Elizabeth Cardell

Aphasia LIFT: Exploratory investigation of an intensive comprehensive aphasia programme

Background: Intensive comprehensive aphasia programs (ICAPs) are gaining popularity in the international aphasia rehabilitation community. ICAPs comprise at least three hours of treatment per day over at least two weeks, have definable start and end dates for one cohort and use a variety of formats including individual treatment, group therapy, education and technology to improve language and communication. While intensive treatment approaches have demonstrated equivocal results on impairment-based measures, positive changes on activity/participation measures provide support for ICAPs in rehabilitation of chronic aphasia. Aphasia Language Impairment and Functional Therapy (LIFT) is a research-based ICAP developed for the purpose of evaluating treatment outcomes across the International Classification of Functioning, Disability and Health (ICF) domains. Aims: The aim of this study was to estimate the magnitude of treatment effects yielded by Aphasia Aphasia LIFT in the domains of language impairment, functional communication and communication-related quality of life (QOL). Methods & Procedures: Eleven individuals with chronic post-stroke aphasia (mean = 26.9 months) completed Aphasia LIFT. The programme comprised individual impairment-based and functional treatment, group therapy, and computer-based treatment for 40 hours over two weeks (n = 4, LIFT 1) or 100 hours over four weeks (n = 7, LIFT 2). Assessments of confrontation naming, discourse production, functional communication and communication-related quality of life were completed at pre-treatment, immediately post-treatment and six to eight weeks following treatment termination. Outcomes & Results: Group-level analyses revealed acquisition and maintenance of treatment effects, as evidenced by significant improvement on at least one outcome measure at follow-up in all domains. The most consistent pattern of improvement at an individual level was observed on measures of functional communication and communication-related QOL. Conclusions: Aphasia LIFT yielded positive outcomes across ICF domains, and in many cases the treatment effect was enduring. These results demonstrate that Aphasia LIFT was successful in meeting the overarching goal of ICAPs, to maximise communication and enhance life participation in individuals with aphasia. Further research into ICAPs is warranted.

A cognitive neuropsychological approach to the assessment and remediation of acquired dysgraphia

This study used a cognitive neuropsychological approach to investigate a case of acquired dysgraphia in an adult who had sustained focal brain damage. The interpretation and remediation of her dysgraphia were guided by reference to a detailed model describing the functional architecture of the normal language processing system. The aims of the study were to investigate the usefulness of model-based assessment1) in identifying the precise nature of the underlying mechanisms responsible for the dysgraphia; and2) in designing an efficacious treatment programme that was informed by theories of normal language processing. Interpretation of detailed pre-therapy testing using tasks derived from current psycholinguistic models suggested that the subject’s dysgraphia arose from deficits with processing low-imageability semantic information as well as from a breakdown at the level of the graphemic assembly buffer. Two treatment phases which targeted the identified deficit areas were implemented using a multiple baseline (across behaviours) methodology. The first treatment consisted of semantic therapy targeting the writing of low-imageability words, and the second treatment involved a segmentation hierarchy for treating the writing of non-words. The results indicated positive and selective treatment effects as well as strong generalization effects to related items and functions. The results are discussed in the light of current psycholinguistic theories of model-based assessment and treatment.

Be Clear: A New Intensive Speech Treatment for Adults With Nonprogressive Dysarthria

PURPOSE This article describes the effects of a new intensive dysarthria treatment program (Be Clear) on speech intelligibility in adults with dysarthria secondary to stroke and traumatic brain injury. METHOD A small group-repeated measures research design was used to examine the effects of treatment on the speech of 8 participants with nonprogressive dysarthria. Treatment consisted of a 1-hr prepractice session followed by 1-hr therapy sessions, 4 times per week, for 4 weeks (16 sessions). Paired-comparison ratings of speech intelligibility served as the primary outcome measure for the study. Perceptual data, quality of life, and communication partner opinion were obtained at 3 time intervals: (a) prior to treatment, (b) immediately posttreatment, and (c) 1-3 months posttreatment. RESULTS Following treatment, group data demonstrated substantial improvements in speech intelligibility as perceived by naive listeners on a paired-comparison rating task. Word intelligibility was clinically significantly improved posttreatment and sentence intelligibility demonstrated statistically significant improvement. Communication partner ratings of speech intelligibility and overall communicative function were statistically significantly improved posttreatment. CONCLUSIONS The results of this study suggest that this new intensive treatment may have potential as an effective intervention for nonprogressive dysarthria. However, controlled studies are required to establish treatment efficacy.

Feasibility and cost analysis of implementing high intensity aphasia clinics within a sub-acute setting.

Abstract The current study explored the clinical feasibility and costs of embedding three different intensive service delivery models for aphasia treatment (computer, group therapy, and therapy with a speech pathology therapy assistant) within three sub-acute facilities. The study employed a two cohort comparison design, with the first cohort (n = 22) receiving the standard service of treatment currently offered. This treatment was delivered by a speech-language pathologist and involved on average 3 hours of treatment/week over 8 weeks. Participants in the second cohort (n = 31) received one of the three intensive treatment models providing up to 9 hours of therapy/week for 11 weeks. Organizational data was collected throughout treatment, with participant, caregiver, and clinician satisfaction with the intensive models also being measured. Participants completed the spoken language production sub-tests and the Disability Questionnaire of the Comprehensive Aphasia Test (CAT) pre- and post-treatment. All intensive models yielded high participant attendance, satisfaction, and significant improvements to the CAT sub-tests. The pro-rata cost of providing treatment per hour per client for the computer and group therapy models was found to be ˜ 30% cheaper compared to the standard service. The outcomes support the potential feasibility of embedding the different models into sub-acute facilities to enhance client access to intensive treatment for aphasia.

Communication Attitude Test for Preschool and Kindergarten Children who Stutter (KiddyCAT)

The incidence of stuttering has often been cited as being approximately 4–5% (e.g., Andrews et al., 1983; Craig, 1998; Mansson, 2000). However, a recent large-scale study found that the incidence of stuttering by age three was 8.5% (Reilly et al., 2009). Other studies that have included children who stuttered for only a short period report the incidence of stuttering to be as high as 15% (e.g., Bloodstein, 1995). While stuttering in early childhood is manifest by its speech characteristics and evaluated accordingly, up until quite recently there has been little formal consideration of the affective and emotional impact that stuttering might have on very young children (i.e., ages two to five years). Indeed, a common view was that it was only in later years, when the child had experienced multiple negative experiences, that negative attitudes and beliefs about speech were formed. It is now known that children as young as three years of age can evaluate their performance in comparison with others and, therefore, can develop feelings of embarrassment or shame about stuttered speech (Lewis, 2000).

Clinicians’ perceptions of delivering new models of high intensity aphasia treatment

ABSTRACT Background: While evidence suggests that intensive aphasia therapy is associated with positive patient outcomes, speech language pathologists continue to report delivering therapy at low intensity schedules. Investigation of the barriers and enablers of delivering intensive therapy in hospital settings is needed to help address this evidence–practice gap. Aims: To explore clinicians’ perceptions of delivering high intensity aphasia treatment through three different service models and their recommendations for future directions in implementing high intensity aphasia clinics in a public health setting. Methods & Procedures: A sequential mixed methods design was employed. Thirteen speech language pathologists who provided intensive aphasia therapy to 31 patients across three facilities as part of a larger study consented to participate. Participants contributed to a log of barriers and facilitators while delivering treatment and completed a questionnaire in the last week of treatment. Findings were used to inform the question guide for a focus group interview conducted with nine of the clinicians post-treatment. Outcomes & Results: Most clinicians found the increased intensity of treatment more difficult to deliver than standard treatment, and reported barriers included patient fatigue, patient personal factors, locating resources, scheduling and coordination issues, and clinician workload and potential burn-out. Emotional challenges were less expected and were potentially intensified by the frequency of contact with patients. Despite this, clinicians remained dedicated, and were motivated by patient progress, peer support and the opportunity to prove the worth of speech language pathology. They were positive about the perceived benefits of patient confidence, clinician development, teamwork, and the relationships that formed between patients, carers and clinicians. Conclusions: Clinicians agreed that delivering the treatment brought great rewards and benefits, but also challenges. Communicating the benefits and finding ways to address the barriers identified by the participants of this study may be instrumental in assisting future implementation of high intensity models of aphasia treatment in existing services.

Communication and well-being outcomes of a hybrid service delivery model of intensive impairment-based treatment for aphasia in the hospital setting: a pilot study

Abstract Purpose: This pilot study aimed to evaluate the effects of an intensive hybrid service delivery model (i.e., combining face-to-face individual, computer and group therapy) on communication and well-being for people with aphasia (PWA) in the hospital setting. Materials and methods: The study explored two different intensities of the hybrid model, 4 h/week (Hybrid-4) and 8 h/week (Hybrid-8) both for 8 weeks. Participants ranging from 1 month to 5 years post-onset were allocated using matched-pair randomisation to receive either Hybrid-4 (n = 5) or Hybrid-8 (n = 4) and assessed using a comprehensive language battery by a blinded assessor, as well as selected activity, participation and well-being measures before, immediately after and 4-week post-treatment. Results: All participants in Hybrid-4 and three out of four participants in Hybrid-8 demonstrated clinically significant improvement to measures of language impairment immediately post-treatment, with the majority also demonstrating maintenance effects 4-week post-treatment. Clinically significant improvements to activity, participation and well-being measures were also observed across participants in both groups. Conclusions: Findings support the potential benefit of employing an intensive hybrid service model and suggest that both 4 and 8 h per week of impairment-based treatment for 8 weeks may result in improvements in communication and well-being for some PWA across different stages of recovery. Implications for rehabilitation The present findings help bridge the gap between what evidence suggests is effective intensity of rehabilitation for aphasia and what can be practically delivered in real-world hospital settings. Findings support the potential clinical value of employing a hybrid service model (using computer, group and individual therapy) to deliver intensive rehabilitation to people with aphasia in the hospital setting, and suggest that clinically significant improvements to communication and well-being can result when the model is delivered at either 4 or 8 h per week. The current study highlights that people with aphasia in the early stages of aphasia recovery can potentially benefit from intensive impairment-based hybrid models of intervention.

The impact of aspiration pneumonia and nasogastric feeding on clinical outcomes in stroke patients: A retrospective cohort study

AIMS AND OBJECTIVES To determine presence of clinical complications related to dysphagia and to explore their operational outcomes. BACKGROUND Dysphagia is a common complication of stroke. The management of poststroke dysphagia is multidisciplinary with nurses playing a key role in screening for dysphagia risk, monitoring tolerance of food and fluids and checking for the development of complications such as fever, dehydration and change in medical status. Dysphagia often results in further complications including aspiration pneumonia and the need for nasogastric feeding. Dysphagia-related complications have been shown to have a significant impact on morbidity and mortality, length of stay and cost of admission. DESIGN Retrospective cohort study. METHODS A total of 110 patients presenting with an ischaemic stroke were chart-audited. RESULTS Aspiration pneumonia poststroke was found to be significantly associated with increased overall length of stay, poorer functional outcomes poststroke as well as being associated with a high risk of mortality. The presence of a nasogastric tube was also associated with reduced functional outcomes poststroke and increased risk of death. CONCLUSION High prevalence and cost of complications associated with stroke highlight the complexity of providing nursing and allied health care to this patient population. This provides a snapshot of dysphagia-related complications experienced by stroke patients. RELEVANCE TO CLINICAL PRACTICE This paper highlights that poststroke complications can significantly impact on patient outcomes and operational factors such as cost of admission; therefore, poststroke care requires a multidisciplinary approach to management. Furthermore, preventing and managing complications poststroke is a key element of nursing care and has the potential to significantly reduce incidence of mortality, length of stay and cost of hospital admission.

Management of swallowing in thrombolysed stroke patients: Implementation of a new protocol

Abstract Purpose: There is a paucity of evidence regarding dysphagia management post-thrombolysis. The aim of this case–control study was to evaluate the impact of a dysphagia management protocol on patient outcomes. Thrombolysis has been completed at our metropolitan hospital since 2011 and a dysphagia management protocol was developed in 2012. Method: Chart auditing was completed for 83 participants in three groups: pre-protocol (n = 12) (2011), post-protocol (n = 28) (2012–2014), and non-thrombolysed stroke patients (n = 43). Result: Following the implementation of this clinical protocol, the average time patient remained nil by mouth reduced by 9.5 h, the percentage of patients who were malnourished or at risk reduced by 24% and the number of patients who developed aspiration pneumonia reduced by 11%. The cost of hospital stay reduced by

Semantic priming in anomic aphasia: a focused investigation using cross-modal methodology

1505. Service compliance with best practice in dysphagia management in thrombolysed patients increased from 67% to 96% in the thrombolysed patient groups. Conclusion: The outcomes suggest that a clinical protocol for dysphagia management in thrombolysed patients has the potential to improve service outcomes, reduce complications from dysphagia, have financial benefits for the hospital and increase service compliance. Furthermore, the results lend support for speech pathology services to manage dysphagia on weekends.