Understanding experiences, unmet needs and priorities related to post-stroke aphasia care: stage one of an experience-based co-design project.

OBJECTIVE: People with post-stroke aphasia (language/communication impairment) and their supporters report mixed satisfaction with stroke and aphasia care. To date, however, their journey of care and the key service interactions that shape their experience have not been comprehensively explored. We aimed to investigate the lived experience of post-stroke aphasia care, across the continuum of care and by geographical location, to establish priorities for service design. DESIGN: This is the first stage of an experience-based co-design study. We purposively sampled people with aphasia (PWA) and significant others (SOs) across 21 hospital and health service sites, community groups and by self-referral. Participants shared experiences of care in online interviews and focus groups. Touchpoints (key moments that shape experience) and unmet needs were identified using qualitative thematic analysis. Priorities for service design were established using an adapted nominal group technique. SETTING: Sites spanned remote, regional and metropolitan areas in Queensland, Australia. PARTICIPANTS: PWA (n=32; mild=56%; moderate=31%; severe=13%) and SOs (n=30) shared 124 experiences of acute, rehabilitation and community-based care in 23 focus groups and 13 interviews. RESULTS: Both positive and negative healthcare experiences occurred most frequently in hospital settings. Negative experiences regularly related to communication with health professionals, while positive experiences related to the interpersonal qualities of healthcare providers (eg, providing hope) for PWA, or witnessing good rapport between a PWA and their health professional for SOs. To improve services, PWA prioritised communicatively accessible education and information and SOs prioritised access to psychological and peer support. CONCLUSIONS: We identified key aspects of post-stroke aphasia care that shape experience. The needs of PWA and SOs may be better met through health professional training in supported communication, increased service availability in regional and remote areas, communication-accessible hospital environments, increased access to psychological and peer support, and meaningful involvement of SOs in rehabilitation.

High-Intensity Aphasia Therapy Is Cost-Effective in People With Poststroke Aphasia: Evidence From the COMPARE Trial.

BACKGROUND: Evidence from systematic reviews confirms that speech and language interventions for people with aphasia during the chronic phase after stroke (>6 months) improve word retrieval, functional communication, and communication-related quality of life. However, there is limited evidence of their cost-effectiveness. We aimed to estimate the cost per quality-adjusted life year gained from 2 speech and language therapies compared with usual care in people with aphasia during the chronic phase (median, 2.9 years) after stroke. METHODS: A 3-arm, randomized controlled trial compared constraint-induced aphasia therapy plus (CIAT-Plus) and multimodality aphasia therapy (M-MAT) with usual care in 216 people with chronic aphasia. Participants were administered a standardized questionnaire before intervention and at 12 weeks after the 2-week intervention/control period to ascertain health service utilization, employment changes, and informal caregiver burden. Unit prices from Australian sources were used to estimate costs in 2020. Quality-adjusted life years were estimated using responses to the EuroQol-5 Dimension-3 Level questionnaire. To test uncertainty around the differences in costs and outcomes between groups, bootstrapping was used with the cohorts resampled 1000 times. RESULTS: Overall 201/216 participants were included (mean age, 63 years, 29% moderate or severe aphasia, 61 usual care, 70 CIAT-Plus, 70 M-MAT). There were no statistically significant differences in mean total costs ($13 797 usual care, $17 478 CIAT-Plus, $11 113 M-MAT) and quality-adjusted life years (0.19 usual care, 0.20 CIAT-Plus, 0.20 M-MAT) between groups. In bootstrapped analysis of CIAT-Plus, 21.5% of iterations were likely to result in better outcomes and be cost saving (dominant) compared with usual care. In contrast, 72.4% of iterations were more favorable for M-MAT than usual care. CONCLUSIONS: We observed that both treatments, but especially M-MAT, may result in better outcomes at an acceptable additional cost, or potentially with cost savings. These findings are relevant in advocating for the use of these therapies for chronic aphasia after stroke.

A Call for Transformative Intersectional LPAA Intervention for Equity and Social Justice in Ethnosocially Diverse Post-Stroke Aphasia Services.

The disproportionate health disparities in ethnoracial groups highlighted by the COVID-19 pandemic catalyzed a sociopolitical momentum for transformative approaches in health care. As the U.S. population progressively becomes more ethnoracially diverse and older, growing vulnerable ethnogeriatric groups of older individuals with contrasting ethnic/racial and social histories are estimated to experience age-related cardiovascular complications with resulting chronic disabilities, such as post-stroke aphasia. Grounded in principles of equity and social justice, transformative health care approaches use input from marginalized communities to inform service strategies to minimize health disparities. This article discusses the population scenario, principles, and possible strategies to support the call for stakeholder-informed intervention toward the social reintegration of ethnosocially mixed geriatric populations with aphasia in the United States. Based on the principles from the Life Participation Approach to Aphasia (LPAA) and intersectional narratives, we discuss how client and caregiver stories can inform culturally authentic individualized aphasia intervention for social readaptation. We conclude with future directions in aphasia education, research, and practice to promote stakeholder-informed strategies for culturally aligned social reintegration of older ethnosocially diverse aphasia populations in post-stroke care.

AI-Generated Images for Speech Pathology-An Exploratory Application to Aphasia Assessment and Intervention Materials.

PURPOSE: Images are a core component of aphasia assessment and intervention that require significant resources to produce or source. Text-to-image generation is an Artificial Intelligence (AI) technology that has recently made significant advances and could be a source of low-cost, highly customizable images. The aim of this study was to explore the potential of AI image generation for use in aphasia by examining its efficiency and cost during generation of typical images. METHOD: Two hundred targets (80 nouns, 80 verbs, and 40 sentences) were selected at random from existing aphasia assessments and treatment software. A widely known image generator, DALL-E 2, was given text prompts for each target. The success rate, number of prompts required, and costs were summarized across target categories (noun/verb/sentence) and compared to frequency and imageability. RESULTS: Of 200 targets, 189 (94.5%) successfully conveyed the key concept. The process took a mean of 2.3 min per target at a cost of $0.31 in U.S. dollars each. However, there were aesthetic flaws in many successful images that could impact their utility. Noun images were generated with the highest efficiency and accuracy, followed by verbs, while sentences were more challenging, particularly those with unusual scenes. Patterns of flaws and errors in image generation are discussed. CONCLUSION: The ability to rapidly generate low-cost, high-quality images using AI is likely to be a major contribution to aphasia assessment and treatment going forward, particularly as advances in this technology continue.

The Intersection of Social Determinants of Health and Post-stroke Aphasia Outcomes: A Need for Intersectional Analysis.

Aphasia is a disorder that results from damage to portions of the brain that are responsible for language and can vary significantly by type and severity. Differences in aphasia outcomes are influenced by the social determinants of health (SDOH). The SDOH are structural, environmental, and personal determinants that influence health outcomes. Intersectionality, or how one's social and political identities interact to influence individual life outcomes and/or advantage in our society, provides a way to examine the varying levels of the SDOH. However, intersectionality is complex, difficult to measure, and has not yet been explored in post-stroke aphasia outcomes. This article reviews the relationship of race and aphasia outcomes and the SDOH and aphasia outcomes. Additionally, we provide a novel current approach to examine the SDOH and aphasia outcomes. Lastly, we discuss the need for evaluation of intersectionality in aphasia and aim to provide a leveled social-ecological framework to examine aphasia-related outcomes. With notable individual differences among aphasia outcomes, we present a framework to support optimizing research and clinical aphasia care in speech-language pathology.

Automatic Assessment of Aphasic Speech Sensed by Audio Sensors for Classification into Aphasia Severity Levels to Recommend Speech Therapies.

Aphasia is a type of speech disorder that can cause speech defects in a person. Identifying the severity level of the aphasia patient is critical for the rehabilitation process. In this research, we identify ten aphasia severity levels motivated by specific speech therapies based on the presence or absence of identified characteristics in aphasic speech in order to give more specific treatment to the patient. In the aphasia severity level classification process, we experiment on different speech feature extraction techniques, lengths of input audio samples, and machine learning classifiers toward classification performance. Aphasic speech is required to be sensed by an audio sensor and then recorded and divided into audio frames and passed through an audio feature extractor before feeding into the machine learning classifier. According to the results, the mel frequency cepstral coefficient (MFCC) is the most suitable audio feature extraction method for the aphasic speech level classification process, as it outperformed the classification performance of all mel-spectrogram, chroma, and zero crossing rates by a large margin. Furthermore, the classification performance is higher when 20 s audio samples are used compared with 10 s chunks, even though the performance gap is narrow. Finally, the deep neural network approach resulted in the best classification performance, which was slightly better than both K-nearest neighbor (KNN) and random forest classifiers, and it was significantly better than decision tree algorithms. Therefore, the study shows that aphasia level classification can be completed with accuracy, precision, recall, and F1-score values of 0.99 using MFCC for 20 s audio samples using the deep neural network approach in order to recommend corresponding speech therapy for the identified level. A web application was developed for English-speaking aphasia patients to self-diagnose the severity level and engage in speech therapies.

Cost-effectiveness of speech and language therapy plus scalp acupuncture versus speech and language therapy alone for community-based patients with Broca's aphasia after stroke: a post hoc analysis of data from a randomised controlled trial.

OBJECTIVE: This study aimed to assess the cost-effectiveness of combined scalp acupuncture therapy with speech and language therapy for patients with Broca's aphasia after stroke. DESIGN: A within-trial cost-effectiveness analysis. SETTINGS: Community health centres. SUBJECTS: A total of 203 participants with Broca's aphasia after stroke who had been randomly assigned to receive scalp acupuncture with speech and language therapy (intervention) or speech and language therapy alone (control). INTERVENTION: Both groups underwent speech and language therapy (30 min per day, 5 days a week, for 4 weeks), while the intervention group simultaneously received scalp acupuncture. PRIMARY OUTCOMES: All outcomes were collected at baseline, and after the 4-week intervention and 12-week follow-up. Cost-effectiveness measures included the Chinese Rehabilitation Research Center Standard Aphasia Examination (CRRCAE) and Boston Diagnostic Aphasia Examination (BDAE). Cost-utility was evaluated using quality-adjusted life-years (QALYs). Incremental cost-effectiveness ratios were expressed, and sensitivity analysis was conducted. RESULTS: The total cost to deliver the intervention was €4001.72, whereas it was €4323.57 for the control group. The incremental cost-effectiveness ratios showed that the intervention was cost-effective (€495.1 per BDAE grade gained; €1.8 per CRRCAE score gained; €4597.1 per QALYs gained) relative to the control over the 12 weeks. The intervention had a 56.4% probability of being cost-effective at the ¥50 696 (€6905.87) Gross Domestic Product (GDP) per capita threshold. Sensitivity analyses confirmed the robustness of the results. CONCLUSIONS: Compared with speech and language therapy alone, the addition of scalp acupuncture was cost-effective in Chinese communities. As the costs of acupuncture services in China are likely to differ from other countries, these results should be carefully interpreted and remain to be confirmed in other populations. TRIAL REGISTRATION NUMBER: ChiCTR-TRC-13003703.

Singing for people with aphasia (SPA): results of a pilot feasibility randomised controlled trial of a group singing intervention investigating acceptability and feasibility.

OBJECTIVES: Pilot feasibility randomised controlled trial (RCT) for the singing groups for people with aphasia (SPA) intervention to assess: (1) the acceptability and feasibility of participant recruitment, randomisation and allocation concealment; (2) retention rates; (3) variance of continuous outcome measures; (4) outcome measure completion and participant burden; (5) fidelity of intervention delivery; (6) SPA intervention costs; (7) acceptability and feasibility of trial and intervention to participants and others involved. DESIGN: A two-group, assessor-blinded, randomised controlled external pilot trial with parallel mixed methods process evaluation and economic evaluation. SETTING: Three community-based cohorts in the South-West of England. PARTICIPANTS: Eligible participants with post-stroke aphasia were randomised 1:1 to SPA or control. INTERVENTION: The manualised SPA intervention was delivered over 10 weekly singing group sessions, led by a music facilitator and assisted by an individual with post-stroke aphasia. The intervention was developed using the Information-Motivation-Behavioural skills model of behaviour change and targeted psychosocial outcomes. Control and intervention participants all received an aphasia information resource pack. OUTCOME MEASURES: Collected at baseline, 3 and 6 months post-randomisation, candidate primary outcomes were measured (well-being, quality of life and social participation) as well as additional clinical outcomes. Feasibility, acceptability and process outcomes included recruitment and retention rates, and measurement burden; and trial experiences were explored in qualitative interviews. RESULTS: Of 87 individuals screened, 42 participants were recruited and 41 randomised (SPA=20, control=21); 36 participants (SPA=17, control=19) completed 3-month follow-up, 34 (SPA=18, control=16) completed 6-month follow-up. Recruitment and retention (83%) were acceptable for a definitive RCT, and participants did not find the study requirements burdensome. High fidelity of the intervention delivery was shown by high attendance rates and facilitator adherence to the manual, and participants found SPA acceptable. Sample size estimates for a definitive RCT and primary/secondary outcomes were identified. CONCLUSIONS: The SPA pilot RCT fulfilled its objectives, and demonstrated that a definitive RCT of the intervention would be both feasible and acceptable. TRIAL REGISTRATION NUMBER: NCT03076736.

Standardizing Assessment of Spoken Discourse in Aphasia: A Working Group With Deliverables.

Purpose The heterogeneous nature of measures, methods, and analyses reported in the aphasia spoken discourse literature precludes comparison of outcomes across studies (e.g., meta-analyses) and inhibits replication. Furthermore, funding and time constraints significantly hinder collecting test-retest data on spoken discourse outcomes. This research note describes the development and structure of a working group, designed to address major gaps in the spoken discourse aphasia literature, including a lack of standardization in methodology, analysis, and reporting, as well as nominal data regarding the psychometric properties of spoken discourse outcomes. Method The initial initiatives for this working group are to (a) propose recommendations regarding standardization of spoken discourse collection, analysis, and reporting in aphasia, based on the results of an international survey and a systematic literature review and (b) create a database of test-retest spoken discourse data from individuals with and without aphasia. The survey of spoken discourse collection, analysis, and interpretation procedures was distributed to clinicians and researchers involved in aphasia assessment and rehabilitation from September to November 2019. We will publish survey results and recommend standards for collecting, analyzing, and reporting spoken discourse in aphasia. A multisite endeavor to collect test-retest spoken discourse data from individuals with and without aphasia will be initiated. This test-retest information will be contributed to a central site for transcription and analysis, and data will be subsequently openly curated. Conclusion The goal of the working group is to create recommendations for field-wide standards in methods, analysis, and reporting of spoken discourse outcomes, as has been done across other related disciplines (e.g., Consolidated Standards of Reporting Trials, Enhancing the Quality and Transparency of Health Research, Committee on Best Practice in Data Analysis and Sharing). Additionally, the creation of a database through our multisite collaboration will allow the identification of psychometrically sound outcome measures and norms that can be used by clinicians and researchers to assess spoken discourse abilities in aphasia.

Computerised speech and language therapy or attention control added to usual care for people with long-term post-stroke aphasia: the Big CACTUS three-arm RCT.

BACKGROUND: People with aphasia may improve their communication with speech and language therapy many months/years after stroke. However, NHS speech and language therapy reduces in availability over time post stroke. OBJECTIVE: This trial evaluated the clinical effectiveness and cost-effectiveness of self-managed computerised speech and language therapy to provide additional therapy. DESIGN: A pragmatic, superiority, single-blind, parallel-group, individually randomised (stratified block randomisation, stratified by word-finding severity and site) adjunct trial. SETTING: Twenty-one UK NHS speech and language therapy departments. PARTICIPANTS: People with post-stroke aphasia (diagnosed by a speech and language therapist) with long-standing (> 4 months) word-finding difficulties. INTERVENTIONS: The groups were (1) usual care; (2) daily self-managed computerised word-finding therapy tailored by speech and language therapists and supported by volunteers/speech and language therapy assistants for 6 months plus usual care (computerised speech and language therapy); and (3) activity/attention control (completion of puzzles and receipt of telephone calls from a researcher for 6 months) plus usual care. MAIN OUTCOME MEASURES: Co-primary outcomes - change in ability to find treated words of personal relevance in a bespoke naming test (impairment) and change in functional communication in conversation rated on the activity scale of the Therapy Outcome Measures (activity) 6 months after randomisation. A key secondary outcome was participant-rated perception of communication and quality of life using the Communication Outcomes After Stroke questionnaire at 6 months. Outcomes were assessed by speech and language therapists using standardised procedures. Cost-effectiveness was estimated using treatment costs and an accessible EuroQol-5 Dimensions, five-level version, measuring quality-adjusted life-years. RESULTS: A total of 818 patients were assessed for eligibility and 278 participants were randomised between October 2014 and August 2016. A total of 240 participants (86 usual care, 83 computerised speech and language therapy, 71 attention control) contributed to modified intention-to-treat analysis at 6 months. The mean improvements in word-finding were 1.1% (standard deviation 11.2%) for usual care, 16.4% (standard deviation 15.3%) for computerised speech and language therapy and 2.4% (standard deviation 8.8%) for attention control. Computerised speech and language therapy improved word-finding 16.2% more than usual care did (95% confidence interval 12.7% to 19.6%; p < 0.0001) and 14.4% more than attention control did (95% confidence interval 10.8% to 18.1%). Most of this effect was maintained at 12 months (n = 219); the mean differences in change in word-finding score were 12.7% (95% confidence interval 8.7% to 16.7%) higher in the computerised speech and language therapy group (n = 74) than in the usual-care group (n = 84) and 9.3% (95% confidence interval 4.8% to 13.7%) higher in the computerised speech and language therapy group than in the attention control group (n = 61). Computerised speech and language therapy did not show significant improvements on the Therapy Outcome Measures or Communication Outcomes After Stroke scale compared with usual care or attention control. Primary cost-effectiveness analysis estimated an incremental cost per participant of £732.73 (95% credible interval £674.23 to £798.05). The incremental quality-adjusted life-year gain was 0.017 for computerised speech and language therapy compared with usual care, but its direction was uncertain (95% credible interval -0.05 to 0.10), resulting in an incremental cost-effectiveness ratio of £42,686 per quality-adjusted life-year gained. For mild and moderate word-finding difficulty subgroups, incremental cost-effectiveness ratios were £22,371 and £28,898 per quality-adjusted life-year gained, respectively, for computerised speech and language therapy compared with usual care. LIMITATIONS: This trial excluded non-English-language speakers, the accessible EuroQol-5 Dimensions, five-level version, was not validated and the measurement of attention control fidelity was limited. CONCLUSIONS: Computerised speech and language therapy enabled additional self-managed speech and language therapy, contributing to significant improvement in finding personally relevant words (as specifically targeted by computerised speech and language therapy) long term post stroke. Gains did not lead to improvements in conversation or quality of life. Cost-effectiveness is uncertain owing to uncertainty around the quality-adjusted life-year gain, but computerised speech and language therapy may be more cost-effective for participants with mild and moderate word-finding difficulties. Exploring ways of helping people with aphasia to use new words in functional communication contexts is a priority. TRIAL REGISTRATION: Current Controlled Trials ISRCTN68798818. FUNDING: This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 19. See the NIHR Journals Library website for further project information. The Tavistock Trust for Aphasia provided additional support to enable people in the control groups to experience the intervention after the trial had ended.

Aphasia is a communication disorder that can be caused by a stroke. It affects a person's understanding of spoken words and their talking, reading and writing abilities. Communication may improve months, or years, after a stroke with speech and language therapy. Many patients want more speech and language therapy than the NHS can provide. The Big CACTUS (clinical and cost-effectiveness of aphasia computer treatment versus usual stimulation or attention control long term post-stroke) trial evaluated the use of speech and language therapy software for people with aphasia to practise finding words independently at home on their own computer or one loaned by the NHS. People with aphasia who had had a stroke at least 4 months previously were randomly allocated to one of three groups: usual speech and language therapy caredaily use of computerised speech and language therapy for 6 months, tailored by a speech and language therapist and supported by a volunteer or speech and language therapy assistantdaily completion of puzzles and supportive telephone calls from a researcher to mimic the activity/attention the computerised speech and language therapy group received. All groups received usual speech and language therapy. A total of 278 people with aphasia took part in this trial, from 21 UK NHS speech and language therapy departments. They had their strokes between 4 months and 36 years previously. Computerised speech and language therapy enabled more practice (28 hours on average) than usual speech and language therapy (3.8 hours). The computerised speech and language therapy group significantly improved their ability to say words they chose to practise compared with those in the usual speech and language therapy or puzzle book groups. Although computerised speech and language therapy can help people with aphasia to learn new words for years after stroke, no improvements in conversation or quality of life were seen. The cost-effectiveness for the NHS is still uncertain. However, our best estimate is that it is unlikely to be cost-effective for everyone with aphasia, but it may be cost-effective for people with mild and moderate word-finding difficulties. Next steps will focus on how to encourage use of new words in conversation to have an impact on quality of life.

Using AphasiaBank for Discourse Assessment.

AphasiaBank is a shared, multimedia database for the study of communication in aphasia. This article describes a variety of discourse measurement tools and teaching resources available at the AphasiaBank website. The discourse measurement tools include main concept analysis, core lexicon checklists, correct information unit computation techniques, and other automated analyses using the CLAN program. These tools can be used to measure a variety of aspects of language production for assessment as well as treatment evaluation and clinical research purposes. Importantly, they are intended to help make the discourse analysis process more efficient and reliable. Teaching resources include an online tutorial on aphasia, videos of typical behaviors seen in aphasia, group treatment videos, classroom activities, tutorial screencasts, and conference posters. These resources can be used for a variety of clinical and educational purposes. The AphasiaBank website is part of the larger TalkBank project which provides many other shared databases and resources that are relevant to professionals interested in communication and communication disorders.

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.

A Comparison of Three Discourse Elicitation Methods in Aphasia and Age-Matched Adults: Implications for Language Assessment and Outcome.

Purpose Discourse analysis is commonly used to assess language ability and to evaluate language change following intervention in aphasia. The purpose of this study was to identify differences in language produced during different discourse tasks in a large aphasia group and an age- and education-matched control group. Method Four structured discourse tasks across 3 discourse types (expositional, narrative, and procedural) were evaluated in a group of adults with aphasia (n = 90) and an age-matched control group (n = 84) drawn from AphasiaBank. CLAN software was used to extract primary linguistic variables (mean length of utterance, propositional density, type-token ratio, words per minute, open-closed class word ratio, noun-verb ratio, and tokens), which served as proxies for various language abilities. Using a series of repeated-measures analyses of covariance, with significantly correlated demographic and descriptive variables as covariates, main effects of discourse type were evaluated. Results Despite an impoverished output from the aphasia group (i.e., the control group produced significantly more overall output), there was a main effect of discourse type on most primary linguistic variables in both groups, suggesting that, in adults with and without language impairments, each discourse type taxed components of the spoken language system to varying extents. Post hoc tests fleshed out these results, demonstrating that, for example, narrative discourse produced speech highest in propositional density. Conclusion Each discourse type taxes the language system in different ways, verifying the importance of using several discourse tasks and selecting the most sensitive discourse tasks when evaluating specific language abilities and outcomes.

Efficacy of cognitive behavior language therapy for aphasia following stroke: Implications for language education research.

BACKGROUND/OBJECTIVE: Evidence from previous research has shown that the incidence of aphasia following a stroke is high in Nigeria and other countries, and there is a call for intervention programs. The objective of the current study was to investigate the efficacy of cognitive behavior language therapy (CBLT) on aphasia following a stroke. METHODS: The study was designed as a group randomized trial, which involved treatment and no-treatment control procedures. The participants of the study were 86 patients who had experienced aphasia following a stroke. The Porch Index of Communicative Ability (PICA) and Speech-Language Unhelpful Thoughts and Beliefs Scale (SLUTBS) were the measures used in the study. The repeated measures analysis of variance procedure, with Partial eta squared (Equation is included in full-text article.), adjusted R, mean, standard deviation, and upper/lower limit was followed in analyzing the data collected in the study. RESULTS: The CBLT intervention significantly reduced aphasia following a stroke and significantly reduced speech-language and unhelpful thought and beliefs among aphasic stroke patients exposed to the treatment intervention when compared with the no-treatment control group. CONCLUSION: Based on the findings of the study, language educators, speech and language pathologists and therapists in education institutions, hospitals, and rehabilitation centers should adopt the principles of CBLT used in the current study to help them improve communication ability among aphasia stroke patients.

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.

Greater healthcare utilization and costs among Black persons compared to White persons with aphasia in the North Carolina stroke belt.

PURPOSE: To examine racial differences in healthcare utilization and costs for persons with aphasia (PWA) being treated in acute care hospitals in North Carolina (NC). METHODS: NC Healthcare Cost and Utilization Project State Inpatient Database (HCUP-SID) data from 2011-2012 were analyzed to examine healthcare utilization and costs of care for stroke patients with aphasia. Analyses emphasized length of stay, charges and cost of general hospital services. Generalized linear models (GLM) were constructed to determine the impact of demographic characteristics, stroke/illness severity, and observed hospital characteristics on utilization and costs. Hospital fixed effects were included to yield within-hospital estimates of disparities. RESULTS: GLM models demonstrated that Blacks with aphasia experienced 1.9days longer lengths of stay compared to Whites with aphasia after controlling for demographic characteristics, 1.4days controlling for stroke/illness severity, 1.2days controlling for observed hospital characteristics, and ~1 extra day controlling for unobserved hospital characteristics. Similarly, Blacks accrued ~$2047 greater total costs compared to Whites after controlling for demographic characteristics, $1659 controlling for stroke/illness severity, $1338 controlling for observed hospital characteristics, and ~$1311 greater total costs after controlling for unobserved hospital characteristics. CONCLUSIONS: In the acute hospital setting, Blacks with aphasia utilize greater hospital services during longer hospitalizations and at substantially higher costs in the state of NC. A substantial portion of the adjusted difference was related to the hospital treating the patient. However, even after controlling for the hospital, the differences remained clinically and statistically significant.

Application of ERPs neuromarkers for assessment and treatment of a patient with chronic crossed aphasia after severe TBI and long-term coma - Case Report.

 Objective. The study aimed to evaluate the application of ERPs neuromarkers for the assessment and treatment of a patient with chronic crossed aphasia after severe TBI and a long-term coma. CASE REPORT: An ambidextrous female patient, aged 29, suffered from posttraumatic chronic crossed aphasia, severe TBI and a prolonged coma after a car accident. The patient took part in two differentiated rehabilitation programmes of neurotherapy included 20 sessions of relative beta training and 20 sessions of rTMS; both programmes were combined with behavioural training. The patient was tested 3 times: before the experiment, after completion of programme A, and after completion of programme B. RESULTS: In the 1st recording, the neuromarker of aphasia was found - an excess of the P2 wave over the left temporal area. There was a cognitive control deficit - an excess of omission errors and an increase of RT variability - all indexes of sporadic ADHD. In the 2nd recording, slight improvements in cognitive control, and language functions were found. In the 3rd recording, after the rTMS sessions most of her cognitive dysfunctions had been resolved, including language functions. It should be stressed that the activation (especially the increase in the ERP potential of the right side over the frontal lobe) was found. The neuromarker of aphasia did not change, only the location had slightly moved frontally. CONCLUSIONS: The application of ERP neuromarkers assists in the diagnosis, treatment, and academic success of an ambidextrous patient with chronic posttraumatic aphasia and sporadic ADHD. ERPs can be used to assess the functional brain changes induced by neurotherapeutical programmes.

Methodological issues in the design and evaluation of supported communication for aphasia training: a cluster-controlled feasibility study.

OBJECTIVE: To assess the feasibility and acceptability of training stroke service staff to provide supported communication for people with moderate-severe aphasia in the acute phase; assess the suitability of outcome measures; collect data to inform sample size and Health Economic evaluation in a definitive trial. DESIGN: Phase II cluster-controlled, observer-blinded feasibility study. SETTINGS: In-patient stroke rehabilitation units in the UK matched for bed numbers and staffing were assigned to control and intervention conditions. PARTICIPANTS: 70 stroke rehabilitation staff from all professional groups, excluding doctors, were recruited. 20 patients with moderate-severe aphasia were recruited. INTERVENTION: Supported communication for aphasia training, adapted to the stroke unit context versus usual care. Training was supplemented by a staff learning log, refresher sessions and provision of communication resources. MAIN OUTCOME MEASURES: Feasibility of recruitment and acceptability of the intervention and of measures required to assess outcomes and Health Economic evaluation in a definitive trial. Staff outcomes: Measure of Support in Conversation; patient outcomes: Stroke and Aphasia Quality of Life Scale; Communicative Access Measure for Stroke; Therapy Outcome Measures for aphasia; EQ-5D-3L was used to assess health outcomes. RESULTS: Feasibility of staff recruitment was demonstrated. Training in the intervention was carried out with 28 staff and was found to be acceptable in qualitative reports. 20 patients consented to take part, 6 withdrew. 18 underwent all measures at baseline; 16 at discharge; and 14 at 6-month follow-up. Of 175 patients screened 71% were deemed to be ineligible, either lacking capacity or too unwell to participate. Poor completion rates impacted on assessment of patient outcomes. We were able to collect sufficient data at baseline, discharge and follow-up for economic evaluation. CONCLUSIONS: The feasibility study informed components of the intervention and implementation in day-to-day practice. Modifications to the design are needed before a definitive cluster-randomised trial can be undertaken. TRIAL REGISTRATION NUMBER: ISRCTN37002304; Results.

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.

'That doesn't translate': the role of evidence-based practice in disempowering speech pathologists in acute aphasia management.

BACKGROUND: An evidence-practice gap has been identified in current acute aphasia management practice, with the provision of services to people with aphasia in the acute hospital widely considered in the literature to be inconsistent with best-practice recommendations. The reasons for this evidence-practice gap are unclear; however, speech pathologists practising in this setting have articulated a sense of dissonance regarding their limited service provision to this population. A clearer understanding of why this evidence-practice gap exists is essential in order to support and promote evidence-based approaches to the care of people with aphasia in acute care settings. AIMS: To provide an understanding of speech pathologists' conceptualization of evidence-based practice for acute post-stroke aphasia, and its implementation. METHODS & PROCEDURES: This study adopted a phenomenological approach, underpinned by a social constructivist paradigm. In-depth interviews were conducted with 14 Australian speech pathologists, recruited using a purposive sampling technique. An inductive thematic analysis of the data was undertaken. OUTCOMES & RESULTS: A single, overarching theme emerged from the data. Speech pathologists demonstrated a sense of disempowerment as a result of their relationship with evidence-based practice for acute aphasia management. Three subthemes contributed to this theme. The first described a restricted conceptualization of evidence-based practice. The second revealed speech pathologists' strained relationships with the research literature. The third elucidated a sense of professional unease over their perceived inability to enact evidence-based clinical recommendations, despite their desire to do so. CONCLUSIONS & IMPLICATIONS: Speech pathologists identified a current knowledge-practice gap in their management of aphasia in acute hospital settings. Speech pathologists place significant emphasis on the research evidence; however, their engagement with the research is limited, in part because it is perceived to lack clinical utility. A sense of professional dissonance arises from the conflict between a desire to provide best practice and the perceived barriers to implementing evidence-based recommendations clinically, resulting in evidence-based practice becoming a disempowering concept for some.