Barriers and facilitators to using the CommFit™ smart phone app to measure talk time for people with aphasia

Background: The use of mobile technology in aphasia rehabilitation is an emerging area of research. CommFit? is a smart phone application which was developed according to aphasia-friendly guidelines to measure the talk time of people with aphasia. Presently, the ease-of-use of CommFit? for people with aphasia has not been investigated, and there is little research on the barriers and facilitators to using mobile technology for this population.

Aims: The aim of this study was to describe the barriers and facilitators experienced by people with aphasia while using CommFit?.

Methods &; Procedures: Twelve people with aphasia used the CommFit? system-app, iPhone and BlueTooth headset, to measure their talking time for 14 days. The Western Aphasia Battery-Revised Aphasia Quotient was used to determine aphasia severity. During the initial training session and data collection period, field notes were taken by researchers. At the end of the data-collection period, participants completed an ease-of-use rating scale and participated in semi-structured interviews on the barriers and facilitators to using the CommFit? system.

Outcomes &; Results: Field notes and data from semi-structured interviews identified eight barriers; physical and language impairments related to stroke, other physical barriers not related to stroke, time constraints, unfamiliarity with technology, social attitudes, design of the technology and technology malfunction. Facilitators included support from researchers, support from other people, app design and use of the manual. On the ease-of-use rating scale, steps involving the headset were rated as less usable than other steps involved in using the CommFit? system. However, all steps had mean scores indicating that they were “easy to use” or “very easy to use”. Spearman correlations indicated that there was no significant relationship between ease-of-use ratings and aphasia severity. However, there was a significant negative correlation between age and ease-of-use rating of “pairing the headset” (r = ?0.8173, p = 0.013).

Conclusions: The results of this study identified barriers to using mobile technology, many of which were not connected to the participants’ stroke-related impairments. It also identified several facilitators which should be capitalised on when using mobile technology with this population. Last, results indicated that the BlueTooth headset was not a highly usable component of the CommFit? system, especially for older users. This will be addressed in future research on the app.     

Functional capacity after hip arthroplasty: A comparison between evaluation with three standard instruments and a personal interview

The aim of the present study was to compare the information obtained from three standard instruments used in physiotherapy and occupational therapy and with information acquired from an unstructured interview. Ten patients with osteoarthritis of the hip were consecutively picked from the waiting list at an orthopedic clinic. All were examined before and six months after arthroplasty. The study layout is a mixture of quantitative and qualitative evaluation. The three instruments used were SF-36 (self-reported health-related quality of life), FAS (an instrument for evaluation of lower extremity dysfunction), and the COPM (for evaluation of self-experienced activity level). All patients were also interviewed in a free, unstructured interview, and data were analyzed with a phenomenological approach. All methods could describe function and activity status of the patients very well, and they were also responsive to postoperative improvement. Together the three instruments gave such good information that almost no extra information was obtained through the interviews. On the other hand, the interviews served as powerful validation of the three instruments. The information in the three separate instruments is qualitatively different, and one instrument cannot replace another. They cannot be replaced by the interview either, because the instruments provide the therapist with specific and structured information that is important for further treatment planning and follow-up.     

Training total communication

ABSTRACT

Background: Many people with severe or moderate aphasia begin to use nonverbal methods of communication spontaneously, but some need special training to do so. Use of total communication, including different nonverbal techniques, is often recommended to enable communication and participation in social interaction. Emphasis has also been placed on the importance of a communication partner in facilitating interaction and co-constructing the meaning in a discussion.

Aims: The aim of the present study was to examine the way people with severe or moderate aphasia perceive they communicate, and if they and their partners perceive changes in the use of different means of communication during an intervention where the aphasic participants are stimulated to use total communication and the communication partners are guided to support the interaction and to facilitate the use of different means of communication.

Methods & Procedures: The data were collected during a regular rehabilitation course. The course was carried out in two parts (8 + 4 days) with a 3-month interval. A total of 38 aphasic respondents, mainly with severe or moderate aphasia, aged 26 to 65 years, and 38 of their partners aged 29 to 71 years participated in the study. The research involved an initial, interim, and delayed post-test questionnaire design stretched over a 9-month period. An investigator-constructed, self-assessment questionnaire called Use of Different Communication Methods (UDCM) was used. With the aphasic participants a pictorial version of the questionnaire was administered in the form of an interview. The partners completed the questionnaire independently.

Outcomes & Results: The results indicate that persons with aphasia and their partners perceive the use of different communication methods quite similarly. The participants with aphasia perceive they use mostly the remaining ability of speech they possess and spontaneous nonverbal communicative methods and in lesser degree low-tech and high-tech devices. Both parties perceived that the use of spontaneous nonverbal means of communication and low-tech devices increased during and after the intervention.

Conclusions: The results indicate that people with severe and moderate aphasia and their partners perceive that total communication, i.e., all available means of communication as for instance, limited speech, spontaneous nonverbal means of communication and low-tech devices is often in use. They also perceive that the use of these different communication methods can further be increased by training and by guiding the communication partner to facilitate and support the use of them.     

Extending the use of Spanish Computer-assisted Anomia Rehabilitation Program (CARP-2) in people with aphasia

Purpose

To extend the use of the Spanish Computer-assisted Anomia Rehabilitation Program (CARP-2) for anomia from a single case to a group of 15 people with aphasia. To evaluate whether the treatment is active (Phase 1) for this group (Robey & Schultz, 1998), providing potential explanations as to why.

Methods

Fifteen participants with chronic aphasia (with a range from moderate to mild anomia) were recruited to 15 weeks of computer-assisted therapy for anomia. A single treatment period with pre- and post-treatment assessments evaluated participants’ ability to name 200 words using the multiple cues provided by the computer. Pre- and post-naming measures of all items examined the effect of treatment. Background linguistic and cognitive skills were measured before and after the therapy to investigate whether the improvements in naming were therapy specific.

Results

All 15 participants showed significant benefits in their naming skills after the therapy. There were no changes to cognitive and linguistic skills unrelated to anomia. There was evidence of some carry-over effects in naming.

Conclusion

The Spanish Computer-assisted Anomia Rehabilitation Program (CARP-2) for anomia is an active treatment for a range of people who have anomia as part of their aphasia profile.Learning outcomes: By the end of the paper you will be able to answer the CEU questions and consider whether to use computer assisted therapy on a wide range of clients with anomia difficulties.     

Combining electroacupuncture and transcranial direct current stimulation as an adjuvant therapy enhances spontaneous conversation and naming in subacute vascular aphasia: A retrospective analysis

ObjectiveEmerging evidence shows the effectiveness of speech and language therapy (SLT); however, precise therapeutic parameters remain unclear. Evidence for the use of adjunctive transcranial direct current stimulation (tDCS) to treat post-stroke aphasia (PSA) is promising; however, the utility of combining tDCS and electroacupuncture (EA) has not yet been analyzed. This study assessed the therapeutic consequences of EA and tDCS coupled with SLT in subacute PSA patients who were also undergoing hyperbaric oxygen therapy (HBOT).MethodsA retrospective analysis was conducted on subacute (< 6 months) PSA patients who were divided into three groups: patients who received EA plus tDCS (acupuncture group), patients who underwent tDCS (tDCS group), and patients who experienced conventional therapy (HBOT + SLT). All subjects underwent 21 days of treatment and also received conventional treatment. The aphasia battery of Chinese (ABC) was used to score pre- and post-intervention status.ResultsThe analysis comprised 238 patients. Cerebral infarction was the most frequent stroke type (137 [57.6%]), while motor (66 [27.7%]) and global aphasia (60 [25.2%]) were the most common types of aphasia. After 21 days of intervention, the ABC scores of all patients were improved. The acupuncture group had the highest ABC scores, but only repetition, naming, and spontaneous speech were statistically improved (P < 0.01). Post-hoc tests revealed significant improvement in word retrieval in the acupuncture and tDCS groups (P < 0.01, P = 0.037), while the acupuncture group had additional significant improvement in spontaneous conversation (P < 0.01).ConclusionCombining acupuncture and tDCS as an adjuvant therapy for subacute PSA led to significant spontaneous speech and word retrieval improvements. Future prospective, multi-ethnic, multi-center trials are warranted.     

Behavioral and Neurophysiologic Response to Therapy for Chronic Aphasia

Breier JI, Juranek J, Maher LM, Schmadeke S, Men D, Papanicolaou AC. Behavioral and neurophysiologic response to therapy for chronic aphasia.

Objective

To characterize the relationship between neurophysiologic changes in the brain and behavioral response to constraint-induced language therapy (CILT) by using magnetoencephalography (MEG).

Design

Case series.

Setting

Medical school.

Participants

Patients (N=23) with chronic aphasia after first-time unilateral stroke in the left hemisphere.

Interventions

Constraint-induced language therapy administered for 3 hours 4 times per week for 3 weeks. Language testing and functional imaging during a language comprehension task using MEG before, immediately after, and 3 months after CILT with a subgroup of patients undergoing additional MEG scanning and language testing 3 weeks before CILT.

Main Outcome Measures

The percent of correct information units and the number of late dipoles normalized to total activation.

Results

Three patterns of behavioral and neurophysiologic response to CILT were identified. Patients with significant improvement in language immediately after CILT who lost these gains at follow-up had greater right hemisphere activation than other patients at all MEG scanning sessions. Patients with significant improvement in language immediately after CILT who maintained these gains at follow-up exhibited an increase in left temporal activation after CILT, whereas patients who did not exhibit significant improvement in language after CILT exhibited comparably greater activation in left parietal areas.

Conclusions

Results suggest that although the right hemisphere may support recovery of language function in response to therapy, this recovery may not be stable, and some participation of perilesional areas of the left hemisphere may be necessary for a stable behavioral response.     

Assessment of arcuate fasciculus with diffusion-tensor tractography may predict the prognosis of aphasia in patients with left middle cerebral artery infarcts

Introduction  It is often clinically difficult to assess the severity of aphasia in the earliest stage of cerebral infarction. A method enabling objective assessment of verbal function is needed for this purpose. We examined whether diffusion tensor (DT) tractography is of clinical value in assessing aphasia. Methods  Thirteen right-handed patients with left middle cerebral artery infarcts who were scanned within 2 days after stroke onset were enrolled in this study. Magnetic resonance data of ten control subjects were also examined by DT tractography. Based on the severity of aphasia at discharge, patients were divided into two groups: six patients in the aphasic group and seven in the nonaphasic group. Fractional anisotropy (FA) and number of arcuate fasciculus fibers were evaluated. Asymmetry index was calculated for both FA and number of fibers. Results  FA values for the arcuate fasciculus fibers did not differ between hemispheres in either the patient groups or the controls. Number of arcuate fasciculus fibers exhibited a significant leftward asymmetry in the controls and the nonaphasic group but not in the aphasic group. Asymmetry index of number of fibers was significantly lower (rightward) in the aphasic group than in the nonaphasic (P = 0.015) and control (P = 0.005) groups. Loss of leftward asymmetry in number of AF fibers predicted aphasia at discharge with a sensitivity of 0.83 and specificity of 0.86. Conclusions  Asymmetry of arcuate fasciculus fibers by DT tractography may deserve to be assessed in acute infarction for predicting the fate of vascular aphasia.     

Modified Response Elaboration Training: A systematic extension with replications

Background: Response Elaboration Training (RET; Kearns, 1985 Kearns, K. P. 1985. “Response elaboration training for patient initiated utterances”. In Clinical aphasiology, Edited by: Brookshire, R. H. 196–204. Minneapolis, MN: BRK.  [Google Scholar]) has been found to consistently result in increased production of content in discourse with persons with aphasia. Positive treatment effects have been reported for persons representing a variety of aphasia types and severities. RET was modified for application with persons with acquired apraxia of speech and aphasia and positive outcomes were also associated with the modified treatment (Wambaugh & Martinez, 2000 Wambaugh, J. L. and Martinez, A. L. 2000. Effects of rate and rhythm control treatment on consonant production accuracy in apraxia of speech. Aphasiology, 14: 851–871. [Taylor & Francis Online], [Web of Science ®] , [Google Scholar]). Although RET has received systematic study, its stimulus generalisation effects are not well understood.

Aims: This investigation was designed to measure the stimulus generalisation effects of modified RET (M-RET) in a variety of conditions as well as to further study the effects of M-RET applied to a personal recount condition.

Methods & Procedures: Multiple baseline designs (across behaviours and participants) were utilised to examine treatment effects. Treatment was applied sequentially to picture sets and a personal recount condition with six persons with chronic aphasia. Production of correct information units (CIUs) was measured in the following conditions: (1) discourse production in response to sets of trained and untrained pictures, (2) home conversations, and (3) production of discourse in structured tasks. Formal measures of functional communication were also completed prior to and following treatment.

Outcomes & Results: Increases in production of CIUs in response to pictures were observed for 11 of the 12 applications of M-RET to picture sets. Response generalisation to untrained picture sets was associated with M-RET applied to pictures sets; increases were slight and were greater for untrained sets that were probed more frequently. Maintenance of gains was generally strong for the participants with nonfluent aphasia, but was minimal for the participant with fluent aphasia. Gains were not evident for M-RET applied to personal recounts; only one participant evidenced changes possibly associated with treatment in the personal recount condition. Improvements in structured discourse samples and a functional communication measure were observed for the majority of the participants following treatment. Lack of compliance in completion of recordings of home conversations limited the utility of that measure.

Conclusions: M-RET applied to pictures resulted in improvements in production of content in treated and untreated picture conditions for the majority of the participants. Treatment effects extended to additional outcome measures. Although some positive changes were observed for the participant with fluent aphasia, maintenance was problematic. Application of M-RET to a personal recount condition was not associated with improved performance for most of the participants.     

经颅直流电刺激背外侧前额叶对脑卒中后失语症患者命名和音位流畅性的影响

目的 观察经颅直流电刺激(tDCS) 脑卒中后失语症患者左侧背外侧前额叶（DLPFC）对其图片命名速度、图片命名正确率和音位流畅性的影响。 方法 采用随机数字表法将脑卒中后失语症患者24例分为观察组和对照组,每组患者12例。2组患者均进行语言训练和图片命名训练,观察组在图片命名训练的同时给予左侧背外侧前额叶tDCS治疗,每日1次,每次20 min,每周治疗6 d,连续治疗2周。对照组患者仅给予假tDCS治疗。于治疗前、治疗2周后分别对患者进行图片命名速度和正确率,以及音位流畅性测试。 结果 治疗2周后,2组患者高频词的准确数和反应时间与组内治疗前比较,差异均有统计学意义（P<0.05）,且观察组治疗2周后高频词的反应时间显著少于对照组治疗2周后,差异有统计学意义（P<0.05）。治疗2周后,观察组低频词的反应时间与组内治疗前比较,差异有统计学意义（P<0.05）。治疗2周后,观察组的音位流畅性为［7.50（4.50,8.75）］个,显著优于组内治疗前和对照组治疗2周后,差异均有统计学意义（P<0.05）。 结论 对脑卒中后失语症患者的左侧背外侧前额叶进行tDCS,可以促进其大脑网络词汇检索的处理,加强患者的执行控制功能。     

虚拟现实语言训练对卒中后失语患者干预效果的Meta分析

目的 评价虚拟现实（virtual reality,VR）技术对卒中后失语（post-stroke aphasia,PSA）患者语言功能的康复疗效,比较该方法 与常规语言康复训练的疗效差异,为临床更规范有效地应用VR技术提供证据。方法 检索Pub Med、CINAHL等9个数据库及临床试验注册平台中关于VR语言训练治疗PSA的随机对照试验,检索时限为建库至2022年3月。由2名研究者独立筛选文献,评价文献质量及提取信息。采用Rev Man 5.4软件进行Meta分析,并采用推荐分级的评价、制订与评估（grades of recommendations assessment,development and evaluation,GRADE）系统进行证据质量评级。结果 共纳入9篇文献,包括311例患者。Meta分析结果 显示：VR语言训练能提高PSA患者的自发言语能力[SMD=0.88,95%CI(0.57,1.20),P<0.001],命名能力[SMD=0.60,95%CI(0.30,0.90),P=0.001],听理解能力[SMD=0.81,95%CI (0.40,1.22),P...