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Leaman MC, Edmonds LA. Pilot Results for ECoLoGiC-Tx: A New Conversation-Level Intervention Improving Language in People With Moderate to Severe Aphasia. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2024; 33:153-172. [PMID: 37934890 DOI: 10.1044/2023_ajslp-23-00141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2023]
Abstract
PURPOSE This study reports pilot data for a novel intervention, ECoLoGiC-Tx, delivered to four people with moderate to severe aphasia. ECoLoGiC-Tx addresses language and communication in unstructured, participant-led conversation. The speech-language pathologist (SLP) uses a framework to choose turns that facilitate a social interaction. When communication breakdown occurs, the SLP implements a least-to-most hierarchy to maximize the people with aphasia's (PWA's) independence in self-repair. ECoLoGiC-Tx draws its theoretical underpinnings from conversation analysis and theories of rehabilitation, including principles of complexity, neuroplasticity, and learning. METHOD Four PWA attended 60-min sessions twice weekly for 10 weeks. Assessment occurred at pretreatment, posttreatment, and 6-week maintenance. Outcomes included established discourse measures for conversation and monologue, tests of language and functional communication, and patient-/family-reported outcome measures (P/FROMs). Discourse samples were collected three times per assessment. Interrater reliability and fidelity for assessment and treatment procedures are reported. RESULTS Participants presented with Broca's aphasia (one moderate, one severe) or conduction aphasia (one moderate, one severe). Each demonstrated improvements in discourse, test batteries, and P/FROMs. They all demonstrated reduced aphasia severity measured by the Western Aphasia Battery-Revised at posttreatment or maintenance. Change in conversation and monologue was robust for three participants, but was mixed for one person (P1: moderate Broca's aphasia). P/FROMs indicated improvement at posttreatment and maintenance for all participants. Most treatment gains were maintained at 6-week follow-up. CONCLUSIONS This study provides promising results for ECoLoGiC-Tx to improve language function of people with chronic moderate to severe aphasia. Generalization occurred to tests, functional communication, spontaneous conversation, and structured monologue tasks.
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Affiliation(s)
| | - Lisa A Edmonds
- Teachers College, Columbia University, New York City, NY
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Azios JH, Lee JB, Sigur A, Archer B, Elman RJ. Online Aphasia Groups: Navigating Issues of Voice and Identity. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2024; 33:333-348. [PMID: 38085656 DOI: 10.1044/2023_ajslp-23-00186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
PURPOSE Participation in aphasia groups is associated with increased communication, reduced feelings of social isolation, and increased quality of life. Despite the growing popularity of online aphasia groups, little is known about how to manage conversation in this format. We examined online aphasia book club sessions to examine how the facilitator supported group members' participation in conversation. METHOD Interactional sociolinguistic discourse analysis was used to analyze the behaviors and actions of the facilitator and group members. Qualitative data for this study were drawn from four recorded online aphasia book club sessions held through a university's free aphasia clinic on the Zoom web-conferencing platform. RESULTS Sociolinguistic discourse analysis revealed strategic facilitator behaviors that served to (a) give members with varying levels of verbal language abilities voice, (b) foreground or background aspects of voice, and (c) minimize her own voice to promote interactional symmetry between herself and group members. CONCLUSIONS Identity formed the backdrop for facilitators' actions when leading online groups, guiding decisions about who got to talk, when, for how long, through what modality, and about what topics. A better understanding of the interactions that occur online, such as how to develop and protect the identities of group members, could equip facilitators with the tools necessary for facilitating positive, engaging aphasia therapy groups online.
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Obermeyer J, Edmonds L, Morgan J. Handwritten and Typed Discourse in People With Aphasia: Reference Data for Sequential Picture Description and Comparison of Performance Across Modality. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2023:1-16. [PMID: 38052054 DOI: 10.1044/2023_ajslp-22-00322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/07/2023]
Abstract
PURPOSE Writing can be completed by hand or by typing. Increasingly, functional and social activities are completed in the virtual domain, which often requires discourse level writing. Yet, there is a shortage of research on discourse writing in aphasia. The purpose of this study was to provide preliminary reference data for a sequential picture description task in writing by hand and typing for people with aphasia. Additionally, we examined individual modality differences when comparing handwritten and typed discourse. METHOD Fifteen people with mild-moderate aphasia participated in this study. They completed a sequential picture description task in handwriting and in typing. Discourse samples were coded for Correct Information Units (CIUs) and Complete Utterances. Measures of productivity were also evaluated (e.g., Total Words, Total Utterances). Participants completed a computer use questionnaire regarding their current and premorbid typing and computer use. RESULTS Preliminary reference data are reported. No significant differences were found at the group level for the measures evaluated. At the individual level, there was evidence of a modality effect for seven participants who demonstrated differences in the proportion of CIUs. CONCLUSIONS Although preliminary, these findings suggest that, at the group level, the handwritten and typed discourse produced by people with mild-moderate aphasia is similar. However, at the individual level, there is potential for modality differences. Consistent patterns of premorbid computer use, difficulty ratings, and individual differences in writing modes were not identified for the participants who demonstrated a modality effect. However, there was preliminary evidence that poststroke handedness may contribute to modality differences exhibited by some participants, which should be explored in future research. Additionally, these reference data are preliminary and further research is required from a more heterogeneous group of people with aphasia and to better establish assessment practices for discourse writing.
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Affiliation(s)
- Jessica Obermeyer
- Department of Communication Sciences and Disorders, University of North Carolina at Greensboro
| | - Lisa Edmonds
- Communication Sciences & Disorders, Teachers College, Columbia University, New York City, NY
| | - Jodi Morgan
- Brooks Rehabilitation Aphasia Center, Jacksonville, FL
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Tetnowski JT, Tetnowski JA, Damico JS. Looking at gesture: The reciprocal influence between gesture and conversation. JOURNAL OF COMMUNICATION DISORDERS 2023; 106:106379. [PMID: 37769381 DOI: 10.1016/j.jcomdis.2023.106379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Revised: 09/04/2023] [Accepted: 09/12/2023] [Indexed: 09/30/2023]
Abstract
INTRODUCTION There is limited research in group communication treatment for people with aphasia but existing studies report benefits of gesture to support conversation. Gesture supports conversation through recipient design features and reducing linguistic demands of lexical retrieval and formulation. Additionally, gesture serves an affiliative function. However, the relationship between gesture use and gestural capacity has not been widely examined. As part of a larger study on group cohesiveness and conversation, this investigation examined the patterns of co-speech gesture within authentic conversations among persons with aphasia to discern the functions of gesture use for the participants, changes in the use of gesture over time, and the relationship between gesture use and gesture ability. METHODS Conversation Analysis (CA) was applied in an embedded case-study design. Three participants received an academic semester of group and individual conversation-based treatment according to Facilitating Authentic Conversation (Damico et al., 2015). Four conversations from the treatment were selected and transcribed for multi-modality communication with CA conventions applied, and then cyclically analysed for patterns of gesture. RESULTS Participants demonstrated gesture that served social and linguistic functions: ratifying clinicians' proxy turns, turn-allocation, turn repair, relaying novel visual information, emphasizing content, demonstrating affiliation with the prior speaker, demonstrating their assessment others' talk, and demonstrating humor. All three participants showed an increased rate of gesture per turn and increasingly used gesture to repair conversation breakdown. Increased gesture use over the course of the semester coincided with increased scores for pantomime on the Porch Index of Communicative Ability (Porch, 1981, PICA). CONCLUSION Individuals with aphasia demonstrated increased use of gesture for varied purposes and improved gestural processing following a semester of conversation-based treatment. This is significant because gesture is an effective support for the repair of conversation breakdown typical of persons with aphasia.
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Affiliation(s)
- Jennifer Thompson Tetnowski
- University of Oklahoma Health Sciences Center, Department of Communication Sciences and Disorders, Oklahoma City, OK, USA.
| | - John A Tetnowski
- Oklahoma State University, Department of Communication Sciences and Disorders, Stillwater, OK, USA
| | - Jack S Damico
- University of Colorado Boulder, Department of Speech, Language, and Hearing Sciences, Boulder, CO, USA
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Dunne M, Hoover E, DeDe G. Efficacy of Aphasia Group Conversation Treatment via Telepractice on Language and Patient-Reported Outcome Measures. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2023; 32:2565-2579. [PMID: 37487551 PMCID: PMC10721252 DOI: 10.1044/2023_ajslp-22-00306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 01/06/2023] [Accepted: 04/04/2023] [Indexed: 07/26/2023]
Abstract
PURPOSE Conversation treatment for people with aphasia (PwA) can lead to significant changes in language impairment and quality of life. The COVID-19 pandemic has resulted in the greater use of telepractice treatment delivery. However, there is little evidence regarding the efficacy of telepractice conversation groups. This study investigated the effects of telepractice group conversation treatment on standardized measures of language function and socially oriented/patient-reported outcomes compared to in-person and no-treatment control data. METHOD This study used a mixed within- and between-groups design (repeated measure/pre-post treatment), with a single-subject delayed treatment design (Shadish & Rindskopf, 2007) to establish baseline, pretreatment, and posttreatment periods for the telepractice group. Telepractice results pre- and posttreatment were compared with historical in-person and no-treatment control data obtained from a larger randomized control trial (RCT) from DeDe et al. (2019). The historical comparison data were a subset of RCT participants from the same location and included six in-person participants and seven no-treatment control group participants. RESULTS Results of standardized testing conducted at baseline, pretreatment, and posttreatment intervals revealed significant improvement from pre- to posttreatment on repetition and picture description tasks for the telepractice group, and significant improvement from pre- to posttreatment on the Aphasia Communication Outcome Measure, total number of relevant utterances, and percentage of complete utterances for the in-person conversation group. No significant differences were observed in the no-treatment groups. CONCLUSIONS In contrast to the no-treatment condition, both the in-person and telepractice conditions showed the benefits of conversation group treatment. The in-person treatment condition showed improvements in a wider number of outcome measures than the telepractice condition. Overall, the results prompt further research regarding telepractice group conversation treatment for PwA.
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Hoover E, Bernstein-Ellis E, Meyerson D. Using bibliotherapy to rebuild identity for people with aphasia: A book club experience. JOURNAL OF COMMUNICATION DISORDERS 2023; 105:106363. [PMID: 37517172 DOI: 10.1016/j.jcomdis.2023.106363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 06/10/2023] [Accepted: 07/04/2023] [Indexed: 08/01/2023]
Abstract
BACKGROUND Aphasia book clubs were developed to support connecting with literature and reading for pleasure within an aphasia-friendly environment. Bibliotherapy is an evidence-based therapeutic approach, in which a book is selected to address the challenges facing the reader. Its aim is to facilitate a deeper understanding of a lived experience in order to promote healing, strategy development, and adjustment. Aphasia book clubs provide an opportunity to discuss books about the challenges associated with aphasia. A recent book, Identity theft: Rediscovering ourselves after stroke recounts the stroke recovery story of Dr. Debra Meyerson and 22 other stroke survivors. Identity Theft focuses on the need to reconstruct positive identities despite remaining disabilities to facilitate rebuilding rewarding lives. The purpose of this study is to understand the impact of reading Identity Theft in an aphasia book club for people with aphasia (PwA). METHOD 27 PwA read the book Identity Theft in one of four online aphasia book clubs offered by two universities. Weekly discussions were facilitated by graduate SLP students under the supervision of experienced clinicians. At the end of the 10 week program, semi-structured qualitative interviews were conducted with participants to understand the lived experience. Interviews were analyzed using reflexive thematic analysis. RESULTS Analysis of the interview data generated four main themes and 13 subthemes. The main themes included: Mechanism for Reflection, Power of Community, Engaged Learning, and Therapeutic Environment. Interview extracts illustrate the way these themes support increasing self-efficacy and rebuilding a positive identity. CONCLUSION The themes align positively with outcomes associated with the bibliotherapy process. Themes also integrate into a self-management model that promotes self-efficacy through education, support, awareness, problem solving and goal setting. Caveats included determining participant readiness to examine recovery issues and facilitator preparation. Aphasia book clubs surrounding psychosocial texts may help PwA reconstruct a positive post-stroke identity.
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Affiliation(s)
- Elizabeth Hoover
- Speech-Language and Hearing Sciences, Boston University, United States.
| | - Ellen Bernstein-Ellis
- Speech-Language and Hearing Sciences, California State University, East Bay, United States
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Donohue C, Carnaby G, Focht Garand KL. A Clinician's Guide to Critically Appraising Randomized Controlled Trials in the Field of Speech-Language Pathology. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2023; 32:411-425. [PMID: 36749981 DOI: 10.1044/2022_ajslp-22-00180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
PURPOSE When considering original research articles, randomized controlled trials (RCTs) provide the highest level of research evidence. Given this, RCTS are often used by clinicians performing evidence-based practice to determine the most effective intervention for a specific patient or patient population. Although RCTs represent a high level of research evidence, it is important for clinicians to critically appraise RCTs to determine the validity of the study methods deployed, the statistical and clinical significance of treatment effects, and whether or not the results generalize to a particular patient, patient population, and/or clinical setting. Therefore, this tutorial will provide clinicians with an overview of what an RCT is, the various types of RCTs, when RCTs are appropriate to conduct and/or use to inform clinical practice, and the advantages and limitations of RCTs. Additionally, this tutorial will provide clinicians with practical tools to employ when reading an RCT, including checklists with questions, definitions of important terminology frequently used in RCTs, and demonstrations of how to critically appraise RCTs using literature examples from the speech-language pathology literature. CONCLUSIONS Learning how to interpret and apply the results from RCTs to inform clinical practice for purposes of improving patient care is a critical evidence-based practice skill for clinicians to develop. This tutorial will assist clinicians in the field of speech-language pathology by furthering their fundamental knowledge of RCTs and by providing them with pragmatic tools to critically appraise RCTs to inform their clinical practice.
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Affiliation(s)
- Cara Donohue
- Aerodigestive Research Core Laboratory, University of Florida, Gainesville
- Department of Speech, Language, and Hearing Sciences, University of Florida, Gainesville
- Breathing Research and Therapeutics Center, University of Florida, Gainesville
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, TN
| | - Giselle Carnaby
- Department of Health Sciences, School of Health Professions, University of Texas Health Science Center, San Antonio
| | - Kendrea L Focht Garand
- Department of Speech Pathology and Audiology, College of Allied Health Professions, University of South Alabama, Mobile
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Kim H, Berube S, Hillis AE. Core lexicon in aphasia: A longitudinal study. APHASIOLOGY 2022; 37:1679-1691. [PMID: 37822874 PMCID: PMC10564387 DOI: 10.1080/02687038.2022.2121598] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 09/01/2022] [Accepted: 09/02/2022] [Indexed: 10/13/2023]
Abstract
Background General consensus exists between clinicians as to the incorporation of discourse outcome measures into language assessment for persons with aphasia (PWA). The development of core lexicon measures (CoreLex) has enabled clinicians to reduce time and labor intensive preparatory work for discourse analysis, which has been considered as an alternative measure to quantify word retrieval ability in discourse in a clinical context. Although previous studies have investigated the quality of the measure, CoreLex has rarely been longitudinally explored. Aims We aimed to investigate the adequacy of CoreLex to document linguistic changes in PWA over time. Specifically, we examined (1) whether natural language recovery from acute to chronic stages is manifested differentially by tasks and (2) the extent to which the ability to retrieve words in isolation predicts the ability to retrieve words in context. Methods A total of 19 PWA participated in the study. They completed a language assessment including confrontation naming tasks (Boston Naming Test [BNT] and Hopkins Action Naming Assessment [HANA]) and a picture description task using the Cookie Theft picture at acute and chronic stages. Discourse samples from the picture description task were quantified using CoreLex. Results We found significant differences across tasks and time-points by PWA. Moderate correlations between the confrontation naming tasks and CoreLex were found at the acute stage but not at the chronic stage. Additionally, McNemar's tests demonstrated a significant difference in PWA's performance in CoreLex from the acute to the chronic stages. Conclusions Our findings show that performance by PWA improves over time on all tasks, but language gains are manifested differentially by tasks. Performance in confrontation naming moderately predicts word retrieval in context acutely. However, lack of correlations between confrontation naming tasks and CoreLex later endorse inadequacy of using confrontation naming tasks as a proxy measure for discourse-level performance and improvement for PWA.
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Affiliation(s)
- Hana Kim
- Department of Communication Sciences and Disorders, University of South Florida, Tampa, FL 33620
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD 21287
| | - Shauna Berube
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD 21287
| | - Argye E. Hillis
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD 21287
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD 21287
- Department of Cognitive Science, Krieger School of Arts and Sciences, Johns Hopkins University, Baltimore, MD 21218
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