“I definitely think it’s a feasible and worthwhile option”: perspectives of speech-language pathologists providing online aphasia group therapy

Background: Speech-language pathologists (SLPs) have begun to incorporate telepractice methods into clinical service delivery and online intervention for aphasia is recognised as an appropriate alternative to face-to-face services. However, little is known about the SLP experience of telepractice with no known study exploring the provision of aphasia group therapy online. The purpose of this study was to describe the experience of SLPs who provided the online aphasia group therapy, Telerehabilitation Group Aphasia Intervention and Networking (TeleGAIN), to people with aphasia (PWA) and their perceptions regarding the outcomes of intervention and feasibility of implementation into clinical practice.

Aims: The aim of this study was to describe the experience of SLPs who provide TeleGAIN to people with aphasia including the perceived outcomes of the intervention and treatment procedures.

Methods & Procedures: Three SLPs with experience in aphasia rehabilitation delivered at least one 12 week block of TeleGAIN – an aphasia group intervention purposefully developed for delivery via telepractice. Prior to TeleGAIN, SLPs were trained in using the technology required and the goals, activities, and constructs of TeleGAIN. The goals of TeleGAIN for PWA were to 1) create opportunities for communicative success, 2) share personal life history, and 3) provide support for living successfully with aphasia through networking with others. The SLPs provided this intervention to 21 PWA across six groups. Following completion of all treatment blocks, each SLP participated in a semi-structured interview exploring their perceptions of TeleGAIN and the potential for implementation. Interviews were analysed using qualitative content analysis and key categories were identified.

Outcomes & Results: SLPs enjoyed providing the online aphasia group therapy TeleGAIN, and considered the intervention to be feasible and worthwhile. SLPs developed a range of strategies to manage the barriers to implementing the online group successfully and promoted those factors that facilitated more efficient and effective group sessions. In addition, benefits for individuals with aphasia, SLPs and SLP services were recognised despite challenges with technology and group dynamics experienced during TeleGAIN.

Conclusions: The results from this study suggested that although SLPs may take time to improve their skills and confidence in telepractice, they were successfully able to provide online group aphasia therapy to PWA. The experience of the SLPs in this study suggested that commonly cited barriers to telepractice such as rapport building and technology issues were able to be overcome. SLPs perceived that TeleGAIN offered PWA many communication and psychosocial benefits and may improve SLP service provision. Findings support investigation of the implementation of TeleGAIN into clinical services.     

The feasibility of improving discourse in people with aphasia through AAC: clinical and functional MRI correlates

Background:The theory of intersystemic reorganization, along with the ability of people with chronic aphasia to recover language function, suggests that a high-tech augmentative and alternative communication (AAC) device could be employed as a dual-purpose tool that simultaneously facilitates language recovery and compensates for deficits. To date, treatments based on intersystemic reorganization have focused on writing, drawing, and gesturing. Further, despite a movement to identify neural mechanisms that support intervention-related recovery, the neurobiological markers of AAC-induced changes have not been established.

Aims: The purpose of this study is twofold: (1) to examine the feasibility of providing a high-tech AAC treatment to people with chronic aphasia, with the goal of evoking changes in spoken language; and (2) to identify evidence of AAC-induced changes in brain activation.

Method and Procedures: We employed a pre- and post-treatment design with a control (usual care) group to observe the impact of an AAC treatment on aphasia severity and spoken discourse. Further, we used functional magnetic resonance imaging (fMRI) to examine associated neural reorganization.

Outcomes and Results: Compared to the usual care group, the AAC intervention trended toward larger treatment effects and resulted in a higher number of responders on behavioral outcomes. Both groups demonstrated a trend toward greater leftward lateralization of language functions via fMRI. Secondary analyses of responders to treatment revealed increased activation in visual processing regions, primarily for the AAC group.

Conclusions: This study provides preliminary guidance regarding how to implement AAC treatment in a manner that simultaneously facilitates language recovery across a variety of aphasia types and severity levels while compensating for residual deficits in people with chronic aphasia. Further, this work motivates continued efforts to unveil the role of AAC-based interventions in the aphasia recovery process and provides insight regarding the neurobiological mechanisms supporting AAC-induced language changes.     

Discourse production in aphasia: a current review of theoretical and methodological challenges

Background: Discourse abilities play an important role in the assessment, classification, and therapy outcome evaluation of people with aphasia. Discourse production in aphasia has been studied quite extensively in the last 15 years. Nevertheless, many questions still do not have definitive answers.

Aims: The aim of this review is to present the current situation in the research on a number of crucial aspects of discourse production in aphasia, focusing on methodological progress and related challenges. This review continues the discussion of the core themes in the field, aiming to render it as up-to-date as possible.

Main Contribution: The review focuses on a number of unexplored theoretical issues, specifically, the interface between micro- and macrolinguistic abilities, and the relationship between linguistic competence and communicative success in aphasia. The emphasis on theoretical challenges, along with the thorough discussion of methodological problems in the field, makes this review a starting point and a comprehensive information source for researchers planning to address language production in people with aphasia.

Conclusion: Although the picture is not yet complete, recent advancements lead to a better understanding of the processes involved in aphasic discourse production. Different approaches provide insights into the complex multifaceted nature of discourse-level phenomena; however, methodological issues, including low comparability, substantially slow down the progress in the field.     

The experience of close personal relationships from the perspective of people with aphasia: thematic analysis of the literature

Background: Although changes within interpersonal relationships have a substantial impact on quality of life, few authors have focused on how these changes are experienced by people with aphasia.

Aims: The aim of this study was to systematically identify contemporary research focussing on the perspectives of people with aphasia about close personal relationships and to conduct a thematic analysis of the findings across these studies.

Methods & Procedures: Using scoping review methodology, four databases (CINAHL/EBSCO, MEDLINE/PubMed, Embase, Psychinfo) were systematically searched yielding 376 articles published from January 2000 to February 2017. Following title, abstract and full-text review 21 studies remained. Data derived from these studies were charted, collated and thematically analysed.

Outcomes & Results: Most studies utilised interview methods and cross-sectional designs. Only seven directly examined the relationship experiences of people with aphasia. The remaining studies indirectly derived relationship focused responses through exploration of related constructs (living successfully, social participation, living with aphasia, participation and activities, social communication, quality of life). Thematic analysis revealed four principal themes across the published findings. The first, living with change, described experiential factors within relationships after the onset of aphasia. The second theme, mediating factors within the interaction, highlighted contextual factors which influenced the experience of interactions. The third theme, connectedness, described feelings of connection or disconnection with others. The final theme described positive relationship outcomes for people with aphasia.

Conclusions: From the perspective of people with aphasia, relationships are not only central to positive aspects of everyday living but also challenging to maintain. Further research is needed to understand how relationships change over time and how to best support clients with aphasia to develop and maintain satisfying relationships.     

Cross-linguistic transfer effects of verb-production therapy in two cases of multilingual aphasia

Background: Verb retrieval is challenging for monolingual and multilingual speakers with aphasia. Previous research on bilingual aphasia shows equivocal results of cross-linguistic transfer and inhibition.

Aims: This study explores the impact of verb-production treatment in the treated and untreated languages of two bilingual speakers with aphasia. The main goals were to explore treatment effects, possible cross-linguistic transfer effects and to investigate possible inhibition of the untreated languages.

Methods & Procedures: The participants were one trilingual speaker (Portuguese-Ronga-Norwegian) with nonfluent aphasia and one bilingual speaker (English-Norwegian) with fluent aphasia. They received two types of treatment: communication-based therapy and Semantic Feature Analysis. Treatment was conducted in Norwegian, a late-acquired language for both speakers. Treatment effects were measured in action naming tasks and narrative tasks in the treated language as well as the untreated languages.

Outcomes & Results: Overall, the participants responded positively to the verb production treatments. This was demonstrated at the lexical level and also in discourse production, especially in the treated, but also in the untreated languages. No inhibition of the untreated languages was found.

Conclusions: The data provide evidence for positive effects of verb-retrieval treatment provided in sentence contexts in a late-learned weaker language of multilingual speakers with aphasia. The treatments did not lead to an unwanted inhibition of the untreated language, which is an important finding for clinicians as well as for researchers. The results provide evidence for a shared conceptual network of the languages in bilingual speakers, supporting current models of bilingual language processing.     

A pilot study examining the impact of aphasia camp participation on quality of life for people with aphasia

Objectives: For people with aphasia (PWA), attending an aphasia camp can result in increased confidence, social relationships, and greater participation in activities. Although much anecdotal evidence of the benefits of aphasia camps exists, systematic studies on outcomes from aphasia camp participation are lacking. The purpose of this pilot study was to examine the effect of attending the Alberta Aphasia Camp on quality of life for people with aphasia.

Methods: Nine PWA who attended the inaugural Alberta Aphasia Camp completed the Assessment for Living with Aphasia-2 before and after camp. A subset of their caregivers (n = 4) completed the Communicative Effectiveness Index, a rating scale evaluating their PWA’s communication, and were interviewed about their experiences and perceptions of camp participation.

Results: Significant changes were observed on total scores on the ALA-2, and in particular the Personal and Participation subtests. These improvements were corroborated by themes identified from interviews with caregivers.

Discussion: This study provides preliminary evidence that aphasia camp participation can result in improved outcomes for PWA across a range of domains. Aphasia camps provide a unique intervention for PWA and caregivers to experience therapeutic and recreational activities, respite and create social connections in a supported communication environment. Future studies should recruit a greater number of participants, employ control groups, and examine outcomes for caregivers.     

Topic selection sequences in aphasia conversation groups

Background: Facilitated group conversation is a feature of many programs designed to help persons with aphasia (PWA) recover from neurogenic injuries. While researchers have studied various aspects of this therapy approach, one facet of facilitated group conversations for aphasia that has been mentioned in the literature, but that remains to be investigated, is the process of topic selection.

Aims: The aim of the qualitative study documented here was to examine how experienced facilitators and conversation group members with aphasia select topics for discussion during the opening moments of conversations.

Methods & Procedures: We video recorded aphasia conversations groups lead by three highly skilled facilitators from three sites. The initial portions of these conversations constituted the data source in this study. We conducted a conversation analysis to shed light on how aphasia conversation groups select topics at the start of interaction. Further, we focused on the resources interactants deploy during conversation such as verbal language as well as the array of other meaningful signs that have been found to play an important role in interaction.

Outcomes & Results: Analysis revealed that facilitators and group members with aphasia engaged in three main topic selection processes during the initial portions of the conversations: nomination and pursuit, topic-initial elicitation and listing sequences. A number of external artifacts, including newspapers, papers and pencils, and whiteboards, formed part of the functional communicative system observed in the data.

Conclusions: The sessions analyzed here illustrate that when appropriate attitudes and supports are present, PWA can meaningfully participate in complex communicative processes such as topic selection. Creating modes of interaction that promote active involvement for PWA during topic selection and the other phases of conversation may play a small but significant role in fostering the feelings of agency and increased self-esteem that stroke survivors who take part in group conversation report.     

Ethics and shared decision-making in paediatric occupational therapy practice

Background: Sharing information and decisions with children and their parents is critical in pediatric rehabilitation. Although the ethical significance and clinical benefits of sharing decisions are established, approaches for implementing shared decision-making in clinical practice are still developing.

Aim: To explore the ethical challenges of sharing information and decisions with one family in pediatric occupational therapy.

Method: We used a single qualitative in-depth interview with an occupational therapist to examine the ethical dimensions of sharing decisions.

Results: We found that asking what was ethically at stake in the information-sharing process, highlighted how timing and style of information sharing impacts on understanding and collaboration within the therapeutic relationship. Using ethics-based questions assisted in drawing out the complexity of implementing the ideals of sharing information and decisions in pediatric practice.

Conclusion: Reflecting on ethical dimensions of communication with families assists to identify approaches to shared decision-making in clinical practice.     

Grammar and cognition: deficits comprehending counterfactuals in Turkish individuals with Broca’s aphasia

Background: Comprehending counterfactuals requires a well-developed cognitive system. Individuals with Broca’s aphasia have impaired cognitive functioning, which may affect their ability to comprehend counterfactuals.

Aims: This study investigated whether cognitive complexity involved in counterfactuals adds to sentence comprehension deficits in Broca’s aphasia.

Methods & Procedures: The sample consisted of 24 Turkish individuals with Broca’s aphasia (mean age: 52.7; SD: 12.7) who were matched in age with a control group of 15 neurologically intact Turkish individuals (mean age: 51.8; SD: 8.5). Each group completed a sentence comprehension task with three sentence conditions: nonconditional, factual, and counterfactual. Nonconditionals did not have if-embedding, whereas factual and counterfactual conditionals were morphosyntactically equivalent if-clauses, but only the latter was cognitively complex.

Outcomes & Results: Conditionals were more difficult to comprehend than nonconditionals for the Broca group. Counterfactuals were more difficult to comprehend than the morphosyntactically equivalent factual counterparts for the Broca group. There was no discrepancy between test conditions for the control group.

Conclusions: Individuals with Broca’s aphasia have difficulty processing counterfactuals due to morphosyntactic complexity (if-embedding) and the cognitive processes involved in comprehending counterfactuals. This indicates that cognitive complexity adds to sentence comprehension deficits in Broca’s aphasia.     

Patterns of decline in naming and semantic knowledge in primary progressive aphasia

Background: Individuals with primary progressive aphasia (PPA) and their caregivers want to know what to expect so that they can plan support appropriately. The ability to predict decline in naming and semantic knowledge, and advise individuals with PPA and their caregivers regarding future planning, would be invaluable clinically.

Aims: The aims of this study were to investigate patterns of decline in naming and semantic knowledge in each of the clinical variants of PPA (logopenic variant PPA, lvPPA; nonfluent agrammatic PPA, nfaPPA; and semantic variant PPA, svPPA) and to examine the effects of other variables on rate of decline. We hypothesized that speech-language rehabilitation, higher education, and higher baseline test scores would be associated with slower decline, and older age with faster decline.

Methods and Procedures: A total of 94 participants with PPA underwent language testing, including 36 participants with lvPPA, 31 participants with nfaPPA, and 27 participants with svPPA. All participant groups were similar in age and education. We focused on decline on three tests: the short form of the Boston Naming Test (BNT), the Hopkins Assessment of Naming Actions (HANA), and the short form of the Pyramids and Palm Trees Test (PPTT).

Outcome and Results: Across language tests, the most precipitous rates of decline (loss of points per month) occurred in nfaPPA, followed by svPPA, then lvPPA. Female sex, longer symptom duration, higher baseline test score, and speech-language rehabilitation were associated with slower decline.

Conclusions: PPA variants were distinguishable by rapidity of decline, with nfaPPA having the most precipitous decline. As hypothesized, higher baseline test scores and speech-language rehabilitation were associated with slower decline. Surprisingly, age and education were not important prognostically for individuals in this study. Further study of prognostically-relevant variables in PPA is indicated in this population.     

Implicit learning and implicit treatment outcomes in individuals with aphasia

Background: Implicit learning is a process of learning that occurs outside of conscious awareness and may be involved in implicit, exposure-based language training. However, research shows that implicit learning abilities are variable among individuals with aphasia, and it remains unknown whether individuals who show basic implicit learning abilities also benefit from implicit language training.

Aims: The aims of this series of experiments were to test implicit learning in individuals with agrammatic aphasia, examine the effects of a novel implicit language treatment, and investigate whether individuals with aphasia who show implicit learning ability also benefit from implicit treatment focused on passive sentence comprehension.

Methods & Procedures: Nine participants with chronic agrammatic aphasia and 21 neurologically intact participants completed a visuomotor serial reaction time test of implicit learning (Experiment 1). The participants with aphasia also completed a short-term novel implicit sentence comprehension treatment (Experiment 2) that consisted of five sessions of repeated exposure to grammatically correct passive sentences and matching photographs. Sentence comprehension was tested in multiple baseline sessions and on each day of training using a sentence–picture matching task. The relation between participants’ learning patterns across experiments was also examined.

Outcomes & Results: Individuals with agrammatic aphasia as well as neurologically intact adults demonstrated significant implicit sequence learning in the serial reaction time task. However, the participants with aphasia did not show concomitant improvement in sentence comprehension as a result of the implicit treatment protocol.

Conclusions: This study suggests that individuals with agrammatic aphasia demonstrate implicit learning ability; however, this ability does not necessarily promote successful outcomes in treatment that is based solely on implicit training methods.     

Associations between physical function,dual-task performance and cognition in patients with mild Alzheimer's disease

Objective: Alzheimer's disease (AD) causes a gradual decline in cognition, limitations of dual-tasking and physical function leading to total dependence. Hence, information about the interaction between physical function, dual-task performance and cognition may lead to new treatment strategies with the purpose of preserving function and quality of life.

The objective of this study was to investigate the associations between physical function, dual-task performance and cognition in community-dwelling patients with mild AD.

Methods: Baseline results from 185 participants (50–90 years old) in the single blinded multicenter RCT ‘ADEX’ (Alzheimer's disease: the effect of physical exercise) were used.

Assessments included tests of physical function: 400-m walk test, 10-m walk test, Timed Up and Go test and 30-s chair stand test; dual-task performance, i.e., 10-m walk while counting backwards from 50 or naming the months backwards; and cognition, i.e., Mini Mental State Examination, Symbol Digit Modalities Test, the Stroop Color and Word Test, and Lexical verbal fluency test.

Results: Results in the 30-s chair stand test correlated significantly with all tests of cognition (r = .208–.242) while the other physical function tests only randomly correlated with tests of cognition. Results in the dual-task counting backwards correlated significantly with results in all tests of cognition (r = .259–.388), which accounted for 7%–15% of the variation indicating that a faster time to complete dual-task performance was associated with better cognitive performance.

Conclusion: The evidence of the associations between physical function, dual-task performance and cognition is important when creating new rehabilitation interventions to patients with mild AD.     

Attentional dysfunction and word-finding difficulties are related to semantic jargon after a thalamic lesion: a case report

Background: Although many case reports on neologistic jargon have been documented, reports on semantic jargon are extremely rare, suggesting that semantic jargon may occur more rarely than neologistic jargon.

Aims: To investigate potential mechanisms underlying semantic jargon.

Methods & Procedures: We describe a patient who presented with semantic jargon after a left thalamic hemorrhage that mainly affected the pulvinar, lateral posterior nucleus, centromedian nucleus, and reticular nucleus. She was followed for 8 years, during which the temporal changes in her linguistic and neuropsychological functions were investigated.

Outcomes & Results: The patient’s semantic jargon disappeared and selective attention improved in parallel. Word-finding deficits remained at the end of the observation period.

Conclusions: Our observations of this patient suggest that a thalamic lesion can cause attentional and linguistic dysfunction that does not activate an intended word and its images and, conversely, fails to inactivate non-relevant words and associated images, resulting in semantic jargon.     

The comprehension of sentences with unaccusative verbs in aphasia: a test of the intervener hypothesis

Background: It is well accepted that individuals with agrammatic Broca’s aphasia have difficulty comprehending some sentences with filler-gap dependencies. While investigations of these difficulties have been conducted with several different sentence types (e.g., object relatives, Wh-questions), we explore sentences containing unaccusative verbs, which arguably have a single noun phrase (NP) that is base-generated in object position but then is displaced to surface subject position. Unaccusative verbs provide an ideal test case for a particular hypothesis about the comprehension disorder—the Intervener Hypothesis—that posits that the difficulty individuals with agrammatic Broca’s aphasia have comprehending sentences containing filler-gap dependencies results from similarity-based interference caused by the presence of an intervening NP between the two elements of a syntactic chain.

Aim: To assess a particular account of the comprehension deficit in agrammatic Broca’s aphasia—the Intervener Hypothesis.

Methods & Procedures: We used a sentence–picture matching task to determine if listeners with agrammatic Broca’s aphasia (LWBA) and age-matched neurologically unimpaired controls (AMC) have difficulty comprehending unaccusative verbs when placed in subject relative and complement phrase (CP) constructions.

Outcomes & Results: We found above-chance comprehension of both sentence constructions with the AMC participants. In contrast, we found above-chance comprehension of CP sentences containing unaccusative verbs but poor comprehension of subject relative sentences containing unaccusative verbs for the LWBA.

Conclusions: These results provide support for the Intervener Hypothesis, wherein the presence of an intervening NP between two elements of a filler-gap dependency adversely affects sentence comprehension.     

A pilot study exploring public awareness and knowledge of right hemisphere communication disorder compared with aphasia and stroke in Northwest London,UK

Background: No previously published research has investigated public awareness and knowledge of Right Hemisphere Communication Disorders (RHCD). In comparison, there are a handful of published studies that have investigated public awareness and knowledge of aphasia. The results of these studies indicate that awareness and knowledge is low but has marginally increased in recent years, due to international efforts to raise the public profile of the disorder.

Aims: The current study investigated public awareness and knowledge of RHCD and compared it to that of aphasia. Information regarding awareness and knowledge of stroke was also determined for those participants who did not have awareness of RHCD or aphasia.

Methods & Procedures: A face-to-face survey of 87 members of the public was undertaken in North West London, United Kingdom.

Outcomes and Results: Of the 87 survey respondents, only 9.2% reported having heard of RHCD and 4.6% met the criteria for having basic knowledge of this disorder. In comparison, 32.2% of participants had heard of aphasia and 24% had basic knowledge about it. While the results show that fewer people were aware and had knowledge of RHCD compared to aphasia, this difference was not significant. Of those participants who had heard of neither disorder, all had heard of and the majority had knowledge of stroke.

Conclusions: The findings suggested that awareness of RHCD amongst members of the public is low. It is suggested that in order to improve quality of services, funding and social re-integration following a right hemisphere stroke, raising public awareness and knowledge is necessary.     

Positive aspects of coping among mothers of adolescent children with developmental disability in the Druze community in Israel

Background The purpose of this study was to compare perceptions of coping as experienced by 240 mothers of adolescents with and without developmental disability in the Druze community in Israel.

Method The mothers completed the Sociodemographic Questionnaire, Grandparents Functional Support Assessment, Family Adaptability and Cohesion Evaluation Scales, and the Posttraumatic Growth Inventory.

Results Both groups were found to be similar in their perception of family cohesion and emotional support. However, mothers of adolescents with a developmental disability reported higher rates of both adaptability to change and personal growth. Moreover, associations were found between family cohesion and adaptability to change and support, and between adaptability to change and social support and personal growth.

Conclusion Druze mothers of adolescents with developmental disability reveal important information regarding positive coping strategies.