Poststroke Aphasia Frequency, Recovery, and Outcomes: A Systematic Review and Meta-Analysis

Return to work for stroke survivors with aphasia: A quantitative scoping review

The international incidence of stroke in people of working age is rising. As such, meaningful work return is a major rehabilitation goal for many individuals, including those with aphasia. This scoping review aimed to outline the post-stroke aphasia evidence related to work outcomes, factors influencing employment along with contemporary vocational-language and communication rehabilitation practice. The review employed terms related to aphasia, stroke, rehabilitation, and return to work in publications preceding 25.6.2023. Data were descriptively analysed, and vocational outcomes were summarized at defined timepoints. Of the 908 articles reviewed, 31 papers were included. Individuals with post-stroke aphasia consistently have lower rates of return to work than those post-stroke without aphasia. Employment at one year was 34.29% for those with aphasia compared to 58.46% for people without aphasia. No literature reported vocational-language assessment practices and there were minimal work-focused aphasia interventions identified. There was insufficient evidence to clearly identify person-related, rehabilitation, workplace or other factors influencing work return. This scoping review has identified that there are gaps in knowledge about the factors that influence work return and targeted vocational rehabilitation for this group. Future research to optimize return to work for individuals with aphasia is recommended.

Need for Human Interaction and Acknowledging Communication-An Interview Study With Patients With Aphasia Following Stroke

AIM

To explore stroke patients' experiences of the communicative practice during their hospitalisation and describe strategies and supporting communication techniques applied by patients and nursing staff from the patient's perspective.

DESIGN

A qualitative descriptive study was undertaken.

METHODS

A qualitative approach was chosen; through a purposeful sample strategy, 13 semi-structed interviews with 12 patients who had aphasia following stroke, and one patient had dysarthria. The interviews were video-recorded and partially transcribed. Data were analysed according to Graneheim and Lundman's content analysis. Interview data were collected in 2022.

RESULTS

The analysis generated one overarching theme; Being acknowledged as an equal human being as it appeared to be a pervasive and underlying trait across the four categories; Waking up to a new communicative reality, A task-oriented communicative agenda, Misunderstandings as a communicative dead end and Establishing a communication-friendly environment: peace, patience and supporting techniques, describing the immediate and descriptive level. The patients did not seem to encounter a systematic approach to communication. They perceived the health care staff's communication as primarily task and purpose-oriented, lacking deeper conversations, which seemed to leave several with unmet emotional and psychological needs. Emotional, relational and existential aspects seemed interwoven in communication.

CONCLUSION

These findings contribute by illuminating an important patient perspective and ultimately, raising the point that from the perspective of patients the nursing staff's communication was primarily task and purpose oriented, and they lacked deeper conversations. Hence also raises the point that the use of supportive communication strategies alone will allow nursing staff to meet the existential needs of patients with aphasia. Supported communication needs to address compassionate and acknowledging aspects of communication. No Patient or Public Contribution in this paper.

Effectiveness of non-pharmacological interventions for post-stroke depression in stroke survivors: A systematic review with meta-analysis

ObjectivesTo evaluate the effectiveness of non-pharmacological interventions for managing post-stroke depression and identify the characteristics of optimal interventions.Data SourcesEight English databases and two Chinese databases were searched from inception to February 2025, alongside grey literature.MethodsTwo reviewers independently screened studies and extracted data from randomised controlled trials (RCTs) or pilot/feasibility RCTs. Study quality was evaluated with the Cochrane Risk of Bias 2 tool. Meta-analyses used Review Manager 5.3 when feasible; otherwise, narrative syntheses were conducted. Certainty of evidence was assessed via the Grading of Recommendations Assessment, Development, and Evaluation system.ResultsSeventeen studies (1297 stroke survivors) were included. Two had a low risk of bias, two had a high risk, and 13 had some concerns. Meta-analyses showed cognitive-behavioural intervention had significant short-term effects (< one month) on depressive symptoms versus control (standardised mean difference SMD: -0.63, 95% CI: -1.00 to -0.26, p < 0.001, I2 = 81%; 7 studies; 693 participants). Cognitive-behavioural interventions without cognitive restructuring showed significant short-term (effect size ES = 0.52-1.08) and medium-term (1-6 months) effects (ES = 0.73-1.71). Preliminary evidence suggested that exercise with music, acceptance and commitment therapy, mindfulness meditation, and aromatherapy also improve depressive symptoms versus control.ConclusionNon-pharmacological interventions, including cognitive-behavioural intervention, exercise, acceptance and commitment therapy, mindfulness meditation, and aromatherapy, could improve post-stroke depressive symptoms. However, with very low evidence certainty, further rigorous RCTs are needed.

The Benefits of Conversation Group Treatment for Individuals With Chronic Aphasia: Updated Evidence From a Multisite Randomized Controlled Trial on Measures of Language and Communication

PURPOSE

Aphasia is a communication disorder that affects up to 30% of stroke survivors. Insufficient access to communication services creates personal, social, and financial costs to people with aphasia (PwA), care partners, and the community. Group conversation treatment has the potential to improve communication and reduce social isolation in a cost-effective manner, but little is known about its critical ingredients. This multicenter randomized controlled trial examined the effects of conversation treatment and whether the pattern of changes on outcome measures differed when treatment was delivered in large groups compared to dyads.

METHOD

One hundred four PwA were randomly assigned to a dyad, large group, or delayed control condition. Conversation group treatment was 1 hr, twice weekly, over 10 weeks. Individual communication goals were addressed within thematically oriented conversation treatment. To evaluate treatment effects, primary (Aphasia Communication Outcome Measure [ACOM]) and secondary outcome measures were examined at pretreatment, posttreatment, and 6 weeks posttreatment.

RESULTS

The ACOM did not show significant changes in the planned omnibus analyses. Post hoc analyses suggested that the large group, but not dyad, treatment condition showed a treatment effect on the ACOM from pre- to posttreatment. Both treatment conditions showed changes on a measure of naming, and the dyads also showed improvement on a measure of repetition.

CONCLUSIONS

The study failed to show the effects of conversation treatment in the omnibus analysis, but there was evidence that conversation group treatment, delivered in a large group, is effective for people with chronic aphasia. This study also illustrated how manipulating the size of the group may alter the outcomes for individuals. The results of this study offer support for a cost-effective treatment option for PwA across the continuum of care.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.28719578.

What You Need to Know If You Want to Run an Aphasia Camp

BACKGROUND

Aphasia camps are an emerging psychosocial approach focusing on re-engaging people with aphasia in recreational and social activities. Current research highlights the positive impacts of aphasia camps on both attendees (people with aphasia and their loved ones) and facilitators (student and professional volunteers). However, the characteristics and facilitation of camps remain unknown due to a paucity of published research.

PURPOSE

The aim of this study was to explore the current scope of aphasia camps including their distribution, structure, and preparation requirements.

METHOD

A mixed-method, cross-sectional exploratory survey was employed to facilitate collection of various camp characteristics. Quantitative data were analyzed via descriptive statistics, and qualitative data were analyzed via inductive content analysis.

RESULTS

Who: The respondents (N = 14) predominantly identified as allied health professionals (n = 12) and were representative of 10 camps. Camps were commonly affiliated with a university or association. Where: Camps were located in the United States (n = 5), Canada (n = 3), Australia (n = 1), and one cruise ship. All camps were held annually, with most having been operating between 10 and 15 years. How: Camp preparations tended to commence 10-12 months before the event. The camps were predominantly funded by the attendees, with half utilizing community grants, and no camps received government support. The typical camp ran over 3 days/two nights and had over 20 people with aphasia attend; however, the schedule was highly varied in structure and types of activities.

CONCLUSIONS

Aphasia camps are highly diverse in structure, operation, and activities. Further research is needed to investigate stakeholder experiences and sustainable implementation practices to continue promoting the development of aphasia camps around the world.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.28764962.

Data-driven classification of narrative speech characteristics in stroke aphasia distinguishes neurological and strategic contributions

Narrative speech deficits are common in post-stroke aphasia, resulting in negative influences on social participation and quality of life. Speech rate, complexity, and informativeness deficits all contribute to narrative speech. Research studies typically (implicitly) assume that these aspects of narrative speech production are a result of cognitive/neurological impairment, but they may also result from strategic choices made as individuals with aphasia attempt to produce narrative speech. Here, we used data-driven methods to classify aphasic narrative speech patterns and evaluated their predictability from lesion patterns. 76 stroke aphasia patients completed 11 narrative speech production tasks. Quantitative Production Analysis (QPA) and Correct Information Unit (CIU) analysis were used to measure their structural and functional properties. Based on prior work, we selected QPA measures of speech rate (words per minute) and complexity (mean sentence length, inflection index, and auxiliary index) and four CIU measures of informativeness (#CIU, CIU/min, %CIU, #nonCIU). These measures produced two orthogonal dimensions with four orthogonal participant clusters. Comprehensive comparison between clusters revealed that speech rate and complexity were strongly associated with general aphasia severity and total lesion volume, and were predicted by frontoparietal grey matter and dorsal pathway white matter damage. In contrast, informativeness was independent of other behavioral and neurological deficits, and was not predictable from lesion patterns, suggesting that it reflects communication strategy rather than specific neurological impairment. These results provide an important step toward distinguishing neurological and strategic aspects of narrative speech deficits in post-stroke aphasia, with potential implications for treatment approaches that target communication strategies.

Speech and Language Therapy Plus Electroacupuncture or Non-Invasive Brain Stimulation for Post-Stroke Aphasia: A Systematic Review and Network Meta-Analysis

BackgroundThe combination of speech and language therapy (SLT) with acupuncture, electroacupuncture, and non-invasive brain stimulation is commonly used in clinical practice and scientific research for post-stroke aphasia (PSA).ObjectiveThis study assesses the therapeutic effectiveness of SLT-based combination therapies in improving language function in patients with PSA.MethodsPubMed, CBM, Embase, Web of Science, Cochrane Library, China National Knowledge Infrastructure (CNKI), Wan Fang Data and Chinese Scientific Journals Database (VIP) were searched through 2 December, 2024. This study included randomized controlled trials (RCTs) that compared the influence of SLT-based combination treatments and controls on language function in patients with PSA. The meta-analysis was conducted using random effects NMA.ResultsA total of 66 studies were included. The NMA assessing the effectiveness of various interventions for improving speech, repetition, and listening comprehension skills following SLT revealed that combined therapies generally outperformed SLT alone. For speaking skills, SLT + Electroacupuncture demonstrated the highest likelihood of improvement (SUCRA = 84.6). For repetition scores, SLT + Electroacupuncture was effective (SUCRA = 92.0). In listening comprehension, SLT + tDCS showed the greatest potential for improvement (SUCRA = 89.8).ConclusionsThe results revealed that any type of SLT-based combination intervention was more effective than SLT alone.

Profiling the expression and functional roles of mRNAs and lncRNAs associated with post-stroke aphasia

Objective

Post-stroke aphasia (PSA) is one of the primary causes of post-stroke impairment, although its underlying mechanism is unknown; therefore, this study aimed to identify the long non-coding RNAs (lncRNAs) and messenger RNAs (mRNAs) linked to PSA and to understand the potential processes by which they may operate.

Methods

RNA sequencing was used to determine the lncRNA and mRNA expression profiles for PSA patients and healthy control peripheral blood mononuclear cells. This allowed for the discovery of lncRNAs and differentially expressed genes (DElncRNAs and DEGs). Gene Ontology (GO) and KEGG enrichment analyses were performed on these DElncRNAs and DEGs, and qPCR was used to confirm their expression. Furthermore, any correlations between these characteristics with differential expression and the language routines of PSA patients were evaluated.

Results

In total, comparisons of the groups yielded 577 DElncRNAs and 892 DEGs. Functional enrichment analyses of these targets demonstrated the strong enrichment of co-expressed DElncRNAs and DEGs in immune system processes and the inflammatory response. The expression levels of the lncRNAs CTD-2545M3.2 and RP11-24N18.1 and the mRNAs RPS10 and LAIR2 were similarly highly connected with verbal conduct in PSA patients upon admission.

Conclusion

The results highlight the lncRNA and mRNA profiles linked to PSA, demonstrating the various methods via which these DElncRNAs and DEGs may influence this clinical setting.

Development and evaluation of a stroke research Public Patient Involvement Panel

Background

Public and patient involvement (PPI) is important in stroke research to ensure that research conducted reflects the priorities and needs of people after stroke. Several factors have been found to affect PPI, including location of the research and time requirements for participation. The incidence of stroke is rising, and can result in symptoms including fatigue, depression, and physical/cognitive impairments.

Aims

1) Describe the development of a PPI panelpanel and a healthcare professional panelpanel for stroke rehabilitation research and 2) to explore the perspectives of the members of the PPI groups on being involved in the research process.

Methods

A stakeholder panel consisting of up to 20 people with stroke, members of the public and healthcare professionals will be formed. A pragmatic purposive sampling technique using snowball sampling will be used to recruit members. The PPI panel will meet four times and will be supported by the guidelines developed from the INVOLVE framework. The PPI panel will be involved as co-researchers in the conceptualisation of future stroke rehabilitation research, the delivery of such studies, the analysis and dissemination of findings. Following the development of the panel, we will conduct a semi-structured focus groups to collect qualitative data, examining the perspectives of members. Data will be transcribed and analysed using Braun and Clarke's Reflexive Thematic Analysis. This will result in a set of themes and subthemes describing participants' opinions and experience of being on a PPI panel in stroke rehabilitation research.

Conclusions

PPI is an essential part of research in stroke. Stakeholders can provide key insights into the research processes. The results of this qualitative study will provide insight into the barriers and enablers of their participation in PPI in stroke rehabilitation research.

Co-designing solutions to the challenges speech pathologists and interpreters encounter when they collaborate to deliver aphasia therapy

PURPOSE

Aphasia caseloads worldwide are becoming increasingly diverse. Both speech pathologists and professional interpreters have identified challenges when working together in the delivery of aphasia rehabilitation to culturally and linguistically diverse people with aphasia. In this study we aimed to co-design solutions to the challenges that speech pathologists and interpreters encounter when they collaborate to adapt and deliver aphasia rehabilitation.

METHODS

A series of five co-design workshops were conducted online via Zoom with 4 Australian speech pathologists and 4 certified interpreters, purposively sampled across language, workplace, gender, and experience levels.

RESULTS

The co-designers generated a total of 23 solutions to address issues of inadequate training, lack of culturally and linguistically appropriate therapy materials, variability in briefing practices, navigating debriefing and feedback, difficulty accessing interpreters, and insufficient time. The solutions were rated for perceived impact and feasibility. Furthermore, the co-designers proposed potential avenues for implementation of these solutions through the consideration of agencies responsible for change.

CONCLUSIONS

This co-design study identified solutions that have the potential to enhance aphasia rehabilitation practices for culturally and linguistically diverse clients. However, achieving change in this area is complex. This research highlights the need for a whole-of-system approach with collaborative engagement from multiple organisations.

Impact of Aphasia on Brain Activation to Motor Commands in Patients with Acute Intracerebral Hemorrhage

BACKGROUND

Brain activation to motor commands is seen in 15% of clinically unresponsive patients with acute brain injury. This state called cognitive motor dissociation (CMD) is detectable by electroencephalogram (EEG) or functional magnetic resonance imaging, predicts long-term recovery, and is recommended by recent guidelines to support prognostication. However, false negative CMD results are a particular concern, and occult aphasia in clinically unresponsive patients may be a major factor. This study aimed to quantify the impact of aphasia on CMD testing.

METHODS

We prospectively studied 61 intensive care unit patients admitted with acute primary intracerebral hemorrhage (ICH) who had behavioral evidence of command following or were able to mimic motor commands. All patients underwent an EEG-based motor command paradigm used to detect CMD and comprehensive aphasia assessments. Logistic regression was used to identify predictors of brain activation, including aphasia types and associations with recovery of independence (Glasgow Outcome Scale-Extended score ≥ 4).

RESULTS

Of 61 patients, 50 completed aphasia and the EEG-based motor command paradigm. A total of 72% (n = 36) were diagnosed with aphasia. Patients with impaired comprehension (i.e., receptive or global aphasia) were less likely to show brain activation than those with intact comprehension (odds ratio [OR] 0.23 [95% confidence interval 0.05-0.89], p = 0.04). Brain activation was independently associated with Glasgow Outcome Scale-Extended ≥ 4 by 12 months (OR 2.4 [95% confidence interval 1.2-5.0], p = 0.01) accounting for the Functional Outcome in Patients with Primary ICH score (OR1.3 [95% confidence interval 1.0-1.8], p = 0.01).

CONCLUSIONS

Brain activation to motor commands is four times less likely for patients with primary ICH with impaired comprehension. False negative results due to occult receptive aphasia need to be considered when interpreting CMD testing. Early detection of brain activation may help predict long-term recovery in conscious patients with ICH.

Unveiling Cognitive Interference: fNIRS Insights Into Poststroke Aphasia During Stroop Tasks

This study examined blood oxygenation changes during a modified Stroop task with colored Chinese words using functional near-infrared spectroscopy (fNIRS) in patients with poststroke aphasia. The task included three conditions: neutral, congruent, and incongruent. Participants consisted of 15 healthy adults and 15 patients with poststroke aphasia. Compared to healthy adults, aphasic patients showed significantly longer reaction times and reduced accuracy across all conditions, with a more pronounced interference effect in the incongruent condition. fNIRS analysis revealed distinct neurophysiological differences: decreased activation in Broca's area, increased activation in the ventromedial frontal pole, and atypical recruitment of the left dorsolateral prefrontal cortex (DLPFC) during Stroop interference tasks. These findings highlight the differing neural mechanisms underlying cognitive interference in poststroke aphasia. The integration of fNIRS with the Stroop task enhances our understanding of intentional inhibition deficits and the impact of cognitive interference in aphasic patients. Importantly, these results suggest that deficits in cognitive control and abnormalities in prefrontal regions, such as the frontal pole and DLPFC, may be potential targets for noninvasive neuromodulation to improve cognitive control in poststroke aphasia. The observed atypical activation patterns in these regions underscore their critical role in managing cognitive interference and intentional inhibition. Noninvasive brain modulation techniques may offer promising strategies for modulating these neural mechanisms. This study underscores the need for targeted interventions that address prefrontal dysfunctions and emphasizes the value of visual language tasks in exploring the complex relationship between language deficits and cognitive control in this population.

Transcranial Magnetic Stimulation Combined With Multimodality Aphasia Therapy for Chronic Poststroke Aphasia: A Randomized Clinical Trial

BACKGROUND AND OBJECTIVES

Intensive speech therapy may improve recovery from poststroke aphasia. Further evidence suggests that pairing repetitive transcranial magnetic stimulation (rTMS) with intensive speech therapy might augment outcomes. This sham-controlled randomized clinical trial evaluated the efficacy of 1-Hz rTMS over the right pars triangularis combined with multimodality aphasia therapy (M-MAT) in chronic poststroke aphasia.

METHODS

A parallel-group, double-blind, sham-controlled randomized clinical trial was conducted between April 2021 and May 2023 at an outpatient neurorehabilitation clinic. Individuals with chronic nonfluent aphasia after left middle cerebral artery stroke (>6 months from stroke) were enrolled and randomly assigned to receive either rTMS or sham stimulation combined with 35 hours of M-MAT over 10 days. The primary outcome was the Western Aphasia Battery aphasia quotient (WAB-AQ) measured at 3 weeks and 15 weeks. Intention-to-treat analysis examined treatment effects over time using linear mixed models.

RESULTS

A total of 44 participants were randomized. Forty-three (mean [SD] age, 63.4 [12.3] years; 14 women [32.6%]) completed the intervention. Overall, WAB-AQ scores improved from baseline to 15 weeks regardless of rTMS allocation (mean difference 5.33, 95% CI 2.9-7.8, p < 0.001). We observed a significant group-by-time interaction (β = 0.31, p = 0.024), suggesting that those who received rTMS combined with M-MAT improved more over time than those who received sham. At 15 weeks, the rTMS group demonstrated significantly less word-finding difficulties and more complete and longer sentences with fewer pauses compared with sham as indicated by higher WAB-AQ scores (mean difference 4.1 points, 95% CI 0.6-7.6, p = 0.022). The change from baseline at 15 weeks was greater in the rTMS group (7.6 points, 95% CI 4.1-11.1) compared with sham (3.0 points, 95% CI -0.3 to 5.2; mean difference 4.6 points, 95% CI 0.6-8.6, p = 0.024).

DISCUSSION

Intensive administration of M-MAT alone improves speech production in patients with chronic poststroke aphasia. Combining 1-Hz rTMS with M-MAT is associated with supplemental improvements in aphasia severity at follow-up. rTMS is a promising candidate as an adjuvant therapy to M-MAT.

TRIAL REGISTRATION INFORMATION

ClinicalTrials.gov Identifier: NCT04102228.

CLASSIFICATION OF EVIDENCE

This study provides Class III evidence that in patients with aphasia 6 or more months after a stroke, 1-Hz rTMS combined with intensive M-MAT improves WAB-AQ more than sham stimulation plus M-MAT.

Development of a Multidimensional, Multigroup Measure of Cognitive-Communication for Inpatient Rehabilitation

OBJECTIVE

To develop a comprehensive, repeatable measure of cognitive-linguistic function for use in inpatient rehabilitation facility (IRF) settings using contemporary methods and to compare the sensitivity of this measure to the functional independence measure (FIM) cognitive items.

DESIGN

Retrospective analysis of clinician-reported assessment data collected as part of routine clinical operations.

SETTING

Free-standing IRF in the Midwestern United States.

PARTICIPANTS

A convenience sample of inpatients (N=12,245) with motor speech, voice, aphasia and/or cognitive-communicative diagnoses, ≥18 years who were admitted to an IRF.

INTERVENTIONS

Standard of care rehabilitation services.

MAIN OUTCOME MEASURES

Cognitive-Communication Ability Quotient (AQ) composed of 10 standard measures used by speech-language pathologists.

RESULTS

Confirmatory factor analysis resulted in good-fitting models (root-mean-square errors of approximation≤0.08, comparative fit indices, and nonnormed fit indices≥0.95) for 5 groups defined by primary communication impairment (Aphasia, Cognitive-Communication Disorder, Brain Injury, Right Hemisphere Dysfunction, Motor Speech/Voice). Re-estimation as a multigroup, MIRT model yielded scores more sensitive to change compared to the FIM cognitive score. True score equating analysis demonstrated a higher ceiling and lower floor for the Cognitive-Communication AQ compared to the FIM.

CONCLUSIONS

We constructed 5 forms of a novel cognitive-communication measure, the Cognitive-Communication AQ, which demonstrates superior measurement characteristics compared with the FIM cognition score with a lower floor and higher ceiling. The AQ can detect changes in cognitive-communicative function that typically occur during an IRF stay. Repeated measurement during the IRF stay allows clinicians to monitor patients' progress and modify rehabilitation plans accordingly.

Aphasia, depression, and psychological therapy (ADaPT): A single case design evaluation of a modified cognitive behavioural therapy to treat depressive symptoms in stroke survivors with aphasia

Cognitive behavioural therapy (CBT) can effectively treat depression in the general population, but there is a lack of studies evaluating CBT tailored to specific cognitive and communication needs of individuals with post-stroke aphasia. We aimed to evaluate the feasibility and preliminary efficacy of a modified CBT intervention to ameliorate depressive symptoms. An ABA withdrawal/reversal single case design with concurrent multiple baselines (2.5, 4.5, or 6.5 weeks) was repeated across 10 participants (six male, four female) with post-stroke aphasia and self-reported depression. Participants completed 10 individual intervention sessions with a clinical neuropsychologist and a 4-week follow-up. The primary outcome was self-rated depression, and secondary outcomes included observer-rated symptoms of depression and anxiety. Data were analysed visually and statistically controlling for baseline trend. Feasibility was addressed by analysing recruitment and retention rates, treatment adaptations, and fidelity ratings. Three participants self-reported decreased depression levels during the intervention phase, which was sustained for two participants. Four additional participants improved during the follow-up phase. Close others reported sustained improvements in depressive symptoms (six participants) and anxiety symptoms (seven participants). Modified CBT appears feasible and potentially efficacious in reducing depressive symptoms in post-stroke aphasia. A randomized controlled trial is warranted, and should consider additional treatment sessions.

The core components of clinical planning for Comprehensive, High-dose Aphasia Treatment (CHAT): A task analysis

BACKGROUND

Intensive comprehensive aphasia programmes (ICAPs) deliver intensive aphasia rehabilitation via a cohort approach, aligning with the World Health Organization's (WHO) International Classification for Functioning, Disability and Health (ICF). ICAPs are an effective treatment approach for aphasia rehabilitation, and their implementation within healthcare settings is currently being investigated. However, there are challenges associated with selecting and tailoring evidence-based treatments for delivery within ICAPs and supportive processes for selecting and tailoring therapy are required. To address this challenge, structured and collaborative clinical planning has been incorporated as a key element of one modified ICAP (mICAP), the Comprehensive, High-dose Aphasia Treatment (CHAT) programme. CHAT provides 50 h of personalized, goal-directed therapy for language impairment and function across 8 weeks. Our current understanding of how clinical planning is conducted for this programme is limited.

AIMS

(1) To identify and define the individual tasks performed as part of a structured, collaborative clinical planning process for CHAT and its telerehabilitation counterpart TeleCHAT; and (2) to understand speech pathologists' perspectives of the key components, roles and resources for clinical planning.

METHODS

A mixed methods hierarchical task analysis (HTA) approach was utilized to analyse observations of 10 goal-setting sessions and planning discussions of 13 patients across two CHAT and TeleCHAT cohorts. Focus groups and interviews with seven speech pathologists and two speech pathology leaders involved in delivering or supporting the delivery of the programmes were also conducted. Clinical planning tasks, personnel involved and resources used were iteratively built into a task analysis framework. Perspectives on the key elements of clinical planning were obtained and analysed using deductive qualitative content analysis.

RESULTS

Seven clinical planning tasks, comprising 25 subtasks, were identified across CHAT and TeleCHAT: assessment and analysis, goal-setting, an initial planning meeting, scheduling and coordination, resource preparation, a midway planning meeting, and planning throughout therapy. One additional task was identified for TeleCHAT: identify and prepare technology. Identifying appropriate patients for CHAT and TeleCHAT was considered a precursor to clinical planning. Each clinical planning task was perceived as essential for its success. The involvement of both clinical and research teams and access to resources to structure clinical planning tasks were also described as key elements.

CONCLUSION/IMPLICATIONS

Clinical planning is a central component of CHAT and TeleCHAT, involving a number of multifaceted processes. Understanding how clinical planning is executed in practice is the first step towards implementing ICAPs and mICAPs such as CHAT and TeleCHAT in other settings. Understanding the factors that influence the implementation of the clinical planning process is needed to further inform this translation.

WHAT THIS PAPER ADDS

What is already known on the subject Speech pathologists experience challenges selecting and tailoring evidence-based aphasia therapy, and support for clinical planning has been reported to facilitate the delivery of ICAPs. What this paper adds to the existing knowledge This study comprehensively describes the process of clinical planning for the CHAT and TeleCHAT programmes, two Australian-modified ICAPs (mICAPS), and is amongst a few descriptions of treatment mapping processes in broader aphasia rehabilitation practice. What are the potential or actual clinical implications of this work? The detailed description of clinical planning processes, in addition to key resources and personnel for CHAT and TeleCHAT, may assist speech pathology teams in improving clinical planning practices. It is a key preliminary step in translating structured, collaborative clinical planning processes into aphasia rehabilitation practice.

Experiences and perspectives of UK speech and language therapists on telehealth assessment with people living with post-stroke aphasia

BACKGROUND

Stroke care in the UK was significantly affected by the COVID-19 pandemic, with many services switching to telehealth. Post-pandemic, a UK survey of speech and language therapists (SLTs) working with people with aphasia (PWA) showed the vast majority planned to continue to use telehealth alongside in-person intervention. Telehealth is considered a cost-effective and feasible method of service delivery; however, there is limited evidence to support its use in the assessment of people with post-stroke aphasia.

AIMS

To investigate what barriers and facilitators SLTs experience when administering telehealth assessments to PWA and to explore SLTs' perspectives on what makes for a positive patient experience.

METHODS & PROCEDURES

Focus groups (dyadic/triadic) were conducted via videoconferencing. Transcripts were analysed using framework analysis. Inclusion criteria for participants were SLTs working in the UK with PWA, with experience of using telehealth assessment.

OUTCOMES & RESULTS

A total of 14 SLTs participated across six groups. Seven themes were identified: assessment; technology; factors specific to PWA; factors specific to family, carers and their environment; factors specific to SLTs; benefits of telehealth assessment; and what telehealth would look like in an ideal world. Facilitators to telehealth assessment included good internet connectivity, access to a helper, adapted assessments, preparation and training PWA to use telehealth platforms. Barriers included reduced control over the environment, having a cognitive impairment, aphasia severity, low beliefs in competence using technology and challenges with managing the emotional needs of PWA during telehealth assessment. A strong therapeutic relationship, offering choice and flexibility in assessment administration, promoted a positive patient experience.

CONCLUSIONS & IMPLICATIONS

This study provides new insights into the current use of telehealth assessment with PWA by SLTs in the UK. Barriers and facilitators identified can support the implementation of telehealth assessment in SLT services. Providing a positive patient experience when using telehealth assessment is important to SLTs, with patient choice a key factor. Further research is indicated to increase the range of standardized assessments for telehealth assessment and investigate the efficacy of a hybrid model approach to service delivery.

WHAT THIS PAPER ADDS

What is already known on the subject There is emerging evidence for the use of telehealth assessment as a feasible and appropriate means of service delivery for SLTs. However, little is known about SLTs' experience of delivering telehealth assessments to PWA. What this paper adds to existing knowledge This study identified both the facilitators and barriers experienced by SLTs when using telehealth assessment with PWA. Practical advice and considerations for telehealth administration are provided. What are the potential or actual clinical implications of this work? Resources are required for the implementation of SLT telehealth assessments, particularly in training for both PWA and SLTs, assessments designed for telehealth and accessible telehealth platforms. A hybrid approach to assessment could be beneficial for both PWA and clinicians, retaining the advantages with the acknowledgement that telehealth may not be suitable for all.

Executive Functions Training Improves Language Abilities in Aphasia Rehabilitation: A Systematic Review

Background/Objectives: In recent years, the popularity of non-verbal cognitive training for aphasia has increased. Building on evidence that language abilities engage brain areas involved in executive functions (EFs) processing, this review aims to analyze the utility of EFs training alone or combined with traditional rehabilitation approaches to improve language abilities in aphasia. Methods: Systematic searches were performed in four databases evaluating studies focusing on the effects of EFs training in language rehabilitation, yielding 185 studies. After reading the full text of the selected studies and applying predefined inclusion criteria, nine studies were included based on pertinence and relevance to the topic. This systematic review has been registered in the Prospective Register of Systematic Reviews (PROSPERO 2024) with the number CRD42024519087. Results: The results of the analyzed studies indicate that various EFs training methods, such as computer-assisted executive control training, Cognitive Flexibility in Aphasia Therapy (CFAT), and the Dr. Neuronowski® program, as well as the combination of transcranial direct current stimulation (tDCS) with EFs training, can lead to improvements in language abilities in people with aphasia. Additionally, EFs training often results in specific effects on treated functions like working memory (near transfer effects) and untreated ones such as spoken sentence comprehension (far transfer effects). Conclusions: Despite the heterogeneity of the treatments and the small simple size of the studies analyzed, preliminary results are promising. Future research should further explore the effectiveness and specific contribution of EFs training to improving language functions in aphasia.

Management of suicidality in stroke patients with and without aphasia-a national survey among healthcare professionals in Sweden

PURPOSE

Investigating how stroke healthcare professionals manage suicidality in stroke patients with and without aphasia.

MATERIALS AND METHODS

A cross-sectional survey of 981 professionals in Sweden was conducted.

RESULTS

Nearly 60% of respondents had encountered suicidality in stroke patients without aphasia, while 40% had encountered it in patients with aphasia. SLPs were more likely to meet patients with aphasia and suicidality. Routine screening was rare, while 40% reported that suicidality was assessed when needed. Psychologists, physicians, and social workers were seen as responsible for assessments, with 13% of respondents feeling it was their responsibility to assess suicidality. Less than half of those felt competent to assess patients with aphasia. Aphasia was viewed as a barrier to assessment. Uncertainty was widespread regarding intervention, particularly in patients with aphasia, and there were concerns about the competence to handle such cases when referred to psychiatry. Free-text responses highlighted a perceived lack of competence, tools, and routine procedures for handling suicidality in aphasia, alongside calls for more mental health professionals and better interprofessional collaboration regarding suicidality in stroke rehabilitation.

CONCLUSIONS

Management of suicidality in stroke patients, particularly with aphasia, is surrounded by uncertainty. Greater competence in suicidality, aphasia-friendly communication, and improved interdisciplinary efforts are needed.

Factors Related to the Quality and Stability of Partner Relationships After Stroke: A Systematic Literature Review

OBJECTIVE

To provide an overview of the current state of knowledge on factors related to relationship quality and relationship stability after stroke.

DATA SOURCES

Cumulative Index to Nursing and Allied Health (CINAHL), Embase, MEDLINE, Psychology and Behavioral Sciences Collection, APA PsycINFO, and PubMed were searched on November 15, 2022, for literature on factors associated with (1) relation quality and (2) relation stability after stroke.

STUDY SELECTION

English quantitative and qualitative studies investigating factors associated with relation quality and/or stability after stroke were included. Three reviewers independently assessed eligibility. Consensus meetings were held in case of divergent opinions. A total of 44 studies were included.

DATA EXTRACTION

Information regarding study objectives and characteristics, participant demographics, independent and dependent variables, and main findings was extracted. Study quality was rated using the Joanna Briggs Institute Checklist for Analytical Cross-Sectional Studies and/or the Critical Appraisal Skills Programme Checklist for Qualitative Research. Both were administered by the lead reviewer and checked by the second reviewer. Identified factors are described and presented according to the domains of the International Classification of Functioning, Disability, and Health model.

DATA SYNTHESIS

Thirty-seven factors related to relationship quality after stroke were identified, covering the domains of body functions and structures (eg, cognitive problems), activities (eg, decrease in physical intimacy), participation (eg, being socially active), environment (eg, medication side effects), and personal factors (eg, hypervigilance). Eight factors related to relationship stability were identified, covering the domains of participation (agreement on reciprocal roles) and personal factors (eg, quality of prestroke relation).

CONCLUSIONS

Relationship quality and stability after stroke are related to a multitude of factors. Future research should confirm the relevance of factors found in a few studies of suboptimal quality; explore possible associations between relationship stability and factors falling in the domains of body functions and structure, activity, and environmental factors; and explicitly explore potential positive effects of stroke on relationships.

The kitchen assessment: an interactional analysis of assessment and feedback between an occupational therapist and a patient with aphasia post stroke

PURPOSE

After stroke, patients undergo frequent multidisciplinary assessments. Little is known about patients' experiences of being assessed and the impact of assessment interactions and feedback for ongoing engagement in rehabilitation. This research aims to stimulate reflection on clinical interactions, even during routine clinical assessments, and the provision of assessment feedback.

MATERIALS AND METHODS

This study involved a detailed analysis of an authentic kitchen assessment interaction between an occupational therapist and a patient with aphasia following stroke. It used a speech function analysis based on systemic functional linguistics resulting in both dynamic and synoptic data, and a consideration of interactive framing, to explore assessment explanation and feedback.

RESULTS

The analysis revealed the clinician's interactive dominance in terms of number and type of moves, and misalignment of interactional framing at different points in the exchange. The session appeared to result in patient disengagement related both to the clinician's misjudged response to the patient's aphasia, and the context of assessment itself, characterised by reliance on question-and-answer exchanges, and a tendency to highlight deficit.

CONCLUSIONS

Assessment sessions may be emotionally challenging for patients after stroke and feedback may be interpreted as bad news. Sensitive communication is required to support psychological wellbeing and engagement in rehabilitation. IMPLICATIONS FOR REHABILITATIONAfter stroke, patients are assessed by the multidisciplinary team to inform intervention and discharge planning.Little is known about the feedback patients receive or their views of this feedback, including when it is perceived as bad news.The presence of aphasia can complicate how assessments are conducted and how feedback is delivered and received.Greater awareness is needed of how feedback following assessment might impact patients' psychological wellbeing and engagement in rehabilitation.

Protocol for a feasibility study evaluating a supported self-management intervention for stroke survivors with aphasia (StarStep study)

BACKGROUND

There is a growing evidence base to support the use of self-management interventions for improving quality of life after stroke. However, stroke survivors with aphasia have been underrepresented in research to date. It is therefore unclear if self-management is an appropriate or effective approach for this group. To address this gap in the evidence base, we have developed a supported self-management intervention (the 'Living with Aphasia' intervention) specifically for stroke survivors with aphasia in the first year after stroke. The StarStep study aims to assess the feasibility of implementing and evaluating the intervention (including the feasibility of participant recruitment, the feasibility of delivering facilitator training, the acceptability of the intervention, the fidelity of intervention delivery and outcome data completeness).

METHODS

StarStep is a mixed-methods, non-randomised feasibility study. The Living with Aphasia intervention will be facilitated by speech and language therapists and implemented in two community stroke teams in the north of England. We aim to recruit 30 stroke survivors who have aphasia (and/or their family members) and who are ≤ 12-month post-stroke to participate in data collection for the study. Following informed consent, participants will complete a baseline data collection questionnaire which will include measures of quality of life, symptoms of depression and perceived communicative effectiveness. Follow-up questionnaires will be completed at 3-month post-intervention. Qualitative data collection will include implementation groups and semi-structured interviews with speech and language therapists, semi-structured interviews with stroke survivors with aphasia (and/or their family members) and observations of the delivery of the intervention. A joint display table will be used to integrate findings from each element of data collection in order to consider overall feasibility.

DISCUSSION

This study will provide the information necessary to optimise data collection processes and to optimise the implementation and delivery of the self-management intervention. Feasibility data will inform decision-making regarding progression to a future definitive cluster randomised controlled trial to evaluate the effectiveness of the intervention.

TRIAL REGISTRATION

ISRCTN registry, trial registration number: ISRCTN10401966. Date of registration: 07/10/2023. URL of trial registry record: https://doi.org/10.1186/ISRCTN10401966 .

Computer- and Smart-Tablet-Based Self-Administered Treatments in Chronic Post-Stroke Aphasia: A Systematic Review

BACKGROUND

In current clinical practice, resources remain limited and are insufficient to address the needs of people with chronic post-stroke aphasia. To improve access to speech therapy, self-administered therapies using computers or smart tablets are increasingly recommended. In addition to enabling more intensive and prolonged treatment, computer- and smart-tablet-delivered therapies can be highly enjoyable and motivating for patients.

AIMS

This systematic review aimed to identify computer- and smart-tablet-based self-administered treatments and analyze the proposed interventions in terms of treatment targets, effectiveness (considering specificity, generalization, transfer, and maintenance), and clinician involvement (during and/or prior self-administered therapies).

METHODS

Terms encompassing three main concepts (rehabilitation, self-administration, and aphasia) were used to search three electronic databases (Scopus, PubMed, and PsycINFO). Two reviewers independently screened titles and abstracts against eligibility criteria. Data extraction of included studies was completed by three reviewers.

RESULTS

Thirty-nine studies were included in this study. In terms of treatment targets, anomia is the most treated symptom in published studies (n = 24), but the existence of promising studies for other disorders means that the targets can be broadened. Therapies are effective for trained items, and gains are maintained. There is some evidence of transfer effects for treatments targeting the sentence level. Most studies offer training sessions, previous self-administered therapy, and/or observation and monitoring sessions during therapy; more rarely, self-administered therapy is supplemented with face-to-face therapy.

CONCLUSIONS

This systematic review is the first to focus specifically on self-administered technology-based therapies. It provides important evidence-based information for clinical practice in self-administered therapies via computer or smart tablet.

Improving the early detection of aphasia in the acute phase of stroke: the contribution of a screening test

BACKGROUND

Aphasia is one of the most common and most debilitating after-effects of a stroke. In the acute phase of a stroke, referrals to speech-language pathology (SLP) are frequently guided by clinical impressions rather than validated tests.

OBJECTIVES

This study aimed to evaluate the advantages of incorporating the Screening test for language disorders in adults and the elderly (DTLA) into clinical practice for detecting language disorders during the acute phase of stroke.

METHODS

The study includes a retrospective and a prospective component, including a questionnaire on the acceptability, feasibility and usefulness of using the DTLA in patients in the acute phase of stroke.

RESULTS

Sixty-one patients admitted for stroke were recruited for each of the two components. The introduction of the DTLA in the prospective component of the study had a significant impact on the detection of language impairment, as more notes about language were found in patients' medical records and more referrals were made to SLP.

CONCLUSIONS

Using a screening test can improve the detection of aphasia during the acute phase of stroke, particularly in patients whose impairments might not be easily identified through subjective assessments.

EEG reveals brain network alterations in chronic aphasia during natural speech listening

Aphasia is a common consequence of a stroke which affects language processing. In search of an objective biomarker for aphasia, we used EEG to investigate how functional network patterns in the cortex are affected in persons with post-stroke chronic aphasia (PWA) compared to healthy controls (HC) while they are listening to a story. EEG was recorded from 22 HC and 27 PWA while they listened to a 25-min-long story. Functional connectivity between scalp regions was measured with the weighted phase lag index. The Network-Based Statistics toolbox was used to detect altered network patterns and to investigate correlations with behavioural tests within the aphasia group. Differences in network geometry were assessed by means of graph theory and a targeted node-attack approach. Group-classification accuracy was obtained with a support vector machine classifier. PWA showed stronger inter-hemispheric connectivity compared to HC in the theta-band (4.5-7 Hz), whilst a weaker subnetwork emerged in the low-gamma band (30.5-49 Hz). Two subnetworks correlated with semantic fluency in PWA respectively in delta- (1-4 Hz) and low-gamma-bands. In the theta-band network, graph alterations in PWA emerged at both local and global level, whilst only local changes were found in the low-gamma-band network. Network metrics discriminated PWA and HC with AUC = 83%. Overall, we demonstrate the potential of EEG-network metrics for the development of informative biomarkers to assess natural speech processing in chronic aphasia. We hypothesize that the detected alterations reflect compensatory mechanisms associated with recovery.

Right brain hemisphere lesions affecting language functioning in the acute phase of stroke recovery: A Croatian survey

Greater empirical and scientific attention is still put on patients with left brain hemisphere (LBH) damage where language impairments are common and expected. In patients with RBH damage, language assessment is therefore rarely done in the acute phase of stroke recovery.

PURPOSE

To investigate language impairments in the acute phase of stroke using a Croatian standardized language battery for the first time and compare patients with RBH stroke, LBH stroke and healthy individuals.

METHODS

This study compares language functioning in three groups of conveniently sampled participants: RBH stroke patients, LBH stroke patients and healthy individuals. Kruskal Wallis H test was used to evaluate a combined group comparison, after which a post-hoc Dunn test was performed.

RESULTS

Patients with RBH stroke scored significantly lower than healthy individuals on the CAT:HR in verbal fluency, comprehension of written sentences, naming, and total production. In addition, comprehension of written and spoken sentences did not differ between patients with RBH and LBH stroke patients which suggests the existence of language impairment (p>.05).

CONCLUSION

RBH stroke can significantly impair language comprehension and production in the acute phase of stroke recovery emphasizing the importance of early detection.

Improving reading competence in aphasia with combined aerobic exercise and phono-motor treatment: Protocol for a randomized controlled trial

Aphasia, a communication disorder caused primarily by left-hemisphere stroke, affects millions of individuals worldwide, with up to 70% experiencing significant reading impairments. These deficits negatively impact independence and quality of life, highlighting the need for effective treatments that target the cognitive and neural processes essential to reading recovery. This Randomized Clinical Trial (RCT) aims to test the efficacy of a combined intervention incorporating aerobic exercise training (AET) and phono-motor treatment (PMT) to enhance reading recovery in individuals with post-stroke aphasia. AET, known for its positive impact on cerebral blood flow (CBF) and oxygenation, is hypothesized to facilitate neuroplasticity when administered before PMT, an intensive therapy aimed at strengthening phonological processing. While most existing treatments focus on spoken language production, this study builds on evidence that PMT can also improve reading skills. The study is structured as a Phase I/II clinical trial and compares the effects of AET plus PMT to a control condition of stretching plus PMT on reading and other language outcomes including naming, auditory comprehension, and spontaneous speech. Additionally, it investigates the immediate and sustained impacts of the intervention on CBF, functional connectivity, and task-evoked brain activity. The central hypothesis posits that AET will increase CBF and, when combined with PMT, will lead to enhanced reading recovery, supporting treatment-induced plasticity. This trial represents one of the first large-scale interventions targeting post-stroke reading impairments and provides critical insights into the potential of combining AET with cognitive rehabilitation to improve language recovery in aphasia.

Advances in diagnostic imaging and interventional treatment of aphasia after basal ganglia stroke

Post-stroke basal ganglia aphasia is an unusual and transient form of aphasia resulting from basal ganglia damage. It is commonly believed that the generation of language function primarily resides in regular language regions of the brain; however, recent findings indicate a prevalence of basal ganglia stroke aphasia as high as 22%. Subcortical structures (e.g., basal ganglia) also play an important role in language processing. Aphasia seriously affects the quality of life and functional outcomes of patients, and early diagnosis and intervention are important for the prognosis of and rehabilitation from aphasia after basal ganglia stroke. In recent years, the main diagnostic methods for basal ganglia aphasia include diffusion tensor imaging, diffusion spectral imaging, and functional magnetic resonance imaging, which explore the changes in patients with basal ganglia aphasia compared to those without from the perspectives of fiber tract imaging and brain function alteration, respectively, and are able to predict the recovery of patients before and after treatment. Treatment for post-stroke basal ganglia aphasia includes transcranial magnetic stimulation, a recent emerging therapeutic technique, in addition to conventional medications and speech rehabilitation. Consequently, understanding this condition is crucial. This review delves into its causes, imaging methods, and therapeutic interventions, offering a systematic and comprehensive analysis of these aspects.

Feasibility of real-time fMRI neurofeedback for rehabilitation of reading deficits in aphasia

Background

Reading impairments, a common consequence of stroke-induced aphasia, significantly hinder life participation, affecting both functional and leisure activities. Traditional post-stroke rehabilitation strategies often show limited generalization beyond trained materials, underscoring the need for novel interventions targeting the underlying neural mechanisms.

Method

This study investigates the feasibility and potential effectiveness of real-time functional magnetic resonance imaging (fMRI) neurofeedback (NFB) intervention for reading deficits associated with stroke and aphasia. We enrolled left-hemisphere stroke survivors in the subacute recovery period and healthy controls in an fMRI NFB intervention study focusing on increasing activation within the left supramarginal gyrus (SMG), a critical region for reading supporting orthography-phonology conversion.

Results

Preliminary findings demonstrate that stroke participants showed significant improvements in reading comprehension and phonological awareness, as evidenced by marked gains on the Reading Comprehension Battery for Aphasia (RCBA) and a phonology two-alternative forced choice test. Functional MRI results indicated that stroke participants exhibited increased activation from day 1 to day 3 of NFB training within the left SMG and the broader left hemisphere reading network, particularly during challenging nonword reading tasks. Healthy controls also showed increased activation during NFB regulation and reading tasks, but these changes were outside the traditional reading network, involving regions associated with cognitive control, reward anticipation, and learning. In both stroke participants and healthy controls, we also found changes in dynamic functional connectivity of multiple resting state networks from before to after NFB training.

Conclusions

Although preliminary, this research contributes to the development of biologically informed interventions for reading deficits in aphasia, representing an early step towards improving post-stroke rehabilitation outcomes. Future randomized controlled trials are necessary to validate these findings by including a sham NFB control group within a larger participant sample.

Registration

The study was preregistered on ClinicalTrials.gov, NCT# NCT04875936.

Adapting a group-based, multimodal aphasia treatment for telehealth - co-design of M-MAT Tele

Multi-Modality Aphasia Treatment (M-MAT) is an effective group intervention for post-stroke aphasia. M-MAT employs interactive card games and the modalities of gesture, drawing, reading, and writing to improve spoken language. However, there are challenges to implementation of group interventions such as M-MAT, particularly for those who cannot travel or live in rural areas. To maximise access to this effective treatment, we aimed to adapt M-MAT to telehealth format (M-MAT Tele). The Human-Centred Design Framework was utilized to guide the adaptation approach. We identified the intended context of use (outpatient/community rehabilitation) and the stakeholders (clinicians, people with aphasia, health service funders). People with aphasia and practising speech pathologists were invited to co-design M-MAT Tele in a series of iterative workshops, to ensure the end product was user-friendly and clinically feasible. The use of co-design allowed us to understand the hardware, software and other constraints and preferences of end users. In particular, clinicians (n = 3) required software compatible with a range of telehealth platforms and people with aphasia (n = 3) valued solutions with minimal technical demands and costs for participants. Co-design within the Human-Centred Design Framework led to a telehealth solution compatible with all major telehealth platforms, with minimal hardware or software requirements. Pilot testing is underway to confirm acceptability of M-MAT Tele to clinicians and people with aphasia, aiming to provide an effective, accessible tool for aphasia therapy in telehealth settings.

Digital tool as speech and language therapy for patients with post-stroke aphasia

Introduction

New technologies could play a role in post-stroke aphasia (PSA). Our aims were to develop a digital tool; to evaluate its acceptance and usability by patients and caregivers; and to demonstrate its effectiveness in improving language skills in patients with PSA, applying it from the acute phase.

Methods

The study consisted of two phases: development of a digital tool; and an interventional before-and-after study. During the first week of admission, the digital tool, VerbalizAPP®, was installed for use with the help of family/caregivers. PSA was evaluated by a summarised version of the Boston Diagnostic Aphasia Examination (sBDAE) with 0-64 points. After 3 months of using VerbalizAPP®, the sBDAE and scales to assess user satisfaction were applied.

Results

Forty patients (29 men, mean age 68.3 years) were included. Aphasia description: Broca's 12 (15.0%), Wernicke's 13 (32.5%), mixed/global 15 (37.5%) cases. Patients began using VerbalizAPP® 4.8 days (range 2-7) after stroke onset. A significant improvement in sBDAE scores was found after 3 months of VerbalizAPP® use: 35.1 (SD 17.6) versus 51.1 (SD 14.4) points; p < .001. Academic level was the only baseline parameter related to outcomes. Comfort of use scored 8.8, and complexity 2.2 points. Expectations were exceeded in 61.1%, and impression of improvement in 83.3% of cases. No adverse effects were reported, and all participants would recommend VerbalizAPP® to other patients.

Conclusions

Our results show the effectiveness of VerbalizAPP® for the treatment of PSA. However, larger prospective validation studies should be conducted to recommend its widespread use.

When Stroke Disguises as Dementia: A Case of Missed Cerebral Venous Thrombosis

Cerebrovascular thrombosis is among the most critical medical conditions, making early diagnosis and management crucial. Although some symptoms of cerebrovascular thrombosis are typical and lead to early diagnosis, they can sometimes present with rare and unusual symptoms, complicating the diagnostic process. Given the morbidity and mortality associated with these events, it is important to be aware of unexpected symptoms to diagnose and manage these patients more accurately and rapidly. We report a 74-year-old female initially misdiagnosed with Alzheimer's because of cognitive decline and disorganized speech. Her symptoms did not improve with Alzheimer's treatment. She was reevaluated by a neurologist, and her cognitive test results were impaired. Her brain MRI revealed a previously undetected left transverse sinus cerebral venous thrombosis with subcortical white matter lesions. The patient was managed acutely with subcutaneous enoxaparin and transitioned to oral rivaroxaban, resulting in significant improvement. This case report aimed to draw attention to the pitfalls of diagnosing dementia-like syndromes in the elderly, advocating for a systematic approach to differential diagnosis. It emphasizes that a collaborative effort between psychiatrists, neurologists, radiologists, and other healthcare members is essential for accurate diagnosis and timely intervention, which can significantly alter the management and outcome for the patient.

Assessment of Skills of Caregivers Providing Care for Stroke Patients in East Kazakhstan Region

OBJECTIVES

This study investigated stroke survivors and the characteristics of care management after discharge from hospital to home. The study aimed to identify caregiving difficulties and to assess mastery of skills in implementing recovery activities at home. This was a cross-sectional study.

METHODS

As part of the study, we interviewed 205 informal caregivers caring for stroke survivors. For descriptive statistics, frequencies, mean, medians, and standard deviations were calculated.

RESULTS

Caregivers determined that the main aim was to restore motor activity in 58% (p ≤ 0.021), and the difficulties they most often encounter during caregiving are difficulties related to obtaining information from medical personnel, or not understanding the information received in people under 50 years of age, which were indicated in 47.9% of cases, while in people over 50 years of age, this indicator was 49.5%. The emotional state of the informal caregivers is closely interrelated with the state of stroke survivors. The informal caregivers with a higher education are more resistant to these changes related to the patient's health.

CONCLUSIONS

The informal caregivers in East Kazakhstan face challenges such as inadequate preparation, limited resources, and emotional strain, hindering effective care. High rates of stroke-related impairments highlight the need for better rehabilitation programs and informal caregiver support. Future research should assess intervention programs and support systems.

Targeting Phonology or Semantics to Improve Reading Aloud Response Times and Accuracy: A Case Series Investigation of Stroke Survivors With Aphasia

PURPOSE

Acquired reading deficits, or alexia, affect a significant proportion of individuals with aphasia. We sought to improve treatment for alexia by targeting specific cognitive information-processing components critical to reading (i.e., phonology or semantics).

METHOD

To target either phonological or semantic processing, we administered two anomia treatments, phonomotor treatment (PMT) and semantic feature analysis, modified to include a focus on reading throughout the therapy. Chronic left-hemisphere stroke survivors (N = 5) completed one or two 60-hr treatment rounds. Based on predictions from a computational reading model, three participants received the treatment recommended for their specific reading challenges (e.g., PMT for phonological deficits), while two participants had the nonrecommended treatment first, followed by the recommended model-matched treatment. Changes in reading aloud accuracy and response times (RTs) from before to after treatment were examined as a function of matching treatment to the deficit profile, type of treatment, therapy round, and word characteristics.

RESULTS

Participants' reading aloud accuracy improved after treatment relative to baseline with higher accuracy for high-frequency words and shorter words. After the first treatment round, participants' accuracy and RT improved, irrespective of whether treatment was matched to the deficit profile. Furthermore, participants who completed the second treatment round continued achieving accuracy gains. Following treatment, participants demonstrated enhanced reading efficiency and generalized improvements on the selected sections of the Woodcock Reading Mastery Test.

CONCLUSIONS

While larger studies are needed to test for the effects of matching treatment type to the deficit profile, we conclude that treatments targeting specific information-processing components can effectively improve reading. Doubling the treatment dose offers small but significant gains.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.26517319.

Post-stroke Cognition is Associated with Stroke Survivor Quality of Life and Caregiver Outcomes: A Systematic Review and Meta-analysis

Disability arising from post-stroke cognitive impairment is a likely contributor to the poor quality of life (QoL) stroke survivors and their carers frequently experience, but this has not been summarily quantified. A systematic literature review and meta-analysis was completed examining the association between general and domain-specific post-stroke cognitive functioning and adult stroke survivor QoL, caregiver QoL, and caregiver burden. Five databases were systematically searched, and eligibility for inclusion, data extraction, and study quality were evaluated by two reviewers using a standardised protocol. Effects sizes (r) were estimated using a random effects model. Thirty-eight studies were identified, generating a sample of 7365 stroke survivors (median age 63.02 years, range 25-93) followed for 3 to 132 months post-stroke. Overall cognition (all domains combined) demonstrated a significant small to medium association with QoL, r = 0.23 (95% CI 0.18-0.28), p < 0.001. The cognitive domains of speed, attention, visuospatial, memory, and executive skills, but not language, also demonstrated a significant relationship with QoL. Regarding caregiver outcomes, 15 studies were identified resulting in a sample of 2421 caregivers (median age 58.12 years, range 18-82) followed for 3 to 84 months post-stroke. Stroke survivor overall cognitive ability again demonstrated a significant small to medium association with caregiver outcomes (QoL and burden combined), r = 0.17 (95% CI 0.10-0.24), p < 0.001. In conclusion, lower post-stroke cognitive performance is associated with significant reductions in stroke survivor QoL and poorer caregiver outcomes. Cognitive assessment is recommended early to identify those at risk and implement timely interventions to support both stroke survivors and their caregivers.

Comparative Efficacy of Cognitive Training for Post-Stroke Aphasia: A Systematic Review and Network Meta-Analysis

BACKGROUND

Although cognitive training has shown potential for treating post-stroke aphasia (PSA), its efficacy varies across studies, and the optimal training approaches remain unclear.

OBJECTIVE

To evaluate and compare the effects of distinct cognitive training interventions, either combined with or independent of speech and language therapy (SLT), on language function in individuals with PSA.

METHODS

A systematic search encompassing PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure, Wanfang, VIP, and Chinese Biomedical Databases was conducted for randomized controlled trials (RCTs). A network meta-analysis evaluated interventions, including computer-assisted cognitive training (CCT), conventional cognitive training (CT), virtual reality (VR)-based cognitive training (vrCT), telerehabilitation computer-assisted cognitive training (tCCT), working memory (WM) training, and attention training (AT).

RESULTS

Eleven RCTs comprising 501 participants were included. Individuals with PSA who underwent combined WM training with SLT led to significantly enhanced Western Aphasia Battery (WAB) Aphasia Quotient (AQ), as well as in spontaneous speech, auditory comprehension, repetition, and naming, compared to those receiving SLT alone. This combination was more effective than both CCT with SLT and tCCT with SLT in improving WAB AQ. Similarly, it outperformed both CCT with SLT and vrCT with SLT in enhancing WAB spontaneous speech. Additionally, both AT and CT combined with SLT were more effective than SLT alone in enhancing WAB spontaneous speech. Specifically, AT combined with SLT proved more effective than vrCT with SLT in this area. Moreover, vrCT combined with SLT significantly improved auditory comprehension compared with SLT alone.

CONCLUSIONS

Combining WM training and SLT and integrating vrCT with SLT both significantly enhance language function in individuals with PSA, compared with SLT alone. Our findings advocate for the use of these cognitive training approaches as promising strategies for language rehabilitation in this population. PROSPERO registration number: CRD42023462361.

Efficacy and safety of DL-3-N-butylphthalide in the treatment of ischemic poststroke aphasia: A randomized clinical trial

OBJECTIVE

Poststroke aphasia (PSA) has a high prevalence and requires a long recovery period, severely impairing life and work. Its existing behavioral interventions, principally speech and language therapy, are limited by numerous factors. The aims of this study are to evaluate the efficacy and safety of DL-3-N-butylphthalein (NBP) and explore its mechanism in the treatment of ischemic PSA.

METHODS

Patients hospitalized in the Second Hospital of Hebei Medical University in China were randomly administered NBP soft capsules or placebo orally for 6 months from July 1, 2021, to February 25, 2023. Language skills were assessed using the Western Aphasia Battery-Aphasia Quotient (WAB-AQ). We collected plasma samples and detected neurotransmitters by liquid chromatography-mass spectrometry.

RESULTS

In total, 118 out of 124 patients were included in the outcome analysis. Compared with the control group, AQ values in the NBP group significantly improved at 6 months (U = 1187.5, p = 0.003). After eliminating baseline interference, NBP treatment was independently associated with the 6-month AQ improvement [mean difference (MD) 0.106, 95% confidence interval (CI) 0.018, 0.195, p = 0.019]. We observed no statistically significant difference between the groups in abnormal liver function at 1 month [relative risk (RR) 1.07, 95% CI 0.89, 1.28] and 6 months [RR 0.99, 95% CI 0.86, 1.42]. Statistically significant differences were observed in tyrosine (p = 0.043) and 5-hydroxytryptophan (p = 0.041) between the two groups.

INTERPRETATION

NBP treatment might promote the recovery of WAB-AQ in patients with ischemic PSA by increasing levels of monoamine neurotransmitters.

Microstructural properties in subacute aphasia: concurrent and prospective relationships underpinning recovery

BACKGROUND

Few investigations examined the relationship between microstructural white matter integrity and subacute post-stroke linguistic performance or the relationship between microstructural integrity and the recovery of language function. We examined two key questions: (1) How does subacute language performance, measured in single words and discourse, relate to the microstructural integrity of key white matter regions of interest in the language network? and (2) Does the integrity of these regions before treatment predict the improvement or resolution of linguistic symptoms immediately and chronically following treatment?

METHODS

58 participants within the first three months of stroke were enrolled in a randomized, single-center, double-blind, sham-controlled, study of anodal transcranial direct current stimulation combined with a computer-delivered speech and language naming therapy for subacute aphasia and were asked to complete magnetic resonance imaging at enrollment. Microstructural integrity was evaluated using diffusion tensor imaging processed with atlas-based segmentation. Regression and correlation analyses were conducted.

RESULTS

A subset of 22 participants received diffusion tensor imaging. Picture naming accuracy significantly correlated with lower mean diffusivity (higher microstructural integrity) in the left posterior inferior temporal gyrus. Recovery of naming performance was predicted by days since stroke and baseline microstructural integrity of the left posterior middle temporal gyrus, arcuate fasciculus, and superior longitudinal fasciculus. Recovery of discourse efficiency was significantly predicted by the same model.

CONCLUSIONS

This study demonstrates an association between picture naming and discourse and microstructural integrity of the key regions in the language network for patients with subacute post-stroke aphasia. Baseline microstructural integrity significantly predicts language recovery.

Does aphasia impact on return to driving after stroke? A scoping review

PURPOSE

Stroke can affect driving, an important activity of daily living. Little is known about whether aphasia (language impairment) impacts driving post-stroke. This scoping review explores impacts and perceived impacts of aphasia on driving performance, and the process of returning to driving post-stroke.

MATERIALS AND METHODS

Scoping review using Arksey and O'Malley's framework, reported using the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). Bibliographic databases were searched and international clinical practice guidelines were sourced online. Full-text articles were independently assessed by two reviewers. Results were tabulated and summarised using narrative synthesis.

RESULTS

Forty-three literature sources and 17 clinical practice guidelines were identified. Six studies investigated return to driving with aphasia post-stroke; 37 sources from the broader literature contributed to objectives. It remains unclear whether aphasia impacts fitness-to-drive; however, people with aphasia face barriers in returning to driving due to: (1) uncertainty regarding the role of language in driving; (2) poor awareness and knowledge of aphasia, and (3) communication demands in the patient-journey and assessment.

CONCLUSIONS

The current evidence base is limited, inconsistent, and lacking in quality and recency and there is a lack of guidelines to support clinical practice. People with aphasia face barriers in returning to driving; however, it is unclear if aphasia affects fitness-to-drive post-stroke. Implications for rehabilitationPeople with aphasia, their caregivers and clinicians have identified return to driving as a top 10 research priority.We do not know if aphasia affects fitness-to-drive post-stroke, but communication difficulties can make the process of returning to driving more difficult.Speech pathologists have an important role in ensuring that driving is discussed with people with aphasia post-stroke.Speech pathologists should support the multidisciplinary team to understand and meet the communication needs of people with aphasia throughout the driving evaluation process.

Aphasia disrupts usual care: "I'm not mad, I'm not deaf" - the experiences of individuals with aphasia and family members in hospital

PURPOSE

Communication difficulties are highly prevalent in the stroke population, with implications for patient experience, safety and outcomes. This study explores the experiences of people with aphasia and family members regarding healthcare communication in acute and subacute stroke settings.

METHODS AND MATERIALS

A phenomenological approach was used to understand participants' experiences. Participants took part in a focus group and data were analysed using an inductive thematic approach.

RESULTS

For individuals with aphasia (n = 4) and family members (n = 2), five themes were generated: "aphasia makes it hard to communicate," "hospital staff focus on the patient's medical status only," "people with aphasia do not get the help they need to improve," "staff lack the skills to communicate with people with aphasia," and "staff are crucial to improving healthcare communication."

CONCLUSIONS

The stroke team has expertise in the medical management of stroke but struggle to communicate with patients with aphasia. Patients' experience of healthcare communication is often one-way and limited to following instructions, with missed opportunities to discuss core topics such as prognosis, rehabilitation, and person-specific needs. Patients and families assert that all members of the stroke healthcare team should be able to adapt communication to accommodate patients.

Prevalence, predictors, and patterns of patient reported non-motor outcomes six months after stroke: a prospective cohort study

Background

Adverse non-motor outcomes have a major impact on patients and caregivers after stroke, but knowledge of their prevalence, predictors and patterns across multiple health domains remains limited; we therefore aimed to obtain these data in a large observational prospective cohort study.

Methods

We included data from the Stroke Investigation Group in North and Central London (SIGNAL) registry based at the University College London Hospitals (UCLH) Comprehensive Stroke Service which serves a multi-ethnic population of ∼1.6 million people. In adult patients diagnosed with acute stroke due to cerebral ischaemia or intracerebral haemorrhage (ICH) from January 2017 to January 2020 we evaluated non-motor outcomes (anxiety, depression, fatigue, sleep disturbance, social participation, pain, bowel dysfunction, bladder dysfunction, mood problems, communication problems, activities of daily living (ADL), memory and thinking problems) at 6-month follow-up. We evaluated baseline predictors in multivariable logistic regression, and correlations between domains using kappa statistics.

Findings

Follow-up was complete for 3080 of 3338 (92.3%) eligible surviving patients (2534 ischaemic stroke, 547 with ICH; mean age 71.2 years, 1379 (44.8%) female, 1774 (59.3%) white). The most prevalent adverse non-motor outcomes were fatigue 1756 (57%), reduced social participation 1694 (55%), sleep disturbance 1663 (54%), and constipation 1355 (44%). The rates of adverse non-motor outcomes in ⩾ 1, ⩾ 2, ⩾ 3, ⩾ 4, and ⩾ 5 domains were 2310 (75%), 1571 (51%), 1519 (49%), 1232 (40%), and 801 (26%), respectively. Factors associated with adverse non-motor outcomes included stroke due to ICH, stroke severity, previous stroke, or history of cardiovascular disease. We identified moderate correlations between fatigue and sleep disturbance (kappa = 0.72); memory and thinking impairment and reduced ADL (kappa = 0.68); and communication problems and ADL (kappa = 0.70).

Interpretation

Adverse non-motor outcomes are highly prevalent and often multiple at 6-months after stroke: 75% have at least one affected domain; fatigue, sleep disturbance, and reduced social participation each affect over 50% of survivors, and 26% of patients report ≥5 adverse outcomes. Our findings suggest an urgent need to better detect and mitigate these outcomes to improve quality of life after stroke.

Funding

The National Institute for Health and Care Research (NIHR) UCLH Biomedical Research Centre.

Quantitative analysis of the gaze and the kinetic/kinematic evaluation of expert and novice physical therapists during standing/sitting assistance: a pilot study

Introduction

In rehabilitation practices, expert therapists are believed to proficiently observe and assist patients. However, limited research has quantified the gaze behaviors of physical therapists during patient support. This study investigated the gaze patterns of expert and novice physical therapists from a first-person perspective during the process of assisting collaborators to stand. The aim was to determine which body parts received prolonged attention and to explore the characteristics of the support provided.

Methods

Seven experienced physical therapists were recruited as expert participants, and 17 physical therapy students served as novice participants. We also recruited additional students as collaborators and asked them to behave as if they were patients. Both expert and novice participants wore a wearable eye tracker while assisting the collaborators to stand. We analyzed the gaze focus on specific body parts and the center of mass sway of the collaborators.

Results

Experts spent 10.75% of the total time gazing at the head area, compared to 4.06% for novices, with experts displaying significantly longer gaze durations (p < .05). Furthermore, there was a significant difference in the number of gaze fixations, with experts averaging 25.71 fixations and novices 8.65 (p < .05). Experts also facilitated a slower sway in the collaborator's center of mass (0.44 m/s for experts vs. 0.49 m/s for novices; p < .01) and positioned the collaborator with a more pronounced trunk flexion during sitting and standing transitions (41.0 degrees for experts vs. 37.8 degrees for novices; p < .01).

Discussion

The findings suggest that experts may monitor the collaborator's center of mass position by focusing on the head area. Properly positioning the head forward may allow for optimal forward movement of the center of mass, potentially reducing the effort required by the collaborator to stand. This study is the first to explore differences in support strategies through the measurement of physical therapists' gaze during assistance.

Drivers of Depression in Chronic Post-Stroke Aphasia

Background

Approximately one third of stroke survivors develop post-stroke depression, which reduces quality of life. Previous studies have often focused on early phases of recovery and excluded people with significant aphasia. Here, we examine relationships of depression symptoms to demographic factors, and different types of stroke-related disability and impairment in adults with chronic left-hemisphere stroke and a history of aphasia.

Methods

92 chronic left-hemisphere stroke survivors with a history of aphasia and 70 controls participated in this cross-sectional study. The Beck Depression Inventory-II (BDI-II) measured depression symptoms. The Stroke Impact Scale 3.0 (SIS) assessed stroke-related disability in Cognitive, Physical, and Social Participation domains, as well as self-perceived Recovery. The Western Aphasia Battery Aphasia Quotient and the NIH Stroke Scale total motor score measured language and motor impairment. Spearman correlations examined bivariate relationships between variables. Ordinal regression models examined group differences in BDI-II scores (Model 1), and disability and impairment factors that predicted BDI-II scores (Model 2), accounting for demographic factors and antidepressant medication status.

Results

BDI-II scores were on average 3.4 points higher in stroke survivors than controls. Model 1 confirmed that this difference was significant, and found that age was inversely related to BDI-II scores. Bivariate correlations demonstrated that higher BDI-II scores were related to lower SIS Cognitive, Social Participation, and Recovery scores. Model 2 found that these three measures independently predicted BDI-II scores.

Conclusions

The factors related to depression may differ depending on the nature of the stroke, the types of deficits experienced, and the phase of recovery. In the chronic phase of left hemisphere stroke with aphasia, cognitive and communication disabilities, social participation, and self-perceived recovery are the primary correlates of depression symptoms. These findings highlight the importance of assessing for depression even long after left hemisphere stroke, and suggest potential targets for psychotherapy to improve depression.

Functional connectivity of stimulus-evoked brain responses to natural speech in post-stroke aphasia

Objective. One out of three stroke-patients develop language processing impairment known as aphasia. The need for ecological validity of the existing diagnostic tools motivates research on biomarkers, such as stimulus-evoked brain responses. With the aim of enhancing the physiological interpretation of the latter, we used EEG to investigate how functional brain network patterns associated with the neural response to natural speech are affected in persons with post-stroke chronic aphasia.Approach. EEG was recorded from 24 healthy controls and 40 persons with aphasia while they listened to a story. Stimulus-evoked brain responses at all scalp regions were measured as neural envelope tracking in the delta (0.5-4 Hz), theta (4-8 Hz) and low-gamma bands (30-49 Hz) using mutual information. Functional connectivity between neural-tracking signals was measured, and the Network-Based Statistics toolbox was used to: (1) assess the added value of the neural tracking vs EEG time series, (2) test between-group differences and (3) investigate any association with language performance in aphasia. Graph theory was also used to investigate topological alterations in aphasia.Main results. Functional connectivity was higher when assessed from neural tracking compared to EEG time series. Persons with aphasia showed weaker low-gamma-band left-hemispheric connectivity, and graph theory-based results showed a greater network segregation and higher region-specific node strength. Aphasia also exhibited a correlation between delta-band connectivity within the left pre-frontal region and language performance.Significance.We demonstrated the added value of combining brain connectomics with neural-tracking measurement when investigating natural speech processing in post-stroke aphasia. The higher sensitivity to language-related brain circuits of this approach favors its use as informative biomarker for the assessment of aphasia.

Validation of the abbreviated version of the Token Test in Latin American Spanish stroke patients

BACKGROUND

The abbreviated version of the Token Test (aTT) is widely used to assess language comprehension deficits in stroke patients (SPs). However, aTT has not been validated for Latin American Spanish speakers, so clinicians tend to use cut-off scores for aTT validated in developed countries.

AIMS

To provide normative data for the Spanish aTT (Sp-aTT) in healthy Chilean Spanish-speaking and SP, determining the influence of sociodemographic variables such as gender, age and education on Sp-aTT performance.

METHODS & PROCEDURES

A total of 210 healthy volunteers (age range = 18-88 years) and 197 SPs (age range = 23-94 years), all native speakers of Chilean Spanish, were recruited. The association of age, gender and years of education on the Sp-aTT performance was analysed. Specificity and sensibility analyses of the Sp-aTT to diagnose language comprehension deficits were completed.

OUTCOMES & RESULTS

Only age (p < 0.001) and years of education (p < 0.001) impacted the total score of Sp-aTT. Gender did not show an association with Sp-aTT performance (p = 0.181). For SPs, the Sp-aTT score showed a significant positive correlation (rho = 0.4, p < 0.001) with the aphasia severity rating scale (ASRS) score. For Sp-aTT, the area under the curve was 0.97, and the optimal cut-off score for the Sp-aTT was 30 (0.73 of sensitivity, 0.92 of specificity and a Youden index of 0.644).

CONCLUSIONS & IMPLICATIONS

Age and years of education are two key factors to be controlled for when determining the optimal cut-off points for the Sp-aTT. Our results also highlight the need for language-specific norms in stroke and aphasia research.

WHAT THIS PAPER ADDS

What is already known on the subject The aTT has been validated and adapted in several countries. Its properties in screening and detecting comprehensive deficits in SPs highlight its potential as a screening tool in clinical practice. Moreover, considering that stroke is the third largest cause of death worldwide, research and clinical practice have focused on how to improve early detection of deficits in these people, especially those related to cognition, language and functionality in SPs. Therefore, counting with validated and adapted tools is essential for clinicians because it could contribute to accurate intervention and classification of language disorders. What this paper adds to the existing knowledge The main contribution of this study is to provide normative data for the aTT in Latin American Spanish speakers. No previous studies have focused on validating this test and analysing the influence of three critical variables (age, gender and years of education) on its performance in SPs from Latin America. In addition, we propose a classification of the severity of comprehension deficits in SPs. Finally, we found comprehension deficits in patients with right and left hemisphere stroke, which would imply that these deficits would not be exclusive to left hemisphere stroke. What are the potential or actual clinical implications of this work? Contribute with validation of language comprehension tools, such as the aTT, could improve early diagnosis of patients with language disorders. This validation provides a test based on the sociodemographic characteristics of Latin American Speakers, which has yet to be established. Due to this, normative data considering the sociodemographic characteristics of the target population is crucial for accurately classifying comprehension deficits after brain damage.

Aberrant neural oscillations in poststroke aphasia

Neural oscillations are electrophysiological indicators of synchronous neuronal activity in the brain. Recent work suggests aberrant patterns of neuronal activity in patients with poststroke aphasia. Yet, there is a lack of systematic explorations of neural oscillations in poststroke aphasia. Investigating changes in the dynamics of neuronal activity after stroke may be helpful to identify neural markers of aphasia and language recovery and increase the current understanding of successful language rehabilitation. This review summarizes research on neural oscillations in poststroke aphasia and evaluates their potential as biomarkers for specific linguistic processes. We searched the literature through PubMed, Web of Science, and EBSCO, and selected 31 studies that met the inclusion criteria. Our analyses focused on neural oscillation activity in each frequency band, brain connectivity, and therapy-induced changes during language recovery. Our review highlights potential neurophysiological markers; however, the literature remains confounded, casting doubt on the reliability of these findings. Future research must address these confounds to confirm the robustness of cross-study findings on neural oscillations in poststroke aphasia.

Dissociation of White Matter Bundles in Different Recovery Measures in Poststroke Aphasia

BACKGROUND

Poststroke aphasia (PSA) recovery shows high variability across individuals and at different time points. Although diffusion biomarkers from the ventral and dorsal streams have demonstrated strong predictive power for language outcomes, it is still unclear how these biomarkers relate to the various stages of PSA recovery. In this study, we aim to compare diffusion metrics and language measures as predictors of language recovery in a longitudinal cohort of participants with PSA.

METHODS

Participants were recruited at a stroke unit at the emergency room, and underwent diffusion magnetic resonance imaging scanning and language assessment within 3 days (acute phase) after stroke, with behavioral follow-ups at subacute (10±3 days) and chronic phases (>6 months). We conducted regression analyses on language performance (cross-sectional), Δscores between all time points (acute-subacute, subacute-chronic, acute-chronic), and relative Δscores between all time points (Δscore/language baseline score), with acute diffusion metrics from language-related white matter tracts, lesion size, language baseline scores, and demographic data as predictors.

RESULTS

Thirty-nine participants presenting PSA were recruited, and 24 participants (mean age, 73 years; 8 women) completed the 3-time point assessment in total. The best prediction model of performance scores used axial diffusivity from the left arcuate fasciculus in both the subacute (R2=0.785) and chronic stages (R2=0.626). Moreover, the prediction of ∆scores depended on axial diffusivity from the left inferior frontal-occipital fasciculus in the subacute stage (R2=0.5) and depended additionally on axial diffusivity from the right inferior frontal-occipital fasciculus in the chronic stage (R2=0.68). The prediction of mediation analyses showed that the lesion load of the left arcuate fasciculus mediated the relationship between axial diffusivity from the left arcuate fasciculus and chronic language performance.

CONCLUSIONS

Language performance at subacute and chronic time points could be predicted by the integrity of the left arcuate fasciculus, whereas Δscores in the subacute and chronic phases depended on the left inferior frontal-occipital fasciculus, showing a dissociation of the white matter pathways about language outcomes. These results suggest a functional differentiation of the dual-stream components in PSA recovery.

Success rates of intensive aphasia therapy: real-world data from 448 patients between 2003 and 2020

BACKGROUND

Aphasia is a devastating consequence after stroke, affecting millions of patients each year. Studies have shown that intensive speech and language therapy (SLT) is effective in the chronic phase of aphasia. Leveraging a large single-center cohort of persons with aphasia (PWA) including patients also in the subacute phase, we assessed treatment effects of intensive aphasia therapy in a real-world setting.

METHODS

Data were collected at the Aachen aphasia ward in Germany between 2003 and 2020. Immediate treatment responses across different language domains were assessed with the Aachen Aphasia Test (AAT) using single-case psychometrics, conducted before and after 6-7 weeks of intensive SLT (10 h per week, median (IQR) dosage = 68 (61-76)). We adjusted for spontaneous recovery in subacute patients. Differential treatment effects between subgroups of chronicity and predictors of therapy response were investigated.

RESULTS

A total of 448 PWA were included (29% female, median (IQR) age = 54 (46-62) years, median (IQR) time post-onset = 11 (6-20) months) with 12% in the early subacute, 15% in the late subacute and 74% in the chronic phase of aphasia. The immediate responder rate was 59%. Significant improvements in all AAT subtests und subscales were observed hinting at broad effectiveness across language domains. The degree of therapy-induced improvement did not differ between the chronicity groups. Time post-onset, dosage of therapy and aphasia severity at the beginning of treatment were predictors of immediate treatment response.

DISCUSSION

Intensive therapy protocols for aphasia after stroke are yielding substantial responder rates in a routine clinical setting including a wide range of patients.

Self-efficacy and resilience in severe aphasia - an exploratory cross-sectional study of two psychosocial factors and their relation to functional communication

PURPOSE

Self-efficacy and resilience are important for various aspects of rehabilitation outcome after stroke. However, little is known about how these factors are affected and related to communication outcome in stroke survivors with aphasia. The purpose was to investigate self-efficacy and resilience, and associations to language and functional communication, in people with severe post-stroke aphasia.

MATERIALS AND METHODS

37 participants with severe aphasia rated their self-efficacy and resilience, using adapted versions of the existing instruments DLSES and CD-RISC. In addition, linguistic ability, executive function and functional communication were assessed.

RESULTS

Participants rated their self-efficacy and resilience as expected based on reports in the literature; somewhat lower than general populations and at similar levels as clinical populations. There were no association between self-efficacy, resilience and linguistic ability. In the sample as a whole, there were no associations between self-efficacy, resilience and functional communication. However, when results were stratified by executive function, associations emerged in the group with stronger executive function.

CONCLUSIONS

People with severe aphasia have decreased self-efficacy and resilience compared to general populations, but not necessarily in proportion to their language impairment. Among participants with relatively spared executive functions there were indications of an association between self-efficacy, resilience and functional communication.

Clinical efficacy and therapeutic mechanism of active 'five-tone' speech therapy compared with conventional speech-language therapy for treatment of post-stroke aphasia: protocol for a randomised controlled trial

INTRODUCTION

Aphasia is a common dysfunction among patients with stroke that can severely affect daily life. Listening to the 'five-tone' melodies of traditional Chinese medicine can improve some of the language functions of patients with post-stroke aphasia; however, passive listening may limit its clinical efficacy. In this study, we transform the passive listening five-tone melodic therapy of traditional Chinese medicine into an active five-tone speech therapy. This randomised controlled trial aims to investigate the clinical efficacy of active five-tone speech therapy in the treatment of post-stroke aphasia, such as language function, daily communication ability and communication efficiency, as well as investigate the therapeutic mechanism of this innovative therapy by electroencephalogram and MRI.

METHODS AND ANALYSIS

The study is a multicentric, randomised, parallel-assignment, single-blind treatment study. 70 participants will be recruited from the Rehabilitation Hospital Affiliated to Fujian University of Traditional Chinese Medicine and the Third People's Hospital Affiliated to Fujian University of Traditional Chinese Medicine and randomly assigned to two groups, the five-tone speech therapy group and the control group, at a 1:1 ratio. The control group will receive 20 sessions of conventional speech-language therapy, while the five-tone speech therapy group will receive 20 sessions of five-tone speech therapy in addition to conventional speech-language therapy. The primary outcome measure for this study will be the score on Western Aphasia Battery. Secondary outcomes include communicative abilities in daily living, percentage of correct information units and correct information units per minute, as well as resting-state electroencephalogram, event-related potentials and MRI data. All outcomes will be evaluated at 0 weeks (before intervention) and at 4 weeks (after 20 intervention sessions).

ETHICS AND DISSEMINATION

Ethical approval of this study was granted by the ethics committees of the Rehabilitation Hospital Affiliated to Fujian University of Traditional Chinese Medicine (2023KY-009-01) and the Third People's Hospital Affiliated to Fujian University of Traditional Chinese Medicine (2023-kl-010). Recruitment commenced on 24 April 2023. Informed consent will be obtained from all participants of the trial (or from their legal guardians, where applicable). The outcomes of the trial will be disseminated through peer-reviewed publications.

TRIAL REGISTRATION NUMBER

ChiCTR2300069257.