Optimizing Telepractice Selection and Implementation for Persons with Aphasia.

Telepractice is used to conduct many aspects of healthcare, including rehabilitation and research. However, information regarding how to identify optimal candidates and overcome barriers to participating in telepractice are limited. In the context of aphasia rehabilitation research, we developed two tools for optimizing telepractice: (1) the Participant Technology Questionnaire (PTQ), an aphasia-friendly tool for gathering information about potential telepractice participants; and (2) the Virtual-Appropriate Decision Approach (VADA), a framework for assessing and modifying methods that support virtual activities. The PTQ provides valuable information about the effects of human, technology and setting influences that may impact the success of transitioning activities to a virtual format, while the VADA takes findings from the PTQ one step further into application. The PTQ and the VADA can help researchers and clinicians with planning and directing virtual engagement, and both tools have potential to be applied broadly in all areas of telepractice.

ASL MRI informs blood flow to chronic stroke lesions in patients with aphasia.

Introduction: Response to post-stroke aphasia language rehabilitation is difficult to anticipate, mainly because few predictors can help identify optimal, individualized treatment options. Imaging techniques, such as Voxel-based Lesion Symptom Mapping have been useful in linking specific brain areas to language behavior; however, further development is required to optimize the use of structural and physiological information in guiding individualized treatment for persons with aphasia (PWA). In this study, we will determine if cerebral blood flow (CBF) mapped in patients with chronic strokes can be further used to understand stroke-related factors and behavior. Methods: We collected perfusion MRI data using pseudo-Continuous Arterial Spin Labeling (pCASL) using a single post-labeling delay of 2,200 ms in 14 chronic PWA, along with high-resolution structural MRI to compute maps of tissue damage using Tissue Integrity Gradation via T2w T1w Ratio (TIGR). To quantify the CBF in chronic stroke lesions, we tested at what point spatial smoothing should be applied in the ASL analysis pipeline. We then related CBF to tissue damage, time since stroke, age, sex, and their respective cross-terms to further understand the variability in lesion CBF. Finally, we assessed the feasibility of computing multivariate brain-behavior maps using CBF and compared them to brain-behavior maps extracted with TIGR MRI. Results: We found that the CBF in chronic stroke lesions is significantly reduced compared to its homologue grey and white matter regions. However, a reliable CBF signal (although smaller than expected) was detected to reveal a negative relationship between CBF and increasing tissue damage. Further, the relationship between the lesion CBF and age, sex, time since stroke, and tissue damage and cross-terms suggested an aging-by-disease interaction. This relationship was strongest when smoothing was applied in the template space. Finally, we show that whole-brain CBF relates to domain-general visuospatial functioning in PWA. The CBF-based brain-behavior maps provide unique and complementary information to structural (lesion-based) brain-behavior maps. Discussion: Therefore, CBF can be detected in chronic stroke lesions using a standard pCASL MRI acquisition and is informative at the whole-brain level in identifying stroke rehabilitation targets in PWAs due to its relationship with demographic factors, stroke-related factors, and behavior.

Motivation as a Predictor of Aphasia Treatment Outcomes: A Scoping Review.

Purpose: Motivation is a complex phenomenon that can influence a person's ability to make progress in treatment. We sought to understand how motivation is currently measured and utilized in aphasia rehabilitation by identifying treatment studies that (1) include measurement of motivation and (2) use motivation to predict treatment response. Method: A scoping review was conducted by systematically searching PubMed, CINAHL, EBSCO, Ovid MEDLINE, and APA PsycInfo using the following search terms: (measurement OR treatment OR rehabilitation OR predict*) AND (motiv* OR engagement OR adherence OR compliance) AND (aphasia OR dysphasia). Results: Two studies met our inclusion criteria. Motivation was measured differently across studies. No studies used motivation to predict treatment outcomes. Discussion/Conclusions: Despite the importance of motivation in aphasia rehabilitation success, studies that include its measurement are sparse. Additional research is needed and should include development of measurement tools and evaluation of the predictive value of motivation on treatment outcomes.