An Exploration of the Impact of Group Treatment for Aphasia on Connected Speech.

OBJECTIVE: Group treatment enables people with aphasia to practise communication skills outside the typical clinician-patient dyad. While there is evidence that this treatment format can improve participation in everyday communication, there is little evidence it impacts linguistic abilities. This project aimed to investigate the effects of 'typical' group treatment on the communication skills of people with aphasia with a focus on word retrieval in discourse. METHODS: Three people with aphasia took part in a 6-week group therapy programme. Each week focused on a different topic, and three topics also received a home programme targeting word retrieval. The six treated topics were compared with two control topics, with regard to language production in connected speech. Semistructured interviews were collected twice prior to treatment and twice following the treatment and analysed using (a) word counts; (b) the profile of word errors and retrieval in speech; (c) a measure of propositional idea density, and (d) perceptual discourse ratings. RESULTS: Two participants showed no significant improvements; one participant showed significant improvement on discourse ratings. CONCLUSIONS: This study provides limited support for group treatment, leading to improved communication as measured by semistructured interviews, even when supplemented with a home programme. We suggest that either group treatment, as implemented here, was not an effective approach for improving communication for our participants and/or that outcome measurement was limited by difficulty assessing changes in connected speech.

Quantitative evaluation of an integrated nurse model of care providing hepatitis C treatment to people attending homeless services in Melbourne, Australia.

BACKGROUND: The prevalence of hepatitis C virus (HCV) has been reported to be high among people experiencing homelessness. People who are homeless often have multiple needs that may take precedence over HCV testing and treatment. We quantitatively evaluated the outcomes of a service providing HCV treatment to people attending homeless services. METHODS: Clients attending homeless services were referred to a nurse specialising in HCV-related care. The nurse provided HCV testing, education and case-management while prescriptions were provided by an affiliated doctor. Logistic regression was used to explore factors associated with treatment commencement. RESULTS: Fifty-two clients referred (78%) underwent testing, thirty-nine were HCV-RNA positive among whom 18 (46%) reported sleeping rough and 29 (74%) reported injecting drug use; 66% had injected less than three months ago. Twenty-four (62%) clients commenced treatment, of whom thirteen (54%) had a sustained virological response test; all were cured. Treatment commencement was lower among people who reported sleeping rough (aOR 0.15, 95%CI 0.029-0.73). There was no difference in treatment commencement based on injecting drugs (aOR 1.06, 95%CI 0.21-5.2). CONCLUSION: Most clients' commenced treatment and the majority were successfully cured using a dedicated nursing service. Clients who reported sleeping rough may still face personal and/or system level barriers to HCV treatment.

The impact of group therapy on word retrieval in people with chronic aphasia.

BACKGROUND: Traditional group-based aphasia intervention has been shown to benefit people with aphasia in a variety of ways. However, despite the prevalence of anomia and the impact it has for communication, there has been little investigation as to whether these interventions improve word retrieval. OBJECTIVE: This study aimed to determine the effects on word retrieval of a 'traditional' out-patient group intervention. METHODS: A 6-week group therapy programme focused on current-affairs topics with facilitator-led discussion and language tasks. Half the topics received a supplementary, self-directed, anomia home programme. Using a single case experimental design, replicated across three participants, we examined the effectiveness of the group, and the group+home programme, in facilitating word retrieval in picture naming and connected speech. RESULTS: The participants showed a pattern of improved picture naming over the course of the study for the treated topics which was not evident for the untreated control topics. However, it was difficult to attribute this improvement unequivocally to the treatment. CONCLUSIONS: While participants felt that the group was beneficial, there was little clear evidence for treatment-related gains in word retrieval. 'Traditional' group treatment has many positive features, but clinicians need to be cautious regarding the extent of impairment-related gains that can be expected, which seem small at best.