Closing the evidence-practice gaps in aphasia management: are we there yet? Where has a decade of implementation research taken us? A review and guide for clinicians

Background: There are evidence-practice gaps in all areas of aphasia management across the continuum of care. Despite the recognition that effective implementation strategies are needed to improve the consistency of speech pathologists’ aphasia management practices, there have been few studies investigating this important issue. Therefore, little is known about the effectiveness of implementation strategies in the field of aphasiology. In light of the developing field of knowledge translation, it is important to review the aphasia implementation literature to highlight current trends, draw together findings, and determine future implementation research needs.

Aims: To critically review, summarise, and discuss the implementation literature in the field of aphasiology to date, in order to guide clinical aphasiologists to work towards closing the evidence-practice gaps in aphasia management.

Main contribution: A review of the literature in this developing area of expertise in the field of aphasiology, with examples of practical applications.

Conclusions: Only six implementation studies have been published in aphasia (related to conversation partner training, discourse analysis, information provision, and collaborative goal-setting practices), showing there is a need for capacity building in this area. Therefore, we are not yet able to state what interventions are effective in which context, nor fully understand how behaviour change occurs for clinicians providing aphasia management. Implications for speech-language pathologists are discussed. An overarching call to action is the need for clinicians and researchers to work together to drive future implementation efforts that can succeed in closing the aphasia management evidence-practice gaps.     

神经干刺激疗法配合言语康复训练在卒中后失语症患者中的应用

目的 评价神经干刺激疗法配合言语康复训练在卒中后失语症患者中的应用效果。方法 选择我院康复科2016年3月～2018年10月收治的卒中后失语症患者82例作为本次研究对象,采用随机数字表法将患者随机分为对照组(n=41)与观察组(n=41)。两组患者均开展常规治疗,对照组在此基础上开展言语康复训练,观察组开展神经干刺激疗法配合言语康复训练,对比两组患者治疗后临床效果,治疗前后语言功能情况。结果 两组患者治疗前后语言功能情况:治疗前,两组患者语言功能自发谈话、理解、复述、命名、阅读、书写6项评分比较,差异均无统计学意义(P0.05),治疗后两组6项评分均明显上升,观察组高于对照组,差异均有统计学意义(P0.05);临床效果:观察组治疗总有效率为95.12%,明显高于对照组的80.49%,差异有统计学意义(P0.05)。结论 神经干刺激疗法配合言语康复训练在卒中后失语症患者中应用效果肯定,能够提升患者口语表达能力、改善理解障碍与复述能力、提高文字阅读能力及书写准确率。     

Validation of the Italian version of the Kagan scales for people with aphasia and their conversation partners

Background: The importance of conversation partners (CPs) for persons with aphasia (PwA) was recently highlighted. Trained CPs are shown to increase communicative access and improve quality of life. The Kagan scales, i.e., “Measure of skills in Supported Conversation” and “Measure of Participation in Conversation” (the MSC-MPC scales), between PwA and their CPs were designed to assess the communication dyad. The MSC-MPC scales were translated and adapted to Italian in 2015.

Aim: To validate the Italian version of the MSC-MPC scales (I-MSC/MPC) by assessing intra- and inter-rater reliability and concurrent validity.

Methods & Procedures: Thirty-two couples formed by 16 PwA and two CPs (one trained and one untrained) for each PwA were enrolled in the study. Aphasia severity was staged by the Therapy Outcome Measures “Dysphasia” impairment scale. Functional communication and pragmatic abilities were assessed with the I-ASHA-FACS and the Pragmatic Protocol, respectively. The PwA were videotaped while communicating both with trained and untrained CPs. All videotapes were assessed using the I-MSC/MPC scales by one expert speech and language therapist and two trainee speech and language therapists. The Intraclass Correlation Coefficient (ICC) was used to calculate inter- and intra-rater reliability. Correlations between the I-MSC/MPC scales and the aphasia severity, the I-ASHA-FACS, and the Pragmatic Protocol results were calculated by the Spearman’s test. The Mann-Whitney test was used to separate the I-MSC/MPC results obtained by the trained CPs from the untrained CPs.

Outcomes & Results: Inter-rater and intra-rater reliability ICC results were highly significant and strong (ICC > .906, ICC > .978, p < .001, respectively). Significant correlations between the aphasia severity and the I-MSC/MPC scales ranged from moderate to strong (Spearman rho>.487, p < .005). Correlations between the I-MSC and the I-ASHA-FACS domains ranged from moderate to strong (rho >.458, p < .008). Correlation between the I-MPC and the I-ASHA-FACS domains were generally strong (rho > .569, p < .001) while correlations between the I-MSC and the I-ASHA-FACS domains ranged from moderate to strong (rho > .458, p = .008). Pragmatic aspects were shown to be mostly preserved in the PwA. All correlations between the I-MSC/MPC scales and the Pragmatic Protocol were strong (rho >.635, p < .008). The Mann-Whitney test showed significant results for the I-MSC scale (p < .026).

Conclusions: The I-MSC-MPC scales proved to be a valid and reliable instrument to assess the communicative dyad. The I-MSC scale was also used to distinguish trained from untrained CPs. The use of I-MSC-MPC scales is recommended in clinical practice.     

Modeling confrontation naming and discourse informativeness using structural equation modeling

Background: People with aphasia (PWA) and their families identify as their priority the ability to use language at the discourse level in order to meet their daily communicative needs. However, measuring connected speech can be a challenging task due to the complex and multidimensional nature of discourse. As a result, professionals often depend on confrontation naming tests to identify and measure impaired underlying cognitive mechanisms that are also hypothesized to be important for discourse production.

Aims: In the current study, we investigated the validity of making inferences about discourse performance based on scores from confrontation naming tests. Specifically, we investigated the strength of the relationship between word retrieval abilities, and the ability to convey information during discourse production.

Method & Procedures: Data from 118 monolingual PWA were retrieved from AphasiaBank and analyzed using structural equation modeling. Performance in confrontation naming tests was modeled as a latent variable based on the Boston Naming Test, the Western Aphasia Battery – R Naming Subtest, and the Verb Naming Test. Performance at the discourse level was modeled based on indices of informativeness in three discourse tasks (free speech, eventcasts, and story re-tell). Informativeness was quantified using the percentage of Correct Information Units.

Outcomes and Results: Based on the fit statistics, the model exhibited adequate fit, indicating that the relationship between confrontation picture naming and informativeness was adequately reflected in the model. We found a strong relationship between confrontation naming test performance and discourse informativeness (standardized regression coefficient between the two latent factors = .79).

Conclusions: Performance on confrontation naming tests was a strong predictor of the amount of information PWA communicated during discourse production. However, our results also highlight that performance on the latter cannot be predicted solely from the former, as evidenced by the large proportion of unexplained variance in the informativeness latent variable.     

Altered speech-related cortical network in frontotemporal dementia

BackgroundIn healthy subjects (HS), transcranial magnetic stimulation (TMS) demonstrated an increase in motor-evoked potential (MEP) amplitudes during specific linguistic tasks. This finding indicates functional connections between speech-related cortical areas and the dominant primary motor cortex (M1).ObjectiveTo investigate M1 function with TMS and the speech-related cortical network with neuroimaging measures in frontotemporal dementia (FTD), including the non-fluent variant of primary progressive aphasia (nfv-PPA) and the behavioral variant of FTD (bv-FTD).MethodsM1 excitability changes during specific linguistc tasks were examined using TMS in 24 patients (15 with nfv-PPA and 9 with bv-FTD) and in 18 age-matched HS. In the same patients neuroimaging was used to assess changes in specific white matter (WM) bundles and grey matter (GM) regions involved in language processing, with diffusion tensor imaging (DTI) and voxel-based morphometry (VBM).ResultsDuring the linguistic task, M1 excitability increased in HS, whereas in FTD patients it did not. M1 excitability changes were comparable in nfv-PPA and bv-FTD. DTI revealed decreased fractional anisotropy in the superior and inferior longitudinal and uncinate fasciculi. Moreover, VBM disclosed GM volume loss in the left frontal operculum though not in the parietal operculum or precentral gyrus. Furthermore, WM and GM changes were comparable in nfv-PPA and bv-FTD. There was no correlation between neurophysiological and neuroimaging changes in FTD. Atrophy in the left frontal operculum correlated with linguistic dysfunction, assessed by semantic and phonemic fluency tests.ConclusionWe provide converging neurophysiological and neuroimaging evidence of abnormal speech-related cortical network activation in FTD.     

Evaluación de las afasias: consideraciones dialectales y culturales en neurología

IntroductionIn the context of neurological disorders, language assessment is traditionally based on the use of the standard language of the community in which the assessment is performed. Dialectal variables constitute a ‘forgotten’ topic. This review aims to provide resources and working guidelines to overcome this limitation.DevelopmentThe study was conducted as follows: 1) review of basic concepts of dialectology (language, dialect, isogloss line, idiolect, register, ‘standard variant’, bilingualism); 2) characterisation of Spanish and Catalan dialectologies and search for online resources for the development of neurological assessment tools; 3) ad hoc search on the PubMed database (keywords ‘dialect’, ‘aphasia’ and ‘multilingual’).ConclusionsWe provide online resources to promote adequate development of assessment tools in Spanish and Catalan, accounting for Dialectal considerations. We propose a set of working guidelines for the introduction of Dialectal variables in language tests to ensure their ultimate objective: to evaluate the real use of the language, and not cultural knowledge of the standard language.     

神经外科疾病术后失语症的早期语言康复训练

康复护理的重点是帮助护理对象重建健康。对21例术后失语症的患者经过听、说、读、写等不同形式的语言早期康复综合训练，取得一定的效果，效果优劣依次为命名性失语，运动性失语，感觉性失语。较差的是混合性失语。另外，术前已有失语者比手术造成的失语康复效果略好。