Comprehensive Assessment of Reading in Aphasia (CARA) reading questionnaire-German version.

BACKGROUND: Reading comprehension is frequently impaired in persons with aphasia (PWA). For goal-setting and outcome measurement, speech and language therapists (SLTs) need to determine an individual's perspective of their reading difficulties and everyday reading activities. The Comprehensive Assessment of Reading in Aphasia (CARA) reading questionnaire provides a person-centred tool to find out the individual perception of reading functions, reading-related emotions and reading activities in PWA. It was developed and evaluated in English. So far, there is no equivalent instrument in German. AIMS: To translate and adapt the CARA reading questionnaire into German language and culture, to evaluate its practicability and acceptance, and to provide the first psychometric properties of the German version. METHODS & PROCEDURES: Based on translation and adaptation guidelines, we conducted two forward translations that were merged and then adapted. A back translation was prepared and compared with the original version. It was found to be semantically equivalent by one of the authors of the original version. We performed pilot testing with 12 PWA, and the pilot version was adapted according to the comments of these participants. We then collected data on self-reported perception of reading and on psychometric properties of the translated and adapted German version. A total of 22 German-speaking PWA completed the questionnaire at least five times during an intervention study. We analysed retest reliability with Spearman correlation, internal consistency with Cronbach's alpha, internal responsiveness with the standardized response mean, as well as the relationship between outcomes of the questionnaire and text comprehension measures using repeated measures correlations. OUTCOMES & RESULTS: Our data suggest good practicability and acceptance of the German version of the CARA reading questionnaire as well as appropriate validity, reliability and sensitivity to measure therapy-induced change. We found moderate correlations between outcomes of the questionnaire and text-level reading speed. CONCLUSIONS & IMPLICATIONS: The German version of the CARA reading questionnaire could be helpful in intervention planning and goal-setting with German-speaking PWA. By using the questionnaire, SLTs can find out about a person's individual perception of reading difficulties as well as individually relevant reading activities. The questionnaire provides a tool to measure change and is therefore valuable to demonstrate self-reported individual progress. As reading speed seems to be an indicator of personal perception of reading difficulty, it is important to consider reading speed in reading interventions and in reading comprehension assessments. WHAT THIS PAPER ADDS: What is already known on the subject Reading comprehension is frequently impaired in PWA. Reading preferences, the perception of difficulties and the impact on everyday life reading activities are specific to the individual and thus need to be known for goal-setting, intervention planning and monitoring of change. As part of a comprehensive assessment of reading, Morris et al. developed a person-centred English language questionnaire for this purpose. So far, there is no equivalent tool in German. What this paper adds to the existing knowledge In this study, we translated and adapted the questionnaire to German language and culture, and analysed its validity and reliability with German-speaking PWA. We demonstrated that the German version is accessible for German-speaking PWA, and that it has appropriate validity, reliability and sensitivity to measure self-reported change. Outcomes of the questionnaire correlate with text level reading speed. What are the potential or actual clinical implications of this work? The German version of the questionnaire could be a valuable self-reported outcome measure to assess individual perceptions of reading and to measure progress (as perceived by an individual) as a consequence of recovery or intervention in either clinical or research settings. As reading speed might be an indicator of everyday life reading as perceived by an individual, it should be considered in reading assessments and interventions.

Regulating emotional responses to aphasia to re-engage in life: a qualitative interview study.

BACKGROUND: People with post-stroke aphasia (PWA) are more likely to experience serious mood disorders compared with those without. Emotional regulation may be important for influencing life participation after stroke. Understanding emotional regulation in the context of aphasia is important for promoting personally defined recovery, psychological well-being and life participation. AIMS: To explore how individuals experience and regulate negative emotional responses to aphasia as part of re-engaging with life. METHODS & PROCEDURES: In-depth semi-structured qualitative interviews with 14 PWA were conducted. The focus and design were developed with public and patient involvement contributors. Reflexive thematic analysis was applied. OUTCOMES & RESULTS: Analysis generated three themes, which captured inherent diversity across participants in terms of emotional experiences, responses and regulation strategies: (1) emotional upheaval at all stages of recovery; (2) regulating emotional upheaval; and (3) discerning possibilities for life participation. Emotional regulation occurred both within and without the context of formal support services. CONCLUSIONS & IMPLICATIONS: Individuals may be differently (en)abled in responding positively, with implications for aphasia psychological support and self-management interventions. The findings may inform future interventions to optimize well-being and personally meaningful outcomes for PWA. WHAT THIS PAPER ADDS: What is already known on the subject PWA experience significant psychosocial upheaval and are at risk of mood disorders. Emotional regulation may be important for influencing one's emotional state, social participation and relationships after stroke. There is a need to better understand the ways in which PWA experience and regulate their emotions to develop better support for personally defined recovery. What this paper adds to existing knowledge PWA may experience significant and pervasive mood disorders in the long term after stroke. This may be compounded by worries for their children's well-being. Some, but not all, regulate emotions by drawing on positivity, determination, gratitude or stoicism. Having (supportive) opportunities to experience the impact of aphasia is important for discerning helpful strategies and participation opportunities. What are the potential or actual clinical implications of this work? Confronting altered abilities requires supportive, responsive opportunities sensitive to emotional responses. Opportunities for peer support and/or meaningful emotional support and compassion from family and friends are important therapeutic targets. Therapeutic input should pay attention to any familial and parenting concerns that may be compounding low mood. Although emotional regulation and recovery may occur without formal support, mental health services must be organized in such a way that PWA can access as needed.

Cognitive assessment scale for stroke patients (CASP): A multicentric validation study.

BACKGROUND: The Mini Mental State Examination and Montreal Cognitive Assessment are commonly used as short screening batteries for assessing cognitive impairment after stroke. However, aphasia or hemispatial neglect may interfere with the results. For this reason, we developed the Cognitive Assessment scale for Stroke Patients (CASP), which takes these conditions into consideration and previously demonstrated its superiority over these scales in terms of feasibility. OBJECTIVES: Our goal was to verify the psychometric properties of the (original) French version of the CASP. METHODS: We included 201 patients with a recent first hemispheric stroke and 50 controls. Stroke patients were examined 4 times (visit 1 [V1] to visit 4 [V4]) in the subacute post-stroke phase. The structural validity of the CASP was studied by principal factorial analysis, convergent validity by comparison with several variables including a comprehensive neuropsychological assessment, divergent validity by comparison with the total score between stroke patients and controls, and sub-scores between right and left stroke. Internal consistency, reproducibility and sensitivity to change were assessed. We propose the Minimal Clinically Important Difference (MCID) value and a pathological threshold as well as a threshold to predict cognitive change between V1 and V4. RESULTS: Of the 201 participants included (63% male; mean [SD] age 63 [13] years), CASP data were available for 199/150/133/93 at V1/V2/V3/V4, respectively. CASP has a one-dimensional structure. The hypotheses of convergent/divergent validities were confirmed. Internal consistency was good and reliability excellent. Responsiveness was small to moderate, but the MCID could still be estimated. We discuss the choice of a pathological threshold and a predictive threshold of V1 over V4. CONCLUSIONS: CASP has good psychometric properties for screening cognitive impairment in the subacute post-stroke phase, which is consistent with its Italian and Korean versions. It can be used for patients with severe motor aphasia or left hemispatial neglect but not in case of severe oral comprehension or visual impairment.

Afasia e inclusão social: panorama brasileiro na Fonoaudiologia / Aphasia and social inclusion: a Brazilian Speech-Therapy overview / Afasia y inclusión social: un panorama brasileño en Fonoaudiología

Introdução: Os impactos da afasia vão além de alterações de linguagem ou comunicação, afetando a qualidade de vida e a participação social. Faz-se necessário, portanto, que o fonoaudiólogo atue de forma interdisciplinar e amplie seu escopo de atuação na terapia das afasias, indo além de uma perspectiva que foca majoritariamente na correção de déficits linguísticos. Esta comunicação discute a importância de metas de incentivo à inclusão social e aponta caminhos para melhor atender às demandas dessa população. Objetivo: Discutir o trabalho do fonoaudiólogo no que tange a metas de enfrentamento dos impactos sociais da afasia. Método: Revisão não sistemática de literatura. São discutidos temas ligados à inclusão social e apresentadas iniciativas nacionais que promovem a participação social da pessoa com afasia. Resultados: Apesar das lacunas ainda existentes, as ações crescentes de diversos grupos de convivência, a criação de associações e as campanhas de conscientização da população apontam para importantes sinais de  mudança no escopo de atuação do fonoaudiólogo junto a essa população. Conclusão: Há um crescimento das intervenções em grupo e valorização de atividades artísticas oferecidas junto a pessoas que vivem com afasia. Os estudos sobre tais intervenções demonstram impactos positivos na qualidade de vida, participação social e funcionalidade da comunicação dessa população. São necessários esforços no sentido de trabalhar com a família e com a sociedade, bem como ampliar políticas públicas e oferecer serviços que promovam a inclusão social da pessoa com afasia.

Introduction: The impacts of aphasia are not restricted to changes in language or communication, and affect both quality of life and social participation. Therefore, it is essential that speech-language pathologists work within an interdisciplinary approach and their scope of action in aphasia therapy should not be restricted to correct language deficits. This study discusses the importance of social inclusion goals in aphasia therapy, suggesting ways to better meet the demands of this population. Objective: To discuss the role of speech-language pathologists in tackling the social impacts of aphasia. Method: This is a non-systematic literature review that addresses topics related to social inclusion, as well as current Brazilian initiatives that promote social participation for people with aphasia. Results: Despite remaining gaps, there are important signs of a change in perspective and scope of action of speech-language pathologists, such as increasing actions involving peer groups, the development of associations, as well as nation-wide awareness campaigns. Conclusion: There has been an increase in group interventions, as well as greater promotion of artistic activities for people with aphasia. Studies on these interventions report positive impacts on quality of life, social participation and functional communication for this population. Further combined efforts with family members and society as a whole are needed, as well as the promotion of policies and services that promote social inclusion for people with aphasia.

Introducción: los impactos de la afasia van más allá que las alteraciones de lenguaje o de comunicación, afectando la calidad de vida y la participación social. Sin embargo, es necesario que el logopeda trabaje de forma interdisciplinar y amplíe su alcance de atención a la terapia de afasia, más allá de una perspectiva centrada en la corrección de déficits lingüísticos. Esta comunicación analiza la importancia de metas de incentivo y de medidas de inclusión social para satisfacer mejor las demandas de esta población. Objetivo: Discutir el trabajo del logopeda en relación con las metas de enfrentamiento del impacto social de la afasia. Métodos: revisión no sistemática de literatura. Son discutidos temas relacionados con la inclusión social y la presentación de iniciativas brasileñas que promueven la participación social de la persona con afasia. Resultados: aún que existan faltas, las iniciativas crecientes de variados grupos de convivencia y la creación de asociaciones y de campañas de concientización indican haber cambios importantes en el ámbito de actuación del logopeda junto a esta población. Conclusión: Ha habido un aumento en las intervenciones en grupo y en las actividades artísticas ofrecidas a las personas que viven con afasia. Los estudios sobre estas intervenciones demuestran impactos positivos en la calidad de vida, la participación social y la funcionalidad de esta población. Son necesarios esfuerzos en el sentido de trabajar junto a familia y la sociedad, así como expandir las políticas públicas y el ofrecimiento de servicios que promuevan la inclusión social de la persona con afasia.

Vision, Aphasia, Neglect Assessment for Large Vessel Occlusion Stroke.

BACKGROUND AND PURPOSE: Vision, Aphasia, Neglect (VAN) is a large vessel occlusion (LVO) screening tool that was initially tested in a small study where emergency department (ED) nurses were trained to perform VAN assessment on stroke code patients. We aimed to validate the VAN assessment in a larger inpatient dataset. METHODS: We utilized a large dataset and used National Institute of Health Stroke Scale (NIHSS) performed by physicians to extrapolate VAN. VAN was compared to NIHSS greater than or equal to 6 and established prehospital LVO screening tools including Rapid Arterial Occlusion Evaluation scale (RACE), Field Assessment Stroke Triage for Emergency Destination (FAST-ED), and Cincinnati Pre-hospital Stroke Scale (CPSS). Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), accuracy, and area under receiver operating characteristics curve was calculated to estimate the predictive value of LVO. RESULTS: VAN was comparable in sensitivity (79% versus 80%) and NPV (88% versus 87%) to NIHSS greater than or equal to 6. It was superior in specificity (69% versus 57%), PPV (53% versus 46%) and accuracy to NIHSS greater than or equal to 6 (72% versus 64%) with significant receiver operating curve (.74 versus .69, P = .02). VAN also had comparable area under the curve when compared to RACE, FAST-ED, and CPSS however slightly lower accuracy (69%-73%) compared to RACE (76%), FAST-ED (77%), and CPSS (75%). VAN had the highest NPV among all screening assessments (88%). CONCLUSIONS: VAN is a simple screening tool that can identify LVOs with adequate accuracy in hospital setting. Future studies need to be conducted in prehospital setting to validate its utility to detect LVOs in the field.

Supporting Confidence and Participation for People with Aphasia Through Student Interaction: A Descriptive Study on the Effects of an Interdisciplinary Campus Program.

PURPOSE: Decreased social participation is one consequence of aphasia that can lead to poor psychological health and reduced quality of life. Involving people with aphasia in advocacy efforts may be one solution for increasing their social participation. The present study investigated the benefits of a campus program for three people with mild aphasia who were involved in educating allied health students about aphasia and training them to communicate with those who have aphasia. METHODS: Three participants with aphasia shared their stories and interacted with interdisciplinary students in two seminar sessions aimed at educating students about aphasia and helping them learn strategies for supportive communication with people with aphasia. A mixed-method analysis approach was used to assess the effects of the program. Quantitative data were obtained via pre- and post-program survey questionnaires. Qualitative data were acquired through focus group interviews. RESULTS: Scores on questionnaires related to communication confidence or social participation were greater following program participation for all three participants with aphasia and quality of communication life scores were greater for one. Thematic coding of focus group data confirmed that participants with aphasia and their spouses perceived benefits to program participation including increased social access and improved self-concept. CONCLUSIONS: Findings suggest that participation in community education efforts may lead to increased social participation and communication confidence for people with aphasia.

Vision, Aphasia, Neglect Assessment to Predict Neurosurgical Intervention in Patients with Nontraumatic Intracerebral Hemorrhage.

BACKGROUND AND PURPOSE: The Vision, Aphasia, and Neglect (VAN) screening tool is a simple bedside test developed to identify patients with large vessel occlusion stroke. In the setting of intracerebral hemorrhage (ICH), there are very few bedside predictors of need for neurosurgical interventions other than age and Glasgow Coma Scale (GCS). We aimed to assess the utility of the VAN screening tool in predicting the need for neurosurgical intervention in patients with ICH. METHODS: We accessed sensitivity, specificity, positive predictive value, negative predictive value (NPV), and area under receiver operating characteristics curve of VAN for identifying ICH patients who require neurosurgical intervention. RESULTS: Among 228 ICH patients, 176 were VAN positive and 52 were VAN negative. On unadjusted analyses, VAN positive patients had a significantly higher ICH volume, GCS score, and National Institutes of Health Stroke Scale score (P < .001 for all). As compared to VAN negative patients, significantly higher proportion of VAN positive ICH patients (15.4% versus 32.4%) underwent a neurosurgical procedure such as external ventricular drain (EVD) and/or hematoma evacuation with craniotomy or craniectomy. The VAN screening tool had high sensitivity and NPV (100%) in predicting the need for craniectomy or hematoma evacuation, but had lower sensitivity (87.7%) for any neurosurgical procedure, as 15.4% of VAN negative patients received EVD. CONCLUSIONS: Our study suggests that VAN screening tool can identify high-risk ICH patients who are more likely to undergo craniotomy or craniectomy but is less sensitive to rule out need for EVD.

The seven habits of highly effective aphasia therapists: The perspective of people living with aphasia.

Purpose: Influential value-driven approaches to aphasia rehabilitation have been proposed previously, but have emphasised how service providers need to deliver their services. The aim of this article is to extract a set of values or habits that define effective aphasia therapists, from a 16-year programme of research that has sought to capture the perspectives of people with aphasia, their family and speech-language pathologists. Method: The findings of 58 studies published by members of our team which have sought the views of people with aphasia (38 studies), speech-language pathologists (11 studies) and family members (5 studies), and those which compared all stakeholder's perspectives (2 studies), were synthesised into seven themes. Presented as habits, these were subsequently described in the same manner as the popular "Seven Habits of Highly Effective People". Result: The seven habits of highly effective aphasia therapists described by people with aphasia and their family were (1) Prioritise relationships; (2) Find a rope team; (3) Begin with the end in mind; (4) Practise SMARTER therapy; (5) Leave no person behind; (6) Look behind the mask and (7) Find a voice. Conclusion: While there are similarities to other value-based approaches to aphasia rehabilitation, these seven habits are detailed using our published research that has privileged the voices of people with aphasia. The seven habits therefore reflect what people with aphasia view as the features of highly effective aphasia therapists. The next steps are to identify how to evaluate evidence-based practices in these areas and ensure their implementation into practice. Effective aphasia therapists are at the heart of effective aphasia rehabilitation.

Evaluating Personal Stroke Narratives from Bilingual Greek-English Immigrants with Aphasia.

OBJECTIVE: For people with aphasia (PWA) and their significant others, narratives are intricately intertwined with quality of life, culture, and social participation. This paper reports stories told by bilingual people with aphasia (bPWA), describing the events or consequences of a stroke on their lives. PATIENTS AND METHODS: Six participants with chronic mild-moderate anomia (mean age 70 years) spontaneously produced a narrative recounting their personal experience of stroke in their native language (Greek) and in their second language (English). All bPWA had learned English in early adulthood upon migration from Greece to Australia, not through formal teaching but on the job (e.g., in the factory). The bPWA had lived in Australia for 46 years (average) and were less than 4 years post-stroke. RESULTS: Narratives in the two languages underwent quantitative (number of propositions, noun/verb tokens) and qualitative analyses (ratings of coherence, ratings of clarity). Most bPWA produced coherent "tellable" stories despite disruptions in language because of aphasia. Overall, stories were better told (length, complexity of content, temporal-causal sequencing, reference) in Greek - their native language. CONCLUSION: The results have implications for policy-makers providing health and welfare services to ageing immigrant populations. The findings are also relevant to other countries that have large immigrant populations of stroke survivors.

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.

Communicative Accessibility in Aphasia: An Investigation of the Interactional Context of Long-Term Care Facilities.

Purpose: The purpose of this study was to examine the ability of persons with aphasia to access interaction and be included in social encounters in long-term care facilities (LTCFs). Method: Four persons with aphasia were the focus of this investigation. A qualitative research approach using ethnographic methods was used to conduct participant observation, semistructured interviews, and artifact analysis. Expanded field notes from observations, transcribed interviews, and artifacts were then coded to identify patterns in the data. Results: The interactional context of LTCFs negatively influenced the ability of persons with aphasia to communicate with others and develop meaningful relationships. Three major themes emerged from the data detailing the contextual elements leading to communication accessibility and inclusion: (a) lack of support, (b) social hierarchy, and (c) focus on performance. Conclusions: Findings highlighted several barriers in LTCFs that worked to discourage persons with aphasia from living social and expressive lives. Specific obstacles included a misunderstanding of aphasia and its influence on communicative exchanges and performance-oriented environment that overlooked psychosocial needs. Speech-language pathologists have an important role for advocacy in LTCFs. Clinical implications for assessment and treatment in institutions are discussed.

An International Survey of Assessment Practices for Short-Term and Working Memory Deficits in Aphasia.

Purpose: Recent research has highlighted the clinical relevance of understanding the nature of short-term memory (STM) and working memory (WM) deficits in persons with aphasia and the way these deficits affect linguistic processing and functional communication in activities of daily living. The psychometric properties of tests commonly used to identify STM/WM problems in individuals with aphasia, however, have been questioned. No previous study has sought to investigate assessment practices and attitudes by speech-language pathologists involved in aphasia management. Accordingly, the aims of this study were (a) to investigate both attitudes toward STM/WM assessment in individuals with aphasia, as well as the types and frequency of STM/WM tests used with individuals with aphasia, and (b) to explore factors (e.g., educational background) that may influence STM/WM assessment practices. Method: Respondents recruited via professional and aphasia support organizations completed an online survey. The survey elicited information about the respondents' demographic and clinical backgrounds and STM/WM assessment clinical practices and views, including frequency and preferred use of specific STM/WM tests. Results: The majority of respondents reported regular use of STM/WM tests as part of aphasia management. Positive attitudes toward STM/WM assessments were also reported. The most popular rankings of tests were the Cognitive Linguistic Quick Test (Helm-Estabrooks, 2001), the Comprehensive Aphasia Test (Swinburn, Porter, & Howard, 2005), and the Token Test (McNeil & Prescott, 1978). Results suggested limited knowledge about measures that assess self-perceptions of functional memory abilities. Regression analyses showed that the frequency of reported STM/WM test use was similar between clinicians and dual-role researchers/clinicians, but their attitudes toward the value of STM/WM differed. U.S. and UK respondents reported similar assessment practices. Conclusions: It is reassuring that STM/WM is taken into consideration by clinicians when providing aphasia management. Two of the most popular tests, however, have poor psychometric properties, and caution should be exercised in clinical decision making. The different value placed on STM/WM testing by clinicians and researchers/clinicians has implications for continuing professional development.

Assessment of mood in aphasia following stroke: validation of the Dynamic Visual Analogue Mood Scales (D-VAMS).

OBJECTIVES: To validate a non-verbal self-report measure of mood - the Dynamic Visual Analogue Mood Scales (D-VAMS) - against the Hospital Anxiety and Depression Scale (HADS) and assess its suitability as an outcome measure or screening measure for depressed mood following stroke. DESIGN: Cross-sectional observational cohort study. PARTICIPANTS: Forty-six stroke survivors (24% with aphasia) recruited from online, from stroke clubs and via an NHS rehabilitation service. METHODS: A set of seven bipolar scales was developed enabling users to report mood by modifying facial expression images using a slider. Participants completed a tablet/computer task, reporting their mood on these scales mixed randomly with versions which used only words. The HADS was then completed, followed by a repeat run of the two versions in a different, random sequence. RESULTS: Exploratory factor analysis identified one factor consistent with pleasantness of mood accounting for 80% of the variance. Internal consistency of D-VAMS was high ( α = 0.95), and there was a high correlation between face-only D-VAMS scores and HADS total scores ( r = -0.80, P < 0.001), as well as HADS-D/HADS-A subscale scores ( r = -0.73, P < 0.001; r = -0.71, P < 0.001). D-VAMS showed good sensitivity and specificity against HADS, with means of 85%/77% (sensitivity/specificity) against the HADS-D and 80%/77% against the HADS-A across nine cut-offs. CONCLUSION: D-VAMS is a valid and reliable measure likely suitable for assessment of depressed mood in aphasia following stroke. Though D-VAMS performed well as a screening measure in this study sample, further study is needed in the acute stage post-stroke.

More Than the Verbal Stimulus Matters: Visual Attention in Language Assessment for People With Aphasia Using Multiple-Choice Image Displays.

Purpose: Language comprehension in people with aphasia (PWA) is frequently evaluated using multiple-choice displays: PWA are asked to choose the image that best corresponds to the verbal stimulus in a display. When a nontarget image is selected, comprehension failure is assumed. However, stimulus-driven factors unrelated to linguistic comprehension may influence performance. In this study we explore the influence of physical image characteristics of multiple-choice image displays on visual attention allocation by PWA. Method: Eye fixations of 41 PWA were recorded while they viewed 40 multiple-choice image sets presented with and without verbal stimuli. Within each display, 3 images (majority images) were the same and 1 (singleton image) differed in terms of 1 image characteristic. The mean proportion of fixation duration (PFD) allocated across majority images was compared against the PFD allocated to singleton images. Results: PWA allocated significantly greater PFD to the singleton than to the majority images in both nonverbal and verbal conditions. Those with greater severity of comprehension deficits allocated greater PFD to nontarget singleton images in the verbal condition. Conclusion: When using tasks that rely on multiple-choice displays and verbal stimuli, one cannot assume that verbal stimuli will override the effect of visual-stimulus characteristics.

Aphasia and literacy-the insider's perspective.

BACKGROUND: Few studies have investigated how people with aphasia (PWA) experience literacy skills. Taking the insider's perspective is a way to increase understanding of the individual experiences of literacy among PWA, which may have clinical implications. AIMS: To describe how literacy, i.e., reading and writing, is experienced in everyday life by PWA and to gain insight into the part played by literacy skills in their lives. METHODS & PROCEDURES: A qualitative descriptive research approach was taken. In-depth interviews were conducted with 12 PWA (six women and six men) who had all lived with aphasia for at least 6 months post-stroke. The interviews were analysed using qualitative content analysis. OUTCOMES & RESULTS: One overarching theme emerged from the data: literacy as an ongoing recovery process. Based on this overarching theme, two subthemes were identified: changes in conditions for literacy (experiences of reading and writing initially post-onset compared with experiences at the time of the interview); and facing expectations about literacy (participants' own and other people's expectations of them in terms of literacy). CONCLUSIONS & IMPLICATIONS: The findings are important at a general level in that they indicate that PWA are able to articulate their individual experiences and thoughts about literacy, i.e., reading and writing. Specifically, PWA in this study experience literacy as playing an essential part in their lives and the findings imply that personal experiences are important in the design of reading and writing interventions in speech and language therapy.

Financial and legal decision-making capacity in the aphasic population - a narrative review.

INTRODUCTION: Capacity is assumed to be present unless proven otherwise. Assessments of specific decision-making capacity for financial and legal decisions, although challenging in the general population, becomes almost impossible for individuals with language disorders (i.e. aphasia) in the absence of appropriate communication aids. Several capacity aids exist for the general population; however, it is unclear whether any communication aids exist specifically for the aphasic population to assist assessment of financial and legal decision-making capacity. METHOD: A literature review was conducted of six databases with the assistance of a research librarian. From 171 articles screened, 12 were included in the final review. RESULTS: The literature focus was on medical decision-making capacity, and in particular, patient consent. Few articles addressed legal or financial decision-making capacity. Several articles identified the presence of general and specific capacity aids for the general population; however, there was a clear absence of similar communication aids available for the aphasic population with only one communication aid identified to assist with decision-making capacity assessment for healthcare and accommodation decisions only. CONCLUSION: Whilst a significant amount of research has been done on decision-making capacity, it is mostly focused on healthcare; in particular, on patient consent for treatment for the non-aphasic population. Although a communication aid exists to aid assessment of decision-making capacity for healthcare for aphasic individuals, no similar tools exist to aid financial and legal decision-making capacity assessments. This paper highlights an important problem encountered during clinical practice which requires further research.

Transcranial direct current stimulation in post-stroke sub-acute aphasia: study protocol for a randomized controlled trial.

BACKGROUND: Transcranial direct current stimulation (tDCS) is a promising new technique to optimize the effect of regular Speech and Language Therapy (SLT) in the context of aphasia rehabilitation. The present study focuses on the effect of tDCS provided during SLT in the sub-acute stage after stroke. The primary aim is to evaluate the potential effect of tDCS on language functioning, specifically on word-finding, as well as generalization effects to verbal communication. The secondary aim is to evaluate its effect on social participation and quality of life, and its cost-effectiveness. METHODS: We strive to include 58 stroke patients with aphasia, enrolled in an inpatient or outpatient stroke rehabilitation program, in a multicenter, double-blind, randomized controlled trial with two parallel groups and 6 months' follow-up. Patients will participate in two separate intervention weeks, with a pause of 2 weeks in between, in the context of their regular aphasia rehabilitation program. The two intervention weeks comprise daily 45-minute sessions of word-finding therapy, combined with either anodal tDCS over the left inferior frontal gyrus (1 mA, 20 minutes; experimental condition) or sham-tDCS over the same region (control condition). The primary outcome measure is word-finding. Secondary outcome measures are verbal communication, social participation, quality of life, and cost-effectiveness of the intervention. DISCUSSION: Our results will contribute to the discussion on whether tDCS should be implemented in regular aphasia rehabilitation programs for the sub-acute post-stroke population in terms of (cost-)effectiveness. TRIAL REGISTRATION: Nederlands Trail Register: NTR4364 . Registered on 21 February 2014.

Reducing the psychosocial impact of aphasia on mood and quality of life in people with aphasia and the impact of caregiving in family members through the Aphasia Action Success Knowledge (Aphasia ASK) program: study protocol for a randomized controlled trial.

BACKGROUND: People with aphasia and their family members are at high risk of experiencing post stroke depression. The impact of early interventions on mood and quality of life for people with aphasia is unknown. METHODS/DESIGN: This study will determine whether an early intervention for both the person with aphasia after stroke and their family members leads to better mood and quality of life outcomes for people with aphasia, and less caregiver burden and better mental health for their family members. This is a multicenter, cluster-randomized controlled trial. Clusters, which are represented by Health Service Districts, will be randomized to the experimental intervention (Aphasia Action Success Knowledge Program) or an attention control (Secondary Stroke Prevention Information Program). People with aphasia and their family members will be blinded to the study design and treatment allocation (that is, will not know there are two arms to the study). Both arms of the study will receive usual care in addition to either the experimental or the attention control intervention. A total of 344 people with aphasia and their family members will be recruited. Considering a cluster size of 20, the required sample size can be achieved from 18 clusters. However, 20 clusters will be recruited to account for the potential of cluster attrition during the study. Primary outcome measures will be mood and quality of life of people with aphasia at 12 months post stroke. Secondary measures will be family member outcomes assessing the impact of caregiving and mental health, and self-reported stroke risk-related behaviors of people with aphasia. DISCUSSION: This is the first known program tailored for people with aphasia and their family members that aims to prevent depression in people with aphasia by providing intervention early after the stroke. TRIAL REGISTRATION: This trial is registered in the Australian New Zealand Clinical Trials Registry (ANZCTR) as ACTRN12614000979651 . Date registered: 11 September 2014.

Relationships among Communication Self-Efficacy, Communication Burden, and the Mental Health of the Families of Persons with Aphasia.

BACKGROUND: The purpose of this study was to elucidate the relationships among communication self-efficacy (SE), communication burden, and the mental health of the families of persons with aphasia using structural equation modeling (SEM). METHODS: This study examined 110 pairs of persons with aphasia receiving home care and 1 family caregiver per person with aphasia. The survey items for this study consisted of the Communication Self-efficacy Scale, the Communication Burden Scale, the Geriatric Depression Scale-Short Form-Japanese, and the Health-Related Quality of Life: SF-8 Health Survey. The relationships between the constructive concept of "communication self-efficacy" and "communication burden," and "mental-health status" were analyzed using SEM. RESULTS: The results of the SEM analysis revealed that a high communication SE of the families was associated with low burden of communication and good mental-health status. CONCLUSIONS: Psychoeducational programs that address the communication SE of family caregivers may have the potential to reduce the burden of communication and to improve the mental health of caregivers. These programs could lead to an enhanced quality of life for both persons with aphasia and their families.

EXTENDING THE ASSESSMENT OF TECHNOLOGY-AIDED PROGRAMS TO SUPPORT LEISURE AND COMMUNICATION IN PEOPLE WITH ACQUIRED BRAIN INJURY AND EXTENSIVE MULTIPLE DISABILITIES.

Intervention programs for people with acquired brain injury and extensive motor and communication impairment need to be diversified according to their characteristics and environment. These two studies assessed two technology-aided programs for supporting leisure (i.e., access to songs and videos) and communication (i.e., expressing needs and feelings and making requests) in six of those people. The three people participating in Study 1 did not possess speech but were able to understand spoken and written sentences. Their program presented leisure and communication options through written phrases appearing on the computer screen. The three people participating in Study 2 did not possess any speech and were unable to understand spoken or written language. Their program presented leisure and communication options through pictorial images. All participants relied on a simple microswitch response to enter the options and activate songs, videos, and communication messages. The data showed that the participants of both studies learned to use the program available to them and to engage in leisure and communication independently. The importance of using programs adapted to the participants and their environment was discussed.