Aphasiology最新文献

Background: Prior studies have highlighted the importance of the right hemisphere in recovery from aphasia due to left hemisphere stroke. In particular, the right hemisphere homologous language network appears to support subacute (and sometimes chronic) recovery for many patients. We developed a telemedicine-delivered therapy that engages diverse right hemisphere-dominant skills to target nouns and verbs within utterances, Producing Increasingly Complex Themes Using Right-hemisphere Engagement - Implemented with Telemedicine "PICTURE-IT".

Aims: This randomized crossover pilot study was designed to examine the feasibility of the PICTURE-IT therapy and determine whether some participants improve more with PICTURE-IT compared to an established telemedicine approach that targets lexical skills.

Methods & procedures: Seventeen adult English-speaking participants with subacute (1-4 months) or chronic (over 6 months) aphasia who continued to experience naming deficits as measured on the Boston Naming Test or Hopkins Assessment of Naming Actions were included. Participants received fifteen 45-minute sessions of each therapy approach, followed by a washout period. Three participants withdrew due to worsening medical circumstances unrelated to therapy. Participants' naming and discourse were assessed at baseline and one week after each therapy block. As the pilot had a modest number of participants, each participant's trajectory was examined separately in order to consider how individual differences may play a role in therapy benefit. After the trial, participants were asked to complete a brief survey rating the PICTURE-IT approach and the established approach in their enjoyableness and utility.

Outcomes & results: Both treatments were effectively administered remotely throughout the trial. Fisher's Exact tests contrasting the improvements provided by each therapy approach were not significant for any individual, nor were there significant differences in the proportion of people who experienced more benefit from one approach or the other relative to their time since stroke (sub-acute versus chronic).

Conclusions: Although average improvements in communication skills were similar across treatments, order, and subacute vs chronic, individuals often responded better to one therapeutic approach or the other. Future studies will build upon these preliminary observations of effectiveness and identify reasons participants respond better to one treatment or the other.

Background: Post-stroke depression negatively impacts the quality of life of people with aphasia. Speech-language pathologists (SLPs) are in a unique position to identify signs of depression in people with aphasia because of their close involvement in the language rehabilitation process. Additionally, popular diagnostic manuals (e.g., Diagnostic and Statistical Manual of Mental Disorders) define depression based on typical populations, and assessments based on these manuals may not be reliable or valid for people with aphasia. While existing literature acknowledges the high prevalence of post-stroke depression and the challenges of diagnosing it in people with aphasia, few studies have explored the barriers in identifying symptoms of depression in people with aphasia from the perspectives of SLPs.

Aim: This study sought to explore the barriers SLPs face in recognizing symptoms of depression in people with aphasia using a qualitative analytical approach.

Methods and procedures: We recruited 13 SLPs with a range of ages (M = 37 years, SD = 11.18) and experience working with people with aphasia (M = 13 years, SD = 11.13). Data were collected through three virtual focus group interviews, each lasting 90 to 120 minutes. We analyzed the focus group data using Dedoose software (version 9.2) to document initial codes that reflected participants' insights. Reflexive thematic analysis was used to generate themes related to barriers that SLPs face in recognizing depression in people with aphasia.

Outcomes and results: Four central themes and two subthemes were extrapolated from the data. First, it's difficult to disentangle symptoms of depression from post-stroke behaviors, complicating the recognition of depression for SLPs. Second, existing depression assessments are problematic, and SLPs discussed the need to modify these tools and make them more accessible for people with aphasia. Third, the lack of interdisciplinary collaboration surfaced as a barrier in accurately identifying depression. Finally, the influence of family involvement in identifying mental health issues revealed duality, with family members acting as both supportive proxies and, at times, a hindrance to accurate depression assessment.

Conclusion: Our findings identify several key barriers that SLPs face in the recognition of depression in people with aphasia. Recognizing depression in people with aphasia requires a more interdisciplinary approach that includes SLPs, mental health clinicians, patients, and their family members. Speech-language pathologists across focus groups also noted the lack of valid assessment tools to measure depression in people with aphasia, offering suggestions to improve current assessments to better accommodate this population.

Background: Speech language pathologists (SLPs) play a vital role in service delivery in post stroke aphasia. However, SLPs can potentially perpetuate health disparities due to 1) a lack of training regarding social determinants of health and how they contribute to clinical outcomes and associated disparities and 2) a lack of understanding of the rapidly evolving research related to equity of service provision needed to reduce or eliminate health disparities.

Aims: This article provides recommendations for individual SLPs and the field more broadly to support health equity for people with aphasia and related disorders.

Methods and procedures: We considered evidence-based practices from general healthcare to promote health equity and identified opportunities to apply these practices in the SLP field, focusing on the literature on racial inequities in post-stroke aphasia as an illustrative example.

Outcome and results: Lack of diversity in the workforce, lack of training in health disparities and methods to promote health equity, and lack of representation in research may contribute to inequities in healthcare for people with aphasia and other communication disorders. We identified eight recommendations for SLPs to promote health equity for people with aphasia and other communication disorders.

Conclusions: SLPs should commit to a goal of equity in service delivery. This viewpoint provides actionable recommendations for clinicians, educators, and researchers, for promoting health equity for people with aphasia and related disorders.

Background: Access, satisfaction, and affordability with healthcare services are critical to optimal health-related outcomes. These issues have not been traditionally considered in the study of people with aphasia (PWA).

Objective: To assess healthcare access, satisfaction, and affordability among a nationally representative sample of PWA and compare wot stroke survivors without aphasia.

Methods: Data from 404 PWA obtained from the 2019, 2020, 2021, and 2022 Medical Expenditure Panel Survey (MEPS) were used to examine ease of accessibility, satisfaction with healthcare, and affordability of healthcare and compared to stroke survivors without aphasia (N=4,120).

Results: Estimates indicated that, compared to their counterparts (stroke survivors without aphasia), PWA who were female (OR=1.1, CI=1.5, 2.4) and those earning low incomes (OR=1.9, CI=1.8, 4.4) were more likely to spend more than 15 minutes traveling to their usual source of care (USC). Hispanic PWA (OR=1.1, CI=1.2, 1.1), Black PWA (OR=1.5, CI=1.2, 1.6), and PWA living in the South (OR=3.4, CI=1.5, 2.4) were more likely to have difficulty contacting their USC by phone than the reference group. Hispanic (OR=1.5, CI=1.4, 1.6) and low income (OR=1.3, CI=1.1, 1.8) PWA had comparatively greater difficulty contacting their USC after hours. Additionally, Black (not explain OR=1.4, CI=1.1, 1.6; decide OR=1.4, CI=1.1, 1.9) and Hispanic (not explain OR=1.8, CI=1.6, 2.5; decide OR=1.3, CI=1.2, 1.3) PWA were more likely than Whites to feel that their provider did not explain all treatment options or ask them to help decide on their treatment. Finally, Black PWA (OR= 4.0, CI=1.3, 12.7) were more likely to have difficulty paying their medical bills than White PWA. No racial or ethnic differences in accessibility, satisfaction, or affordability appeared among those without aphasia.

Conclusions: The study results indicate that PWA, particularly those from marginalized and low-income populations, may face additional barriers accessing healthcare, receive comparatively less satisfying care, and experience greater difficulty financing their healthcare.

Background: Logopenic variant of primary progressive aphasia (lvPPA) has been identified as more challenging to diagnose compared to other PPA-variants. A more nuanced characterization of lvPPA symptoms may be needed to facilitate accurate and timely diagnoses. Spelling engages a range of neural networks, some of which are more susceptible to lvPPA-atrophy than others, resulting in variable spelling outcomes, depending on which systems are recruited for the task. This variability may be influenced by the specific psycholinguistic characteristics of the word being spelled.

Aims: The primary aim of this study is to examine the effects of psycholinguistic variables of words on spelling accuracy for people with lvPPA.

Methods and procedures: Sixteen participants completed an abbreviated spelling assessment of 40 words taken from the Arizona Battery of Reading and Spelling (ABRS). Thirteen psycholinguistic variables, potentially relevant to orthographic, phonological, and/or lexical-semantic processing, were identified in the literature. Values for psycholinguistic variables of interest for each word were pulled from the SCOPE: South Carolina Psycholinguistic Metabase. Multilevel logistic regression modeling was used to evaluate the effect of psycholinguistic variables (at word-level) on spelling accuracy, as well as participant-level clustering effects. The main outcome variable was spelling accuracy (accurate/inaccurate). The final parsimonious model included regularity (REG), age-of-acquisition (AOA), orthographic (ONLD) and phonological neighborhood (PNLD) measured by Levenshtein's distance (LD), and emotional valence (VAL) as predictors. Predicted probabilities were calculated to estimate effect sizes for each significant variable.

Results: REG, AOA, ONLD, and VAL were significant predictors of lvPPA spelling accuracy. The effect of PNLD was not significant. REG had the largest effect on spelling accuracy, with a 93% probability of spelling accuracy on REG words compared to a 67% probability on irregular (IRREG) words. Words acquired at an earlier age (low AOA), as well as those with denser orthographic neighborhoods (lower ONLD) and positive emotional valence (high VAL) were significantly associated with greater probability of spelling accuracy.

Conclusions: Differences in psycholinguistic variables of words significantly impact spelling accuracy for people with lvPPA. Findings illustrate the utility and value of spelling assessments in PPA diagnosis. Further research is needed to determine if these effects are distinct to lvPPA.

Background: Generalization of speech-language pathology treatment is an important goal in clinical practice and research. Functional communication rating scales are often used to investigate potential treatment effects in daily life. Connected speech samples more closely reflect meaningful changes in communication as a result of treatment than test/re-test outcomes. Little attention has been directed to this relationship in aphasia due to neurodegenerative etiologies.

Aims: We investigated whether correlations between ratings on the Georgetown University Center for Aphasia Research and Rehabilitation Functional Communication Scale (CARR-FCS) and total content units (CUs) from spoken descriptions of the Cookie Theft Picture from the Boston Diagnostic Aphasia Examination (CTP-BDAE), versus correlations with scores on the Boston Naming Test (BNT), differed among variants of primary progressive aphasia (PPA) at baseline testing and 6-12 month follow-up (ClinicalTrials.gov Identifier: NCT02675270). At baseline and follow-up, for semantic variant PPA (svPPA), we hypothesized that performance on picture description will correlate more strongly with the CARR-FCS, compared to confrontation naming, as those with svPPA tend to have especially poor performance on confrontation naming [compared to logopenic variant PPA (lvPPA) and nonfluent agrammatic PPA (nfaPPA)], a task that may not be reflective of functional communication ability because communication via other means (e.g., circumlocutions) is not captured. We did not expect to find this effect in lvPPA or nfaPPA because, although anomia is present in all PPA variants, it is less severely compromised in these variants. At follow-up, for nfaPPA, we hypothesized that performance on picture description will correlate more strongly with the CARR-FCS, compared to confrontation naming, because those with nfaPPA can have a marked decline in confrontation naming due to worsening apraxia of speech.

Methods and procedures: At two time points, we calculated correlation coefficients between care partners' ratings on the CARR-FCS and total CUs from spoken descriptions of the CPT-BDAE and BNT scores of individuals with PPA. We compared the size of the correlations.

Outcomes and results: Correlations were significantly stronger between total CUs and ratings on the CARR-FCS, compared to BNT scores and CARR-FCS ratings, for svPPA at both time points, but were not significantly different for lvPPA and nfaPPA.

Conclusions: These findings suggest that, while confrontation naming performance may be a proxy for functional communication in lvPPA and nfaPPA, a measure of connected speech is more representative of functional communication in svPPA because confrontation naming is typically more impaired in svPPA than in either of the other two variants.

Purpose: People with aphasia often present with higher levels of emotional distress than people without aphasia. Coping strategies are behaviors or thoughts that can help individuals reduce the negative impact of stress on one's well-being, yet a sparsity of studies have sought to examine the coping strategies used by people with aphasia. The purpose of this scoping review was to (a) determine the extent to which coping strategies are examined in the aphasia literature and (b) summarize and evaluate the research findings on this subject.

Methods: PubMed, Web of Science, and PsychINFO were systematically searched for articles that explored coping strategies used by people with chronic aphasia. Research methods and coping strategies identified from all included articles were extracted and charted in Excel. A thematic analysis was used to organize and synthesize the findings.

Results: Four hundred thirty-six unique articles were found, and 19 articles met the inclusion/exclusion criteria for this review. Of the 19 articles included, 14 studies used a qualitative research methodology approach to explore coping strategies in people with aphasia. The thematic analysis generated six distinct themes of coping strategies, listed in order of most frequent use: cognitive strategies, social support, community engagement, behavioral strategies, resources, and spirituality.

Conclusions: Cognitive strategies were the most commonly identified theme of coping strategies reported by people with aphasia. However, our findings suggest that coping strategies are heavily interconnected with each other and do not occur in isolation. Future research may benefit from exploring how cognitive strategies can be trained as an adjunct to routine language rehabilitation for people with aphasia to promote positive adaptation following aphasia.

Background: The language symptomology in semantic variant primary progressive aphasia (svPPA), namely word finding difficulties with loss of word meaning, leads to multimodal communication difficulties that can be detrimental to establishing and maintaining relationships, including those with spouses.

Aims: This study describes a spouse's experiences of communicating with an individual with svPPA, the role of communication supports, and expectations for speech-language therapy.

Method: A semi-structured interview was conducted with the spouse of an individual with svPPA and analyzed using thematic analysis.

Results: Four themes emerged, including: living with an individual with svPPA, communication supports, and spouse's expectations from speech therapy. The spouse describes a personal dictionary created by the individual with svPPA to manage loss of word meaning. With the progression of the disease to affect all modalities of communication, the different communication supports including the personal dictionary required various modification until there was no longer benefit. Despite the emotional challenges, this spouse demonstrates resilience by making adjustments and accommodations to support their participation in the activities that they had mutually enjoyed prior to the progression of the disease.

Conclusion: The study highlights the challenges faced by a spouse of an individual with svPPA, the benefit of communication supports in maintaining interaction despite the progression of symptoms, and the role of speech-language pathology and the community in enhancing care partner well-being.

Background: People with aphasia have an increased risk of developing symptoms of depression, anxiety, and chronic stress - all of which interfere with rehabilitation and limit functional outcomes. Interventions addressing the mental health needs of people with aphasia are critically important and rapidly emerging. Most self-rated questionnaires are highly language-dependent. It is unclear how aphasia researchers are managing this potential study limitation.

Aims: To examine how treatment-induced changes in depression, anxiety, and chronic stress are currently being measured in people with stroke-induced aphasia and identify areas of concern and implications for future research.

Methods & procedures: PsycINFO, CINAHL, PubMed, Embase, and Google Scholar were searched in February 2024. Key search terms included "depression", "anxiety", "chronic stress", "measurement", "aphasia", "stroke", and "treatment". Quantitative intervention studies reporting pre-post and/or group comparisons of depression, anxiety, or chronic stress, as either a primary or secondary outcome, with samples consisting of at least 50% of people with aphasia (or those reporting separate data for people with aphasia) were included in the review. Psychometric properties of the 10 most commonly used measures in the included studies were also evaluated.

Outcomes & results: Thirty-six studies (out of 1518 screened) met inclusion criteria (13 randomized controlled trials; 23 non-randomized), from which 33 distinct measures were identified, including observer/clinician-rated (proxy), language-dependent self-rated, as well as visual scale/picture-supported measures. Most frequently used measures include the Stroke Aphasic Depression Questionnaire (SADQ-21 and SADQ-Hospital) and Visual Analog Mood Scale (VAMS) for depression; the Hospital Anxiety and Depression Scale - Anxiety subscale (HADS-A) for anxiety; the modified Perceived Stress Scale (mPSS) for chronic stress. Most significant treatment effects reported by studies were derived from measures with weak psychometric support for use with people with aphasia.

Conclusions: Measures used to evaluate treatment-induced changes in depression, anxiety, and chronic stress in people with aphasia varied widely across studies. This variability may stem from a lack of validated measures available for this population and/or the absence of best practice recommendations for measuring mental health outcomes in people with aphasia. Given these limitations, caution is urged when interpreting treatment studies using current measures, and there is an urgent need for valid and reliable self-report measures specifically designed with and tested for people with aphasia.

Background & aims: Decades of research on structural priming - speakers' tacit reuse of previously encountered syntactic structures in subsequent production and comprehension of sentences - has made substantial contributions to theories of syntactic representations, processing, and language learning and acquisition. There is growing interest in the application of structural priming to assess and facilitate language processing and learning in clinical populations. Yet, little research has explored structural priming in aphasia. The purpose of this paper is to provide a state-of-the art review of structural priming studies in aphasia and provide future research directions with an eye towards using structural priming for aphasia rehabilitation.

Main contribution: Structural priming occurs not only in laboratory settings, but also in everyday speech, across many simple to complex grammatical structures, different languages, and throughout the lifespan. Importantly, a body of literature suggests that structural priming may reflect processes of implicit learning, strengthening the language user's ability to map messages and sentence structures. With respect to aphasia, existing studies have discovered that priming can help persons with aphasia (PWA) produce and comprehend more complex sentences that are otherwise difficult to produce or comprehend on their own. Additionally, priming effects transfer across production and comprehension modalities, and create long-lasting, cumulative improvements of sentence processing in PWA.

Conclusions: The review of the literature suggests that structural priming can be used to assess PWA's ability to access various syntactic structures but also to intervene sentence production deficits in PWA. Future research is recommended to systematically investigate functions of structural priming for widespread recovery of aphasia beyond increasing syntactic complexity, to delineate essential tenants of structural priming intervention at both person and treatment levels, and to examine its use for cross-linguistic treatment of bi/multi-lingual aphasia.