Accessibility and Applicability of Currently Available e-Mental Health Programs for Depression for People With Poststroke Aphasia: Scoping Review.

BACKGROUND: Depression affects approximately 60% of people with aphasia 1 year post stroke and is associated with disability, lower quality of life, and mortality. Web-delivered mental health (e-mental health) programs are effective, convenient, and cost-effective for the general population and thus are increasingly used in the management of depression. However, it is unknown if such services are applicable and communicatively accessible to people with poststroke aphasia. OBJECTIVE: The aim of this study was to identify freely available e-mental health programs for depression and determine their applicability and accessibility for people with poststroke aphasia. METHODS: A Web-based search was conducted to identify and review freely available e-mental health programs for depression. These programs were then evaluated in terms of their (1) general features via a general evaluation tool, (2) communicative accessibility for people with aphasia via an aphasia-specific communicative accessibility evaluation tool, and (3) empirical evidence for the general population and stroke survivors with and without aphasia. The program that met the most general evaluation criteria and aphasia-specific communicative accessibility evaluation criteria was then trialed by a small subgroup of people with poststroke aphasia. RESULTS: A total of 8 programs were identified. Of these, 4 had published evidence in support of their efficacy for use within the general population. However, no empirical evidence was identified that specifically supported any programs' use for stroke survivors with or without aphasia. One evidence-based program scored at least 80% (16/19 and 16/20, respectively) on both the general and aphasia-specific communicative accessibility evaluation tools and was subject to a preliminary trial by 3 people with poststroke aphasia. During this trial, participants were either unable to independently use the program or gave it low usability scores on a post-trial satisfaction survey. On this basis, further evaluation was considered unwarranted. CONCLUSIONS: Despite fulfilling majority of the general evaluation and aphasia-specific evaluation criteria, the highest rated program was still found to be unsuitable for people with poststroke aphasia. Thus, e-mental health programs require substantial redevelopment if they are likely to be useful to people with poststroke aphasia.

Experimental pain assessment in patients with poststroke aphasia.

OBJECTIVE: To evaluate an observational-behavioral pain tool among individuals with acute poststroke aphasia. METHODS: We performed a randomized, double-blind, controlled study of experimental pain assessment among 36 adult patients with acute poststroke aphasia. Patients were administered 3 levels of mechanical pain, including placebo. The behavioral responses were video recorded and then evaluated by 3 neurology nurses using the Pain Assessment Checklist for Seniors With Limited Ability to Communicate (PACSLAC-II). Pain-specific facial action units were quantified with FaceReader version 6.1. RESULTS: Median PACSLAC-II ratings for 0-, 2-, and 4.5-lb weight stimuli were 2 (0, 3), 1 (0, 3), and 2 (1, 5), respectively. Overall, differences were not detected (p = 0.06). Pairwise comparisons with the Wilcoxon method demonstrated significance in differentiating PACSLAC-II ratings of patients experiencing the 4.5-lb stimulus vs either the 2-lb weight (p = 0.03) or placebo (p = 0.05). Overall interrater reliability by the Cronbach α was strong at 0.87, 0.94, and 0.96 for weights of 0, 2, and 4.5 lb, respectively. Pain-specific facial activation and negative valence were observed similarly in placebo and experimental pain groups. CONCLUSIONS: Among our cohort with acute poststroke aphasia, the PACSLAC-II was not able to overall differentiate patients experiencing experimental mechanical pain, although differences in those experiencing the strongest pain stimulus were significant. The detection of pain-specific facial activation and negative valence in the placebo group indicates that pain and distress are unmet needs among stroke patients who are unable to verbally communicate.

The assessment of language and the emergence from disorders of consciousness.

In order to demonstrate emergence from a disorder of consciousness (DoC) an individual is currently required to demonstrate functional object use of two objects, or functional communication defined as accurately answering six yes/no questions on two consecutive occasions (Giacino et al., 2002). In practice, experienced speech and language therapists (SLTs) working with this group often focus on facilitating object use or employ other language tasks, since achieving a 100% accurate yes/no response can be difficult for patients following an extensive brain injury due to language and/or cognitive impairments. There is an increasing awareness of this issue in the literature and in practice and there is discussion about reviewing the current definition of emergence. This paper outlines the traditional definition of emergence and recent updates, discusses some of the problems and implications associated with current assessment, highlights the importance of getting it right, explores potential other ways to determine emergence, and suggests further areas for research.

Supporting autonomy for people with aphasia: use of the Life Interests and Values (LIV) Cards.

BACKGROUND: People with aphasia (PWA) are frequently disregarded as reliable respondents because their language problems may restrict their responses to oral and written questioning. Consequently, family members are often asked to speak on their behalf. The Life Interests and Values (LIV) Cards are a nonlinguistic, picture-based instrument designed for communicating directly with PWA about their current and desired life activities. PURPOSE: The goals of this study were to (1) explore utility of LIV Cards for interviewing PWA and (2) examine congruence between responses of PWA and proxies. METHOD: Study participants were 10 PWA with varying language and cognitive abilities and 10 family member proxies. Both groups participated in LIV Card interviews to identify current and preferred activities of the PWA. Core interview times for the PWA and percentage of selected activities for 4 activity categories were calculated, as was item-by-item response congruency between PWA and proxies. RESULTS: All 10 PWA completed LIV Cards interviews in 45 minutes or less. There were individualized response patterns regarding activity participation and preferences. Mean point-to-point agreement between PWA and their proxies was 74% for current activities and 71% for activity preferences of the PWA. CONCLUSIONS: PWA were able to provide information about their current and preferred involvement in life activities through use of the LIV Cards. Family members did not predict activity choices and desires of PWA with full accuracy. The LIV Cards appear to be a viable tool for setting goals and discussing life priorities of PWA.

The assessment of low mood in stroke patients with aphasia: reliability and validity of the 10-item Hospital version of the Stroke Aphasic Depression Questionnaire (SADQH-10).

OBJECTIVE: To assess the psychometric properties of an observational screening measure of depressive symptoms (SADQH-10; 10-item Hospital version of the Stroke Aphasic Depression Questionnaire) for use in stroke patients with aphasia and to determine the convergent and divergent validity of the SADQH-10. DESIGN: Cross-sectional cohort. SETTING: Hospital and community. PARTICIPANTS: Stroke patients with aphasia (n = 165) were recruited through hospital wards and community services as part of a randomised controlled trial. Participants were aged 29 to 94 years (68.6 ± 12.1) and 65% were men. RESULTS: The SADQH-10 demonstrated good internal consistency (α = 0.77). Factor analysis revealed the SADQH-10 to be measuring three constructs (social interaction and physical pain, tearfulness, loss of interest and motivation). Significant correlations were found between scores on the SADQH-10 and VAMS 'sad' item (r(s) = 0.297, P < 0.01) but not with the VASES 'depression' item (r(s) = 0.064, P = 0.590) or measures of physical and language abilities. CONCLUSIONS: The SADQH-10 is both a valid and reliable observational screening measure of depressive symptoms for stroke patients with aphasia.

Rehabilitative intervention and social participation of a case with Balint's syndrome and aphasia.

Balint's syndrome is characterized by three major disorders of spatial analysis: fixed gaze or psychic paralysis, simultagnosia, and optic ataxia or misreaching. Most patients with Balint's syndrome generally do not show all three of these signs. The authors herein reported the more than four-year clinical course of a case (a 43-year-old man) with Balint's syndrome presenting these three disorders. The patient also had a mild type of conduction aphasia, but his attentional, intellectual and memory functions were well preserved. SPECT showed cerebral hypoperfusion in the bilateral parieto-occipital areas. Whereas rehabilitative intervention with process specific approach for the impaired visual cognition seemed to be significantly ineffective, a functional adaptation approach successfully promoted the patient's social participation. However, the present patient could not help having to resign from his job. Additionally, double impairment of visual (including optic ataxia) and language functions made it impossible for him to obtain a new work. Like the present case, those who have a higher brain dysfunction, but retain good physical ability can hardly receive the benefit of the social welfare system in Japan. Legislation addressing this problem is a matter of great urgency.

Neuropsychiatric assessment.

Neuropsychiatric examination is an interdisciplinary approach to diagnostic assessment of mental and brain diseases. When performed in a skillful way, with a conceptually grounded structure, neuropsychiatric assessment offers the potential for comprehensive diagnostic insight, thereby facilitating optimally informed treatment planning.

Supreme Court to tackle ADA/social security conflict.

AIDS: The Supreme Court is scheduled to hear arguments involving [name removed]. [Name removed] who claims that he lost his job because he has AIDS. Originally, the Third U.S. Circuit Court of Appeals ruled that he was barred from suing because he had accepted disability payments while waiting for the Equal Employment Opportunity Commission to issue a determination regarding his claim. The Circuit Court's ruling was not unanimous. Also, Federal courts have increasingly ruled that receipt of benefits is not an automatic bar to an ADA claim. The different definitions of disability by Social Security and by the ADA need clarification.^ieng

Speech and memory assessment in psychomotor epileptics.

Thirty post-lobectomy patients operated on for relief of seizures due to temporal lobe epilepsy and six patients who had had implantation of depth electrodes only were assessed in terms of their speech and memory abilities. The results from two subtests of the Boston Diagnostic Aphasia Examination show no significant group differences on speech tests. On the other hand, patients with left or dominant temporal lobectomies showed a greater memory deficit than those operated upon on the right or non-dominant side. This difference was apparent on tests of both recent verbal memory and long-term memory.