Efficacy and safety of mirror therapy for post-stroke aphasia: A systematic review and meta-analysis protocol.

BACKGROUND: Aphasia is one of the most common complications of stroke. Mirror therapy (MT) is promising rehabilitation measure for the treatment of post-stroke aphasia. Although some studies suggested that MT is effective and safe for aphasia, the effects and safety remain uncertain due to lacking strong evidence, such as the relevant systematic review and meta- analysis. METHODS: This study will search PubMed, Web of Science, Cochrane Library, EMBASE, Medline, China Knowledge Network (CNKI), WANFANG, China Biomedical Literature Database (CBM), from inception to 1th May 2023 to identify any eligible study. No language or date of publication shall be limited. We will only include randomised controlled trials of MT in the Treatment of poststroke aphasia. Two investigators will work separately on the study selection, data extraction, and study quality assessment. The western aphasia battery (WAB) and aphasia quotient (AQ) will be included as the main outcomes. Boston diagnostic aphasia examination method (BDAE), Chinese standard aphasia examination (CRRCAE) will be included as the secondary outcomes. The statistical analysis will be conducted by RevMan V.5.4 software. The risk of bias of included studies will be assessed by the Cochrane 'Risk of bias' tool. The quality of proof of the results will be evaluated by using the Grading of Recommendations Assessment, Development and Evaluation guidelines. RESULTS: The finding will be presented in a journal or related conferences. CONCLUSION: This study will provide a basis for whether mirror therapy (MT) is effective and safe in the treatment of post-stroke aphasia. TRIAL REGISTRATION: Systematic review registration INPLASY registration number: INPLASY 202340054.

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.

Structural Neuroplasticity Effects of Singing in Chronic Aphasia.

Singing-based treatments of aphasia can improve language outcomes, but the neural benefits of group-based singing in aphasia are unknown. Here, we set out to determine the structural neuroplasticity changes underpinning group-based singing-induced treatment effects in chronic aphasia. Twenty-eight patients with at least mild nonfluent poststroke aphasia were randomized into two groups that received a 4-month multicomponent singing intervention (singing group) or standard care (control group). High-resolution T1 images and multishell diffusion-weighted MRI data were collected in two time points (baseline/5 months). Structural gray matter (GM) and white matter (WM) neuroplasticity changes were assessed using language network region of interest-based voxel-based morphometry (VBM) and quantitative anisotropy-based connectometry, and their associations to improved language outcomes (Western Aphasia Battery Naming and Repetition) were evaluated. Connectometry analyses showed that the singing group enhanced structural WM connectivity in the left arcuate fasciculus (AF) and corpus callosum as well as in the frontal aslant tract (FAT), superior longitudinal fasciculus, and corticostriatal tract bilaterally compared with the control group. Moreover, in VBM, the singing group showed GM volume increase in the left inferior frontal cortex (Brodmann area 44) compared with the control group. The neuroplasticity effects in the left BA44, AF, and FAT correlated with improved naming abilities after the intervention. These findings suggest that in the poststroke aphasia group, singing can bring about structural neuroplasticity changes in left frontal language areas and in bilateral language pathways, which underpin treatment-induced improvement in speech production.

Predicting Language Function Post-Stroke: A Model-Based Structural Connectivity Approach.

BACKGROUND: The prediction of post-stroke language function is essential for the development of individualized treatment plans based on the personal recovery potential of aphasic stroke patients. OBJECTIVE: To establish a framework for integrating information on connectivity disruption of the language network based on routinely collected clinical magnetic resonance (MR) images into Random Forest modeling to predict post-stroke language function. METHODS: Language function was assessed in 76 stroke patients from the Non-Invasive Repeated Therapeutic Stimulation for Aphasia Recovery trial, using the Token Test (TT), Boston Naming Test (BNT), and Semantic Verbal Fluency (sVF) Test as primary outcome measures. Individual infarct masks were superimposed onto a diffusion tensor imaging tractogram reference set to calculate Change in Connectivity scores of language-relevant gray matter regions as estimates of structural connectivity disruption. Multivariable Random Forest models were derived to predict language function. RESULTS: Random Forest models explained moderate to high amount of variance at baseline and follow-up for the TT (62.7% and 76.2%), BNT (47.0% and 84.3%), and sVF (52.2% and 61.1%). Initial language function and non-verbal cognitive ability were the most important variables to predict language function. Connectivity disruption explained additional variance, resulting in a prediction error increase of up to 12.8% with variable omission. Left middle temporal gyrus (12.8%) and supramarginal gyrus (9.8%) were identified as among the most important network nodes. CONCLUSION: Connectivity disruption of the language network adds predictive value beyond lesion volume, initial language function, and non-verbal cognitive ability. Obtaining information on connectivity disruption based on routine clinical MR images constitutes a significant advancement toward practical clinical application.

Comprehensive quality assessment for aphasia rehabilitation after stroke: protocol for a multicentre, mixed-methods study.

INTRODUCTION: People with aphasia following stroke experience disproportionally poor outcomes, yet there is no comprehensive approach to measuring the quality of aphasia services. The Meaningful Evaluation of Aphasia SeRvicES (MEASuRES) minimum dataset was developed in partnership with people with lived experience of aphasia, clinicians and researchers to address this gap. It comprises sociodemographic characteristics, quality indicators, treatment descriptors and outcome measurement instruments. We present a protocol to pilot the MEASuRES minimum dataset in clinical practice, describe the factors that hinder or support implementation and determine meaningful thresholds of clinical change for core outcome measurement instruments. METHODS AND ANALYSIS: This research aims to deliver a comprehensive quality assessment toolkit for poststroke aphasia services in four studies. A multicentre pilot study (study 1) will test the administration of the MEASuRES minimum dataset within five Australian health services. An embedded mixed-methods process evaluation (study 2) will evaluate the performance of the minimum dataset and explore its clinical applicability. A consensus study (study 3) will establish consumer-informed thresholds of meaningful change on core aphasia outcome constructs, which will then be used to establish minimal important change values for corresponding core outcome measurement instruments (study 4). ETHICS AND DISSEMINATION: Studies 1 and 2 have been registered with the Australian and New Zealand Clinical Trial Registry (ACTRN12623001313628). Ethics approval has been obtained from the Royal Brisbane and Women's Hospital (HREC/2023/MNHB/95293) and The University of Queensland (2022/HE001946 and 2023/HE001175). Study findings will be disseminated through peer-reviewed publications, conference presentations and engagement with relevant stakeholders including healthcare providers, policy-makers, stroke and rehabilitation audit and clinical quality registry custodians, consumer support organisations, and individuals with aphasia and their families.

"Good," "Hopeless," and "Alright": People with Aphasia Expressing Their Opinions on Their Rehabilitation Experiences.

Treatment for people with aphasia mainly concentrates on facilitating the communication of needs or providing facts. This focus is in danger of downplaying the significance of the expression of attitudes and emotion. Evaluative expression is critical for recreating identity and social interaction. However, the linguistic expression of emotions following aphasia has been insufficiently explored. This study aimed to determine which semantic-lexical devices people with aphasia used to express their opinions and views about their clinicians and rehabilitation. In-depth interviews with 50 people with aphasia describing their emotions during their rehabilitation were analyzed using the appraisal framework comprising appreciation, affect, and judgment. Speakers also graded their attitudes toward people, things, or events. Almost half of instances expressed appreciation, over one-third expressed judgment, and about 16% expressed affect. Amplification of emotions was used frequently, in over 40% of instances. Affective difficulties following aphasia and other brain injuries are among the most important factors for rehabilitation, social reintegration, and the burden on family members. To ameliorate these issues, the focus of rehabilitation in aphasia needs to shift from expressing needs toward facilitating the expression of opinions and feelings and providing people with aphasia with the opportunities and means to express their views on their healthcare.

Smartphone use as an efficient tool to improve anomia in primary progressive aphasia.

Cognitive interventions are helpful in the non-pharmacological management of Primary progressive aphasia (PPA) and other neurodegenerative disorders of cognition, by helping patients to compensate for their cognitive deficits and improve their functional independence. In this study, we examined the effectiveness of cognitive rehabilitation based on the use of mobile device technology in PPA. The aim of this research study was to determine if BL, a patient with semantic variant PPA (svPPA) and severe anomia, was able to learn using specific smartphone functions and an application to reduce her word finding difficulties. She was trained during the intervention sessions on a list of target pictures to measure changes in picture naming performance. Errorless learning was applied during learning. BL quickly learned to use smartphone functions and the application over the course of the intervention. She significantly improved her anomia for trained pictures, and to a lesser extent for untrained semantically related pictures. Picture naming performance was maintained six months after the intervention, and she continued to use her smartphone regularly to communicate with family members and friends. This study confirms that smartphone use can be learned in PPA, which can help reduce the symptoms of anomia and improve communication skills.

From concept to practice: a scoping review of the application of AI to aphasia diagnosis and management.

PURPOSE: Aphasia is an acquired communication disability resulting from impairments in language processing following brain injury, most commonly stroke. People with aphasia experience difficulties in all modalities of language that impact their quality of life. Therefore, researchers have investigated the use of Artificial Intelligence (AI) to deliver innovative solutions in Aphasia management and rehabilitation. MATERIALS AND METHODS: We conducted a scoping review of the use of AI in aphasia research and rehabilitation to explore the evolution of AI applications to aphasia, the progression of technologies and applications. Furthermore, we aimed to identify gaps in the use of AI in Aphasia to highlight the potential areas where AI might add value. We analysed 77 studies to determine the research objectives, the history of AI techniques in Aphasia and their progression over time. RESULTS: Most of the studies focus on automated assessment using AI, with recent studies focusing on AI for therapy and personalised assistive systems. Starting from prototypes and simulations, the use of AI has progressed to include supervised machine learning, unsupervised machine learning, natural language processing, fuzzy rules, and genetic programming. CONCLUSION: Considerable scope remains to align AI technology with aphasia rehabilitation to empower patient-centred, customised rehabilitation and enhanced self-management.

Aphasia is an acquired communication disorder that impacts everyday functioning due to impairments in speech, auditory comprehension, reading, and writing.Given this communication burden, researchers have focused on utilising artificial intelligence (AI) methods for assessment, therapy and self-management.From a conceptualisation era in the early 1940s, the application of AI has evolved with significant developments in AI applications at different points in time.Despite these developments, there are ample opportunities to exploit the use of AI to deliver more advanced applications in self-management and personalising care.

Economic evaluation of the Very Early Rehabilitation in SpEech (VERSE) intervention.

INTRODUCTION: There is limited evidence on the costs and outcomes of patients with aphasia after stroke. The aim of this study was to estimate costs in patients with aphasia after stroke according to the aphasia therapies provided. METHODS: A three-arm, prospective, randomized, parallel group, open-label, blinded endpoint assessment trial conducted in Australia and New Zealand. Usual ward-based care (Usual Care) was compared to additional usual ward-based therapy (Usual Care Plus) and a prescribed and structured aphasia therapy program in addition to Usual Care (the VERSE intervention). Information about healthcare utilization and productivity were collected to estimate costs in Australian dollars for 2017-18. Multivariable regression models with bootstrapping were used to estimate differences in costs and outcomes (clinically meaningful change in aphasia severity measured by the WAB-R-AQ). RESULTS: Overall, 202/246 (82%) participants completed follow-up at 26 weeks. Median costs per person were $23,322 (Q1 5,367, Q3 52,669, n = 63) for Usual Care, $26,923 (Q1 7,303, Q3 76,174, n = 70) for Usual Care Plus and $31,143 (Q1 7,001. Q3 62,390, n = 69) for VERSE. No differences in costs and outcomes were detected between groups. Usual Care Plus was inferior (i.e. more costly and less effective) in 64% of iterations, and in 18% was less costly and less effective compared to Usual Care. VERSE was inferior in 65% of samples and less costly and less effective in 12% compared to Usual Care. CONCLUSION: There was limited evidence that additional intensively delivered aphasia therapy within the context of usual acute care provided was worthwhile in terms of costs for the outcomes gained.

Understanding and Addressing the Individualized Emotional Impact of Aphasia: A Framework for Speech-Language Pathologists.

Emotion plays an integral role in communication and has long been considered relevant to aphasia rehabilitation. Speech-language pathologists (SLPs), however, may sometimes wonder how or whether to address emotional responses. The purpose of this article was to (1) present a framework that clinicians can use to understand individualized emotional responses in aphasia and (2) discuss examples of how the framework informs practical strategies that SLPs can use to provide emotional support to people with aphasia (PWA). Drawing upon a cognitive-motivational-relational theory of emotions perspective combined with emerging research in aphasia, I show that emotion impacts and is impacted by both language processing and social participation, but this impact should be interpreted in light of individual variability. Personal characteristics, environmental conditions, and cognitive appraisal, considered within a specific cultural context, help account for individualized emotional responses. SLPs should consider interactions among emotional response, language processing, and social participation in aphasia while recognizing each person's unique perception of the situation and resources to cope with it. Additionally, the presented framework provides insights about how SLPs could offer emotional support to PWA. Specific examples related to harnessing situational demands to improve communication, employing active listening, facilitating reappraisal, and strengthening social support are discussed.

A meta-analysis of functional recovery of aphasia after stroke by acupuncture combined with language rehabilitation training.

BACKGROUND: The aim of this systematic review is to evaluate the effectiveness of combining acupuncture with speech rehabilitation training, compared to acupuncture alone or speech rehabilitation training alone, in the treatment of post-stroke aphasia. METHODS: To gather data for this study, we searched 6 databases: PubMed, Cochrane Library, Embase, China National Knowledge Infrastructure, WanFang Data, and Chongqing VIP Database. We included clinical randomized controlled trials on acupuncture combined with rehabilitation training for post-stroke aphasia published between January 1, 2011 and October 8, 2023. Two researchers independently screened the literature, evaluated its quality, and extracted the data using Stata 15.1 SE and RevMan 5.4 software. We conducted a meta-analysis using the random effects model, and expressed dichotomous variables as odds ratios (OR) with 95% confidence intervals (CIs) and continuous variables as weighted mean differences (WMD) with 95% confidence intervals. Specifically, the odds of improvement were significantly higher in the combination group (OR = 3.89, 95% CI = [2.62, 5.78]). Improvements were also seen in several language functions, including expression (WMD = 5.14, 95% CI = [3.87, 6.41]), understanding (WMD = 9.16, 95% CI = [5.20, 13.12]), retelling (WMD = 11.35, 95% CI = [8.70, 14.00]), naming (WMD = 11.36, 95% CI = [8.12, 14.61] ), reading (WMD = 9.20, 95% CI = [4.87, 13.52]), writing (WMD = 5.65, 95% CI = [3.04, 8.26]), and reading aloud (WMD = 7.45, 95% CI = [3.12, 11.78]). Scores on the Chinese Aphasia Complete Test Scale, Western Aphasia Complete Test Scale, and China Rehabilitation Research Center Aphasia Check Scale were also significantly higher in the combination group, with improvements of 7.89, 9.89, and 9.27, respectively. RESULTS: A total of 16 clinical randomized controlled trials, including 1258 patients, were included in this meta-analysis. The results showed that compared to simple rehabilitation training or acupuncture treatment alone, the combination of acupuncture and language rehabilitation training was more effective in improving clinical outcomes for patients with post-stroke aphasia. CONCLUSIONS: The results of this meta-analysis indicate that acupuncture combined with language rehabilitation training can effectively improve the language function of post-stroke aphasia patients and increase clinical effectiveness. However, further research is needed to confirm these findings and provide a more reliable evidence-based basis for clinical practice. In particular, additional studies with large sample sizes, high quality, and more specific and standardized outcome measures are needed to strengthen the evidence. The limited quantity and quality of the current studies may affect the generalizability of the results.

Targeted neurorehabilitation strategies in post-stroke aphasia.

BACKGROUND: Aphasia is a debilitating language impairment, affecting millions of people worldwide. About 40% of stroke survivors develop chronic aphasia, resulting in life-long disability. OBJECTIVE: This review examines extrinsic and intrinsic neuromodulation techniques, aimed at enhancing the effects of speech and language therapies in stroke survivors with aphasia. METHODS: We discuss the available evidence supporting the use of transcranial direct current stimulation (tDCS), repetitive transcranial magnetic stimulation, and functional MRI (fMRI) real-time neurofeedback in aphasia rehabilitation. RESULTS: This review systematically evaluates studies focusing on efficacy and implementation of specialized methods for post-treatment outcome optimization and transfer to functional skills. It considers stimulation target determination and various targeting approaches. The translation of neuromodulation interventions to clinical practice is explored, emphasizing generalization and functional communication. The review also covers real-time fMRI neurofeedback, discussing current evidence for efficacy and essential implementation parameters. Finally, we address future directions for neuromodulation research in aphasia. CONCLUSIONS: This comprehensive review aims to serve as a resource for a broad audience of researchers and clinicians interested in incorporating neuromodulation for advancing aphasia care.

Expressive recall and recognition as complementary measures to assess novel word learning ability in aphasia.

Novel word learning ability has been associated with language treatment outcomes in people with aphasia (PWA), and its assessment could inform prognosis and rehabilitation. We used a brief experimental task to examine novel word learning in PWA, determine the value of phonological cueing in assessing learning outcomes, and identify factors that modulate learning ability. Twelve PWA and nineteen healthy controls completed the task, and recall and recognition tests of learning ability. Most PWA showed comparable learning outcomes to those of the healthy controls. Learning assessed via expressive recall was more clearly evidenced with phonological cues. Better single word processing abilities and phonological short-term memory and higher integrity of the left inferior frontal gyrus were related to better learning performance. Brief learning tasks like this one are clinically feasible and hold promise as screening tools of verbal learning in PWA once validated and evaluated for their capacity to predict treatment outcomes.

'It's been an extraordinary journey': Experience of engagement from the perspectives of people with post-stroke aphasia.

BACKGROUND: Engagement is recognized as an important factor in aphasia treatment response and outcomes, yet gaps remain in our understanding of engagement and practices that promote engagement from the client perspective. AIMS: The purpose of this phenomenological study was to explore how clients with aphasia experience engagement during their inpatient aphasia rehabilitation. METHODS & PROCEDURES: An interpretative phenomenological analysis approach guided the study design and analysis. Data were collected through in-depth interviews with nine clients with aphasia, recruited through purposive sampling, during their inpatient rehabilitation admission. Analysis was completed using a variety of analytic techniques including coding, memoing, triangulation between coders and team discussion. OUTCOMES & RESULTS: The analysis revealed that for clients with aphasia in the acute phrase of recovery, the rehabilitation process resembles travelling on a journey through a foreign land. Successful engagement in the journey was accomplished when one had a therapist who served as a trusted guide and was able to be a friend, invested, adaptable, a co-creator, encouraging and dependable. CONCLUSIONS & IMPLICATIONS: Engagement is a dynamic, multifaceted and person-centred process involving the client, provider and rehabilitation context. Findings from this work have implications for measuring engagement, training student clinicians to be skilled facilitators in engaging their clients and implementing person-centred practices that promote engagement within clinical settings. WHAT THIS PAPER ADDS: What is already known on the subject Engagement is recognized as an important factor in rehabilitation treatment response and outcomes. Prior literature suggests that the therapist plays a critical role in facilitating engagement within the client-provider relationship. Communication impairments associated with aphasia may negatively impact a client's ability to develop interpersonal connections and participate in the rehabilitation process. There is a dearth of research directly exploring the topic of engagement in aphasia rehabilitation, particularly from the perspective of clients with aphasia. Capturing the client perspective can provide novel insights regarding practices to foster and maintain engagement in aphasia rehabilitation. What this paper adds to existing knowledge This interpretative phenomenological study revealed that for individuals with aphasia in the acute phase of recovery, the rehabilitation process resembles travelling on a sudden and foreign journey. Successful engagement in the journey was accomplished when one had a therapist who served as a 'trusted guide' and was able to be a friend, invested, adaptable, a co-creator, encouraging and dependable. Through the client experience, engagement is seen as a dynamic, multifaceted and person-centred process involving the client, provider and rehabilitation context. What are the potential or actual clinical implications of this work? The current study highlights the complexity and nuance of engagement within the rehabilitation context, which has implications for measuring engagement, training student clinicians to be skilled in engaging their clients and implementing person-centred practices that promote engagement within clinical settings. It is necessary to recognize that client and provider interactions (and thus engagement) are embedded in and influenced by the broader healthcare system. With this in mind, a patient-centred approach to engagement in aphasia care delivery cannot be achieved through individual efforts only and may require prioritization and action at the systems level. Future work is needed to explore barriers and facilitators to enacting engagement practices, in order to develop and test strategies to support practice change.

Elizabeth Usher memorial lecture: Beyond our practice borders-using a biopsychosocial framework to improve long-term outcomes for people living with aphasia.

Purpose: Over 140 000 Australians live with aphasia after stroke, with this number of people living with aphasia increasing significantly when aphasia arising from traumatic brain injury, neoplasm, and infectious and progressive neurological diseases is also included. The resulting communication disability frequently compromises every aspect of daily life, significantly impacting everyday activity, employment, social participation, mental health, identity, and family functioning. Rehabilitation services rarely meet the needs of this group who have, for example, poorer healthcare outcomes than stroke peers without aphasia, nor address long-term recovery and support needs.Method: In this discussion paper, I argue that given the broad impacts of aphasia, a biopsychosocial approach to aphasia rehabilitation is required. Rehabilitation must include: interventions to improve the communication environment; programs that directly target identity, wellbeing, and mental health; and therapies focusing on functional activity, communication participation, and long-term self-management.Result: The evidence for these approaches is mounting and includes strongly stated consumer needs. I discuss the need for multidisciplinary involvement and argue that for speech-language pathologists to achieve such comprehensive service provision, an expanded scope of practice is required.Conclusion: There is a need to rethink standard therapy approaches, timeframes, and funding mechanisms. It is time to reflect on our practice borders to ask what must change and define how change can be achieved.

Accuracy of rating scales for evaluating aphasic patients' psychological aspects and language function: A scoping review protocol.

Aphasia nearly affects half of all poststroke patients. Furthermore, aphasia affects all language functions, well-being, and quality of life of patients. Therefore, rehabilitation of patients with aphasia requires an accurate assessment of language function and psychological aspects. However, assessment scales for language function and psychological aspects of patients with aphasia are said to be inaccurate. In Japan, this sign is more prominent than in English-speaking countries. Therefore, we are putting together a scoping review of research articles published in English and Japanese to date, with the aim of summarizing the accuracy of rating scales for language function and psychological aspects of people with aphasia. The scoping review was intended to be a comprehensive examination of the accuracy of rating scales for people with aphasia. We will search the article databases PubMed, MEDLINE, Embase, PsycINFO, Web of Science, and the Medical Journal Web (Japan). The observational studies that describe the reliability and validity of the rating scales in adult aphasic after stroke will be searched for. There will be no publication date for the articles that will be searched. We believe that this scoping review aims to assess the accuracy of rating scales used to measure different aspects of aphasia, with a focus on research conducted in English-speaking countries and Japan. By conducting this review, we believe to identify any problems with rating scales used in English and Japanese research and improve their accuracy.

[The institutional presence of music therapists in aphasia therapy in Hungary]. / Zeneterapeuták intézményi jelenléte a magyarországi aphasiaterápiában.

INTRODUCTION: Numerous international studies have reported on the relevance of music therapy for aphasia, but music-based therapy for the rehabilitation of acquired language and speech disorders is not common in the clinical practice of Hungary. OBJECTIVE: The aim of our study is to provide insights into the composition of professional teams involved in aphasia care in active neurology and stroke wards and rehabilitation departments in Hungarian hospitals, with a special focus on the presence of music therapists. We are looking for the answer to why the employment of music therapists in hospitals is so low in our country. METHOD: For our research, we selected the relevant institutions and departments from a list of hospitals on the website of the National Directorate General for Hospitals. Data were then collected from the websites of the hospital departments, supplemented or clarified with information from the head of department's physicians where necessary. RESULTS: None of the active neurology and stroke wards employ a music therapist. Two of the rehabilitation wards have a total of 4 music therapists. DISCUSSION: The low number of trained professionals in music therapy for aphasia is due to financial reasons, lack of professionals and lack of professional demand. CONCLUSION: Our research shows that music therapy is deeply underrepresented in the field of aphasia rehabilitation in Hungarian hospitals. The reasons for this are quite diverse and their elimination would require effective intervention in many areas. Orv Hetil. 2023; 164(19): 747-752.

Predicting home discharge after inpatient rehabilitation of stroke patients with aphasia.

The early identification of the discharge setting from Inpatient Rehabilitation Facilities is a primary goal in stroke-related research because of its clinical and socio-economic relevance. Several features have been identified as significant predictors of the discharge setting. Within cognitive deficits, aphasia is known to be a common and disabling condition that could influence rehabilitation outcome. However, it is often set as an exclusion criterion in stroke research. This study aims to investigate the predictive power of clinical variables, in particular specific language disturbances and nonlinguistic cognitive deficits, for discharge setting in post-acute stroke patients with aphasia after intensive multidisciplinary rehabilitation. In a sample of 158 patients, demographic, motor, language, and nonverbal cognitive data were retrospectively considered for the prediction of the discharge to home vs. another institutional setting. Univariate analysis identified relevant differences between groups and the significant variables were included in a logistic regression model. The results showed that better functional motor status, absence of dysphagia and unimpaired nonlinguistic cognitive profile independently predict the discharge to home. In particular, nonverbal cognitive functioning seemed to be specifically relevant within the aphasic population. The findings could be helpful for setting up the rehabilitation priorities and an adequate discharge arrangement.

Which blueberries are better value? The development and validation of the functional numeracy assessment for adults with aphasia.

BACKGROUND: People with aphasia (PWA) can experience functional numeracy difficulties, that is, problems understanding or using numbers in everyday life, which can have numerous negative impacts on their daily lives. There is growing interest in designing functional numeracy interventions for PWA; however, there are limited suitable assessments available to monitor the impact of these interventions. Existing functional numeracy assessments lack breadth and are not designed to be accessible for PWA, potentially confounding their performance. Additionally, they do not include real-life demands, such as time pressure, which may affect their ecological validity. Thus, there is a crucial need for a new assessment to facilitate further research of PWA's functional numeracy. AIMS: To develop, validate and pilot a wide-ranging, aphasia-friendly functional numeracy assessment to investigate how functional numeracy is impacted by aphasia severity and time pressure demands, and to explore predictors of PWA's functional numeracy. METHODS & PROCEDURES: To develop the Functional Numeracy Assessment (FNA), 38 items inspired by the General Health Numeracy Test (GHNT) and Excellence Gateway were adapted for suitability for PWA and entered in a computerized psychometric-style test. The final 23 items (FNA23) were selected based on 213 neurotypical controls' performance, and controlled for difficulty, response modality and required numeracy skills. Aphasia-friendly adaptations of the GHNT and Subjective Numeracy Scale were used to examine the FNA23's concurrent validity. Internal consistency reliability and interrater reliability (for spoken responses) were also examined. A novel Time Pressure Task was created by slight adaptation of seven FNA23 questions to explore the effects of time pressure on functional numeracy performance. A total of 20 PWA and 102 controls completed all measures on an online testing platform. OUTCOMES & RESULTS: The FNA23 demonstrated acceptable internal consistency reliability (KR-20 = 0.81) and perfect interrater reliability (for spoken responses). FNA23 and GHNT scores were positively associated, suggesting satisfactory concurrent validity. PWA demonstrated poorer functional numeracy than controls and took longer to complete assessments, indicating that aphasia impacts functional numeracy. Time pressure did not significantly impact performance. PWA demonstrated a wide range of functional numeracy abilities, with some performing similarly to controls. CONCLUSIONS & IMPLICATIONS: The FNA23 is a wide-ranging, valid and reliable assessment which, with further development, will be a useful tool to identify and monitor PWA's functional numeracy difficulties in research and clinical practice. Considering PWA's widespread functional numeracy difficulties evidenced by this study, all PWA would likely benefit from routine evaluation for functional numeracy difficulties as part of their neurorehabilitation journeys. WHAT THIS PAPER ADDS: What is already known on this subject Few studies have investigated functional numeracy difficulties in PWA. No published functional numeracy assessments exist that have been specifically designed to be accessible for PWA. What this paper adds to existing knowledge The newly developed FNA23 is a valid and reliable tool to extensively assess PWA's functional numeracy. This study confirmed previous findings of widespread functional numeracy difficulties in PWA that are related to their aphasia severity. What are the potential or actual clinical implications of this work? The FNA23 can be used to assess PWA's functional numeracy to inform areas of strengths and difficulties to target in intervention, and to monitor progress towards achieving intervention objectives. All PWA should be routinely evaluated for functional numeracy difficulties.