Stimulus- and Person-Level Variables Influence Word Production and Response to Anomia Treatment for Individuals With Chronic Poststroke Aphasia.

PURPOSE: The impact of stimulus-level psycholinguistic variables and person-level semantic and phonological processing skills on treatment outcomes in individuals with aphasia requires further examination to inform clinical decision making in treatment prescription and stimuli selection. This study investigated the influence of stimulus-level psycholinguistic properties and person-level semantic and phonological processing skills on word production accuracy and treatment response. METHOD: This retrospective analysis included 35 individuals with chronic, poststroke aphasia, 30 of whom completed typicality-based semantic feature treatment. Mixed-effects logistic regression models were used to predict binary naming accuracy (a) at baseline and (b) over the course of treatment using stimulus-level psycholinguistic word properties and person-level semantic and phonological processing skills as predictors. RESULTS: In baseline naming, words with less complex lexical-semantic and phonological properties showed greater predicted accuracy. There was also an interaction at baseline between stimulus-level lexical-semantic properties and person-level semantic processing skills in predicting baseline naming accuracy. With treatment, words that were more complex from a lexical-semantic standpoint (vs. less complex) and less complex from a phonological standpoint (vs. more complex) improved more. Individuals with greater baseline semantic and phonological processing skills showed a greater treatment response. CONCLUSIONS: This study suggests that future clinical research and clinical work should consider semantic and phonological properties of words in selecting stimuli for semantically based treatment. Furthermore, future clinical research should continue to evaluate baseline individual semantic and phonological profiles as predictors of response to semantically based treatment. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.21256341.

White matter microstructural integrity pre- and post-treatment in individuals with chronic post-stroke aphasia.

While previous studies have found that white matter damage relates to impairment severity in individuals with aphasia, further study is required to understand the relationship between white matter integrity and treatment response. In this study, 34 individuals with chronic post-stroke aphasia underwent behavioral testing and structural magnetic resonance imaging at two timepoints. Thirty participants within this sample completed typicality-based semantic feature treatment for anomia. Tractography of bi-hemispheric white matter tracts was completed via Automated Fiber Quantification. Associations between microstructural integrity metrics and behavioral measures were evaluated at the tract level and in nodes along the tract. Diffusion measures of the left inferior longitudinal, superior longitudinal, and arcuate fasciculi were related to aphasia severity and diffusion measures of the left inferior longitudinal fasciculus were related to naming and treatment response. This study also found preliminary evidence of left inferior longitudinal fasciculus microstructural changes following treatment.

Multimodal Neural and Behavioral Data Predict Response to Rehabilitation in Chronic Poststroke Aphasia.

BACKGROUND: Poststroke recovery depends on multiple factors and varies greatly across individuals. Using machine learning models, this study investigated the independent and complementary prognostic role of different patient-related factors in predicting response to language rehabilitation after a stroke. METHODS: Fifty-five individuals with chronic poststroke aphasia underwent a battery of standardized assessments and structural and functional magnetic resonance imaging scans, and received 12 weeks of language treatment. Support vector machine and random forest models were constructed to predict responsiveness to treatment using pretreatment behavioral, demographic, and structural and functional neuroimaging data. RESULTS: The best prediction performance was achieved by a support vector machine model trained on aphasia severity, demographics, measures of anatomic integrity and resting-state functional connectivity (F1=0.94). This model resulted in a significantly superior prediction performance compared with support vector machine models trained on all feature sets (F1=0.82, P<0.001) or a single feature set (F1 range=0.68-0.84, P<0.001). Across random forest models, training on resting-state functional magnetic resonance imaging connectivity data yielded the best F1 score (F1=0.87). CONCLUSIONS: While behavioral, multimodal neuroimaging data and demographic information carry complementary information in predicting response to rehabilitation in chronic poststroke aphasia, functional connectivity of the brain at rest after stroke is a particularly important predictor of responsiveness to treatment, both alone and combined with other patient-related factors.

Videoconference Administration of the Western Aphasia Battery-Revised: Feasibility and Validity.

Purpose There is a rapid growth of telepractice in both clinical and research settings; however, the literature validating translation of traditional methods of assessments and interventions to valid remote videoconference administrations is limited. This is especially true in the field of speech-language pathology where assessments of language and communication can be easily conducted via remote administration. The aim of this study was to validate videoconference administration of the Western Aphasia Battery-Revised (WAB-R). Method Twenty adults with chronic aphasia completed the assessment both in person and via videoconference with the order counterbalanced across administrations. Specific modifications to select WAB-R subtests were made to accommodate interaction by computer and Internet. Results Results revealed that the two methods of administration were highly correlated and showed no difference in domain scores. Additionally, most participants endorsed being mostly or very satisfied with the videoconference administration. Conclusion These findings suggest that administration of the WAB-R in person and via videoconference may be used interchangeably in this patient population. Modifications and guidelines are provided to ensure reproducibility and access to other clinicians and scientists interested in remote administration of the WAB-R. Supplemental Material https://doi.org/10.23641/asha.11977857.

Treatment Fidelity Procedures for an Aphasia Intervention Within a Randomized Controlled Trial: Design, Feasibility, and Results.

Purpose This study reports on the treatment fidelity procedures implemented during a 5-year randomized controlled trial comparing intensive and distributed comprehensive aphasia therapy. Specifically, the results of 1 treatment, verb network strengthening treatment (VNeST), are examined. Method Eight participants were recruited for each of 7 consecutive cohorts for a total of 56 participants. Participants completed 60 hr of aphasia therapy, including 15 hr of VNeST. Two experienced speech-language pathologists delivered the treatment. To promote treatment fidelity, the study team developed a detailed manual of procedures and fidelity checklists, completed role plays to standardize treatment administration, and video-recorded all treatment sessions for review. To assess protocol adherence during treatment delivery, trained research assistants not involved in the treatment reviewed video recordings of a subset of randomly selected VNeST treatment sessions and completed the fidelity checklists. This process was completed for 32 participants representing 2 early cohorts and 2 later cohorts, which allowed for measurement of protocol adherence over time. Percent accuracy of protocol adherence was calculated across clinicians, cohorts, and study condition (intensive vs. distributed therapy). Results The fidelity procedures were sufficient to promote and verify a high level of adherence to the treatment protocol across clinicians, cohorts, and study condition. Conclusion Treatment fidelity strategies and monitoring are feasible when incorporated into the study design. Treatment fidelity monitoring should be completed at regular intervals during the course of a study to ensure that high levels of protocol adherence are maintained over time and across conditions.

Optimising recovery in aphasia: Learning following exposure to a single dose of computer-based script training.

Purpose: Intensity of therapy influences outcomes in aphasia treatment, but little is known about optimum dosage across treatment approaches. Improved understanding of the effects of dose could help facilitate clinical decisions that maximise patient outcomes. This study examines learning in individuals with aphasia following exposure to one 60-min dose of computer-delivered script training, with or without a rest break. Method: Twenty participants (6F, 14M; 17 nonfluent, 3 fluent) with chronic aphasia due to left-hemisphere stroke participated. Participants had a mean (SD) age of 56.9 (8.4) years, a mean time post onset of 55.1 (range: 6.4-396.4) months, and a mean (SD) Comprehensive Aphasia Test score of 47.8 (4.0). Participants were exposed to 60 min of training, with or without a rest break, of a three-turn conversational script about either weather or traffic. Treatment was delivered via computer using a virtual clinician that visually modelled speech and guided treatment, promoting treatment fidelity. Oral reading probes for script sentences were administered at baseline (3 times), mid-treatment, immediately post-treatment, and, at various times, up to 2 weeks post-treatment to track script acquisition and maintenance. The study also examined generalisation from a trained script to a conversation with a clinician via a generalisation probe at three time points: baseline, immediately post-treatment, and 2 weeks post-treatment. Result: Following exposure to one dose of script training, participants demonstrated statistically significant improvements in oral reading accuracy and rate of script production on trained probes from baseline to immediately post-treatment and 2 weeks post-treatment. Participants also demonstrated significant change from baseline in generalisation to a conversation with a clinician immediately post-treatment and at 2 weeks post-treatment. Conclusion: Exposure to a single dose of computer-delivered script training may facilitate learning. These results have implications for future research investigating optimal dosage and scheduling parameters.