Sally Byng

Stroke and Aphasia Quality of Life Scale-39 (SAQOL-39): Evaluation of Acceptability, Reliability, and Validity

Background and Purpose— Health-related quality of life (HRQL) is a key outcome in stroke clinical trials. Stroke-specific HRQL scales (eg, SS-QOL, SIS) have generally been developed with samples of stroke survivors that exclude people with aphasia. We adapted the SS-QOL for use with people with aphasia to produce the Stroke and Aphasia Quality of Life Scale (SAQOL). We report results from the psychometric evaluation of the initial 53-item SAQOL and the item-reduced SAQOL-39. Methods— We studied 95 people with long-term aphasia to evaluate the acceptability, reliability, and validity of the SAQOL and SAQOL-39 using standard psychometric methods. Results— A total of 83 of 95 (87%) were able to complete the SAQOL by self-report; their results are reported here. Results supported the reliability and validity of the overall score on the 53-item SAQOL, but there was little support for hypothesized subdomains. Using factor analysis, we derived a shorter version (SAQOL-39) that identified 4 subdomains (physical, psychosocial, communication, and energy). The SAQOL-39 demonstrated good acceptability, internal consistency (Cronbach’s &agr;=0.74 to 0.94), test-retest reliability (intraclass correlation coefficient=0.89 to 0.98), and construct validity (corrected domain–total correlations, r =0.38 to 0.58; convergent, r =0.55 to 0.67; discriminant, r =0.02 to 0.27 validity). Conclusions— The SAQOL-39 is an acceptable, reliable, and valid measure of HRQL in people with long-term aphasia. Further testing is needed to evaluate the responsiveness of the SAQOL-39 and to investigate its usefulness in evaluative research and routine clinical practice.

Sentence processing deficits: Theory and therapy

Abstract Investigations of sentence processing were carried out using two patients with impairments in comprehending and producing sentences. The deficits observed were interpreted as resulting from impairments to the procedures which map thematic relations in sentence comprehension and production (Schwartz, Linebarger, & Saffran, 1985). Therapy for these mapping disorders was carried out, and as a result of the treatment, improvements were measured in sentence comprehension and production for both patients, despite the fact that they had both been aphasic for at least five years prior to this therapy. The improvement observed was specific to tasks in which mapping of thematic relations is crucial. Impairments in carrying out tasks unrelated to the mapping procedure were not improved by the mapping therapy. Furthermore, therapy was then applied for one of the patients to an untreated function which then improved, suggesting that all the improvements measured were specific effects of the treatment applied....

Replicating therapy for mapping deficits in agrammatism: Remapping the deficit?

Abstract This study was designed to replicate and extend an earlier study in which a therapy programme was carried out with two agrammatic aphasic patients with sentence processing impairments suggested to be at the level of mapping thematic roles and grammatical relations (Byng 1988). In the current study one of the therapy procedures implemented in the previous study was repeated with three different people with long-term ‘agrammatism’. The outcome of the therapy resulted in some gains in sentence production and verb retrieval, but these gains varied across the three patients. Whilst some change had taken place for each person, the pattern of results showed that the quality and extent of the change was different in each case. The potential source for these differences is explored and the implications of the study for the necessary development of theories about therapy are discussed.

Measuring quality of life in people with aphasia: The Stroke Specific Quality of Life Scale

Assessing health related quality of life (HRQOL) in people with communication disabilities is a challenge in health related research. Materials used to assess HRQOL are often linguistically complex and their mode of administration usually does not facilitate people with communication disabilities to give their experiences. We are currently running a medium scale study (80 participants) which aims to explore the HRQOL of people with long-term aphasia and to assess the psychometric properties and the acceptability of the Stroke Specific Quality of Life Scale (SS-QOL) (Williams et al. 1999) as a single measure for the assessment of HRQOL in this population. Here the initial stages of modifying the SS-QOL for use with people with aphasia will be presented. We will concentrate on the process of making the scale communicatively accessible to people with aphasia and increasing its content validity with this population group.

Predictors of health-related quality of life (HRQL) in people with chronic aphasia

Background: In recent years, quality of life measures have been used increasingly to evaluate the effectiveness of services or interventions. For people with chronic disabilities, research has focused on identifying the main predictors of their health-related quality of life (HRQL), in order to address the issue of how to meet their needs in rehabilitation in a more holistic way. Aims: This study assessed the main predictors of HRQL in people with chronic aphasia following stroke. We investigated the relationship between HRQL and various demographic and stroke-related variables and other variables that have been associated with HRQL in stroke survivors (e.g., emotional distress, daily activities, social support). Methods: A cross-sectional design was adopted. A cluster sampling framework was used to recruit participants with chronic aphasia (> 1 year) from three different sites. Questionnaires and assessments on the different variables were administered to all participants by a speech and language therapist, in an interview format. Multiple regression analysis was used to assess what were the main predictors of HRQL in people with aphasia. Results: Of 95 participants, 83 (87%) were able to self-report on all the assessments. Emotional distress, involvement in home and outdoors activities, extent of communication disability, and number of comorbid conditions explained 52% of the variance in HRQL (adjusted R 2 = .52). Stroke type (infarct vs haemorrhage), time post-onset, and demographic variables (gender, ethnicity, marital status, employment status, and socioeconomic status) were not significantly associated with HRQL in these participants. Conclusions: Increased distress, reduced involvement in activities, increased communication disability, and comorbidity predict poorer HRQL in people with chronic aphasia after stroke. Service providers need to take these factors into account when designing intervention programmes.

Sentence processing deficits: A replication of therapy

This paper describes the replication of a therapeutic programme originally used by one of the authors, Byng (Cognitive Neuropsychology, 1988, 5, 629-676) to remediate a specific sentence processing deficit. Our patient is shown to have similar although not identical deficits to those of one of the patients (JG) described in that programme. Sentence comprehension and production both improved as a result of therapy. The pattern of results observed gave further insights into both the nature of the patients deficit and the mechanism of therapy.

Health‐related quality of life in people with severe aphasia

BACKGROUND Health-related quality of life (HRQL) measures are increasingly used to help us understand the impact of disease or disability on a persons life and to measure the effectiveness of interventions. A small number of studies have looked at perceived HRQL in people with mild or moderate aphasia. They report that reduced HRQL is associated with low psychological well-being and depression, reduced activity levels and high levels of communication disability. Still, very little is known about the quality of life of people with severe aphasia. AIMS This study aimed to evaluate the HRQL of people with severe aphasia as rated by their proxy respondents. To increase our understanding of these proxy evaluations, the findings were compared with those of two other studies of HRQL in people with moderate or mild aphasia, using proxy and self-report respondents. METHODS & PROCEDURES A questionnaire-based cross-sectional survey was carried out where proxies of people with severe aphasia reported on their HRQL. The people with severe aphasia who took part in this study were part of a larger cohort of people with aphasia who were able to self-report on their HRQL. Aphasia was assessed with the American Speech and Hearing Association Functional Assessment of Communication Skills for Adults (ASHA-FACS) and the Frenchay Aphasia Screening Test (FAST) and HRQL with the Stroke and Aphasia Quality of Life (SAQOL) scale (proxy-reported). SAQOL-39 scores were derived from the SAQOL. RESULTS & RESULTS: People with severe aphasias quality of life, as measured by their proxies (n = 12), was low and more than one standard deviation below that of the standardization sample of the SAQOL. The overall mean score for the SAQOL-39 and the means for its physical and communication domains were below the 20th centile. They were also significantly lower that those of the comparison studies of self-reports (n = 83) and proxy ratings (n = 50) of people with mild or moderate aphasia (p<or=0.003). In the comparison studies there were no significant differences between the self-report and proxy ratings of people with mild or moderate aphasia. CONCLUSIONS & IMPLICATIONS This small study suggests that the HRQL of people with severe aphasia, as reported by their proxies, is severely compromised. Further research, using a wide range of methodologies, is needed in order to address the challenge of understanding better the quality of life of people with severe aphasia.

Some aspects of sentence production in aphasia

Abstract In this paper, we address the question of whether aphasic patients can produce complete predicate-argument structures. We present a descriptive framework for analyzing this particular aspect of output, and identify different patterns of deficit. We argue that specific output analyses along these lines are a necessary first step in the assessment and treatment of sentence production deficits.

Aphasia Therapy Research: Methodological Requirements and Illustrative Results

A rehabilitation approach to aphasia is described and tested on one aphasic patient. This approach seeks to restore, partially or fully, the impaired specific communicative ability. The patients sentence comprehension deficit and deficit in abstract-word comprehension were treated by specially developed methods, and it is concluded that the positive effects noted for both these deficits, can only be ascribed to the treatment given.

Values in practice and practising values.

UNLABELLED This paper first explores evidence that speech-language pathologists are experiencing dissatisfaction with their roles and then argues that one source of dissatisfaction may be in a mismatch between personal and organisational values. In order to clarify their notion of values, the authors next present a model that outlines various levels at which values operate in therapy and show how values pervade all aspects of practice. The paper then offers some practical examples of how a new organisation has tried to address overtly the implementation of values in practice, with suggestions for how other practitioners might go about making their own personal and organisational values more explicit. The paper ends with a few caveats about the difficulties and dangers of attending to values and conclude with why it is a beneficial endeavour. LEARNING OUTCOMES Participants will be able to (1) understand issues and practices that contribute to professional burnout; (2) describe a values-based framework for clinical practice; (3) understand the importance of concerning oneself with values, despite the difficulties in so doing; (4) explore some difficulties in adopting a medical model.