Replication in Evidence-Based Aphasia Treatments.

PURPOSE: A critical review was completed to evaluate replication of aphasia treatments that have been vetted and accepted on the American Speech-Language-Hearing Association Practice Portal. METHOD: The electronic databases Academic Search Premier, ProQuest Central, CINAHL Complete, and ERIC were searched for relevant articles using treatment names as keywords. Coders compared stimuli, material, design, and statistical analysis to pilot treatment approaches. Each study was coded as direct, conceptual, failed, or no replication. RESULTS: Eighteen treatment approaches were selected for this review. A total of 188 articles met the inclusion criteria. Results revealed that 14 out of 18 treatment approaches were somehow replicated. Direct replications as the most valuable replication type for affirming previously found results were represented in only 1.5% of all studies (3/188). Failed direct replication were at 2% overall (4/188). Conceptual replications were more common across treatment approaches, but also represented at a low level with 22.8% (43/188). The majority of studies were coded as no replication attempt with 73.4%. DISCUSSION: A critical factor in developing an evidence-based practice is the existence of replicated results for treatment. Replication evaluates the reproducibility of an author's or authors' research methodology and resulting outcomes and helps to ensure that observed treatment effects are reproducible. For an evidence-based treatment to be implemented or used in any clinical setting, it must be one that can be replicated. Direct and conceptual replications of aphasia treatment approaches were found to be alarmingly low considering the importance of replication in our field. It is recommended that replication should become more valued and mainstreamed in aphasia research. A replication database that compiles and maintains treatment manuals for replication purposes can increase the accessibility and acceptability of replications for researchers.

Aphasia Practice in the Year 2026.

The purpose of this article is to envision how the clinical practice of aphasia management might be done 10 years in the future. The vision of how an individual clinician's daily tasks are changed is built on current trends, including the aging of the population, the life participation approach to aphasia, development and use of evidence-based practices, person-centered care, and technology. To be prepared for the future of these trends, we will need to develop clinical capacity, not only in the number of speech-language pathologists but also most importantly in their competence for using evidence-based practices and training others to support effective communication, including other health care providers. Research needs that will support the future are also described.

Implementation Science: Buzzword or Game Changer?

PURPOSE: The purpose of this supplement article is to provide a resource of pertinent information concerning implementation science for immediate research application in communication sciences and disorders. METHOD: Key terminology related to implementation science is reviewed. Practical suggestions for the application of implementation science theories and methodologies are provided, including an overview of hybrid research designs that simultaneously investigate clinical effectiveness and implementation as well as an introduction to approaches for engaging stakeholders in the research process. A detailed example from education is shared to show how implementation science was utilized to move an intervention program for autism into routine practice in the public school system. In particular, the example highlights the value of strong partnership among researchers, policy makers, and frontline practitioners in implementing and sustaining new evidence-based practices. CONCLUSIONS: Implementation science is not just a buzzword. This is a new field of study that can make a substantive contribution in communication sciences and disorders by informing research agendas, reducing health and education disparities, improving accountability and quality control, increasing clinician satisfaction and competence, and improving client outcomes.

Perceptions of speech-language pathologists linked to evidence-based practice use in skilled nursing facilities.

PURPOSE: This study explored whether perceptions of evidence or organizational context were associated with the use of external memory aids with residents with dementia in skilled nursing facilities (SNFs). METHOD: A survey design, supplemented by a small sample of exploratory interviews, was completed within the Promoting Action on Research Implementation in Health Services framework. Ninety-six speech-language pathologists (SLPs) and 68 facility rehabilitation directors (FRDs) completed the Organizational Readiness to Change Assessment (Helfrich, Li, Sharp, & Sales, 2009) in relationship to the use of external memory aids. Five SLPs completed an interview exploring perceptions of evidence and context in relationship to memory aid use. RESULTS: SLPs and FRDs had favorable perceptions of evidence supporting memory aids. FRDs perceived the organizational context of the SNF more favorably than SLPs. SLP participants used external memory aids in the past 6 months in 45.89% of cases of residents with dementia. For SLP participants, a 26% (p < .05) increase of external memory aid use was associated with every 1-unit change in favor of the evidence. Interview data revealed barriers to external memory aid implementation. CONCLUSIONS: Part of evidence-based practice implementation may be influenced by clinician perceptions. Efforts to increase implementation of external memory aids in SNFs should address these clinician perceptions.

A case for the implementation of cognitive-communication screenings in acute stroke.

PURPOSE: The purpose of this article was to illustrate the importance of the implementation of cognitive-communication screenings in acute stroke and to discuss the need for further research on whether and how these screenings are implemented. Cognitive-communication screenings after stroke are the subject of existing practice guidelines and are supported by accumulated evidence. METHOD: The author uses an autoethnographic narrative--a tool founded in phenomenology--to provide an in-depth description of the experiences of a family in which one member experienced right-hemispheric stroke. She uses systematic introspection to produce a narrative using literary techniques. RESULTS: The narrative illustrates the experiences of one family when one of their members has a right-hemisphere stroke, and cognitive-communication impairments are never formally identified by professionals involved in the patient's care. CONCLUSIONS: The narrative is linked to the published literature and the importance of identifying and managing cognitive-communication impairments after stroke. A model of implementation science is presented as one way to consider the challenges clinicians face when attempting to implement evidence-based practices. The model and examples from other fields show avenues for further research.

Treatment fidelity: its importance and reported frequency in aphasia treatment studies.

PURPOSE: Treatment fidelity is a measure of the reliability of the administration of an intervention in a treatment study. It is an important aspect of the validity of a research study, and it has implications for the ultimate implementation of evidence-supported interventions in typical clinical settings. METHOD: Aphasia treatment studies published in the last 10 years in 3 journals were reviewed using coding techniques that were adapted from Gresham, Gansle, Noell, Cohen, and Rosenblum (1993). The following items were noted: identifying information, study design, description of both the dependent and independent variables, and whether a measure of treatment fidelity was explicitly included. RESULTS: Of the aphasia treatment studies published in the last 10 years, 14% explicitly reported treatment fidelity. Most studies reporting treatment fidelity used checking of videotaped sessions by independent raters. Of the reviewed studies, 45% provided sufficient treatment description to support replication. CONCLUSION: Treatment fidelity is widely acknowledged as being critical to research validity and is a foundation for the implementation of evidence-based practices, but only a small percentage of aphasia treatment studies published in the last 10 years explicitly reported treatment fidelity. Recommendations for research practices include increased attention to matters of treatment fidelity in the peer review process and explicit incorporation of 3 levels of treatment fidelity in treatment research.

What people living with aphasia think about the availability of aphasia resources.

PURPOSE: Obtaining health information and resources can influence an individual's (a) access to services, (b) interactions with health care providers, and (c) ability to manage one's own health needs. The purpose of this study was to gather the perceptions of consumers living with aphasia about resource availability and information needs. METHOD: An online survey of consumers in the United States was conducted about the availability of aphasia resources. Analysis of survey responses and comments formed the basis for focus group questions. Four focus groups consisting of persons with aphasia and their caregivers were conducted to explore the survey response themes more deeply. RESULTS: Survey respondents (N   =   302) rated aphasia resources as "somewhat difficult to find." Topics ranked as most important by these respondents were (a) how to keep improving, (b) communication strategies, (c) aphasia treatment techniques, (d) coping strategies, and (e) strategies for caregivers. Survey comments and focus group themes suggested that accessing information is difficult, health care providers are not perceived to know about aphasia resources, and there is a lack of public awareness of aphasia that is a barrier to finding information and resources. CONCLUSION: Understanding how people living with aphasia seek information may allow us to better tailor access to resources in the future.

Neural correlates of semantic activation spreading on the path to picture naming in adults who stutter.

OBJECTIVE: On the path to picture naming, words that relate semantically to the pictured object become activated in the mental lexicon. We used a neuroscientific approach to investigate this semantic activation spreading process in adults who stutter (AWS). METHODS: Fourteen AWS and 14 adults who do not stutter (AWNS) completed a picture-word priming task. On each trial, a picture was named at a delay. On some trials, an unattended auditory probe word was presented after the picture, before naming commenced. Event-related potentials recorded to probe words Semantically-Related to the picture labels, and to probe words Semantically- and Phonologically-Unrelated to the picture labels, were compared using spatial-temporal principal component analysis. RESULTS: Posterior N400 amplitude was attenuated for Semantically-Related versus Unrelated probes in AWNS, while in AWS posterior N400 amplitude was enhanced for Semantically-Related versus Unrelated probes. Marginal albeit potentially relevant group differences in the morphology of other ERP components were also observed. CONCLUSIONS: The posterior N400 results point to a strategic, inhibitory influence on semantic activation spreading in AWS on the path to naming. Group differences in the amplitude of other ERP components tentatively suggest that AWS allocated attentional resources differently than the AWNS during the task. Preliminary ERP evidence of intact conceptual (as opposed to lexical-semantic) priming in the AWS is also discussed. SIGNIFICANCE: This study contributes to a growing body of research describing linguistic performance in AWS.

Finding messages in bottles: living successfully with stroke and aphasia.

The question "What does it take to live successfully with stroke and aphasia?" was posed and answers were sought within already published accounts written by people living with aphasia. Published accounts that were identified as eligible and included in the study had to meet the following criteria: they had to be a published book or journal article that would be nationally available; they had to be authored or co-authored by a person with chronic aphasia due to stroke; and they had to be a personal narrative of some type. 28 publications meeting these criteria were identified through a search of bibliographic databases and websites, and 20 were available for analysis. 4 themes emerged. First, social support was identified as a critical factor in living successfully. Second, successful living appears to require an adaptation of one's perception of self. Third, most of the writers of the accounts looked to the future and set new goals. Finally, all of the published accounts noted the importance of taking charge of one's own continued communication improvement. Characteristics of the writers are discussed. The 4 themes are linked to the professional literature, and implications for future clinical work are explored. The potential bias of the interpreter is acknowledged.

Vocational and social outcomes of adults with chronic aphasia.

UNLABELLED: Vocational and social outcomes of rehabilitation, such as employment, Social Integration, and life satisfaction, are critical determinants of the usefulness of rehabilitation. The purpose of this study was to describe the employment status, Social Integration, and perceived life satisfaction of adults with chronic aphasia 2 years after discharge from an intensive treatment program. Among the 20 survey respondents, 62% of those who had been working prior to aphasia onset were also working at the time of follow-up. Those who were working before but not after onset had higher Home Integration scores. There was a relatively large perceived change in communication from clinic discharge to the 2-year follow-up. Eighty-five percent of the respondents indicated a positive life satisfaction rating. There was a significant positive relationship between Home Integration and life satisfaction ratings. The results are discussed in relation to other reports of employment and social outcomes for stroke and aphasia. LEARNING OUTCOMES: As a result of this activity, the participant will be able to: (1) identify factors that may contribute to the successful return to work for adults with chronic aphasia; (2) describe the vocational and social outcomes of a select group of adults with chronic aphasia after participation in an intensive treatment program; and (3) discuss future need areas in understanding vocational and social participation for adults with chronic aphasia after intervention.

Alternative family education programming for adults with chronic aphasia.

Serious psychological consequences and limited social access are significant effects of chronic aphasia due to stroke. There appears to be a need for ongoing family education and counseling throughout the chronic stage in order to address the psychosocial needs of these individuals and their families. We describe an alternative approach to family education for chronically aphasic individuals. Six-month follow-up results suggest that this educational program has a positive impact on social behaviors, understanding of aphasia, and family communication patterns. The importance of developing and providing educational programs to the chronically impaired beyond the point of formal rehabilitation is discussed.