Generalization in Aphasia Treatment: A Tutorial for Speech-Language Pathologists.

PURPOSE: Generalization has been defined and instantiated in a variety of ways over the last half-century, and this lack of consistency has created challenges for speech-language pathologists to plan for, implement, and measure generalization in aphasia treatment protocols. This tutorial provides an overview of generalization with a focus on how it relates to aphasia intervention, including a synthesis of existing principles of generalization and examples of how these can be embedded in approaches to aphasia treatment in clinical and research settings. METHOD: Three articles collectively listing 20 principles of generalization formed the foundation for this tutorial. The seminal work of Stokes and Baer (1977) focused attention on generalization in behavioral change following treatment. Two aphasia-specific resources identified principles of generalization in relation to aphasia treatment (Coppens & Patterson, 2018; Thompson, 1989). A selective literature review was conducted to identify evidence-based examples of each of these 20 principles from the extant literature. RESULTS: Five principles of generalization were synthesized from the original list of 20. Each principle was supported by studies drawn from the aphasia treatment literature to exemplify its application. CONCLUSIONS: Generalization is an essential aspect of meaningful aphasia intervention. Successful generalization requires the same dedication to strategic planning and outcome measurement as the direct training aspect of intervention. Although not all people with aphasia are likely to benefit equally from each of the principles reviewed herein, our synthesis provides information to consider for maximizing generalization of aphasia treatment outcomes. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.24714399.

Aphasia and friendship: Stroke survivors' self-reported changes over time.

INTRODUCTION: Friendships are an important contributor to quality of life. Due to communication and other stroke-related challenges, people with aphasia (PWA) can experience negative friendship changes, which have been linked with increased physiological distress. This study examined friendship experiences over time for PWA to understand how friendships evolve throughout the course of stroke and aphasia recovery. METHODS: Fifteen stroke survivors with chronic aphasia completed language testing and a friendship questionnaire created by the researchers. The friendship questionnaire was composed of open and closed-ended questions that asked PWA to reflect back on their friendship satisfaction, support, activities, and communication during the time before aphasia and during the acute stage of recovery. The questionnaire also addressed their current friendships in the present-day chronic stage of recovery, as well as questions about an ideal friendship. Quantitative and qualitative methods were used to examine the data, with quantitative findings reported in this study. RESULTS: The majority of PWA reported maintaining some friendships and developing new friendships, often with a fellow stroke survivor with aphasia; however, a few PWA in this study were not able to maintain or develop any new friendships. Average ratings of perceived friendship satisfaction and support improved from the acute to chronic stage, nearing those of the ratings pre-stroke, yet there was greater variability in the chronic stage with some currently feeling dissatisfied and not well supported. Aphasia severity, as measured by a standardized assessment, had a negative relationship with perceived friendship support. In contrast, perception of communicative participation had a positive relationship with friendship support. CONCLUSIONS: This work highlights lasting social implications of aphasia. The overall health of PWA deserves greater attention, including interventions targeting friendship maintenance and development. Continued stakeholder-engaged research and clinical practice focused on the social and emotional consequences of aphasia on PWA, as well as their friends and family, is needed to assist all involved in aphasia recovery achieve better friendships and well-being.

Aphasia and Friendship: The Role and Perspectives of Speech-Language Pathologists.

Purpose Speech-language pathologists (SLPs) who work with people with aphasia focus on assessment and intervention to support improved communication outcomes for their clients. Friendship, a key component of quality of life, often depends on communicative interaction, and many people with aphasia report having reduced social circles. The purpose of this study was to explore the perceptions of SLPs working with clients with aphasia on their role in supporting friendship development and maintenance. Method An online survey composed of questions addressing SLP perspectives and goal setting, assessment, and treatment practices related to aphasia and friendship was distributed to SLPs across the United States. Survey data were analyzed using both quantitative and qualitative methods. Results Forty-seven SLPs completed the survey. While many SLPs reported that the friendships of their clients with aphasia were impacted by aphasia and that it was within their scope of practice to support friendship development and maintenance, many did not specifically assess or target friendship and friendship outcomes in the treatment plan. SLPs identified barriers and facilitators to focusing on friendship within the context of speech and language therapy. Conclusions Findings suggest the majority of participating SLPs were interested in addressing friendship with clients with aphasia; however, they experienced barriers in practice. Further examination of SLP perspectives and clinical practice regarding friendship and aphasia is warranted. Additionally, research investigating effective assessment and therapeutic methods that target friendship in aphasia is needed to support clinical practice and the well-being of clients with aphasia. Supplemental Material https://doi.org/10.23641/asha.15032217.

Cognitive and Linguistic Benefits of Aerobic Exercise: A State-of-the-Art Systematic Review of the Stroke Literature.

This systematic review aimed to determine how aerobic exercise affects cognition after stroke, with particular focus on aphasia and language improvement. Methodological quality was assessed with the PEDro+ scale with half of the 27 included studies rated as high quality. Data extraction focused on cognitive effects of aerobic exercise post-stroke, intervention characteristics, outcome measures, and participant characteristics. Whereas attention, memory, and executive functioning measures were common across the included studies, no study included a language-specific, performance-based measure. Seventeen studies reported positive cognitive effects, most frequently in the domains of attention, memory and executive functioning. Variability in outcome measures, intervention characteristics, and participant characteristics made it difficult to identify similarities among studies reporting positive cognitive effects of exercise or among those studies reporting null outcomes. Only three studies provided specific information about the number of individuals with aphasia included or excluded, who comprise approximately one-third of the stroke population. The review identified patent gaps in our understanding of how aerobic exercise may affect not only the cognitive domain of language post-stroke but also the broader cognitive functioning of individuals with post-stroke aphasia. Methodological limitations of the reviewed studies also warrant further examination of the direct impact of aerobic exercise on cognition post-stroke with careful attention to the selection and reporting of population, intervention, and outcomes.