Abby Foster

Multi-modality aphasia therapy is as efficacious as a constraint-induced aphasia therapy for chronic aphasia: A phase 1 study

Background: There is an urgent need for treatment comparison studies for chronic aphasia. Two different treatments, Constraint-Induced Aphasia Therapy Plus (CIAT Plus) and Multi-Modality Aphasia Therapy (M-MAT) aim to improve spoken language production through intensive shaping of responses, and social-mediated repetitive practice. CIAT Plus constrains responses to the verbal modality, while M-MAT includes gesture, drawing, writing and reading-based cues to assist production. Aims: This Phase 1 study compared the efficacy of CIAT Plus and M-MAT. The study also aimed to investigate the relationship between treatment responsiveness and participants aphasia severity and cognitive variables. Methods & Procedures: We utilised 11 single-subject multiple baseline designs with a cross-over for treatment type. Participants had chronic aphasia (17–88 months post onset) and a range of aphasia severities (WAB AQ 36.2–92.8). Participants named 180 noun and verb probes three times at pre-, mid-, post-treatments and at 1- and 3-month follow-ups. Both CIAT Plus and M-MAT were delivered for 32 hours over 2 weeks. Six participants received M-MAT first while five received CIAT Plus first. Standard case charts were developed for visual analysis of each participants probe results. Within-subject effect sizes (ESs) were calculated on naming the probe scores. Discourse measures were analysed with descriptive statistics. Participants satisfaction with each treatment type was probed. Results & Conclusions: A total of 32 (of 44 total) immediate post-treatment ESs reached small (3), medium (7) or large (22) levels, and ranged from –0.96 to 30.6. Higher ESs were found for nouns as compared to verbs, and for items treated during the first treatment phase. The mean ES was comparable for items treated with M-MAT (M = 8.00) and CIAT Plus (M = 8.58) and was well maintained at the 1-month follow-up. As a group, aphasia severity was significantly reduced at the 1-month and 3-month follow-up time points. WAB AQ change scores immediately post-treatment favoured M-MAT for four participants and CIAT Plus for five; however, order effects are likely to have played a significant role. Treatment potency was demonstrated with generalisation to noun (8 participants) and verb production (1 participant) in discourse. Overall , CIAT Plus and M-MAT were equally efficacious for these 11 individuals, although six participants expressed preference for M-MAT and three for CIAT Plus. Delayed treatment effects were present in some participants. Future large-scale studies are required to deal with order effects and a participants variability.

Gesture production patterns in aphasic discourse: in-depth description and preliminary predictions

Background: Gesture frequently accompanies speech in healthy speakers. For many individuals with aphasia, gestures are a target of speech-language pathology intervention, either as an alternative form of communication or as a facilitative device for language restoration. The patterns of gesture production for people with aphasia and the participant variables that predict these patterns remain unclear. Aims: We aimed to examine gesture production during conversational discourse in a large sample of individuals with aphasia. We used a detailed gesture coding system to determine patterns of gesture production associated with specific aphasia types and severities. Methods & Procedures: We analysed conversation samples from AphasiaBank, gathered from 46 people with post-stroke aphasia and 10 healthy matched controls all of whom had gestured at least once during a story re-tell task. Twelve gesture types were coded. Descriptive statistics were used to describe the patterns of gesture production. Possible significant differences in production patterns according to aphasia type and severity were examined with a series of analyses of variance (ANOVA) statistics, and multiple regression analysis was used to examine these potential predictors of gesture production patterns. Outcomes & Results: Individuals with aphasia gestured significantly more frequently than healthy controls. Aphasia type and severity impacted significantly on gesture type in specific identified patterns detailed here, especially on the production of meaning-laden gestures. Conclusions: These patterns suggest the opportunity for gestures as targets of aphasia therapy. Aphasia fluency accounted for a greater degree of data variability than aphasia severity or naming skills. More work is required to delineate predictive factors.

“Communication is taking a back seat”: speech pathologists’ perceptions of aphasia management in acute hospital settings

Background: Current service provision to people with aphasia in the acute hospital setting is reported to be inconsistent with best-practice recommendations. While speech pathologists (SPs) have been noted to express dissatisfaction with this, the underlying reasons for this evidence–practice gap are unclear. Change is required in order to move towards the provision of gold-standard aphasia management in acute hospitals. The voices of SPs working in this setting, and knowledge of their perceptions of the factors that influence their current practice, are essential in order to facilitate their capacity to act as agents for change. Aims: This research explored acute SPs’ conceptualisation, experiences, and perceptions of poststroke aphasia management, and provided a greater understanding of the factors that influence their practice. Methods & Procedures: A purposive, maximal variation technique was used to sample SPs. Semistructured in-depth interviews were conducted with 14 SP participants who work with people with acute poststroke aphasia. Inductive thematic analysis was used to analyse the results. Outcomes & Results: Analysis yielded five key themes. As a result of undertaking this research, insight was gained into (1) acute SPs’ perception of their role in relation to acute aphasia management; (2) the professional tension created by competing priorities; (3) the de-prioritisation of aphasia in relation to dysphagia management; (4) SPs’ beliefs about aphasia and their current aphasia management; and (5) their understanding of facilitators for acute aphasia management. Conclusions: This study elucidated the complex and multifaceted nature of the factors influencing SPs’ management of aphasia in the acute health care setting. Findings included the identification of modifiable factors—such as supportive practice environments, locus of control, and reflective practice—which facilitate evidence-based approaches to aphasia management in that acute hospital setting.

'I do the best I can': an in-depth exploration of the aphasia management pathway in the acute hospital setting

Abstract Purpose: While research has begun to explore the management of aphasia across the continuum of care, to date there is little in-depth, context specific knowledge relating to the speech pathology aphasia management pathway. This research aimed to provide an in-depth understanding of the current aphasia management pathway in the acute hospital setting, from the perspective of speech pathologists. Method: Underpinned by a social constructivist paradigm, the researchers implemented an interpretive phenomenological method when conducting in-depth interviews with 14 Australian speech pathologists working in the acute hospital setting. Interview transcripts and interviewer field notes were subjected to a qualitative content analysis. Results: Analysis identified a single guiding construct and five main categories to describe the management of aphasia in the acute hospital setting. The guiding construct, First contact with the profession, informed the entire management pathway. Five additional main categories were identified: Referral processes; Screening and assessment; Therapeutic intervention; Educational and affective counselling; and Advocacy. Conclusions: Findings suggest significant diversity in the pathways of care for people with aphasia and their families in the acute hospital setting. Additional support mechanisms are required in order to support speech pathologists to minimise the evidence-practice gap. Implications for Rehabilitation Significant diversity exists in the current aphasia management pathway for people with acute post-stroke aphasia and their families in the acute hospital setting. Mechanisms that support speech pathologists to minimise the evidence-practice gap, and consequently reduce their sense of professional dissonance, are required.

Does intensity matter in aphasia rehabilitation

Aphasia is a serious acquired communication disability, that affects approximately 30% of stroke survivors. It is chronic in nature: 50% of people diagnosed with aphasia have persistent communication problems 1 year after stroke. Aphasia compromises an individual’s ability to undertake many activities of daily living, resulting in reduced mood and quality of life. In addition to the personal cost of aphasia, health-care costs for people with aphasia are the highest in stroke care. Therefore, the recent identification of recovery from aphasia as one of the top ten research priorities related to life after stroke is unsurprising. International best practice consensus statements regarding the management of aphasia state that “people with aphasia should be offered intensive and individualized aphasia therapy designed to have a meaningful impact on communication and life”. Additionally, the most recent Cochrane review suggests that high-intensity therapy leads to reduced aphasia severity and greater improvement in functional communication compared with lower-intensity therapies. Despite these results, the documented level of intervention provided in clinical settings is far from what would be considered intensive. Confusion remains regarding the overall dose and intensity of treatment required for meaningful change in people with aphasia after stroke. In The Lancet, Caterina Breitenstein and colleagues report a randomised controlled trial in 19 rehabilitation centres in Germany investigating intensive speech and language therapy in patients with chronic aphasia after stroke, and touch on some of the controversy about whether the intensity of usual care is effective. The waiting-list-controlled trial of intensive speech and language therapy had an intervention group that received 10 h or more of therapy per week for at least 3 weeks (n=78) and a control group (n=78) in which treatment was deferred for 3 weeks. The primary endpoint was change from baseline in effectiveness of verbal communication in everyday life scenarios. The 10% improvement in this primary outcome among patients in the intervention group (mean difference 2·61 points [SD 4·94]; 95% CI 1·49 to 3·72) compared with the control group has implications for aphasia therapy worldwide, because most aphasia therapy is provided less intensively than in this trial. Therapy consisted of combined one-to-one speech and language therapy, group therapy provided by a speech and language therapist, and prescribed (but self-managed) computer-based or paper-and-pencil linguistic exercises. The finding that at least 10 h per week of this type of intensive therapy is feasible in a usual care setting is important. This study also adds weight to the argument made in recent systematic reviews that substantial and clinically important improvements can be made in the chronic phase of stroke recovery. This study has several strengths that make it widely applicable to the aphasia community. In addition to supporting the clinical relevance of the findings, these strengths provide a model for future aphasia research. First, the use of a meaningful, established, and sensitive primary outcome that measures everyday communicative effectiveness is to be commended, as is the use of masking and counterbalancing to account for learning effects. Second, the use of a representative sample has incredible value. The large, comprehensively described sample is also unusual in studies of people with aphasia. The study had broad inclusion criteria, allowing participation of people of diverse ages, stroke type, time after onset of aphasia, aphasia severity, and aphasia syndrome. Additionally, participants with global and severe aphasia were included; such people are often excluded from efficacy studies but must be included in effectiveness studies in usual care contexts. Third, Published Online February 27, 2017 http://dx.doi.org/10.1016/ S0140-6736(17)30546-9

Acute post-stroke aphasia management: Multiple perspectives on a single patient journey

### A Systematic Comparison of Different Techniques to Measure Clot Length in Patients with Acute Ischemic Stroke Qazi, A1, 3 Eesa, M1, 2 Qazi, E1, 3 Goyal, M2, 1 Demchuk, A1, 4, 3 Menon, B1, 4, 3; 1. Calgary Stroke Program, Calgary, AB; 2. Department of Radiology, Calgary, AB; 3. University of Calgary, Calgary, AB; 4. Department of Neurology, Calgary, AB Introduction: Clot length on CT/CTA has been used to predict recanalization with thrombolytic treatment in patients with acute ischemic stroke(AIS). We compared different techniques of measuring clot length on CT/CTA to identify the most reliable method. Methods: 4 1 patients with M1-MCA occlusions from INTERRSeCT, a prospective imaging based cohort study of AIS patients, were included. Hyperdense sign was measured on NCCT(5mm slice thickness). Clot length was measured on CTA at 3mm and 24mm-slices in the axial and coronal plane by:1) measuring the non-visualized segment of M1-MCA and 2) calculating ratio of residual lumen length within M1-MCA segment to length of contralateral patent M1-MCA segment. Two readers analyzed all images independently and were blinded to CTA when reading NCCT. Level of concordance between raters for each method was calculated using Cohen’s kappa for categorical variables and Intra-class Correlation Coefficient(ICC type2, single measure). A method has high inter-rater reliability if the level of concordance is high. Results: Measuring residual lumen ratio on CTA(3mm) is the most reliable technique for measuring clot length. Measuring length of hyperdense sign on NCCT is fairly reliable. Direct clot length measurements on CTA are only reliable if done on 24mm CTA slices using MIP. Conclusion: Reliability of clot length assessment and its interaction with treatment type in predicting recanalization depends on the type of imaging modality and technique used. CTA remains the best tool to measure clot length. ### New Approaches to Fast Stroke Imaging with Magnetic Resonance Yerly, J2 Lauzon, M1 Lebel, R3, 1 Sevick, RJ1 Barber, PA1 Frayne, …In order to compare research evidence and best practice recommendations with expressed needs of consumers, facilitators conducted 90 minute focus groups with: A national group of aphasia researchers, stroke thought leaders, and practitioners reviewed existing research inventories and BPGs from around the world. The group examined evidence sources and levels of evidence in order to identify gaps in evidence and priorities for knowledge translation. Background

That doesn't translate: Acute aphasia management, evidence-based practice, and the disempowerment of speech pathologists

Habitat loss is viewed as a primary cause of pollinator population declines. Managed meadows and gardens provide benefits to wildlife, including pollinating insects. Given the interest in planting flowers for pollinators, lists of recommended varieties have been produced by professional organizations and amateurs alike. These lists serve as a good starting point but are often not grounded in empirical data. Coreopsis is a popular garden plant and a frequent component of commercial pollinator seed mixes. The aim of this study is to compare the ecological role of commercially available Coreopsis plants. It is hypothesized that pollinating insects exhibit preferences based on color and other floral traits. To address this question 4 species of wildtype Coreopsis and 13 cultivars were evaluated for their attractiveness to pollinating insects. Data was collected between June and August 2014 from Coreopsis plants in the Mount Cuba Center trial garden (Hockessin, Delaware). Flower visitors were observed and recorded to morphospecies. To assess which visual floral traits were correlated with pollinator visitation, inflorescence diameter, inflorescences per plant, inflorescence color and pattern, plant height, and number of flowers per inflorescence were measured. Correlating visitation with floral traits may explain the differential attraction of pollinators to Coreopsis flowers. David Ray The Nature Conservancy, MD/DC Chapter Atlantic White-Cedar Stand History and Rehabilitation Prospects Abstract: Efforts to understand the history and dynamics of Atlantic white-cedar (AWC) communities within the Nassawango Creek Watershed were undertaken to help inform various aspects of projects aimed at reestablishing and rehabilitating AWC across the ownership. We used a combination of local knowledge, aerial imagery and ancillary GIS layers (e.g. soils and wetlands), and extensive field transects to identify areas where AWC either currently exists or was known to have been present historically. This information has been assembled using GPS/GIS mapping and spatial analysis, through a dendrochronological study (analysis of tree rings), and observations of natural regeneration. Results presented in this poster suggest there is considerable potential to rehabilitate degraded AWC stands, an aspect of this effort that we have recently begun working on. Efforts to understand the history and dynamics of Atlantic white-cedar (AWC) communities within the Nassawango Creek Watershed were undertaken to help inform various aspects of projects aimed at reestablishing and rehabilitating AWC across the ownership. We used a combination of local knowledge, aerial imagery and ancillary GIS layers (e.g. soils and wetlands), and extensive field transects to identify areas where AWC either currently exists or was known to have been present historically. This information has been assembled using GPS/GIS mapping and spatial analysis, through a dendrochronological study (analysis of tree rings), and observations of natural regeneration. Results presented in this poster suggest there is considerable potential to rehabilitate degraded AWC stands, an aspect of this effort that we have recently begun working on. POSTER PRESENTATIONS Larry Murrell Air Infusion removes Biomat-Lining of Septic Stone-Filled Trench in less than Six Hours: New Protocol to Restore Impaired Septic System Function It is widely recognized that soil decline of residential properties in New Jersey follows a pattern of 1) waterlogging, 2) anaerobic-bacteria-generated toxins impairing plant health, 3) compaction, 4) rapid erosion, and 5) rising water tables. Use of pesticides and inorganic fertilizers accelerate the compaction and erosion in a vicious cycle. These negative impacts on soil health have a domino effect causing chronically high, usually perched water tables, contributing to water-logging and basement flooding. What is not widely recognized is that the soil surrounding the trenches of septic systems, also called drainfields or laterals, is highly susceptible to water-logging and the increasing water tables found all along the Eastern Seaboard. A high water table for septic fields promotes rapid formation of a 1-2” thick black biomat that forms in the surrounding soil. This biomat leads to compromised water flow from the stone-filled trench, or drainfield, into the septic field, and eventually to complete failure of the septic system. We have found that an effective way to attack the biomat of a septic system in a one-step procedure that destroys the biomat and allows the entrained waste water in the gravel train to surge into the soil of the septic field, literally saturating the soil of the field. Once this entrained waste water is transferred to the soil, natural aerobic bacteria digest the remains of the biomat and any toxins present in the field. This new protocol is effective because it saturates void spaces in the trench, and then saturates the entire septic field with aerated water. The restoration process is cost effective and takes only 6 8 hours to complete for each trench of a septic system. With our protocol, the entire biomat is destroyed by uniform air-infusion to the entire trench, and subsequently to the entire field. Samantha Nestory and Judy HoughGoldstein University of Delaware Entomology and Wildlife Ecology Mechanical control methods for Japanese stiltgrass (Microstegium vimineum) Abstract: Japanese stiltgrass (Microstegium vimineum) is an invasive grass that poses a major threat to native biodiversity and restoration efforts in invaded areas. While there are recommended control methods, few studies have scientifically quantified the efficacy of these control methods. A previous study determined that mowing any time after midsummer reduces the M. vimineum population, so we expanded upon this study to determine the effect of mowing height on M. vimineum populations. We established small plots at two sites that were dominated by M. vimineum. Vegetation surveys were conducted for each plot and then plots were mowed at one of three different heights (10 cm, 5 cm, 0 cm) in late summer before seed set. After 5 weeks, prior to senescence, all vegetation in the plots was harvested. Seed spikelets were counted, dried, and weighed. Vegetation was sorted into M. vimineum vegetation and all other vegetation, then dried and weighed. Results show that mowing at any of the three heights significantly reduced seed production and seed biomass of M. vimineum. Mowing at 10 cm reduced seed production by 85.9% and mowing at ground level reduced seed production by 99.5%. Seed biomass was reduced by 92.1% when plots were mowed 10 cm and by 99.5% when mowed at ground level. The results demonstrate that mowing below 10 cm before seeding occurs can significantly reduce M. vimineum reproductive output and could be integrated into an effective management program, which could increase the success of restoration efforts. Japanese stiltgrass (Microstegium vimineum) is an invasive grass that poses a major threat to native biodiversity and restoration efforts in invaded areas. While there are recommended control methods, few studies have scientifically quantified the efficacy of these control methods. A previous study determined that mowing any time after midsummer reduces the M. vimineum population, so we expanded upon this study to determine the effect of mowing height on M. vimineum populations. We established small plots at two sites that were dominated by M. vimineum. Vegetation surveys were conducted for each plot and then plots were mowed at one of three different heights (10 cm, 5 cm, 0 cm) in late summer before seed set. After 5 weeks, prior to senescence, all vegetation in the plots was harvested. Seed spikelets were counted, dried, and weighed. Vegetation was sorted into M. vimineum vegetation and all other vegetation, then dried and weighed. Results show that mowing at any of the three heights significantly reduced seed production and seed biomass of M. vimineum. Mowing at 10 cm reduced seed production by 85.9% and mowing at ground level reduced seed production by 99.5%. Seed biomass was reduced by 92.1% when plots were mowed 10 cm and by 99.5% when mowed at ground level. The results demonstrate that mowing below 10 cm before seeding occurs can significantly reduce M. vimineum reproductive output and could be integrated into an effective management program, which could increase the success of restoration efforts. POSTER PRESENTATIONS Monica Gagliardi Temple University School of Environmental Design ML Architect Student Oxford Wetland Sanctuary: What Nature Intended Abstract: In the era of global climate change, wetlands are a vital resource, providing the link to a resilient social, economic and environmental future. The Oxford Wetland Sanctuary goes beyond simply connecting people to nature, it uses a metric––the Evaluation for Planned Wetlands (EPW)––to restore a wetland, ensuring a highly impactful design based on science. The project incorporates creative social engagement, educational programming and economic opportunities. In the era of global climate change, wetlands are a vital resource, providing the link to a resilient social, economic and environmental future. The Oxford Wetland Sanctuary goes beyond simply connecting people to nature, it uses a metric––the Evaluation for Planned Wetlands (EPW)––to restore a wetland, ensuring a highly impactful design based on science. The project incorporates creative social engagement, educational programming and economic opportunities. Wetland mitigation banking represents an important economic component of the environmental sector, showcasing synergies between effective environmental protection and economic expansion while elevating the value of wetlands in society. The plan uses strategic micro grading and native re-vegetation to create a complex system that absorbs rainwater and slowly releases it to the aquifer; absorbs chem

Speech pathologists' perceptions of the factors that influence decision-making in acute post-stroke aphasia management

This abstract looks at establishing the effectiveness of combined walking and cognitive training in long-term stroke through a series of N-of-1 studiesIntroduction: To overcome the limitations of the current activity monitoring methods and to effectively investigate early stage functional activities post stroke, we are developing a new computerised Real Time Location System (RTLS).Having previously established excellent RTLS reliability (Intraclass Correlation Coefficients≥0.90), this study aims to determine its validity by comparing it to the Observational Behaviour Mapping Technique (OBMT). Methods: All rooms routinely accessed by patients are fitted with infra-red room locators which send their location codes to specialised Radio-Frequency Identification (RFID) tags. The RFID tags that have in-built motion sensors transmit their location and movement signals to a computer. All participating patients and staff members wear the tags and additional tags are attached to equipment like walking-aids and wheelchairs. Simultaneously, on various days, OBMT is being used to record patients’ location, interaction and activity every ten minutes. Descriptive statistics and Pearson’s Correlation Coefficients (PCCs) are being used for statistical analysis. Results: So far, we have analysed the results for the location category of three patients and have observed only small differences between the two systems for mean time spent in own room (diff=7min; OBMT=550, RTLS=557) and in therapy room (diff=4min; OBMT=90, RTLS=86). Further analysis will involve comparing the methods for time spent in categories like interacting with staff members, doing therapeutic and non therapeutic activities and using equipment. Conclusion: Based on results, we hope to determine that the RTLS is a valid system for continuous, unobtrusive patient activity measurement and can provide much needed quantifiable information about functional recovery post stroke.order Oral Presentations Acute Care 1 Case Reports and Interesting Cases Secondary Prevention Rehabilitation 1 Audit 1 Education Good Practice in User Involvement Health Economics and Impact of Stroke Service Development and Delivery 1 Other Communication Swallowing Nutrition Vision Social and Community Care Vascular Cognitive Impairment Acute Care 2 Rehabilitation 2 Cognitive, Emotional and Psychological Genetics Basic Neuroscience Imaging Audit 2 Service Development and Delivery 2 TIA Primary Prevention Risk Factors of Stroke Exercise After Stroke Assistive Technology IJS_960_Front index.indd iv 11/1/2012 6:33:11 PM