions were even worse.
A recent study5 evaluated the completeness of descriptions of the physical therapist interventions in a sample of 200 randomized controlled trials published in 2013. Overall, the interventions were poorly described. For the intervention groups, about one quarter of the trials did not fulfill at least half of the criteria. Reporting for the control groups was even worse, with around three quarters of trials not fulfilling at least half of the criteria. In other words, for the majority of the physical therapy trials, clinicians and …
Background:
Aphasia is an acquired language impairment following brain damage that affects some or all language modalities: expression and understanding of speech, reading, and writing. Approximately one third of people who have a stroke experience aphasia.
Objectives:
To assess the effects of speech and language therapy (SLT) for aphasia following stroke.
Search methods:
We searched the Cochrane Stroke Group Trials Register (last searched 9 September 2015), CENTRAL (2015, Issue 5) and other Cochrane Library Databases (CDSR, DARE, HTA, to 22 September 2015), MEDLINE (1946 to September 2015), EMBASE (1980 to September 2015), CINAHL (1982 to September 2015), AMED (1985 to September 2015), LLBA (1973 to September 2015), and SpeechBITE (2008 to September 2015). We also searched major trials registers for ongoing trials including ClinicalTrials.gov (to 21 September 2015), the Stroke Trials Registry (to 21 September 2015), Current Controlled Trials (to 22 September 2015), and WHO ICTRP (to 22 September 2015). In an effort to identify further published, unpublished, and ongoing trials we also handsearched the International Journal of Language and Communication Disorders (1969 to 2005) and reference lists of relevant articles, and we contacted academic institutions and other researchers. There were no language restrictions.
Selection criteria:
Randomised controlled trials (RCTs) comparing SLT (a formal intervention that aims to improve language and communication abilities, activity and participation) versus no SLT; social support or stimulation (an intervention that provides social support and communication stimulation but does not include targeted therapeutic interventions); or another SLT intervention (differing in duration, intensity, frequency, intervention methodology or theoretical approach).
Data collection and analysis:
We independently extracted the data and assessed the quality of included trials. We sought missing data from investigators.
Main results:
We included 57 RCTs (74 randomised comparisons) involving 3002 participants in this review (some appearing in more than one comparison). Twenty-seven randomised comparisons (1620 participants) assessed SLT versus no SLT; SLT resulted in clinically and statistically significant benefits to patients' functional communication (standardised mean difference (SMD) 0.28, 95% confidence interval (CI) 0.06 to 0.49, P = 0.01), reading, writing, and expressive language, but (based on smaller numbers) benefits were not evident at follow-up. Nine randomised comparisons (447 participants) assessed SLT with social support and stimulation; meta-analyses found no evidence of a difference in functional communication, but more participants withdrew from social support interventions than SLT. Thirty-eight randomised comparisons (1242 participants) assessed two approaches to SLT. Functional communication was significantly better in people with aphasia that received therapy at a high intensity, high dose, or over a long duration compared to those that received therapy at a lower intensity, lower dose, or over a shorter period of time. The benefits of a high intensity or a high dose of SLT were confounded by a significantly higher dropout rate in these intervention groups. Generally, trials randomised small numbers of participants across a range of characteristics (age, time since stroke, and severity profiles), interventions, and outcomes.
Authors' conclusions:
Our review provides evidence of the effectiveness of SLT for people with aphasia following stroke in terms of improved functional communication, reading, writing, and expressive language compared with no therapy. There is some indication that therapy at high intensity, high dose or over a longer period may be beneficial. HIgh-intensity and high dose interventions may not be acceptable to all.
Aims: This study evaluated two forms of discrimination therapy for auditory processing impairment in aphasia. It aimed to determine whether therapy can improve speech perception and/or help participants use semantic information to compensate for their impairment. Changes in listening were also explored by recording the level of facilitation needed during therapy tasks. Finally the study examined the effect of therapy on an everyday listening activity: a telephone message task.
Method: The study employed a repeated measures design. Eight participants received 12 sessions each of phonological and semantic–phonological therapy. Both programmes used minimal pair judgement tasks, but the latter embedded such tasks within a meaningful context, so encouraged the strategic use of semantic information (semantic bootstrapping). Experimental measures of auditory discrimination and comprehension were administered twice before therapy, once after each programme, and again six weeks later. The telephone message task was also administered at each time point. Test data were subjected to both group and individual analyses. Records of progress during therapy (i.e., changes in support needed to carry out therapy tasks) were completed during treatment and analysed across the group.
Results: Group analyses showed no significant changes in tests of word and nonword discrimination as a result of therapy. One comprehension task improved following therapy, but two did not. There was also no indication that therapy improved the discrimination of treated words, as assessed by a priming task. The facilitation scores indicated that participants needed less support during tasks as therapy progressed, possibly as a result of improved listening. There was a significant effect of time on the telephone message task. Across all tasks there were few individual gains.
Conclusions: The results offer little evidence that therapy improved participants’ discrimination or semantic bootstrapping skills. Some changes in listening may have occurred, as indicated by the facilitation scores. Reasons for the null findings are discussed.
The aim of this research is to evaluate the effects of active music therapy (MT) based on free-improvisation (relational approach) in addition to speech language therapy (SLT) compared to speech language therapy alone (communicative-pragmatic approach, PACE) in stroke patients with chronic aphasia.
The experimental group (n = 10) was randomized to 30 MT individual sessions over 15 weeks in addition to 30 SLT individual sessions while the control group (n = 10) was randomized to only 30 SLT sessions in the same period. Psychological and speech language assessment were made before (T0) and after (T1) treatments.
The study shows a significant improvement in spontaneous speech in the experimental group (Aachener Aphasie subtest: p = 0.020; Cohen's d = 0.35); the 50% of the experimental group showed also an improvement in vitality scores of Short Form Health Survey (chi squared 4.114; p = 0.043).
The current trial highlights the possibility that the combined use of MT and SLT can lead to a better result in the rehabilitation of aphasia than SLT alone.
Developing language treatments that not only improve trained items but also promote generalisation to untrained items is a major focus in aphasia research. This study is a replication and extension of previous work which found that training abstract words in a particular context-category promotes generalisation to concrete words but not vice versa (Kiran, Sandberg, & Abbott, 200927.
Kiran, S., Sandberg, C., & Abbott, K. (2009). Treatment for lexical retrieval using abstract and concrete words in persons with aphasia: Effect of complexity. Aphasiology, 23, 835–853. doi: 10.1080/02687030802588866[Taylor & Francis Online], [PubMed], [Web of Science ®]View all references). Twelve persons with aphasia (five female) with varying types and degrees of severity participated in a generative naming treatment based on the Complexity Account of Treatment Efficacy (CATE; Thompson, Shapiro, Kiran, & Sobecks, 200344.
Thompson, C., Shapiro, L., Kiran, S., & Sobecks, J. (2003). The role of syntactic complexity in treatment of sentence deficits in agrammatic aphasia: The Complexity Account of Treatment Efficacy (CATE). Journal of Speech, Language, and Hearing Research, 46, 591–607. doi: 10.1044/1092-4388(2003/047)[CrossRef], [PubMed], [Web of Science ®]View all references). All participants were trained to generate abstract words in a particular context-category by analysing the semantic features of the target words. Two other context-categories were used as controls. Ten of the twelve participants improved on the trained abstract words in the trained context-category. Eight of the ten participants who responded to treatment also generalised to concrete words in the same context-category. These results suggest that this treatment is both efficacious and efficient. We discuss possible mechanisms of training and generalisation effects.
The current study investigated the effectiveness of a home practice program based on the iPad (Apple Inc., Cupertino, CA), implemented after 2 weeks of intensive language therapy, for maintaining and augmenting treatment gains in people with chronic poststroke aphasia. Five of eight original participants completed the 6-month home practice program in which they autonomously practiced retrieving words for objects and actions. Half of these words had been trained and half were untrained during therapy. Practice included tasks such as naming to confrontation, repeating from a video model, and picture/word matching presented on an iPad. All participants maintained advances made on words trained during the intensive treatment and additionally were able to learn new words by practicing daily over a 6-month period. The iPad and other tablet devices have great potential for personalized home practice to maintain and augment traditional aphasia rehabilitation. It appears that motivation to use the technology and adequate training are more important factors than age, aphasia type or severity, or prior experience with computers.
There is conflicting evidence regarding the benefits of intensive speech and language therapy (SLT), particularly because intensity is often confounded with total SLT provided.
A two-centre, randomized, rater-blinded, parallel study was conducted to compare the efficacy of 100 h of SLT in a regular (RT) versus intensive (IT) treatment in sub-acute post-stroke aphasia.
Consecutive patients with aphasia, within 3 months of a left hemisphere ischemic stroke, were randomized to IT (2 h per day × 5 days per week, 10 weeks) or RT (2 h per week × 50 weeks). Evaluations took place at 10, 50 and 62 weeks. Primary outcome was the frequency of responders, defined by 15% increase of Aphasia Quotient (AQ) from the baseline to 50 weeks. Secondary outcomes were changes from the baseline in AQ and functional communication profile (FCP) at 50 and 62 weeks and improvement stability between 50 and 62 weeks.
Thirty patients were randomized and 18 completed the study. No significant differences were found between groups in primary or secondary outcomes, although IT patients (N = 9) obtained higher scores in language measures between 10 and 62 weeks in per protocol analysis. The number of non-completions was identical between groups.
This study suggests that, in the sub-acute period following stroke and controlling for the number of hours of SLT provided, there is a trend for a greater improvement in language and functional communication measures with IT compared with RT. The lack of statistical significance in results was probably due to the small sample size.
Background: Errorless learning continues to be much debated in rehabilitation literature. Emerging data suggest that errorless learning is as effective as errorful learning when applied to the treatment of aphasic word-finding difficulties (Fillingham, Hodgson, Sage, & Lambon Ralph, 2003; Fillingham, Sage, & Lambon Ralph, in press; Fillingham, Sage, & Lambon Ralph, 2005).Aims: This paper presents a third investigation, which was designed to replicate this result and also to explore and extend other important and interesting findings from the previous empirical studies: (1) that withdrawing feedback during therapy (not giving information about whether a patient's response was correct or not) does not prevent learning; (2) that frontal executive skills are a predictor of therapy outcome but not language skill. We also used this third study to explore whether the number of naming attempts during therapy affects outcome.Methods & Procedures: Seven of the original eleven participants took part in a multiple baseline, crossover, case-series design.Outcomes & Results: The previous results were replicated: errorless and errorful therapy produced equivalent results immediately post-therapy and at follow-up. There was no effect of omitting feedback—the participants learned equally well without therapists' feedback. Also, executive/problem-solving skills and monitoring ability again predicted immediate naming improvements not language ability. In addition, we found that increasing the number of naming attempts during therapy affected learning outcome.Conclusions: The final section of the paper draws together the results of all three studies, and their implications for the treatment of aphasic word-finding difficulties are discussed.
There is a lack of empirical evidence on which clinicians can base their daily decisions about aphasia treatment rate and duration. The purpose of this series of studies was to review the outcomes of various rates of speech/language therapy on the naming performances of adults with aphasia. A retrospective pre/post design was employed with a total of 40 subjects across studies. Results revealed the significant positive effects of intensive speech/language therapy on the naming skills of adults with aphasia, and that these improvements were greater than those obtained during non-intensive treatment, Although there are limitations of the treatment-based, retrospective research design, this line of research contributes to the ability of rehabilitation professionals to make appropriate treatment recommendations regarding treatment rate.
A controlled study of the comparative efficacy of intensive (daily) versus regular (three treatments weekly) speech therapy treatment in a group of global aphasics of vascular origin is reported. Application of psychometric single-case analysis showed that the number of patients reaching a significant improvement in all language modalities was greater in the intensive therapy group.