Lucette Lanyon

Do the hands have it? The facilitation effects of arm and hand gesture on word retrieval in aphasia

Background: There is considerable disagreement in the literature concerning the function of co‐verbal gesture. Studies of the relationship between speech and gesture have employed an array of methods to investigate the origin and functions of arm and hand gesture. Commonly, these studies have utilised an experimental design to examine possible speech facilitation effects. However there is a need to examine spontaneous gesture production and its effect on speech production, as evidence suggests that natural gesture production is distinct from that produced under test conditions. Aims: To investigate the possible facilitation effects of spontaneously generated arm and hand gestures during word retrieval difficulty in people with aphasia. Methods & Procedures: Conversational samples 20 minutes long were acquired from 18 participants with chronic aphasia. Verbal utterances were transcribed for word retrieval difficulty, resolved word retrieval difficulty, and fluent speech production. The transcription was augmented with all arm and hand gestures produced by the participants. Gestures were segmented into gesture units and classified into types. A second rater classified 20% of the samples for gesture type, occurrence of word retrieval difficulty, and whether the difficulty was successfully resolved or not. Consensus ratings were carried out where disagreement occurred. Variables were paired for comparison using a series of non‐parametric Wilcoxon Signed‐Ranks Tests. Outcomes & Results: Gesture production was significantly higher during instances of word retrieval difficulties. The resolution of word retrieval difficulty was significantly more frequent with a gesture present. Crucially, there was no significant difference between the amounts of gesture produced during resolved, as compared to unresolved, word retrieval difficulties. However performance in the group was variable. Five individuals produced over 50% more gesture during resolved word retrieval events than during unresolved. Post‐hoc examination of the linguistic characteristics of these five participants suggested they had a specific phonological level impairment. Conclusions: Gesture production is multifunctional for people with aphasia. People with mild aphasia, who have the majority of their linguistic resources still accessible, are likely to experience facilitation from gesture production, and hence gesture treatment maybe an appropriate and potent therapy focus. Some individuals with severe language impairment are capable of using many rich, communicative gestures. Such gesture expression should be explored as a viable component of a “total communication” therapeutic approach for those individuals.

The efficacy of outpatient and community-based aphasia group interventions: a systematic review

Abstract This paper examines the evidence for community and outpatient aphasia groups using the International Classification of Functioning, Disability and Health (ICF) framework. A systematic search of the literature using eight electronic databases was completed; 29 studies met inclusion and exclusion criteria. Level of evidence and methodological quality was assessed and effect sizes calculated where possible. Evidence favouring community and outpatient groups centred on four level ii and level iii-i studies that examined the efficacy of highly structured group activities for improving specific linguistic processes with five medium–large effect sizes calculated. Medium and large effect sizes were also calculated on a level iii-i study examining number of friendships and community access. No effect sizes were available for level ii or level iii studies examining communication activity and participation. Overall, the results indicate that community and outpatient group participation can improve specific linguistic processes. There is also some evidence that group participation can benefit social networks and community access. However, there is limited evidence demonstrating improvement in functional communication as a consequence of group participation. The current evidence is not comprehensive. Further well-designed studies, particularly examining activity and participation, and contextual factors are required to advance community and outpatient aphasia group practice and participation.

The comparative effects of Multi-Modality Aphasia Therapy and Constraint-Induced Aphasia Therapy-Plus for severe chronic Broca's aphasia: An in-depth pilot study

Background: Anomia is a debilitating symptom of aphasia, which impacts significantly on patient quality of life. There is strong evidence in the literature to indicate that treatments for anomia are successful for individuals with aphasia, including those in the chronic stage. However, numerous limitations exist within the methodologies of relevant studies. It remains unclear which treatments provide optimal benefits for varying types and severities of aphasia. Aims: The primary aim of this study was to compare the effectiveness of two treatments, Constraint-Induced Aphasia Therapy-Plus (CIATplus) and Multi-modality Aphasia Therapy (M-MAT) for noun retrieval in individuals with severe chronic Brocas aphasia. The secondary aim was to investigate whether the use of verbal constraint is an essential element of therapy. We hypothesised that M-MAT and CIATplus would lead to equally improved naming scores for treated stimuli. Methods & Procedures: Two females with chronic Brocas aphasia (CH and MT) participated in the study. We utilised two single-participant, alternating treatment designs with multiple probes. For each treatment participants received 3.25-hour treatment sessions along with 45 minutes social interaction 4 days a week, for 2 weeks (32 hours total). Treatment involved naming items in the context of turn-taking card games and home transfer request tasks. Naming probes and assessments were conducted at baseline, following each treatment, and at 6 weeks and 3 months post treatment. Outcomes & Results: Both participants differed in their responses to the treatments. However, M-MAT proved equally efficacious as CIATplus for naming of treated items. Overall, generalisation was not observed for any of the measures. CH reported enjoying both treatments, while MT preferred M-MAT. Conclusions: As expected, a number of variables are likely to have contributed to differences in participant responses to treatment. Replication with larger, well-stratified samples is required to better ascertain the effects of CIATplus and M-MAT on anomia in different types and severities of aphasia. This information would contribute to the more effective application of client-tailored treatment practices.

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.

Consumer perspectives on community aphasia groups: a narrative literature review in the context of psychological well-being

Background: Community aphasia groups (CAGs) for people living with chronic aphasia are known to be efficacious for improving various aspects of communication and psychological functioning based on empirical quantitative evidence. However, the specific mechanisms and processes involved are not well understood and only a small number of groups exist. Further, there is a paucity of evidence on this topic from consumers, potentially limiting the development and uptake of these services. In order to proliferate and maintain groups of high quality, a deeper understanding of the potential mechanisms of positive outcomes is required. Aims: The aim of this study was to investigate consumer (people with aphasia (PWA) and family member) experiences of CAGs within the qualitative literature in relation to the theoretical construct of psychological well-being. Methods & Procedures: An extensive review of qualitative research relating to consumer views of CAGs was conducted in a systematic fashion. Study quality was evaluated using the Critical Appraisal Skills Programme, and content was interpreted in the context of a theoretical model for psychological well-being. Outcomes & Results: Eleven key studies and 35 secondary studies were found to include consumer perspectives of CAGs. The findings of the 11 key studies are presented as a narrative literature review. Overall, evidence suggests CAGs contribute positively to the psychological well-being of PWA and their caregivers. Outcomes relate to forming positive relations with others, purpose in life, environmental mastery, autonomy, personal growth, and self-acceptance. CAG characteristics and mechanisms proposed to mediate psychological well-being are discussed. However, the review is limited by a range of methodological issues in the literature. Conclusions: In order to optimise CAGs in practice, clinicians should consider group characteristics and aim to manipulate the possible mechanisms underlying positive outcomes. Further research is needed to understand the long-term lived experience of CAGs members, including those currently under-represented in the literature.

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.

The efficacy of community aphasia groups: a systematic review

Hypothesis / aims of study Urinary incontinence following acute stroke is common, affecting between 40%-60% of people admitted to hospital [1]. It is related to poor outcome and is poorly managed in many cases. Our NIHR funded research programme aims to develop, implement and explore the potential effectiveness and costeffectiveness of a systematic voiding programme for the in-patient management of urinary incontinence after stroke. The systematic voiding programme includes bladder training and pelvic floor muscle training for patients who are cognitively able and prompted voiding for patients with cognitive impairments.

Exploring participant perspectives of community aphasia group participation: from “I know where I belong now” to “Some people didn’t really fit in”

ABSTRACT Background: Community aphasia groups have consistently been highlighted as a viable and effective means of supporting people with chronic aphasia to live full lives. The multi-person nature of the group is viewed as providing a distinctive opportunity for dynamic interaction, relationship development and adaption to communication disability. A critical examination of participant perspectives, drawn from long-term group members and members who have left groups, can reveal both positive and negative participation experiences and serve to support enhanced service delivery. Aims: The aim of this study was to explore both positive and negative experiences resulting from community aphasia group participation. Methods & Procedures: 22 people with aphasia from across Australia participated in semi-structured interviews about their experiences of participating in community aphasia groups. Perspectives were drawn from a diverse group of individuals, including people who maintained long-term membership and people who had left groups, as well as people with mild, moderate and severe aphasia. An interpretative phenomenological framework was employed to examine data collected. Outcomes & Results: Analysis of participant transcripts revealed themes related to the importance of belonging, the value of contributing and supporting others, experiencing affirming and regular social activity and developing new relationships. In addition to positive experiences, there was evidence in each of these themes of experiences of marginalisation, disablement, and exclusion. Conclusions: For people with aphasia, community aphasia group participation is viewed through the prism of changes to the individual’s personal and social life. People with aphasia perceive community aphasia groups as providing opportunities for positive affirmation, personal value, and renewed sense of purpose. Conversely, the group environ can be associated with perceptions of negative evaluation, marginalisation, and disempowerment. These findings necessitate further critical examination of the potential factors contributing to participation experiences. A focus on factors both facilitating and impeding group participation will support improved and high-quality community aphasia group practice.

What really matters to people with aphasia when it comes to group work? A qualitative investigation of factors impacting participation and integration

BACKGROUND Participation in a group environment is an inherently complex undertaking for people with aphasia. It involves engaging in multi-person interactions with other people who may have a range of communication strengths and strategies at their disposal. The potential challenges of community aphasia-group participation and practice has had limited attention in the research literature. Evidence from group users have primarily been drawn from the perspective of long-term members or those participating in highly specific and time-bound groups. There is a need to explore the experiences of a broader sample, including people who have left groups, to improve our understanding of structures, processes as well as leadership behaviours that may facilitate positive group participation experiences. AIM To examine the potential factors operating within the group environment that contribute to positive and negative participation experiences. METHODS & PROCEDURES Twenty-two people with aphasia participated in semi-structured interviews about their experiences of community aphasia groups. People who maintained long-term membership as well as those who had left groups were sampled. An interpretative phenomenological framework was employed to examine the data collected. OUTCOMES & RESULTS Seven factors emerged as central to participation experiences and contributed to the ability of people with aphasia to integrate and engage in the group space. These factors included: (1) balanced interactional patterns; (2) an open and non-hierarchical group environment; (3) communication awareness and education amongst members; (4) meaningful activity; (5) ritual and structure; (6) composition and group size; and (7) group leadership. CONCLUSIONS & IMPLICATIONS People with aphasia perceive community aphasia-group participation to be beneficial to their ability to live well with aphasia. However, a range of challenges to successful participation are also evident. Inputs such as peer-to-peer communication strategies, shared roles and responsibilities, and consultation with regard to group objectives and processes provide group members with the opportunity to become active contributors, demonstrate competence and have influence over the group. When inputs are poorly implemented or absent, people with aphasia are at risk of feeling disabled and marginalized by the group experience.

It's not really worth my while: understanding contextual factors contributing to decisions to participate in community aphasia groups

Abstract Purpose: Community aphasia groups represent a formalised opportunity for social participation. The potential barriers and facilitators to accessing and maintaining group participation remain poorly understood. The aim of this study was to explore environmental and personal factors contributing to community aphasia group participation. Methods: A framework analysis (FA) was used to analyse the semi-structured interview data from 22 current and past members of community aphasia groups. Results: People with aphasia weigh up the benefits of group participation in the context of a range of personal and environmental factors. These include personal coping mechanisms, perceptions of existing social support as well as the practicalities of accessing the group. Conclusions: Understanding factors that contribute to participation experiences is critical to ensure that, people with aphasia are well supported to access and engage in community aphasia groups. This study found that people may be more able to participate when they are accepting of the chronic nature of the aphasia, when they identify tangible benefits to participation, and when they have easy access to the group. This suggests a role for speech pathologists to recognise critical periods of need and support people with aphasia and their significant others to access and engage in group services. Implications for Rehabilitation Critical stages exist when people with aphasia may feel more ready and able to participate in community aphasia groups. These critical stages include an acceptance of the chronic nature of aphasia, as well as a desire to make positive change. There is a need for clinicians to minimise barriers to participation early in the therapeutic relationship. Proliferation of community aphasia groups will function to alleviate environmental barriers associated with poor public awareness of groups and group accessibility.