Importance of collaboration and contextual factors in the development and implementation of social participation initiatives for older adults living in rural areas.

INTRODUCTION: To encourage isolated and vulnerable older adults to accomplish meaningful social activities, occupational therapists and other healthcare workers must collaborate with community organisations and municipalities to develop and implement initiatives fostering social participation. In a rural Regional County Municipality in Quebec (Canada), four social participation initiatives were selected and implemented: (1) Benevolent Community, (2) urban transportation system, (3) creation of a website on social participation activities, and (4) social participation workshop. Little is known about contextual factors such as the structures and organisations, stakeholders, and physical environment that influence the development and implementation of such initiatives. METHODS: Led by an academic occupational therapist, an action research to implement social participation initiatives was initiated by community stakeholders. The 26 stakeholders were involved in a Management and Partnership Committee, two focus groups and an interview with a trainer, which documented and analysed contextual factors and the implementation process. FINDINGS AND DISCUSSION: Development and implementation were facilitated by stakeholder collaboration, mission of the community organisations, and stakeholders' shared desire to reduce older adults' isolation and vulnerability. The established partnerships and predefined orientations as well as the leadership, motivation, and professional skills of the stakeholders also fostered the initiatives. Among the challenges encountered, the stakeholders' limited involvement in implementation tasks was attributable to important changes in the key stakeholders' organisations and structures and the number of organisations involved. Difficulty reaching a consensus resulting from the different attitudes, vision, and understanding of the stakeholders delayed the development and implementation of some initiatives. Despite regular meetings between stakeholders, geographic distance limited spontaneous exchanges. CONCLUSION: This action research highlighted the importance of collaboration and contextual factors in developing and implementing social participation initiatives with community organisations and municipalities.

Intensive and non-intensive treatment of lexical anomia are equally efficient in post-stroke aphasia.

Although the treatment for lexical anomia in individuals with aphasia (IWA) was shown effective, little is known about the optimal treatment intensity required. The aim of this study was to verify whether intensive and non-intensive treatments led to different outcomes when parameters of intensity are rigorously controlled. Six IWA with post-stroke lexical anomia received phonological treatment at two distinct frequencies: intensive (four times a week) and non-intensive (once a week). Results showed that both treatments were equally effective. This finding is especially relevant in contexts in which speech-language therapy delivery services are limited.

Social participation needs of older adults living in a rural regional county municipality: toward reducing situations of isolation and vulnerability.

BACKGROUND: Social participation is restricted for approximately half the older adult population but is critical in fostering community vitality, promoting health, and preventing disabilities. Although targeted through interventions by community organizations, healthcare professionals and municipalities, little is known about the needs of older adults to participate socially, especially in rural areas. This study thus aimed to identify and prioritize the social participation needs of older adults living in a rural regional county municipality. METHODS: A participatory action research was conducted in a rural regional county municipality (RCM) in Quebec, Canada, with a convenience sample of 139 stakeholders, including older adults, caregivers, healthcare and community organization managers, healthcare and community organization workers, community partners and key informants. RESULTS: Facilitators and barriers to social participation are related to personal factors (e.g., health, interests, motivation), the social environment (e.g., availability of assistance or volunteers) and the physical environment (e.g., distance to resources, recreational facilities and social partners). Nine older adults' needs emerged and were prioritized as follows: 1) having access to and being informed about transportation options, 2) being informed about available activities and services, 3) having access to activities, including volunteering opportunities, suited to their interests, schedule, cost, language and health condition, 4) being accompanied to activities, 5) having access to meeting places near home and adapted to their health condition, and 6-9 (no preferred order) being reached when isolated, being personally invited and welcomed to activities, having a social support network, and being valued and recognized. Differences emerged when prioritizing needs of older adults with disabilities (greater need for assistance, accessibility and adapted activities) and older adults living in a rural area (greater need for transportation). CONCLUSIONS: To promote active participation in the community, the social participation needs of older women and men living in rural areas must be addressed, especially in regard to transportation, information, adapted activities, assistance and accessibility. The first part of this action research will be followed by community selection and implementation of initiatives designed to ultimately foster their social participation.

Key Factors for the Success of Self-Administered Treatments of Poststroke Aphasia Using Technologies.

Background: Use of technology in language rehabilitation has grown significantly in recent years, and there is increasing evidence of its effectiveness in the treatment of poststroke aphasia. Technology has the potential to foster intensity and repetition by enabling people with aphasia to improve their skills without the constant presence of the clinician. The main objective of this article is to review and illustrate key factors for the success of self-administered treatments of poststroke aphasia using technologies. Methods: We briefly reviewed technology-based treatments of aphasia and described three determining factors for the success of self-administered treatments delivered by technology, namely, treatment-related, technology-related, and patient-related factors. Two clinical cases were also presented to illustrate issues and challenges related to the various factors to be considered before proposing such treatments. Conclusions: Self-administered treatments of poststroke aphasia using new technologies enable patients to be more independent in their rehabilitation and to benefit from more intensive and extended treatment. These benefits are important in the current economic context, where human and financial resources for clinical practice are limited. Speech-language therapists should consider these opportunities and propose new methods to deliver attractive and intensive treatments of poststroke aphasia.

Treatment of verb anomia in aphasia: efficacy of self-administered therapy using a smart tablet.

Aphasia is a chronic condition that usually requires long-term rehabilitation. However, even if many effective treatments can be offered to patients and families, speech therapy services for individuals with aphasia often remain limited because of logistical and financial considerations, especially more than 6 months after stroke. Therefore, the need to develop tools to maximize rehabilitation potential is unquestionable. The aim of this study was to test the efficacy of a self-administered treatment delivered with a smart tablet to improve written verb naming skills in CP, a 63-year-old woman with chronic aphasia. An ABA multiple baseline design was used to compare CP's performance in verb naming on three equivalent lists of stimuli trained with a hierarchy of cues, trained with no cues, and not trained. Results suggest that graphemic cueing therapy, done four times a week for 3 weeks, led to better written verb naming compared to baseline and to the untrained list. Moreover, generalization of the effects of treatment was observed in verb production, assessed with a noun-to-verb production task. Results of this study suggest that self-administered training with a smart tablet is effective in improving naming skills in chronic aphasia. Future studies are needed to confirm the effectiveness of new technologies in self-administered treatment of acquired language deficits.

The contrast between cueing and/or observation in therapy for verb retrieval in post-stroke aphasia.

BACKGROUND: Studies measuring treatment efficacy for post-stroke verb anomia are scarce. These studies mainly assessed the efficacy of three strategies: semantic, phonological and sensorimotor. Following these previous treatments, the performance of most participants improved on treated verbs, while improvement on untreated stimuli and tasks was inconsistent. AIMS: This study aimed to measure the effectiveness of a semantic-phonological strategy and a sensorimotor strategy for verb anomia in post-stroke aphasia. METHODS: A multiple baseline single-subject experimental study was conducted with two participants (9-37 years post-stroke). Four phases were completed: (1) background assessment, (2) baselines, (3) therapy, and (4) follow-up. Three equivalent lists of verbs were created for each participant and two of them were trained with a different strategy: action observation+semantic-phonological cues, action observation alone. The stimuli of the third list (control list) were not treated. RESULTS: The semantic-phonological cueing strategy led to a significant improvement. No improvement was observed after action observation. No generalization to untreated verbs was found. CONCLUSIONS: Verb naming can be enhanced by semantic/phonological cueing. In addition, other studies (clinical, neuroimaging, etc.) are needed to document the effect of action observation for the treatment of verb anomia. LEARNING OUTCOMES: The reader will be able to (1) describe semantic-phonological therapies used in post-stroke verb anomia, (2) describe sensorimotor therapies used in post-stroke verb anomia, and (3) identify factors contributing to the efficacy of therapies to improve action naming in aphasia.

[Non-pharmacological therapies for language deficits in the agrammatic and logopenic variants of primary progressive aphasia: a literature review]. / Les approches thérapeutiques non pharmacologiques des troubles du langage dans les variantes agrammatique et logopénique de l'aphasie progressive primaire : revue de la literature.

Primary progressive aphasia is a neurodegenerative condition characterised by a progressive and isolated disorder of expressive language, associated with atrophy of the left posterior frontoinsular region (nonfluent/agrammatic variant) or with atrophy of the left temporoparietal junction area (logopenic variant). This literature review reports studies about language therapies for these two variants of primary progressive aphasia. More precisely, the review presents the behavioral interventions and the augmentative/alternative communication tools reported in the literature to improve language performances or to compensate for language difficulties. Most of these studies reported that interventions are efficient. However, inconsistent results are found regarding maintenance of improvement and generalization to untreated language abilities. Other studies are still required to establish the clinical relevance of interventions for language and communication disorders in primary progressive aphasia. In these studies, the use of more ecological interventions focusing on the specific needs of people living with this disease should be specifically addressed.

[Non-pharmacological therapies of language deficits in semantic dementia]. / Les approches thérapeutiques non pharmacologiques des troubles du langage dans la démence sémantique.

Semantic dementia (SD) is a neurodegenerative condition characterised by a progressive disorder of semantic processing, word comprehension and anomia. This literature review reports behavioural studies about language therapies for SD. More precisely, the review presents the cognitive, participative and alternative/augmentative interventions reported in the literature to improve language performances or to compensate for language worsening associated with the disease. Most studies show that interventions are efficient. However, maintenance of improvement and generalization to untreated language abilities remain limited. Other studies are still required to establish the clinical relevance of interventions for language and communication disorders in semantic dementia. In these studies, the use of more ecological interventions focusing on the specific needs of people living with semantic dementia should be specifically addressed.

The specificity of notation codes in apraxic agraphia: dissociation between Arabic and alphabetical scripts in a patient with severe ideomotor and visuoconstructional apraxia.

This article describes the case of a patient with corticobasal syndrome, who showed severe ideomotor and visuoconstructional apraxia along with handwriting difficulties more marked for letters and words than for digits and numbers. For alphabetical script, these difficulties were less marked when graphic motor patterns were activated with a model, whilst for digits IV's graphic productions were better in dictation. Moreover, IV's graphic production was negatively influenced by graphomotor complexity for letters but not for numbers. IV is the first reported case of a patient with severe limb apraxia, who also showed peripheral agraphia, with dissociation in alphabetical and numerical notation codes resulting from a specific deficit in the activation of graphomotor programs.

Evaluation of intolerance of uncertainty: development and validation of a new self-report measure.

Intolerance of uncertainty represents an important risk factor for development of anxiety disorders. However, few measures have been developed in order to evaluate this construct. Four studies were conducted in order to validate a new instrument evaluating intolerance of uncertainty: the Intolerance of Uncertainty Inventory (IUI). The first study described the questionnaire's development and evaluated the psychometric properties of its preliminary version. Study 2 examined the reliability and the factorial validity of the final version of the questionnaire, while Study 3 mainly addressed its convergent validity. Finally, Study 4 examined the questionnaire's temporal stability. Factorial analyses confirmed the IUI's validity. Results also supported the IUI's reliability, convergent validity, and temporal stability. The IUI is the first instrument that offers the possibility of measuring intolerance of uncertainty as a tendency to consider uncertainties to be unacceptable, as well as in terms of cognitive and behavioral manifestations.