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Breitenstein C, Wallace SJ, Gilmore N, Finch E, Pettigrove K, Brady MC. Invaluable Benefits of 10 Years of the International Collaboration of Aphasia Trialists (CATs). Stroke 2024; 55:1129-1135. [PMID: 38527148 DOI: 10.1161/strokeaha.124.046487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 02/13/2024] [Indexed: 03/27/2024]
Abstract
Aphasia research has traditionally been considered a (unidisciplinary) niche topic in medical science. The international Collaboration of Aphasia Trialists (CATs) is a global collaboration of multidisciplinary aphasia researchers. Over the past 10 years, CATs has collectively taken a rigorous approach to systematically address persistent challenges to aphasia research quality. This article summarizes the achievements over the past decade. CATs' achievements include: standardizing terminology, advancing aphasia research design by aphasia expert consensus recommendations, developing a core data set and intervention descriptors, facilitating the involvement of people with the language impairment aphasia in the research process, translating, and adapting assessment tools into global languages, encouraging data sharing, developing innovative secondary data analysis methodologies and promoting the transparency and accessibility of high quality aphasia research reports. CATs' educational and scientific achievements over the past 10 years far exceed what individual researchers in the field could have ever achieved.
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Affiliation(s)
| | - Sarah J Wallace
- Queensland Aphasia Research Centre, Brisbane, Australia (S.J.W.)
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane,
Australia (S.J.W., E.F., M.C.B.)
| | - Natalie Gilmore
- Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital, Boston, MA (N.G.)
| | - Emma Finch
- Research and Innovation, West Moreton Health, Ipswich, Australia (E.F.)
- Speech Pathology Department, Princess Alexandra Hospital, Brisbane, Australia (E.F.)
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane,
Australia (S.J.W., E.F., M.C.B.)
| | - Kathryn Pettigrove
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University, Melbourne, Australia (K.P.)
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia (K.P.)
| | - Marian C Brady
- Nursing, Midwifery and Allied Health Professionals Research Unit, Glasgow Caledonian University, Glasgow, United Kingdom (M.C.B.)
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane,
Australia (S.J.W., E.F., M.C.B.)
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Kim J, Rose ML, Pierce JE, Nickels L, Copland DA, Togher L, Godecke E, Meinzer M, Rai T, Hurley M, Foster A, Carragher M, Wilcox C, Cadilhac DA. High-Intensity Aphasia Therapy Is Cost-Effective in People With Poststroke Aphasia: Evidence From the COMPARE Trial. Stroke 2024; 55:705-714. [PMID: 38328930 DOI: 10.1161/strokeaha.123.045183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 01/08/2024] [Indexed: 02/09/2024]
Abstract
BACKGROUND Evidence from systematic reviews confirms that speech and language interventions for people with aphasia during the chronic phase after stroke (>6 months) improve word retrieval, functional communication, and communication-related quality of life. However, there is limited evidence of their cost-effectiveness. We aimed to estimate the cost per quality-adjusted life year gained from 2 speech and language therapies compared with usual care in people with aphasia during the chronic phase (median, 2.9 years) after stroke. METHODS A 3-arm, randomized controlled trial compared constraint-induced aphasia therapy plus (CIAT-Plus) and multimodality aphasia therapy (M-MAT) with usual care in 216 people with chronic aphasia. Participants were administered a standardized questionnaire before intervention and at 12 weeks after the 2-week intervention/control period to ascertain health service utilization, employment changes, and informal caregiver burden. Unit prices from Australian sources were used to estimate costs in 2020. Quality-adjusted life years were estimated using responses to the EuroQol-5 Dimension-3 Level questionnaire. To test uncertainty around the differences in costs and outcomes between groups, bootstrapping was used with the cohorts resampled 1000 times. RESULTS Overall 201/216 participants were included (mean age, 63 years, 29% moderate or severe aphasia, 61 usual care, 70 CIAT-Plus, 70 M-MAT). There were no statistically significant differences in mean total costs ($13 797 usual care, $17 478 CIAT-Plus, $11 113 M-MAT) and quality-adjusted life years (0.19 usual care, 0.20 CIAT-Plus, 0.20 M-MAT) between groups. In bootstrapped analysis of CIAT-Plus, 21.5% of iterations were likely to result in better outcomes and be cost saving (dominant) compared with usual care. In contrast, 72.4% of iterations were more favorable for M-MAT than usual care. CONCLUSIONS We observed that both treatments, but especially M-MAT, may result in better outcomes at an acceptable additional cost, or potentially with cost savings. These findings are relevant in advocating for the use of these therapies for chronic aphasia after stroke.
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Affiliation(s)
- Joosup Kim
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences, Monash University, Clayton, Victoria, Australia (J.K., D.A. Cadilhac)
- Stroke Division, Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia (J.K., D.A. Cadilhac)
| | - Miranda L Rose
- School of Allied Health, Human Services and Sport (M.L.R., J.E.P., A.M., M.C., C.W.), Melbourne, Victoria, Australia
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University (M.L.R., J.E.P., M.H., A.F., M.C., C.W., D.A. Cadilhac), Melbourne, Victoria, Australia
| | - John E Pierce
- School of Allied Health, Human Services and Sport (M.L.R., J.E.P., A.M., M.C., C.W.), Melbourne, Victoria, Australia
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University (M.L.R., J.E.P., M.H., A.F., M.C., C.W., D.A. Cadilhac), Melbourne, Victoria, Australia
| | - Lyndsey Nickels
- School of Psychological Sciences, Macquarie University, Sydney, New South Wales, Australia (L.N.)
| | - David A Copland
- Queensland Aphasia Research Centre, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia (D.A. Copland)
- Surgical Treatment and Rehabilitation Service (STARS) Education and Research Alliance, The University of Queensland and Metro North Health, Australia (D.A. Copland)
| | - Leanne Togher
- Faculty of Medicine and Health, The University of Sydney, New South Wales, Australia (L.T.)
| | - Erin Godecke
- Edith Cowan University, Joondalup, Western Australia (E.G.)
| | - Marcus Meinzer
- Department of Neurology, University Medicine Greifswald, Germany (M.M.)
| | - Tapan Rai
- University of Technology Sydney, New South Wales, Australia (T.R.)
| | - Melanie Hurley
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University (M.L.R., J.E.P., M.H., A.F., M.C., C.W., D.A. Cadilhac), Melbourne, Victoria, Australia
| | - Abby Foster
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University (M.L.R., J.E.P., M.H., A.F., M.C., C.W., D.A. Cadilhac), Melbourne, Victoria, Australia
- Monash Health, Clayton, Victoria, Australia (A.F.)
- School of Primary & Allied Health Care, Monash University, Frankston, Victoria, Australia (A.F.)
| | - Marcella Carragher
- School of Allied Health, Human Services and Sport (M.L.R., J.E.P., A.M., M.C., C.W.), Melbourne, Victoria, Australia
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University (M.L.R., J.E.P., M.H., A.F., M.C., C.W., D.A. Cadilhac), Melbourne, Victoria, Australia
| | - Cassie Wilcox
- School of Allied Health, Human Services and Sport (M.L.R., J.E.P., A.M., M.C., C.W.), Melbourne, Victoria, Australia
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University (M.L.R., J.E.P., M.H., A.F., M.C., C.W., D.A. Cadilhac), Melbourne, Victoria, Australia
| | - Dominique A Cadilhac
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences, Monash University, Clayton, Victoria, Australia (J.K., D.A. Cadilhac)
- Stroke Division, Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia (J.K., D.A. Cadilhac)
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University (M.L.R., J.E.P., M.H., A.F., M.C., C.W., D.A. Cadilhac), Melbourne, Victoria, Australia
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Donadio DMDO, Simões-Zenari M, Santos THF, Sanchez MG, Molini-Avejonas DR, Cardilli-Dias D. Use of the Prompts for Reestructuring Oral Muscular Phonetic Targets (PROMPT) in Autism Spectrum Disorder: a case study. Codas 2023; 36:e20220299. [PMID: 38126591 PMCID: PMC10750890 DOI: 10.1590/2317-1782/20232022299pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 06/12/2023] [Indexed: 12/23/2023] Open
Abstract
Autism Spectrum Disorder (ASD) is classified by Diagnostic and Statistical Manual of Mental Disorders (DSM-5) as a neurodevelopmental disorder, whose characteristics are mainly deficits in social communication and a restricted range of interests. There are several studies about autism, speech, and language in the literature, but few correlate speech and autism. This study aims to carry out a case study that will address autism, speech, and PROMPT (Restructuring Oral Muscular Phonetic Targets) and also to describe the speech improvement in the participant with autism using the method. The target words were defined for the entire intervention according to the System Analysis Observation (SAO) and Motor Speech Hierarchy (MSH), which are parts of the PROMPT evaluation. After the evaluation, the participant was attended for 16 sessions, once weekly, with the objective of improving their speech. After analyzing the data, it was possible to observe improvement in all aspects outlined according to the pre-treatment evaluation of the method such as phonatory control, mandibular control, lip-facial control and lingual control as well as in the sequenced movement although this was not the aim outlined in the evaluation. It was also possible to measure the improvement of an adequate number of words, an adequate number of phonemes, percentages of correct consonants - revised (PCC-R), and intelligibility.
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Affiliation(s)
| | - Marcia Simões-Zenari
- Faculdade de Medicina, Universidade de São Paulo – USP - São Paulo (SP), Brasil.
| | - Thaís Helena Ferreira Santos
- Laboratório de Investigação Fonoaudiológica de Saúde Mental, Faculdade de Medicina, Universidade de São Paulo – USP - São Paulo (SP), Brasil.
| | | | | | - Daniela Cardilli-Dias
- Programa de Pós-graduação em Ciências da Reabilitação, Faculdade de Medicina, Universidade de São Paulo – USP - São Paulo (SP), Brasil.
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Harrison M, Palmer R, Cooper C. Identifying the Active Ingredients of a Computerized Speech and Language Therapy Intervention for Poststroke Aphasia: Multiple Methods Investigation Alongside a Randomized Controlled Trial. JMIR Rehabil Assist Technol 2023; 10:e47542. [PMID: 38051577 PMCID: PMC10731555 DOI: 10.2196/47542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 08/09/2023] [Accepted: 10/12/2023] [Indexed: 12/07/2023] Open
Abstract
BACKGROUND Aphasia is a communication disorder affecting more than one-third of stroke survivors. Computerized Speech and Language Therapy (CSLT) is a complex intervention requiring computer software, speech and language therapists, volunteers, or therapy assistants, as well as self-managed practice from the person with aphasia. CSLT was found to improve word finding, a common symptom of aphasia, in a multicenter randomized controlled trial (Clinical and Cost Effectiveness of Computer Treatment for Aphasia Post Stroke [Big CACTUS]). OBJECTIVE This study provides a detailed description of the CSLT intervention delivered in the Big CACTUS trial and identified the active ingredients of the intervention directly associated with improved word finding for people with aphasia. METHODS We conducted a multiple methods study within the context of a randomized controlled trial. In study 1, qualitative interviews explored key informants' understanding of the CSLT intervention, how the components interacted, and how they could be measured. Qualitative data were transcribed verbatim and analyzed thematically. Qualitative findings informed the process measures collected as part of a process evaluation of the CSLT intervention delivered in the Big CACTUS trial. In study 2, quantitative analyses explored the relationship between intervention process measures (length of computer therapy access; therapists' knowledge of CSLT; degree of rationale for CSLT tailoring; and time spent using the software to practice cued confrontation naming, noncued naming, and using words in functional sentences) and change in word-finding ability over a 6-month intervention period. RESULTS Qualitative interviews were conducted with 7 CSLT approach experts. Thematic analysis identified four overarching components of the CSLT approach: (1) the StepByStep software (version 5; Steps Consulting Ltd), (2) therapy setup: tailoring and personalizing, (3) regular independent practice, and (4) support and monitoring. Quantitative analyses included process and outcome data from 83 participants randomized to the intervention arm of the Big CACTUS trial. The process measures found to be directly associated with improved word-finding ability were therapists providing a thorough rationale for tailoring the computerized therapy exercises and the amount of time the person with aphasia spent using the computer software to practice using words in functional sentences. CONCLUSIONS The qualitative exploration of the CSLT approach provided a detailed description of the components, theories, and mechanisms underpinning the intervention and facilitated the identification of process measures to be collected in the Big CACTUS trial. Quantitative analysis furthered our understanding of which components of the intervention are associated with clinical improvement. To optimize the benefits of using the CSLT approach for word finding, therapists are advised to pay particular attention to the active ingredients of the intervention: tailoring the therapy exercises based on the individual's specific language difficulties and encouraging people with aphasia to practice the exercises focused on saying words in functional sentences. TRIAL REGISTRATION ISRCTN Registry ISRCTN68798818; https://www.isrctn.com/ISRCTN68798818.
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Affiliation(s)
- Madeleine Harrison
- Sheffield Centre for Health and Related Research, University of Sheffield, Sheffield, United Kingdom
| | - Rebecca Palmer
- Sheffield Centre for Health and Related Research, University of Sheffield, Sheffield, United Kingdom
| | - Cindy Cooper
- Sheffield Centre for Health and Related Research, University of Sheffield, Sheffield, United Kingdom
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Hsu SC, Wong AMK. Association between interruption of intervention and language performance in young children with language delay-a cohort study during COVID-19 pandemic. Front Pediatr 2023; 11:1240354. [PMID: 37780049 PMCID: PMC10540636 DOI: 10.3389/fped.2023.1240354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 08/17/2023] [Indexed: 10/03/2023] Open
Abstract
Introduction To assess the association between a three-month interruption of language intervention programs and the language performance of children with language delay during the COVID-19 pandemic, and to identify which children are more vulnerable to such interruptions. Materials and methods This is a retrospective study involving 33 children with language delay who experienced a three-month suspension of language interventions due to the COVID-19 pandemic. We collected their demographic data and language performance scores from the Comprehensive Developmental Inventory for Infants and Toddlers-Diagnostic test (CDIIT-DT) at four different time points. The scores were analyzed using a Wilcoxon Signed Ranks test. Results The median scores of language comprehension and overall language ability showed a decreasing trend during the interruption period. However, resuming interventions post-interruption showed a statistically significant increase in all language domains. Children in the borderline delay group (CDIIT-DT DQ scores between 71 and 85) were more likely to experience a decline in their language abilities during the interruption. Discussion This is the first study to reveal a decreasing trend in language performance during interruption periods, and highlighting the significance of post-interruption language interventions in facilitating improvements. Furthermore, our study brings attention to the heightened vulnerability of children exhibiting borderline language delay in overall language ability tests when faced with interruptions in language interventions.
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Affiliation(s)
- Shao-Chih Hsu
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Department of Physical Medicine and Rehabiltiation, New Taipei City Municipal Tucheng Hospital, Chang Gung Memorial Hospital, Tucheng branch, New Taipei City, Taiwan
| | - Alice May-Kuen Wong
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Department of Physical Medicine and Rehabiltiation, New Taipei City Municipal Tucheng Hospital, Chang Gung Memorial Hospital, Tucheng branch, New Taipei City, Taiwan
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Olthof-Nefkens MWLJ, Derksen EWC, Debets F, de Swart BJM, Nijhuis-van der Sanden MWG, Kalf JG. Com-mens: a home-based logopaedic intervention program for communication problems between people with dementia and their caregivers - a single-group mixed-methods pilot study. Int J Lang Commun Disord 2023; 58:704-722. [PMID: 36394262 DOI: 10.1111/1460-6984.12811] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 10/06/2022] [Indexed: 05/12/2023]
Abstract
BACKGROUND Communication difficulties are common in people with dementia, and often present from an early stage. However, direct treatment options for people with dementia that positively influence their daily communication are scarce. AIMS To evaluate the potential impact and feasibility of a personalized logopaedic intervention. METHODS & PROCEDURES A total of 40 community-dwelling persons with dementia and their caregivers were recruited. Five experienced speech and language therapists (SLTs) delivered the six-session Com-mens intervention at home. Com-mens aims to improve positive communication between people with dementia and their primary caregivers and comprises five elements: interactive history-taking, dynamic observational assessment, education about the consequences of dementia on communication, development and use of personalized communication tools, use motivational, and person-centred strategies by the SLT. We conducted a single-group mixed-methods pilot study with five measurements: baseline, directly after intervention, and at 3, 6 and 9 months follow-up. Semi-structured interviews and questionnaires for Experienced Communication in Dementia, quality of life, psychological well-being and caregiver burden were conducted. Process evaluation was performed by interviewing participants, drop-outs, SLTs and other stakeholders. OUTCOMES & RESULTS A total of 32 dyads completed the intervention. Repeated measures analyses revealed no significant changes over time. In the interviews, participants reported a positive impact on their feelings, increased communication skills and better coping with the diagnosis. Participants would recommend the intervention to others. Facilitators were timely delivery, personalized content and adequate reimbursement. Barriers were unfamiliarity with Com-mens among referrers, an overburdened caregiver or disrupted family relationships. CONCLUSIONS & IMPLICATIONS This newly developed logopaedic intervention is feasible and has a perceived positive impact on both people with dementia and their caregivers, which is confirmed by a stable pattern over a period of 1 year. Future comparative studies are needed to test the effectiveness of personalized interventions in this patient population. WHAT THIS PAPER ADDS What is already known on the subject? SLTs are experts in the field of communication, but even though communication problems are common between people with dementia and their caregivers, there is a lack of logopaedic guidelines and materials for the direct treatment for this population. Interventions that are available either focus on (professional) caregivers only or aim to enhance cognitive functioning and do not target on joined communication. What this paper adds to the existing knowledge? A newly developed intervention called Com-mens can be provided by trained SLTs and takes an average of six 1-h sessions. The intervention is perceived to be valuable and feasible for people with dementia and their caregivers, by the participants themselves, as well as by healthcare professionals and other stakeholders. What are the potential or actual clinical implications of this work? Dissemination of this intervention will give SLTs skills, tools and materials to provide meaningful care to home-dwelling persons with dementia and their caregivers. Also, persons with dementia and their caregivers will receive education and materials that can help them increase their understanding of communication problems, enhance their communication skills and better cope with the communication problems that result from dementia. We consider the Com-mens intervention to be a valuable addition to the field of speech language therapy and dementia.
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Affiliation(s)
- Maria W L J Olthof-Nefkens
- Zorggroep Maas & Waal, Beneden-Leeuwen, the Netherlands
- Radboud university medical center, Department of Primary and Community Care, Radboud Institute for Health Sciences, Nijmegen, the Netherlands
- Radboud university medical center, Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, the Netherlands
- Radboud university medical center, Radboudumc Alzheimer Center, Nijmegen, the Netherlands
| | - Els W C Derksen
- Radboud university medical center, Department of Primary and Community Care, Radboud Institute for Health Sciences, Nijmegen, the Netherlands
- Radboud university medical center, Radboudumc Alzheimer Center, Nijmegen, the Netherlands
| | - Frieda Debets
- Radboud university medical center, Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, the Netherlands
| | - Bert J M de Swart
- Radboud university medical center, Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, the Netherlands
| | - Maria W G Nijhuis-van der Sanden
- Radboud university medical center, Radboudumc Alzheimer Center, Nijmegen, the Netherlands
- Radboud university medical center, Radboud Institute for Health Sciences, Scientific Center for Quality of Care (IQ healthcare), Nijmegen, the Netherlands
| | - Johanna G Kalf
- Radboud university medical center, Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, the Netherlands
- Radboud university medical center, Radboudumc Alzheimer Center, Nijmegen, the Netherlands
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Mavragani A, Beeke S, Volkmer A, Dangerfield L, Bloch S. A Communication Partner Training Program Delivered via Telehealth for People Living With Parkinson's (Better Conversations With Parkinson's): Protocol for a Feasibility Study. JMIR Res Protoc 2023; 12:e41416. [PMID: 36735301 PMCID: PMC9938441 DOI: 10.2196/41416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 11/17/2022] [Accepted: 12/05/2022] [Indexed: 12/09/2022] Open
Abstract
BACKGROUND Parkinson's can impact people's speech, cognition, pragmatics, and language, significantly affecting their conversations with others. The speech and language therapy approach called communication partner training (CPT) is effective for a range of communication difficulties. However, speech and language therapy interventions for people with Parkinson's predominantly focus on impairments, with little provision of CPT for this population. Better Conversations is a CPT approach that involves working with a dyad (the person with the communication difficulty and a conversation partner [CP]) to build conversation skills. It is effective at reducing barriers to conversation, and for some, it significantly increases targeted facilitatory strategies. Some approaches to CPT have been adapted to be delivered via telehealth. This can maximize ecological validity and convenience. Furthermore, telehealth is widely accepted as a delivery method for other interventions for Parkinson's. This study presents the protocol for a pilot feasibility study of a Better Conversations CPT delivered via telehealth to people living with Parkinson's and their CPs, called Better Conversations with Parkinson's (BCP). OBJECTIVE The primary aim is to evaluate the feasibility of the BCP program delivered via telehealth with a treatment group from a collaborating National Health Service (NHS) site to establish for a main trial whether BCP can be delivered as intended in an NHS setting. The aim is to establish: (1) the acceptability of the program for people living with Parkinson's, family members, and speech and language therapists (SLTs); (2) the feasibility of delivering the BCP program; (3) the recruitment and retention rates; (4) a sample size calculation; and (5) the most appropriate primary outcome measure. METHODS Ethical approval for this study was obtained from London-Central Research Ethics Committee (reference: 22/LO/0332). This case-series feasibility pilot study will recruit 10-12 dyads to ensure 10 complete data sets. Participants will be recruited by a collaborating NHS site located in England. Participants will be involved for 16 weeks (weeks 1-2 preintervention measures, weeks 3-8 intervention, weeks 10-12 postintervention measures, week 16 follow-up interview). Quantitative and qualitative methods will be used to analyze the study data. Speech, communication, and quality of life assessment data will be analyzed statistically to determine a suitably sensitive outcome measure. Descriptive statistics will be used to report on recruitment, attendance, and attrition. Finally, acceptability and feasibility will be evaluated using participant feedback, interviews, and the reflective diary and feedback of the SLT administering the therapy (by the research assistant who is the first author). This data will be analyzed using descriptive statistics and reflexive thematic analysis. RESULTS This study was approved for funding from Parkinson's UK. Study recruitment commenced in July 2022. The results of the data analysis are expected to be available by September 2024. CONCLUSIONS Insights from this study will provide valuable information about the acceptability and feasibility of a remotely delivered Better Conversations CPT approach for people living with Parkinson's and their CPs. An outcome of this study will be a manualized BCP program coproduced by people living with Parkinson's, their families, and a group of expert SLTs. The study results will guide the next stages of intervention development. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/41416.
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Affiliation(s)
| | - Suzanne Beeke
- Division of Psychology and Language Sciences, University College London, London, United Kingdom
| | - Anna Volkmer
- Division of Psychology and Language Sciences, University College London, London, United Kingdom
| | - Lynn Dangerfield
- Adult Community Speech and Language Therapy, Solent NHS Trust, Portsmouth, United Kingdom
| | - Steven Bloch
- Division of Psychology and Language Sciences, University College London, London, United Kingdom
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Zumbansen A, Kneifel H, Lazzouni L, Ophey A, Black SE, Chen JL, Edwards D, Funck T, Hartmann AE, Heiss WD, Hildesheim F, Lanthier S, Lespérance P, Mochizuki G, Paquette C, Rochon E, Rubi-Fessen I, Valles J, Wortman-Jutt S, Thiel A. Differential Effects of Speech and Language Therapy and rTMS in Chronic Versus Subacute Post-stroke Aphasia: Results of the NORTHSTAR-CA Trial. Neurorehabil Neural Repair 2022; 36:306-316. [PMID: 35337223 PMCID: PMC9003806 DOI: 10.1177/15459683211065448] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background & objective Contralesional 1-Hz repetitive transcranial magnetic stimulation (rTMS) over the right pars triangularis combined with speech-language therapy (SLT) has shown positive results on the recovery of naming in subacute (5–45 days) post-stroke aphasia. NORTHSTAR-CA is an extension of the previously reported NORTHSTAR trial to chronic aphasia (>6 months post-stroke) designed to compare the effectiveness of the same rTMS protocol in both phases. Methods Sixty-seven patients with left middle cerebral artery infarcts (28 chronic, 39 subacute) were recruited (01-2014 to 07-2019) and randomized to receive rTMS (N = 34) or sham stimulation (N = 33) with SLT for 10 days. Primary outcome variables were Z-score changes in naming, semantic fluency and comprehension tests and adverse event frequency. Intention-to-treat analyses tested between-group effects at days 1 and 30 post-treatment. Chronic and subacute results were compared. Results Adverse events were rare, mild, and did not differ between groups. Language outcomes improved significantly in all groups irrespective of treatment and recovery phase. At 30-day follow-up, there was a significant interaction of stimulation and recovery phase on naming recovery (P <.001). Naming recovery with rTMS was larger in subacute (Mdn = 1.91/IQR = .77) than chronic patients (Mdn = .15/IQR = 1.68/P = .015). There was no significant rTMS effect in the chronic aphasia group. Conclusions The addition of rTMS to SLT led to significant supplemental gains in naming recovery in the subacute phase only. While this needs confirmation in larger studies, our results clarify neuromodulatory vs training-induced effects and indicate a possible window of opportunity for contralesional inhibitory stimulation interventions in post-stroke aphasia. NORTHSTAR trial registration https://clinicaltrials.gov/ct2/show/NCT02020421.
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Affiliation(s)
- Anna Zumbansen
- Jewish General Hospital, 5620McGill University, Montreal, QC, Canada.,School of Rehabilitation Sciences, 6363University of Ottawa, Ottawa, ON, Canada
| | - Heike Kneifel
- Jewish General Hospital, 5620McGill University, Montreal, QC, Canada.,School of Rehabilitation Sciences, 6363University of Ottawa, Ottawa, ON, Canada
| | - Latifa Lazzouni
- Jewish General Hospital, 5620McGill University, Montreal, QC, Canada
| | - Anja Ophey
- Jewish General Hospital, 5620McGill University, Montreal, QC, Canada
| | - Sandra E Black
- Department of Medicine-Neurology and Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, Sunnybrook Research Institute, 177420University of Toronto, Toronto, ON, Canada.,KITE Research Institute, Toronto Rehabilitation Institute, 177420University Health Network, University of Toronto, Toronto, ON, Canada
| | - Joyce L Chen
- Faculty of Kinesiology and Physical Education, and Rehabilitation Sciences Institute, 177420University of Toronto, Toronto, ON, Canada
| | - Dylan Edwards
- 10997Burke Neurological Institute, White Plains, NY, USA.,Moss Rehabilitation Research Institute, Elkins Park, PA, USA.,Edith Cowan University, Joondalup, WA, Australia
| | - Thomas Funck
- Jewish General Hospital, 5620McGill University, Montreal, QC, Canada
| | - Alexander Erich Hartmann
- Hospital of the City of Cologne and Department of Neurosurgery, 163483University of Witten-Herdecke, Germany
| | - Wolf-Dieter Heiss
- Max Planck Institute für Stoffwechsel Forschung - MPI for Metabolism Research, and 28302Universität zu Köln, Cologne, Germany
| | - Franziska Hildesheim
- Jewish General Hospital, 5620McGill University, Montreal, QC, Canada.,Canadian Platform for Trials in Non-invasive Brain Stimulation (CanSTIM), Montreal, QC, Canada
| | - Sylvain Lanthier
- Hôpital du Sacré-Cœur de Montreal, 12368Université de Montréal, Montreal, QC, Canada
| | | | - George Mochizuki
- School of Kinesiology and Health Science, 56014York University, Toronto, ON, Canada
| | - Caroline Paquette
- Jewish General Hospital, 5620McGill University, Montreal, QC, Canada
| | - Elizabet Rochon
- KITE Research Institute, Toronto Rehabilitation Institute, 177420University Health Network, University of Toronto, Toronto, ON, Canada
| | - Ilona Rubi-Fessen
- RehaNova, Neurological Rehabilitation Clinic, Cologne, Germany.,Department of Special Education and Rehabilitation, Faculty of Human Sciences, 14309University of Cologne, Cologne, Germany
| | - Jennie Valles
- 10997Burke Rehabilitation Hospital, White Plains, NY, USA
| | - Susan Wortman-Jutt
- 10997Burke Neurological Institute, White Plains, NY, USA.,10997Burke Rehabilitation Hospital, White Plains, NY, USA
| | - Alexander Thiel
- Jewish General Hospital, 5620McGill University, Montreal, QC, Canada.,Canadian Platform for Trials in Non-invasive Brain Stimulation (CanSTIM), Montreal, QC, Canada
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9
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Herrmann O, Ficek B, Webster KT, Frangakis C, Spira AP, Tsapkini K. Sleep as a predictor of tDCS and language therapy outcomes. Sleep 2022; 45:zsab275. [PMID: 34875098 PMCID: PMC8919198 DOI: 10.1093/sleep/zsab275] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 10/01/2021] [Indexed: 12/17/2022] Open
Abstract
STUDY OBJECTIVES To determine whether sleep at baseline (before therapy) predicted improvements in language following either language therapy alone or coupled with transcranial direct current stimulation (tDCS) in individuals with primary progressive aphasia (PPA). METHODS Twenty-three participants with PPA (mean age 68.13 ± 6.21) received written naming/spelling therapy coupled with either anodal tDCS over the left inferior frontal gyrus (IFG) or sham condition in a crossover, sham-controlled, double-blind design (ClinicalTrials.gov identifier: NCT02606422). The outcome measure was percent of letters spelled correctly for trained and untrained words retrieved in a naming/spelling task. Given its particular importance as a sleep parameter in older adults, we calculated sleep efficiency (total sleep time/time in bed x100) based on subjective responses on the Pittsburgh Sleep Quality Index (PSQI). We grouped individuals based on a median split: high versus low sleep efficiency. RESULTS Participants with high sleep efficiency benefited more from written naming/spelling therapy than participants with low sleep efficiency in learning therapy materials (trained words). There was no effect of sleep efficiency in generalization of therapy materials to untrained words. Among participants with high sleep efficiency, those who received tDCS benefitted more from therapy than those who received sham condition. There was no additional benefit from tDCS in participants with low sleep efficiency. CONCLUSION Sleep efficiency modified the effects of language therapy and tDCS on language in participants with PPA. These results suggest sleep is a determinant of neuromodulation effects.Clinical Trial: tDCS Intervention in Primary Progressive Aphasia https://clinicaltrials.gov/ct2/show/NCT02606422.
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Affiliation(s)
- Olivia Herrmann
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Bronte Ficek
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Kimberly T Webster
- Department of Otolaryngology, Head & Neck Surgery, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Constantine Frangakis
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA
- Department of Biostatistics, Johns Hopkins School of Public Health, Baltimore, MD, USA
- Department of Radiology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Adam P Spira
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Johns Hopkins Center on Aging and Health, Baltimore, MD, USA
| | - Kyrana Tsapkini
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, USA
- Department of Cognitive Science, The Johns Hopkins University, Baltimore, MD, USA
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10
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Du Y, Choe S, Vega J, Liu Y, Trujillo A. Listening to Stakeholders Involved in Speech- Language Therapy for Children With Communication Disorders: Content Analysis of Apple App Store Reviews. JMIR Pediatr Parent 2022; 5:e28661. [PMID: 35060912 PMCID: PMC8817219 DOI: 10.2196/28661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 10/09/2021] [Accepted: 11/01/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND With the plethora of mobile apps available on the Apple App Store, more speech-language pathologists (SLPs) have adopted apps for speech-language therapy services, especially for pediatric clients. App Store reviews are publicly available data sources that can not only create avenues for communication between technology developers and consumers but also enable stakeholders such as parents and clinicians to share their opinions and view opinions about the app content and quality based on user experiences. OBJECTIVE This study examines the Apple App Store reviews from multiple key stakeholders (eg, parents, educators, and SLPs) to identify and understand user needs and challenges of using speech-language therapy apps (including augmentative and alternative communication [AAC] apps) for pediatric clients who receive speech-language therapy services. METHODS We selected 16 apps from a prior interview study with SLPs that covered multiple American Speech-Language-Hearing Association Big Nine competencies, including articulation, receptive and expressive language, fluency, voice, social communication, and communication modalities. Using an automatic Python (Python Software Foundation) crawler developed by our research team and a Really Simple Syndication feed generator provided by Apple, we extracted a total of 721 app reviews from 2009 to 2020. Using qualitative coding to identify emerging themes, we conducted a content analysis of 57.9% (418/721) reviews and synthesized user feedback related to app features and content, usability issues, recommendations for improvement, and multiple influential factors related to app design and use. RESULTS Our analyses revealed that key stakeholders such as family members, educators, and individuals with communication disorders have used App Store reviews as a platform to share their experiences with AAC and speech-language apps. User reviews for AAC apps were primarily written by parents who indicated that AAC apps consistently exhibited more usability issues owing to violations of design guidelines in areas of aesthetics, user errors, controls, and customization. Reviews for speech-language apps were primarily written by SLPs and educators who requested and recommended specific app features (eg, customization of visuals, recorded feedback within the app, and culturally diverse character roles) based on their experiences working with a diverse group of pediatric clients with a variety of communication disorders. CONCLUSIONS To our knowledge, this is the first study to compile and analyze publicly available App Store reviews to identify areas for improvement within mobile apps for pediatric speech-language therapy apps from children with communication disorders and different stakeholders (eg, clinicians, parents, and educators). The findings contribute to the understanding of apps for children with communication disorders regarding content and features, app usability and accessibility issues, and influential factors that impact both AAC apps and speech-language apps for children with communication disorders who need speech therapy.
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Affiliation(s)
- Yao Du
- Monmouth University, West Long Branch, NJ, United States
| | - Sarah Choe
- California State University, Fullerton, Fullerton, CA, United States
| | - Jennifer Vega
- Long Beach Unified School District, Long Beach, CA, United States
| | - Yusa Liu
- San Francisco State University, San Francisco, CA, United States
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11
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REhabilitation and recovery of peopLE with Aphasia after StrokE (RELEASE) Collaborators. Dosage, Intensity, and Frequency of Language Therapy for Aphasia: A Systematic Review-Based, Individual Participant Data Network Meta-Analysis. Stroke 2021;:STROKEAHA121035216. [PMID: 34847708 DOI: 10.1161/STROKEAHA.121.035216] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Supplemental Digital Content is available in the text. Optimizing speech and language therapy (SLT) regimens for maximal aphasia recovery is a clinical research priority. We examined associations between SLT intensity (hours/week), dosage (total hours), frequency (days/week), duration (weeks), delivery (face to face, computer supported, individual tailoring, and home practice), content, and language outcomes for people with aphasia.
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12
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Suárez-González A, Savage SA, Bier N, Henry ML, Jokel R, Nickels L, Taylor-Rubin C. Semantic Variant Primary Progressive Aphasia: Practical Recommendations for Treatment from 20 Years of Behavioural Research. Brain Sci 2021; 11:1552. [PMID: 34942854 DOI: 10.3390/brainsci11121552] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 11/15/2021] [Accepted: 11/16/2021] [Indexed: 12/01/2022] Open
Abstract
People with semantic variant primary progressive aphasia (svPPA) present with a characteristic progressive breakdown of semantic knowledge. There are currently no pharmacological interventions to cure or slow svPPA, but promising behavioural approaches are increasingly reported. This article offers an overview of the last two decades of research into interventions to support language in people with svPPA including recommendations for clinical practice and future research based on the best available evidence. We offer a lay summary in English, Spanish and French for education and dissemination purposes. This paper discusses the implications of right- versus left-predominant atrophy in svPPA, which naming therapies offer the best outcomes and how to capitalise on preserved long-term memory systems. Current knowledge regarding the maintenance and generalisation of language therapy gains is described in detail along with the development of compensatory approaches and educational and support group programmes. It is concluded that there is evidence to support an integrative framework of treatment and care as best practice for svPPA. Such an approach should combine rehabilitation interventions addressing the language impairment, compensatory approaches to support activities of daily living and provision of education and support within the context of dementia.
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13
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Suárez‐González A, Cassani A, Gopalan R, Stott J, Savage S. When it is not primary progressive aphasia: A scoping review of spoken language impairment in other neurodegenerative dementias. Alzheimers Dement (N Y) 2021; 7:e12205. [PMID: 34485677 PMCID: PMC8409087 DOI: 10.1002/trc2.12205] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Progressive difficulties with spoken language occur across the spectrum of degenerative dementia. When not a primary presenting and dominant symptom, language difficulties may be overlooked in favor of more prominent cognitive, behavior, or motor deficits. The aim of this scoping review is to examine the extent and nature of the research evidence describing (1) the spoken language impairments found in non-language led dementias, (2) their impact on everyday living, and (3) the reported language interventions. METHODS We searched PubMed, MEDLINE, OVID-EMBASE, PsycINFO, and SpeechBITE using terms related to spoken language for the following dementia types: Parkinson's disease dementia (PDD), dementia with Lewy bodies (DLB), progressive supranuclear palsy (PSP), cortico-basal syndrome (CBS), behavior variant frontotemporal dementia (bvFTD), early-onset Alzheimer's disease (EOAD), posterior cortical atrophy (PCA), and motor neuron disease associated with FTD (MND+FTD). Risk of bias was assessed with the QualSyst tool. RESULTS Seventy-three eligible studies were included. A wide range of spoken language impairments were reported, involving both linguistic (e.g., syntactic processing) and other cognitive (e.g., sustained attention) underlying mechanisms. Although the severity of these deficits was scarcely reported, in some cases they manifested as non-fluent, dynamic, and global aphasias. No papers in the review described either the impact of these language impairments on everyday living or language therapies to treat them. DISCUSSION There is a need to understand better the level of disability produced by language impairment in people living with non-language-led dementias. Our findings suggest three calls for action: (1) research studies should assess the clinical relevance of any spoken language deficits examined, (2) both linguistic and cognitive underlying mechanisms should be fully described (to inform the design of effective language and behavioral interventions), and (3) trials of language therapy should be conducted in those groups of individuals where significant language impairment is proved.
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Affiliation(s)
- Aida Suárez‐González
- Dementia Research CentreUCL Queen Square Institute of NeurologyUniversity College LondonLondonUK
| | - Alice Cassani
- Discipline of PsychologyWashington Singer LaboratoriesUniversity of ExeterExeterUK
| | - Ragaviveka Gopalan
- Discipline of PsychologyWashington Singer LaboratoriesUniversity of ExeterExeterUK
| | - Joshua Stott
- Research Department of ClinicalEducational and Health PsychologyUniversity College LondonLondonUK
| | - Sharon Savage
- School of PsychologyUniversity of NewcastleNewcastleNew South WalesAustralia
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14
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Liu M, Qian Q, Wang W, Chen L, Wang L, Zhou Y, Xu S, Wu J, Feng T, Zhu Z, Xiang J. Improvement in Language Function in Patients with Aphasia using Computer-Assisted Executive Function Training: A Controlled Clinical Trial. PM R 2021; 14:913-921. [PMID: 34310072 DOI: 10.1002/pmrj.12679] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 06/13/2021] [Accepted: 07/02/2021] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Non-verbal cognitive training has gained popularity for the management of aphasia. The correlation between language function and cognitive control has been explored previously. Cognitive status affects language to a certain degree. In this study, we aimed to determine whether non-verbal computer-assisted executive control training (CAET) to improve cognitive status affects language performance in patients with aphasia (PWA). DESIGN A total of 73 participants were included in the study, and 5 subjects dropped out. A total of 68 individuals were randomly divided into two groups and underwent treatment. The experimental group was treated with traditional speech and language therapy (SLT) combined with CAET. The control group underwent SLT only. RESULTS Differences between pre- and post-treatment language outcomes expect oral naming (group × time, P = 0.236) were significantly greater in the experimental group compared with the control group: Spontaneous speech (group × time, P = 0.026), Auditory Comprehension (group × time, P < 0.001), Speech repetition (group × time, P = 0.001), AQ (group × time, P < 0.001). A similar effect was observed for cognitive function such as TMT-A (group × time, P = 0.006), TMT-B (group × time, P = 0.005) and VFT-V (group × time, P = 0.018). CONCLUSION Our study demonstrates that CAET combined with SLT can yield favorable language outcomes for PWA, especially improvements in auditory comprehension and AQ. CAET combined with SLT generates benefits in both cognitive function and language performance. Therefore, CAET may be applied as an adjuvant aphasia therapy in conjunction with traditional SLT. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Mengting Liu
- Department of Rehabilitation, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China.,Medical Technology School, Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Qiuchen Qian
- Department of Rehabilitation, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China.,Medical Technology School, Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Wei Wang
- Department of Rehabilitation, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China.,Medical Technology School, Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Lu Chen
- Department of Rehabilitation, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Lingmin Wang
- Department of Rehabilitation, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Yeqing Zhou
- Department of Rehabilitation, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Siwei Xu
- Department of Rehabilitation, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Jie Wu
- Department of Rehabilitation, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Tao Feng
- Department of Rehabilitation, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Zude Zhu
- School of Linguistic Sciences and Arts, Jiangsu Normal University, Xuzhou, China
| | - Jie Xiang
- Department of Rehabilitation, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China.,Medical Technology School, Xuzhou Medical University, Xuzhou, Jiangsu, China
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15
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Rechowicz KJ, Shull JB, Hascall MM, Diallo SY, O'Brien KJ. Internet-of-Things Devices in Support of the Development of Echoic Skills among Children with Autism Spectrum Disorder. Sensors (Basel) 2021; 21:4621. [PMID: 34283166 DOI: 10.3390/s21134621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 06/23/2021] [Accepted: 07/01/2021] [Indexed: 11/18/2022]
Abstract
A significant therapeutic challenge for people with disabilities is the development of verbal and echoic skills. Digital voice assistants (DVAs), such as Amazon’s Alexa, provide networked intelligence to billions of Internet-of-Things devices and have the potential to offer opportunities to people, such as those diagnosed with autism spectrum disorder (ASD), to advance these necessary skills. Voice interfaces can enable children with ASD to practice such skills at home; however, it remains unclear whether DVAs can be as proficient as therapists in recognizing utterances by a developing speaker. We developed an Alexa-based skill called ASPECT to measure how well the DVA identified verbalization by autistic children. The participants, nine children diagnosed with ASD, each participated in 30 sessions focused on increasing vocalizations and echoic responses. Children interacted with ASPECT prompted by instructions from an Echo device. ASPECT was trained to recognize utterances and evaluate them as a therapist would—simultaneously, a therapist scored the child’s responses. The study identified no significant difference between how ASPECT and the therapists scored participants; this conclusion held even when subsetting participants by a pre-treatment echoic skill assessment score. This indicates considerable potential for providing a continuum of therapeutic opportunities and reinforcement outside of clinical settings.
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16
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Peñaloza C, Scimeca M, Gaona A, Carpenter E, Mukadam N, Gray T, Shamapant S, Kiran S. Telerehabilitation for Word Retrieval Deficits in Bilinguals With Aphasia: Effectiveness and Reliability as Compared to In-person Language Therapy. Front Neurol 2021; 12:589330. [PMID: 34093382 PMCID: PMC8172788 DOI: 10.3389/fneur.2021.589330] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 03/29/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Bilinguals with post-stroke aphasia (BWA) require treatment options that are sensitive to their particular bilingual background and deficits across languages. However, they may experience limited access to bilingual clinical resources due to reduced availability of bilingual practitioners, geographical constraints, and other difficulties. Telerehabilitation can improve access to bilingual clinical services for BWA and facilitate the delivery of specific language treatments at distance, but more evidence on its effectiveness and reliability is needed. This study aimed to determine the equivalence of effectiveness and reliability of a semantic treatment for word retrieval deficits in BWA delivered via telerehabilitation relative to in-person therapy. Methods: We examined the retrospective data of 16 BWA who received 20 sessions of therapy based on semantic feature analysis for word retrieval deficits in person (n = 8) or via telerehabilitation (n = 8). The two groups were comparable on age, years of education, time of post-stroke onset, aphasia severity, and naming ability in both languages. Treatment effectiveness (i.e., effect sizes in the treated and the untreated language, and change on secondary outcome measures) and reliability (i.e., clinician adherence to treatment protocol) were computed for each delivery modality and compared across groups. Results: Significant improvements were observed in most patients, with no significant differences in treatment effect sizes or secondary outcomes in the treated and the untreated language between the teletherapy group and the in-person therapy group. Also, the average percentage of correctly delivered treatment steps by clinicians was high for both therapy delivery methods with no significant differences between the telerehabilitation vs. the in-person modality. Discussion: This study provides evidence of the equivalence of treatment gains between teletherapy and in-person therapy in BWA and the high reliability with which treatment for word retrieval deficits can be delivered via telerehabilitation, suggesting that the essential treatment components of the intervention can be conducted in a comparable manner in both delivery modalities. We further discuss the benefits and potential challenges of the implementation of telerehabilitation for BWA. In the future, telerehabilitation may increase access to therapy for BWA with varying linguistic and cultural backgrounds, thus, offering a more inclusive treatment approach to this population.
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Affiliation(s)
- Claudia Peñaloza
- Aphasia Research Laboratory, Department of Speech, Language and Hearing Sciences, Boston University, Boston, MA, United States
| | - Michael Scimeca
- Aphasia Research Laboratory, Department of Speech, Language and Hearing Sciences, Boston University, Boston, MA, United States
| | - Angelica Gaona
- Aphasia Research Laboratory, Department of Speech, Language and Hearing Sciences, Boston University, Boston, MA, United States
| | - Erin Carpenter
- Aphasia Research Laboratory, Department of Speech, Language and Hearing Sciences, Boston University, Boston, MA, United States
| | - Nishaat Mukadam
- Aphasia Research Laboratory, Department of Speech, Language and Hearing Sciences, Boston University, Boston, MA, United States
| | - Teresa Gray
- Gray Matter Laboratory, Department of Speech, Language and Hearing Sciences, San Francisco State University, San Francisco, CA, United States
| | | | - Swathi Kiran
- Aphasia Research Laboratory, Department of Speech, Language and Hearing Sciences, Boston University, Boston, MA, United States
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17
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Vyshedskiy A. Imagination in Autism: A Chance to Improve Early Language Therapy. Healthcare (Basel) 2021; 9:63. [PMID: 33440627 DOI: 10.3390/healthcare9010063] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 01/07/2021] [Accepted: 01/08/2021] [Indexed: 02/02/2023] Open
Abstract
Children with autism often have difficulties in imaginative play, Theory of Mind, and playing out different scenarios in their minds. Research shows that the root of these problems may be the voluntary imagination network that involves the lateral prefrontal cortex and its long frontoposterior connections to the temporal-parietal-occipital area. Previously disconnected visuospatial issues (stimulus overselectivity and tunnel vision) and language issues (lack of comprehension of spatial prepositions and complex recursive sentences) may be explained by the same voluntary imagination deficit. This review highlights the new insights into the mechanism of voluntary imagination, its difference from involuntary imagination, and its unusually strong critical period. Clearer developmental terminology and a better understanding of voluntary imagination have the potential to facilitate communication between therapists and parents, and improve therapy outcomes in children.
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18
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da Cunha RDB, Pacheco TF, Barreto SDS. Effects of language stimulation on cognition of institutionalized aged people: a preliminary case series study. Dement Neuropsychol 2021; 15:136-144. [PMID: 33907607 PMCID: PMC8049570 DOI: 10.1590/1980-57642021dn15-010015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Accepted: 12/02/2020] [Indexed: 11/24/2022] Open
Abstract
Cognitive stimulation programs for institutionalized elderly people show positive results, however few studies have investigated the effectiveness of language stimulation programs for the health of this population. OBJECTIVES To characterize the cognitive-linguistic profile of institutionalized elderly and to compare their performance before and after a language stimulation program (LSP). METHODS An exploratory case series study was conducted with nine residents of a Home for the Aged. Elderly people aged 60 or over, of both sexes, without neurological or neuropsychiatric diseases, communication disorders, intellectual impairment or severe visual or hearing impairment were included. The participants were submitted to an initial assessment through the Montreal Cognitive Assessment (MoCA) and Montreal Toulouse Battery Language Assessment - Brazil to characterize the cognitive-linguistic profile of the studied group. Five elderly were selected to participate in the LSP, of wich only two participated effectively in the program, but all were reassessed after the program was completed. RESULTS on the initial assessment, of the nine participants, only one had adequate cognitive performance and all presented changes in macro and/or microlinguistics aspects of oral discourse, with oral comprehension preserved. On the reassessment carried out with five participants, only two participants who adhered effectively to the program obtained improvements in MoCa scores. In regarding language, three participants performed better in the oral emission measures. The performance of the participants in oral comprehension remained or declined. CONCLUSION The speech-language therapy intervention through a LSP contributes to improving the cognitive-linguistic performance of institutionalized elderly.
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Affiliation(s)
| | - Tayane Frez Pacheco
- Instituto Israelita de Ensino e Pesquisa Albert Einstein – Rio
de Janeiro, RJ, Brazil
| | - Simone dos Santos Barreto
- Department of Specific Training in Speech-Language Pathology,
Instituto de Saúde de Nova Friburgo, Universidade Federal Fluminense – Nova
Friburgo, RJ, Brazil
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19
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Olthof-Nefkens MWLJ, Derksen EWC, de Swart BJM, Nijhuis-van der Sanden MWG, Kalf JG. Development of the Experienced Communication in Dementia Questionnaire: A Qualitative Study. Inquiry 2021; 58:469580211028181. [PMID: 34167366 PMCID: PMC8246470 DOI: 10.1177/00469580211028181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 05/27/2021] [Accepted: 06/07/2021] [Indexed: 11/15/2022]
Abstract
Communication problems with their caregivers are common in people with dementia. Although interventions for improvement of communication are being developed, a tool to measure how participants experience their communication is lacking. The objective of this article is to describe the development of a questionnaire that measures the "experienced communication" of persons with dementia (ECD-P) as well as of their caregivers (ECD-C). Interviews were conducted with five person with dementia-caregiver dyads who had recently received a new communication intervention. Reflexive thematic analysis was performed on the transcripts using ATLAS.ti. Codes were created, categories and themes were identified, and items for the questionnaires were generated. Selection of items and response scales was done in collaboration with the same dyads. The final version was established after pilot testing with seven other dyads and discussion with five experts in the field of dementia care. Analysis of the transcripts resulted in 212 codes and 17 categories within four themes: caregiver competence, social communication, communication difficulties in daily life, and experienced emotions during conversations. The final version of the ECD-P consists of part 1 with 22 items and 4-point Likert scales, and part 2 with two items and 1 to 10 scales. In the final ECD-C (proxy version), part 1 and part 2 are similar to the ECD-P, while a part 3 was added to assess caregivers' own perspective and emotions (five items). Based on the experiences of people with dementia and their caregivers, we constructed a face-valid questionnaire. This justifies future research to test its clinimetric characteristics.
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Affiliation(s)
- Maria W. L. J. Olthof-Nefkens
- Zorggroep Maas & Waal, Beneden-Leeuwen, The Netherlands
- Radboud university medical center, Radboud Institute for Health Sciences, Department of Primary and Community Care, Nijmegen, The Netherlands
- Radboud university medical center, Donders Institute for Brain, Cognition and Behaviour, Department of Rehabilitation, Nijmegen, The Netherlands
- Radboud university medical center, Radboudumc Alzheimer Center, Nijmegen, The Netherlands
| | - Els W. C. Derksen
- Radboud university medical center, Radboud Institute for Health Sciences, Department of Primary and Community Care, Nijmegen, The Netherlands
- Radboud university medical center, Radboudumc Alzheimer Center, Nijmegen, The Netherlands
| | - Bert J. M. de Swart
- Radboud university medical center, Donders Institute for Brain, Cognition and Behaviour, Department of Rehabilitation, Nijmegen, The Netherlands
| | - Maria W. G. Nijhuis-van der Sanden
- Radboud university medical center, Radboudumc Alzheimer Center, Nijmegen, The Netherlands
- Radboud university medical center, Radboud Institute for Health Sciences, Scientific Center for Quality of Care (IQ healthcare), Nijmegen, The Netherlands
| | - Johanna G. Kalf
- Radboud university medical center, Donders Institute for Brain, Cognition and Behaviour, Department of Rehabilitation, Nijmegen, The Netherlands
- Radboud university medical center, Radboudumc Alzheimer Center, Nijmegen, The Netherlands
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20
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Zhao Y, Ficek B, Webster K, Frangakis C, Caffo B, Hillis AE, Faria A, Tsapkini K. White Matter Integrity Predicts Electrical Stimulation (tDCS) and Language Therapy Effects in Primary Progressive Aphasia. Neurorehabil Neural Repair 2021; 35:44-57. [PMID: 33317422 PMCID: PMC7748290 DOI: 10.1177/1545968320971741] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND Transcranial direct current stimulation (tDCS), in conjunction with language therapy, improves language therapy outcomes in primary progressive aphasia (PPA). However, no studies show whether white matter integrity predicts language therapy or tDCS effects in PPA. OBJECTIVE We aimed to determine whether white matter integrity, measured by diffusion tensor imaging (DTI), predicts written naming/spelling language therapy effects (letter accuracy on trained and untrained words) with and without tDCS over the left inferior frontal gyrus (IFG) in PPA. METHODS Thirty-nine participants with PPA were randomly assigned to tDCS or sham condition, coupled with language therapy for 15 daily sessions. White matter integrity was measured by mean diffusivity (MD) and fractional anisotropy (FA) in DTI scans before therapy. Written naming outcomes were evaluated before, immediately after, 2 weeks, and 2 months posttherapy. To assess tDCS treatment effect, we used a mixed-effects model with treatment evaluation and time interaction. We considered a forward model selection approach to identify brain regions/fasciculi of which white matter integrity can predict improvement in performance of word naming. RESULTS Both sham and tDCS groups significantly improved in trained items immediately after and at 2 months posttherapy. Improvement in the tDCS group was greater and generalized to untrained words. White matter integrity of ventral language pathways predicted tDCS effects in trained items whereas white matter integrity of dorsal language pathways predicted tDCS effects in untrained items. CONCLUSIONS White matter integrity influences both language therapy and tDCS effects. Thus, it holds promise as a biomarker for deciding which patients will benefit from language therapy and tDCS.
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Affiliation(s)
- Yi Zhao
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health
| | - Bronte Ficek
- Department of Neurology, Johns Hopkins School of Medicine
| | - Kimberly Webster
- Department of Neurology, Johns Hopkins School of Medicine
- Department of Otolaryngology-Head and Neck Surgery
| | - Constantine Frangakis
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health
- Department of Radiology, Johns Hopkins School of Medicine
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine
| | - Brian Caffo
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health
| | - Argye E. Hillis
- Department of Neurology, Johns Hopkins School of Medicine
- Department of Cognitive Science, Johns Hopkins University
- Department of Physical Medicine and Rehabilitation, Johns Hopkins School of Medicine
| | - Andreia Faria
- Department of Radiology, Johns Hopkins School of Medicine
| | - Kyrana Tsapkini
- Department of Neurology, Johns Hopkins School of Medicine
- Department of Cognitive Science, Johns Hopkins University
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21
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Manning M, MacFarlane A, Hickey A, Galvin R, Franklin S. The relevance of stroke care for living well with post-stroke aphasia: a qualitative interview study with working-aged adults. Disabil Rehabil 2020; 44:3440-3452. [PMID: 33356970 DOI: 10.1080/09638288.2020.1863483] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
PURPOSE This study aimed to explore the perspectives of working-aged adults with post-stroke aphasia (PWA) towards what has or would help them in living well with aphasia (LWA). This paper reports the findings in relation to stroke care and its relevance for LWA. MATERIALS AND METHODS This qualitative study was designed with input from a Public and Patient Involvement advisory group. We conducted in-depth, semi-structured interviews with 14 PWA. Data were analysed following principles of reflexive thematic analysis. RESULTS Support services and LWA spanned five themes: Inpatient care; Support in the community; Speech therapy; Mental health; and Aphasia education and training. Per the findings, all aspects of stroke care were affected and challenged by aphasia. Access to services and information was variable. PWA of working-age, their families and children need access to person-centred stroke care and information responsive to their changing needs at all stages of recovery. Healthcare workers must be equipped with aphasia competency. CONCLUSIONS The results highlight a need for equitable, transparent, responsive access to services, information and stroke liaison support. The findings extend knowledge of the importance of stroke care for supporting working-aged adults and their families to live well in the context of aphasia.Implications for rehabilitationThere is a need for equitable, transparent access to a responsive integrated pathway of stroke care to support living well with aphasia.People with aphasia post-stroke and their families need access to person-centred stroke care and information responsive to their changing needs at all stages of recovery.This includes flexible access to mental healthcare and speech and language therapy.In order to access relevant care, people with post-stroke aphasia need access to information and stroke liaison support.Training to improve aphasia competency is imperative for healthcare workers.
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Affiliation(s)
- Molly Manning
- School of Allied Health, Faculty of Education and Health Sciences & Health Research Institute, University of Limerick, Limerick, Ireland
| | - Anne MacFarlane
- Graduate Entry Medical School (GEMS), Faculty of Education and Health Sciences & Health Research Institute, University of Limerick, Limerick, Ireland
| | - Anne Hickey
- Department of Psychology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Rose Galvin
- School of Allied Health, Faculty of Education and Health Sciences & Health Research Institute, University of Limerick, Limerick, Ireland.,Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Sue Franklin
- School of Allied Health, Faculty of Education and Health Sciences & Health Research Institute, University of Limerick, Limerick, Ireland
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22
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Vyshedskiy A, Khokhlovich E, Dunn R, Faisman A, Elgart J, Lokshina L, Gankin Y, Ostrovsky S, deTorres L, Edelson SM, Ilyinskii PO. Novel Prefrontal Synthesis Intervention Improves Language in Children with Autism. Healthcare (Basel) 2020; 8:healthcare8040566. [PMID: 33339269 PMCID: PMC7765988 DOI: 10.3390/healthcare8040566] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 12/07/2020] [Accepted: 12/10/2020] [Indexed: 12/03/2022] Open
Abstract
Prefrontal synthesis (PFS) is defined as the ability to juxtapose mental visuospatial objects at will. Paralysis of PFS may be responsible for the lack of comprehension of spatial prepositions, semantically-reversible sentences, and recursive sentences observed in 30 to 40% of individuals with autism spectrum disorder (ASD). In this report we present data from a three-year-long clinical trial of 6454 ASD children age 2 to 12 years, which were administered a PFS-targeting intervention. Tablet-based verbal and nonverbal exercises emphasizing mental-juxtaposition-of-objects were organized into an application called Mental Imagery Therapy for Autism (MITA). The test group included participants who completed more than one thousand exercises and made no more than one error per exercise. The control group was selected from the rest of participants by a matching procedure. Each test group participant was matched to the control group participant by age, gender, expressive language, receptive language, sociability, cognitive awareness, and health score at first evaluation using propensity score analysis. The test group showed a 2.2-fold improvement in receptive language score vs. control group (p < 0.0001) and a 1.4-fold improvement in expressive language (p = 0.0144). No statistically significant change was detected in other subscales not targeted by the exercises. These findings show that language acquisition improves after training PFS and that a further investigation of the PFS-targeting intervention in a randomized controlled study is warranted.
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Affiliation(s)
- Andrey Vyshedskiy
- Biology Department, Boston University, Boston, MA 02215, USA
- ImagiRation, Boston, MA 02135, USA; (R.D.); (J.E.); (L.L.); (S.O.); (L.d.)
- Correspondence: ; Tel.: +1-(617)-433-7724
| | | | - Rita Dunn
- ImagiRation, Boston, MA 02135, USA; (R.D.); (J.E.); (L.L.); (S.O.); (L.d.)
| | | | - Jonah Elgart
- ImagiRation, Boston, MA 02135, USA; (R.D.); (J.E.); (L.L.); (S.O.); (L.d.)
| | - Lisa Lokshina
- ImagiRation, Boston, MA 02135, USA; (R.D.); (J.E.); (L.L.); (S.O.); (L.d.)
| | | | - Simone Ostrovsky
- ImagiRation, Boston, MA 02135, USA; (R.D.); (J.E.); (L.L.); (S.O.); (L.d.)
| | - Lauren deTorres
- ImagiRation, Boston, MA 02135, USA; (R.D.); (J.E.); (L.L.); (S.O.); (L.d.)
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23
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Sebastian R, Kim JH, Brenowitz R, Tippett DC, Desmond JE, Celnik PA, Hillis AE. Cerebellar neuromodulation improves naming in post-stroke aphasia. Brain Commun 2020; 2:fcaa179. [PMID: 33241212 PMCID: PMC7677607 DOI: 10.1093/braincomms/fcaa179] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 09/09/2020] [Accepted: 09/16/2020] [Indexed: 12/19/2022] Open
Abstract
Transcranial direct current stimulation has been shown to increase the efficiency of language therapy in chronic aphasia; however, to date, an optimal stimulation site has not been identified. We investigated whether neuromodulation of the right cerebellum can improve naming skills in chronic aphasia. Using a randomized, double-blind, sham-controlled, within-subject crossover study design, participants received anodal cerebellar stimulation (n = 12) or cathodal cerebellar stimulation (n = 12) + computerized aphasia therapy then sham + computerized aphasia therapy, or the opposite order. There was no significant effect of treatment (cerebellar stimulation versus sham) for trained naming. However, there was a significant order x treatment interaction, indicating that cerebellar stimulation was more effective than sham immediately post-treatment for participants who received cerebellar stimulation in the first phase. There was a significant effect of treatment (cerebellar stimulation versus sham) for untrained naming immediately post-treatment and the significant improvement in untrained naming was maintained at two months post-treatment. Greater gains in naming (relative to sham) were noted for participants receiving cathodal stimulation for both trained and untrained items. Thus, our study provides evidence that repetitive cerebellar transcranial direct stimulation combined with computerized aphasia treatment can improve picture naming in chronic post-stroke aphasia. These findings suggest that the right cerebellum might be an optimal stimulation site for aphasia rehabilitation and this could be an answer to handle heterogeneous participants who vary in their size and site of left hemisphere lesions.
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Affiliation(s)
- Rajani Sebastian
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ji Hyun Kim
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Rachel Brenowitz
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Donna C Tippett
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Otolaryngology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - John E Desmond
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Pablo A Celnik
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Argye E Hillis
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Cognitive Science, Johns Hopkins University, Baltimore, MD, USA
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24
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Vaezipour A, Campbell J, Theodoros D, Russell T. Mobile Apps for Speech- Language Therapy in Adults With Communication Disorders: Review of Content and Quality. JMIR Mhealth Uhealth 2020; 8:e18858. [PMID: 33118953 PMCID: PMC7661246 DOI: 10.2196/18858] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 09/02/2020] [Accepted: 09/27/2020] [Indexed: 02/06/2023] Open
Abstract
Background Worldwide, more than 75% of people with acquired brain injury (ABI) experience communication disorders. Communication disorders are impairments in the ability to communicate effectively, that is, sending, receiving, processing, and comprehending verbal and nonverbal concepts and symbols. Such disorders may have enduring impacts on employment, social participation, and quality of life. Technology-enabled interventions such as mobile apps have the potential to increase the reach of speech-language therapy to treat communication disorders. However, ensuring that apps are evidence-based and of high quality is critical for facilitating safe and effective treatment for adults with communication disorders. Objective The aim of this review is to identify mobile apps that are currently widely available to adults with communication disorders for speech-language therapy and to assess their content and quality using the validated Mobile App Rating Scale (MARS). Methods Google Play Store, Apple App Store, and webpages were searched to identify mobile apps for speech-language therapy. Apps were included in the review if they were designed for the treatment of adult communication disorders after ABI, were in English, and were either free or for purchase. Certified speech-language pathologists used the MARS to assess the quality of the apps. Results From a total of 2680 apps identified from Google Play Store, Apple App Store, and web searches, 2.61% (70/2680) apps met the eligibility criteria for inclusion. Overall, 61% (43/70) were available for download on the iPhone Operating System (iOS) platform, 20% (14/70) on the Android platform, and 19% (13/70) on both iOS and Android platforms. A content analysis of the apps revealed 43 apps for language, 17 apps for speech, 8 apps for cognitive communication, 6 apps for voice, and 5 apps for oromotor function or numeracy. The overall MARS mean score was 3.7 out of 5, SD 0.6, ranging between 2.1 and 4.5, with functionality being the highest-scored subscale (4.3, SD 0.6), followed by aesthetics (3.8, SD 0.8), information (3.4, SD 0.6), and engagement (3.3, SD 0.6). The top 5 apps were Naming Therapy (4.6/5), Speech Flipbook Standard (4.6/5), Number Therapy (4.5/5), Answering Therapy, and Constant Therapy (4.4/5). Conclusions To our knowledge, this is the first study to systematically identify and evaluate a broad range of mobile apps for speech-language therapy for adults with communication disorders after sustaining ABI. We found a lack of interactive and engaging elements in the apps, a critical factor in sustaining self-managed speech-language therapy. More evidence-based apps with a focus on human factors, user experience, and a patient-led design approach are required to enhance effectiveness and long-term use.
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Affiliation(s)
- Atiyeh Vaezipour
- RECOVER Injury Research Centre, Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, Australia
| | - Jessica Campbell
- Queensland Aphasia Research Centre, Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, Australia
| | - Deborah Theodoros
- RECOVER Injury Research Centre, Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, Australia
| | - Trevor Russell
- RECOVER Injury Research Centre, Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, Australia
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25
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Zumbansen A, Black SE, Chen JL, J Edwards D, Hartmann A, Heiss WD, Lanthier S, Lesperance P, Mochizuki G, Paquette C, Rochon EA, Rubi-Fessen I, Valles J, Kneifel H, Wortman-Jutt S, Thiel A. Non-invasive brain stimulation as add-on therapy for subacute post-stroke aphasia: a randomized trial (NORTHSTAR). Eur Stroke J 2020; 5:402-413. [PMID: 33598559 DOI: 10.1177/2396987320934935] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 05/23/2020] [Indexed: 11/17/2022] Open
Abstract
Introduction Non-invasive brain stimulation (NIBS) with speech therapy might improve recovery from post-stroke aphasia. This three-armed sham-controlled blinded prospective proof-of-concept study tested 1 Hz subthreshold repetitive transcranial magnetic stimulation (rTMS) and 2-mA cathodal transcranial direct current stimulation (ctDCS) on the right pars triangularis in subacute post-stroke aphasia. Patients and methods Sixty-three patients with left middle cerebral artery infarcts were recruited in five hospitals (Canada/United States/Germany, 01-2014/03-2018) and randomized to receive rTMS (N = 20), ctDCS (N = 24) or sham stimulation (N = 19) with ST for 10 days. Primary outcome variables were Z-score changes in naming, semantic fluency and comprehension tests and adverse event frequency. Secondary outcome variable was the percent change in the Unified Aphasia Score. Intention-to-treat analyses tested between-group effects at days 1 and 30 post-treatment with a pre-planned subgroup analysis for lesion location (affecting Broca's area or not). Results Naming was significantly improved by rTMS (median = 1.91/interquartile range = 0.77/p = .01) at 30 days versus ctDCS (median = 1.11/interquartile range = 1.51) and sham stimulation (median = 1.02/interquartile range = 1.71). All other primary results were non-significant. The rTMS effect was driven by the patient subgroup with intact Broca's area where NIBS tended to improve UnAS (median = 33.2%/interquartile range = 46.7%/p = .062) versus sham stimulation (median = 12.5%/interquartile range = 7.9%) at day 30. Conversely, in patients with infarcted Broca's area, UnAS tended to improve more with sham stimulation (median = 75.0%/interquartile range = 86.9%/p = .053) versus NIBS (median = 12.7%/interquartile range = 31.7).Conclusion: We found a delayed positive effect of low-frequency rTMS targeting the right pars triangularis on the recovery of naming performance in subacute post-stroke aphasia. This intervention may be beneficial only in patients with morphologically intact Broca's area.
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Affiliation(s)
- Anna Zumbansen
- Jewish General Hospital, Lady Davis Institute for Medical Research, Department of Neurology & Neurosurgery, McGill University, Montreal, Quebec
| | - Sandra E Black
- Department of Medicine-Neurology and Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, Sunnybrook Research Institute, University of Toronto, Toronto, Ontario
| | - Joyce L Chen
- Faculty of Kinesiology and Physical Education, and Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario
| | - Dylan J Edwards
- Burke Neurological Institute, White Plains, NY, USA.,Moss Rehabilitation Research Institute, Elkins Park, PA, USA.,School of Medical and Health Sciences, Edith Cowan University, Joondalup, Australia
| | - Alexander Hartmann
- Department of Neurosurgery, Hospital of the City of Cologne, University of Witten-Herdecke, Germany
| | - Wolf-Dieter Heiss
- Max Planck Institute für Stoffwechsel Forschung -- MPI for Metabolism Research, and Department of Neurology, Universität zu Köln, Cologne, Germany
| | - Sylvain Lanthier
- Hôpital du Sacré-Cœur de Montreal, and Department of medicine, Université de Montréal, Quebec
| | | | - George Mochizuki
- School of Kinesiology and Health Science, York University, Toronto, Ontario
| | - Caroline Paquette
- Department of Kinesiology and Physical Education, McGill University, Montreal, Quebec
| | - Elizabeth A Rochon
- Toronto Rehabilitation Institute, and Department of Speech-Language Pathology, University of Toronto, Toronto, Ontario
| | | | - Jennie Valles
- Burke Rehabilitation Hospital, White Plains, NY, USA
| | - Heike Kneifel
- RehaNova Neurologische Rehabilitationsklinik, Cologne, Germany
| | - Susan Wortman-Jutt
- Burke Neurological Institute, White Plains, NY, USA.,Burke Rehabilitation Hospital, White Plains, NY, USA
| | - Alexander Thiel
- Jewish General Hospital, Lady Davis Institute for Medical Research, Department of Neurology & Neurosurgery, McGill University, Montreal, Quebec
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26
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Vyshedskiy A, Radi K, DuBois MC, Mugford E, Maslova V, Braverman J, Piryatinsky I. Novel linguistic evaluation of prefrontal synthesis (LEPS) test measures prefrontal synthesis acquisition in neurotypical children and predicts high-functioning versus low-functioning class assignment in individuals with autism. Appl Neuropsychol Child 2020; 11:99-114. [PMID: 32420749 DOI: 10.1080/21622965.2020.1758700] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
In order to grasp the difference between "the cat on the mat" and "the mat on the cat," understanding the words and the grammar is not enough. Rather it is essential to visualize the cat and the mat together to appreciate their relations. This type of imagination, which involves juxtaposition of mental objects is conducted by the prefrontal cortex and is therefore called Prefrontal Synthesis (PFS). PFS acquisition has a strong experience-dependent critical period putting children with language delay in danger of never acquiring PFS and, consequently, not mastering complex language comprehension. In typical children, the timeline of PFS acquisition correlates with vocabulary expansion. Conversely, atypically developing children may learn many words but never acquire PFS. In these individuals, intelligence tests based on vocabulary assessment may miss the profound deficit in PFS. Accordingly, we developed a test specific for PFS - Linguistic Evaluation of Prefrontal Synthesis or LEPS - and administered it to 50 neurotypical children, age 4.1 ± 1.3 years and to 23 individuals with impairments, age 16.4 ± 3.0 years. All neurotypical children older than 4 years received the LEPS score 7/10 or greater indicating good PFS ability. Among individuals with impairments only 39% received the LEPS score 7/10 or greater. LEPS was 90% correct in predicting high-functioning vs. low-functioning class assignment in individuals with impairments.
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Affiliation(s)
- Andrey Vyshedskiy
- Boston University, Boston, MA, USA.,ImagiRation LLC, Boston, MA, USA
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27
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Feil S, Eisenhut P, Strakeljahn F, Müller S, Nauer C, Bansi J, Weber S, Liebs A, Lefaucheur JP, Kesselring J, Gonzenbach R, Mylius V. Left Shifting of Language Related Activity Induced by Bihemispheric tDCS in Postacute Aphasia Following Stroke. Front Neurosci 2019; 13:295. [PMID: 31105510 PMCID: PMC6498872 DOI: 10.3389/fnins.2019.00295] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2018] [Accepted: 03/13/2019] [Indexed: 12/02/2022] Open
Abstract
Both anodal transcranial direct current stimulation (tDCS) of the left IFG and cathodal stimulation of the right IFG were shown to improve rehabilitation of stroke patients with Broca’s aphasia. The study aimed at assessing the impact of a bihemispheric IFG stimulation compared to sham on postacute non-fluent aphasia. Twelve patients with non-fluent aphasia were included at least 4 weeks following cerebral stroke. Ten daily sessions of 2 mA bihemispheric verum or sham tDCS (anode on left IFG and cathode on right IFG) were performed concomitantly with individual language therapy in a double-blinded randomized controlled study with parallel group design. Language functions [i.e., communication (ANELT), picture naming and the Aachen aphasia test (AAT)] were assessed up to 1 month following tDCS. The picture naming task significantly improved (increased number of nouns) at the end of the tDCS procedure in the verum but not sham group. Improvements in the picture naming task and the communication task of the AAT at 4 weeks after tDCS procedure were only seen in the verum group. In patients with postacute cerebral stroke, repeated sessions of tDCS applied on both IFG concomitantly with language therapy were able to induce immediate effects on picture naming presumably due to an early left shift of language-associated function that maintained for 4 weeks. Effects on clinically relevant communicative abilities are likely.
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Affiliation(s)
- Sarah Feil
- Department of Neurology, Center for Neurorehabilitation, Valens, Switzerland.,Schweizer Hochschule für Logopädie Rorschach, Rorschach, Switzerland
| | - Peter Eisenhut
- Department of Neurology, Center for Neurorehabilitation, Valens, Switzerland
| | - Frauke Strakeljahn
- Department of Neurology, Center for Neurorehabilitation, Valens, Switzerland
| | - Sarah Müller
- Department of Neurology, Center for Neurorehabilitation, Valens, Switzerland
| | - Claude Nauer
- Department of Radiology, Kantonsspital Graubünden, Chur, Switzerland
| | - Jens Bansi
- Department of Neurology, Center for Neurorehabilitation, Valens, Switzerland
| | - Stefan Weber
- Department of Neurology, Center for Neurorehabilitation, Valens, Switzerland
| | - Alexandra Liebs
- Department of Neurology, Center for Neurorehabilitation, Valens, Switzerland
| | - Jean-Pascal Lefaucheur
- Service de Physiologie - Explorations Fonctionnelles, Hôpital Henri-Mondor AP-HP, Université Paris-Est Créteil, Créteil, France
| | - Jürg Kesselring
- Department of Neurology, Center for Neurorehabilitation, Valens, Switzerland
| | - Roman Gonzenbach
- Department of Neurology, Center for Neurorehabilitation, Valens, Switzerland
| | - Veit Mylius
- Department of Neurology, Center for Neurorehabilitation, Valens, Switzerland.,Department of Neurology, Kantonsspital St. Gallen, St. Gallen, Switzerland.,Department of Neurology, Philipps-University Marburg, Marburg, Germany
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28
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Braverman J, Dunn R, Vyshedskiy A. Development of the Mental Synthesis Evaluation Checklist (MSEC): A Parent-Report Tool for Mental Synthesis Ability Assessment in Children with Language Delay. Children (Basel) 2018; 5:E62. [PMID: 29783788 PMCID: PMC5977044 DOI: 10.3390/children5050062] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 05/14/2018] [Accepted: 05/14/2018] [Indexed: 12/02/2022]
Abstract
Mental synthesis is the conscious purposeful process of synthesizing novel mental images from objects stored in memory. Mental synthesis ability is essential for understanding complex syntax, spatial prepositions, and verb tenses. In typical children, the timeline of mental synthesis acquisition is highly correlated with an increasing vocabulary. Children with Autism Spectrum Disorder (ASD), on the other hand, may learn hundreds of words but never acquire mental synthesis. In these individuals, tests assessing vocabulary comprehension may fail to demonstrate the profound deficit in mental synthesis. We developed a parent-reported Mental Synthesis Evaluation Checklist (MSEC) designed to assess mental synthesis acquisition in ASD children. The psychometric quality of MSEC was tested with 3715 parents of ASD children. Internal reliability of the 20-item MSEC was good (Cronbach's alpha >0.9). MSEC exhibited adequate test⁻retest reliability; good construct validity, supported by a positive correlation with the Autism Treatment Evaluation Checklist (ATEC) Communication subscale; and good known group validity reflected by the difference in MSEC scores for children of different ASD severity levels. The MSEC questionnaire is copyright-free and can be used by researchers as a complimentary subscale for the ATEC evaluation. We hope that the addition of MSEC will make the combined assessment more sensitive to small steps in a child's development. As MSEC does not rely on productive language, it may be an especially useful tool for assessing the development of nonverbal and minimally verbal children.
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Affiliation(s)
| | - Rita Dunn
- ImagiRation LLC, Boston, MA 02215, USA.
| | - Andrey Vyshedskiy
- ImagiRation LLC, Boston, MA 02215, USA.
- Boston University, Boston, MA 02215, USA.
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Abstract
Background. Patients with brain lesions and resultant chronic aphasia frequently suffer from depression. However, no effective interventions are available to target neuropsychiatric symptoms in patients with aphasia who have severe language and communication deficits. Objective. The present study aimed to investigate the efficacy of 2 different methods of speech and language therapy in reducing symptoms of depression in aphasia on the Beck Depression Inventory (BDI) using secondary analysis (BILAT-1 trial). Methods. In a crossover randomized controlled trial, 18 participants with chronic nonfluent aphasia following left-hemispheric brain lesions were assigned to 2 consecutive treatments: (1) intensive language-action therapy (ILAT), emphasizing communicative language use in social interaction, and (2) intensive naming therapy (INT), an utterance-centered standard method. Patients were randomly assigned to 2 groups, receiving both treatments in counterbalanced order. Both interventions were applied for 3.5 hours daily over a period of 6 consecutive working days. Outcome measures included depression scores on the BDI and a clinical language test (Aachen Aphasia Test). Results. Patients showed a significant decrease in symptoms of depression after ILAT but not after INT, which paralleled changes on clinical language tests. Treatment-induced decreases in depression scores persisted when controlling for individual changes in language performance. Conclusions. Intensive training of behaviorally relevant verbal communication in social interaction might help reduce symptoms of depression in patients with chronic nonfluent aphasia.
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Affiliation(s)
- Bettina Mohr
- 1 Charité Universitätsmedizin Berlin, Department of Psychiatry, Berlin, Germany
| | - Benjamin Stahl
- 2 Charité Universitätsmedizin Berlin, Department of Neurology, Berlin, Germany.,3 Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany.,4 Universität Greifswald, Department of Neurology, Germany.,5 Freie Universität Berlin, Brain Language Laboratory, Department of Philosophy and Humanities, Berlin, Germany
| | - Marcelo L Berthier
- 6 University of Malaga and Instituto de Investigaciones Biomédicas de Málaga (IBIMA), Unit of Cognitive Neurology and Aphasia, Centro de Investigaciones Medico-Sanitarias (CIMES), Malaga, Spain.,7 Cathedra ARPA of Aphasia, Malaga, Spain
| | - Friedemann Pulvermüller
- 5 Freie Universität Berlin, Brain Language Laboratory, Department of Philosophy and Humanities, Berlin, Germany.,8 Berlin School of Mind and Brain, Humboldt University, Berlin, Germany.,9 Einstein Center for Neurosciences, Berlin, Germany
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McConathey EM, White NC, Gervits F, Ash S, Coslett HB, Grossman M, Hamilton RH. Baseline Performance Predicts tDCS-Mediated Improvements in Language Symptoms in Primary Progressive Aphasia. Front Hum Neurosci 2017; 11:347. [PMID: 28713256 PMCID: PMC5492829 DOI: 10.3389/fnhum.2017.00347] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Accepted: 06/16/2017] [Indexed: 01/12/2023] Open
Abstract
Primary Progressive Aphasia (PPA) is a neurodegenerative condition characterized by insidious irreversible loss of language abilities. Prior studies suggest that transcranial direct current stimulation (tDCS) directed toward language areas of the brain may help to ameliorate symptoms of PPA. In the present sham-controlled study, we examined whether tDCS could be used to enhance language abilities (e.g., picture naming) in individuals with PPA variants primarily characterized by difficulties with speech production (non-fluent and logopenic). Participants were recruited from the Penn Frontotemporal Dementia Center to receive 10 days of both real and sham tDCS (counter-balanced, full-crossover design; participants were naïve to stimulation condition). A battery of language tests was administered at baseline, immediately post-tDCS (real and sham), and 6 weeks and 12 weeks following stimulation. When we accounted for individuals' baseline performance, our analyses demonstrated a stratification of tDCS effects. Individuals who performed worse at baseline showed tDCS-related improvements in global language performance, grammatical comprehension and semantic processing. Individuals who performed better at baseline showed a slight tDCS-related benefit on our speech repetition metric. Real tDCS may improve language performance in some individuals with PPA. Severity of deficits at baseline may be an important factor in predicting which patients will respond positively to language-targeted tDCS therapies. Clinicaltrials.gov ID: NCT02928848.
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Affiliation(s)
- Eric M McConathey
- Laboratory for Cognition and Neural Stimulation, Department of Neurology, University of PennsylvaniaPhiladelphia, PA, United States
| | - Nicole C White
- Laboratory for Cognition and Neural Stimulation, Department of Neurology, University of PennsylvaniaPhiladelphia, PA, United States
| | - Felix Gervits
- Laboratory for Cognition and Neural Stimulation, Department of Neurology, University of PennsylvaniaPhiladelphia, PA, United States
| | - Sherry Ash
- Penn Frontotemporal Degeneration CenterPhiladelphia, PA, United States
| | - H Branch Coslett
- Laboratory for Cognition and Neural Stimulation, Department of Neurology, University of PennsylvaniaPhiladelphia, PA, United States.,Neurology, Perelman School of MedicinePhiladelphia, PA, United States
| | - Murray Grossman
- Penn Frontotemporal Degeneration CenterPhiladelphia, PA, United States.,Neurology, Perelman School of MedicinePhiladelphia, PA, United States
| | - Roy H Hamilton
- Laboratory for Cognition and Neural Stimulation, Department of Neurology, University of PennsylvaniaPhiladelphia, PA, United States.,Neurology, Perelman School of MedicinePhiladelphia, PA, United States
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31
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Van Der Meulen I, Van De Sandt-Koenderman MWME, Heijenbrok MH, Visch-Brink E, Ribbers GM. Melodic Intonation Therapy in Chronic Aphasia: Evidence from a Pilot Randomized Controlled Trial. Front Hum Neurosci 2016; 10:533. [PMID: 27847473 PMCID: PMC5088197 DOI: 10.3389/fnhum.2016.00533] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Accepted: 10/07/2016] [Indexed: 11/13/2022] Open
Abstract
Melodic Intonation Therapy (MIT) is a language production therapy for severely non-fluent aphasic patients using melodic intoning and rhythm to restore language. Although many studies have reported its beneficial effects on language production, randomized controlled trials (RCT) examining the efficacy of MIT are rare. In an earlier publication, we presented the results of an RCT on MIT in subacute aphasia and found that MIT was effective on trained and untrained items. Further, we observed a clear trend in improved functional language use after MIT: subacute aphasic patients receiving MIT improved considerably on language tasks measuring connected speech and daily life verbal communication. Here, we present the results of a pilot RCT on MIT in chronic aphasia and compare these to the results observed in subacute aphasia. We used a multicenter waiting-list RCT design. Patients with chronic (>1 year) post-stroke aphasia were randomly allocated to the experimental group (6 weeks MIT) or to the control group (6 weeks no intervention followed by 6 weeks MIT). Assessments were done at baseline (T1), after 6 weeks (T2), and 6 weeks later (T3). Efficacy was evaluated at T2 using univariable linear regression analyses. Outcome measures were chosen to examine several levels of therapy success: improvement on trained items, generalization to untrained items, and generalization to verbal communication. Of 17 included patients, 10 were allocated to the experimental condition and 7 to the control condition. MIT significantly improved repetition of trained items (β = 13.32, p = 0.02). This effect did not remain stable at follow-up assessment. In contrast to earlier studies, we found only a limited and temporary effect of MIT, without generalization to untrained material or to functional communication. The results further suggest that the effect of MIT in chronic aphasia is more restricted than its effect in earlier stages post stroke. This is in line with studies showing larger effects of aphasia therapy in earlier compared to later stages post stroke. The study was designed as an RCT, but was underpowered. The results therefore have to be interpreted cautiously and future larger studies are needed. CLINICAL TRIAL REGISTRATION www.ClinicalTrials.gov, identifier NTR 1961.
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Affiliation(s)
- Ineke Van Der Meulen
- Rijndam Rehabilitation InstituteRotterdam, Netherlands; Department of Rehabilitation Medicine, Erasmus MC University Medical CentreRotterdam, Netherlands
| | - Mieke W M E Van De Sandt-Koenderman
- Rijndam Rehabilitation InstituteRotterdam, Netherlands; Department of Rehabilitation Medicine, Erasmus MC University Medical CentreRotterdam, Netherlands
| | - Majanka H Heijenbrok
- Rijndam Rehabilitation InstituteRotterdam, Netherlands; Department of Rehabilitation Medicine, Erasmus MC University Medical CentreRotterdam, Netherlands
| | - Evy Visch-Brink
- Department of Neurology, Erasmus MC University Medical Centre Rotterdam, Netherlands
| | - Gerard M Ribbers
- Rijndam Rehabilitation InstituteRotterdam, Netherlands; Department of Rehabilitation Medicine, Erasmus MC University Medical CentreRotterdam, Netherlands
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32
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Murphy CFB, Pagan-Neves LO, Wertzner HF, Schochat E. Children with speech sound disorder: comparing a non-linguistic auditory approach with a phonological intervention approach to improve phonological skills. Front Psychol 2015; 6:64. [PMID: 25698997 PMCID: PMC4316717 DOI: 10.3389/fpsyg.2015.00064] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Accepted: 01/13/2015] [Indexed: 12/03/2022] Open
Abstract
This study aimed to compare the effects of a non-linguistic auditory intervention approach with a phonological intervention approach on the phonological skills of children with speech sound disorder (SSD). A total of 17 children, aged 7–12 years, with SSD were randomly allocated to either the non-linguistic auditory temporal intervention group (n = 10, average age 7.7 ± 1.2) or phonological intervention group (n = 7, average age 8.6 ± 1.2). The intervention outcomes included auditory-sensory measures (auditory temporal processing skills) and cognitive measures (attention, short-term memory, speech production, and phonological awareness skills). The auditory approach focused on non-linguistic auditory training (e.g., backward masking and frequency discrimination), whereas the phonological approach focused on speech sound training (e.g., phonological organization and awareness). Both interventions consisted of 12 45-min sessions delivered twice per week, for a total of 9 h. Intra-group analysis demonstrated that the auditory intervention group showed significant gains in both auditory and cognitive measures, whereas no significant gain was observed in the phonological intervention group. No significant improvement on phonological skills was observed in any of the groups. Inter-group analysis demonstrated significant differences between the improvement following training for both groups, with a more pronounced gain for the non-linguistic auditory temporal intervention in one of the visual attention measures and both auditory measures. Therefore, both analyses suggest that although the non-linguistic auditory intervention approach appeared to be the most effective intervention approach, it was not sufficient to promote the enhancement of phonological skills.
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Affiliation(s)
- Cristina F B Murphy
- Department of Physical Therapy, Speech-Language Pathology and Occupational Therapy, Center for Teaching and Research, School of Medicine, University of São Paulo São Paulo, Brazil
| | - Luciana O Pagan-Neves
- Department of Physical Therapy, Speech-Language Pathology and Occupational Therapy, Center for Teaching and Research, School of Medicine, University of São Paulo São Paulo, Brazil
| | - Haydée F Wertzner
- Department of Physical Therapy, Speech-Language Pathology and Occupational Therapy, Center for Teaching and Research, School of Medicine, University of São Paulo São Paulo, Brazil
| | - Eliane Schochat
- Department of Physical Therapy, Speech-Language Pathology and Occupational Therapy, Center for Teaching and Research, School of Medicine, University of São Paulo São Paulo, Brazil
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Méndez Orellana CP, van de Sandt-Koenderman ME, Saliasi E, van der Meulen I, Klip S, van der Lugt A, Smits M. Insight into the neurophysiological processes of melodically intoned language with functional MRI. Brain Behav 2014; 4:615-25. [PMID: 25328839 PMCID: PMC4107379 DOI: 10.1002/brb3.245] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Revised: 06/05/2014] [Accepted: 06/09/2014] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Melodic Intonation Therapy (MIT) uses the melodic elements of speech to improve language production in severe nonfluent aphasia. A crucial element of MIT is the melodically intoned auditory input: the patient listens to the therapist singing a target utterance. Such input of melodically intoned language facilitates production, whereas auditory input of spoken language does not. METHODS Using a sparse sampling fMRI sequence, we examined the differential auditory processing of spoken and melodically intoned language. Nineteen right-handed healthy volunteers performed an auditory lexical decision task in an event related design consisting of spoken and melodically intoned meaningful and meaningless items. The control conditions consisted of neutral utterances, either melodically intoned or spoken. RESULTS Irrespective of whether the items were normally spoken or melodically intoned, meaningful items showed greater activation in the supramarginal gyrus and inferior parietal lobule, predominantly in the left hemisphere. Melodically intoned language activated both temporal lobes rather symmetrically, as well as the right frontal lobe cortices, indicating that these regions are engaged in the acoustic complexity of melodically intoned stimuli. Compared to spoken language, melodically intoned language activated sensory motor regions and articulatory language networks in the left hemisphere, but only when meaningful language was used. DISCUSSION Our results suggest that the facilitatory effect of MIT may - in part - depend on an auditory input which combines melody and meaning. CONCLUSION Combined melody and meaning provide a sound basis for the further investigation of melodic language processing in aphasic patients, and eventually the neurophysiological processes underlying MIT.
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Affiliation(s)
- Carolina P Méndez Orellana
- Department of Radiology, Erasmus MC - University Medical Center Rotterdam Rotterdam, The Netherlands ; Department of Neurology, Erasmus MC - University Medical Center Rotterdam Rotterdam, The Netherlands
| | - Mieke E van de Sandt-Koenderman
- Rehabilitation Medicine, Erasmus MC - University Medical Center Rotterdam Rotterdam, The Netherlands ; Rijndam Rehabilitation Center Rotterdam, The Netherlands
| | - Emi Saliasi
- Department of Neurology - University Medical Center Groningen Groningen, The Netherlands
| | - Ineke van der Meulen
- Rehabilitation Medicine, Erasmus MC - University Medical Center Rotterdam Rotterdam, The Netherlands ; Rijndam Rehabilitation Center Rotterdam, The Netherlands
| | - Simone Klip
- Department of Radiology, Erasmus MC - University Medical Center Rotterdam Rotterdam, The Netherlands
| | - Aad van der Lugt
- Department of Radiology, Erasmus MC - University Medical Center Rotterdam Rotterdam, The Netherlands
| | - Marion Smits
- Department of Radiology, Erasmus MC - University Medical Center Rotterdam Rotterdam, The Netherlands
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Tompkins CA, Scharp VL, Meigh K, Blake ML, Wambaugh J. Generalization of a Novel, Implicit Treatment for Coarse Coding Deficit in Right Hemisphere Brain Damage: A Single Subject Experiment. Aphasiology 2012; 26:689-708. [PMID: 22837589 PMCID: PMC3402378 DOI: 10.1080/02687038.2012.676869] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND: This manuscript reports generalization effects of Contextual Constraint Treatment for an adult with right hemisphere brain damage (RHD). Contextual Constraint Treatment is designed to stimulate inefficient language comprehension processes implicitly, by providing linguistic context to prime, or constrain, the intended interpretations of treatment stimuli. The study participant had a coarse coding deficit, defined as delayed mental activation of particularly distant semantic features of words (e.g., rotten as a feature of "apple"). Treatment effects were expected to generalize to auditory comprehension of narrative discourse, and perhaps to figurative language interpretation, because coarse coding has been hypothesized and/or demonstrated to support these abilities. AIMS: This treatment study aimed to induce generalization of Contextual Constraint Treatment in an adult with RHD with inefficient coarse coding. METHODS #ENTITYSTARTX00026; PROCEDURES: The participant in this study was a 75 year old man with RHD and a coarse coding deficit. A single subject experimental design across behaviors (stimulus lists) was used to document performance in baseline, treatment, and follow-up phases. Treatment consisted of providing brief, spoken context sentences to prestimulate, or constrain, intended interpretations of stimulus items. The participant made no explicit associations or metalinguistic judgments about the constraint sentences or stimulus words; rather, these contexts served only as implicit primes. Probe tasks were adapted from prior work on coarse coding in RHD. The dependent measure was the percentage of responses that met predetermined response time criteria. There were two levels of contextual constraint, Strong and Moderate. Treatment for each item began with the provision of the Strong constraint context, to minimize the production or reinforcement of erroneous or exceedingly slow responses. Generalization was assessed to a well-standardized measure of narrative discourse comprehension and to several metalinguistic tasks of figurative language interpretation. OUTCOMES #ENTITYSTARTX00026; RESULTS: Treatment-contingent gains, associated with respectable effect sizes, were evident after a brief period of treatment on one stimulus list. Generalization occurred to untrained items, suggesting that the treatment was facilitating the underlying coarse coding process. Most importantly, generalization was evident to narrative comprehension performance, for both overall accuracy and accuracy answering questions about implied information, and all of these gains maintained through three follow-up sessions. CONCLUSIONS: Though the results are still preliminary, this single-subject experimental design documents the potential for meaningful gains from a novel treatment that implicitly targets an underlying language comprehension process in an adult with RHD.
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Affiliation(s)
- Connie A. Tompkins
- Communication Science & Disorders, University of Pittsburgh, Pittsburgh, PA, USA
| | - Victoria L. Scharp
- Communication Science & Disorders, University of Pittsburgh, Pittsburgh, PA, USA
| | - Kimberly Meigh
- Communication Science & Disorders, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Julie Wambaugh
- Communication Sciences & Disorders, University of Houston, Houston, TX, USA
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Abstract
A first step in evaluating the use of computers in language therapy for individuals with aphasia is to establish the treatment as active in small groups prior to large-scale clinical trials. The present study evaluated a comprehensive computer-based language therapy program in a group of eight individuals with chronic in aphasia varying broadly in age, time post onset and aphasia type. Results revealed an overall therapeutic benefit in auditory comprehension, as well as positive trends in functional communication. Findings suggest that comprehensive therapy programs may be beneficial for many individuals with aphasia, and computer-based therapy may be one feasible avenue of providing this intervention.
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Affiliation(s)
- Lisa M D Archibald
- School of Communication Sciences and Disorders, Elborn College, University of Western Ontario, London, Ontario, Canada
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Rothi LJG, Fuller R, Leon SA, Kendall D, Moore A, Wu SS, Crosson B, Heilman KM, Nadeau SE. Errorless practice as a possible adjuvant to donepezil in Alzheimer's disease. J Int Neuropsychol Soc 2009; 15:311-22. [PMID: 19241637 PMCID: PMC3010871 DOI: 10.1017/s1355617709090201] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Six individuals with probable Alzheimer's disease (AD) participated in a phase 1 study employing a repeated measures, parallel baseline design testing the hypothesis that error-free experience during word production practice combined with an acetyl cholinesterase inhibitor would improve confrontation naming ability. While acetyl cholinesterase inhibitors are safe and delay cognition decline associated with AD, improvement over baseline cognition is less evident; clinically significant cognitive deficits persist and progress. Both animal and clinical research strongly implicate acetylcholine in learning, a form of neuroplasticity. In clinical practice, however, people with AD are given cholinergic medications without concomitant systematic/targeted retraining. In this study six participants with probable AD and taking donepezil participated in targeted word production practice using an errorless learning strategy. Results showed that combining behavioral enrichment training and an acetyl cholinesterase inhibitor resulted in significant improvements in verbal confrontation naming of trained items for three of six participants. Differences in baseline dementia severity, living conditions, and medications may have influenced the training response. Detection of substantial treatment effects in 50% of subjects suggests further language treatment studies in AD in combination with an acetyl cholinesterase inhibitor are warranted and provide useful information on inclusion/exclusion criteria for use in subsequent studies.
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Affiliation(s)
- Leslie J Gonzalez Rothi
- Brain Rehabilitation Research Center, Malcom Randall VA Medical Center, Gainesville, Florida 32608-1197, USA.
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Abstract
BACKGROUND The term 'acquired brain injury' (ABI) incorporates a range of aetiologies including cerebrovascular accident, brain tumour and traumatic brain injury. ABI is a common cause of disability in the paediatric population, and dysarthria is a common and often persistent sequelae associated with ABI in children. OBJECTIVES To assess the efficacy of intervention delivered by Speech and Language Pathologists/Therapists targeting dysarthric speech in children resulting from acquired brain injury. SEARCH STRATEGY We searched CENTRAL (Issue 4, 2006), MEDLINE (1966 to 02/2007), CINAHL (1982 to 02/2007), EMBASE (1980 to 02/2007), ERIC (1965 to 02/2007), Linguistics Abstracts Online (1985 to 02/07), PsycINFO (1872 to 02/2007). Additional references were also sought from reference lists studies. SELECTION CRITERIA The review considered randomised controlled trials (RCTs) and quasi-experimental design studies of children aged 3-16 years with acquired dysarthria grouped by aetiology (e.g., brain tumour, traumatic brain injury, cerebrovascular accident). DATA COLLECTION AND ANALYSIS Each author independently assessed the titles and abstracts for relevance (100% inter-rater reliability) and the full text version of all potentially relevant articles was obtained. No studies met inclusion criteria. MAIN RESULTS Of 2091 titles and abstracts identified, full text versions of only three (Morgan 2007; Murdoch 1999; Netsell 2001) were obtained. 2088 were excluded, largely on the basis of not including dysarthria, being diagnostic or descriptive papers, and for concerning adults rather than children. Morgan 2007 and Murdoch 1999 were excluded for not employing RCT or quasi-randomised methodology; Netsell 2001 on the basis of being a theoretical review paper, rather than an intervention study. Five references were identified and obtained from the bibliography of the Murdoch 1999 paper. All were excluded due to including populations without ABI, adults with dysarthria, or inappropriate design. Thus, no studies met inclusion criteria. AUTHORS' CONCLUSIONS The review demonstrates a critical lack of studies, let alone RCTs, addressing treatment efficacy for dysarthria in children with ABI. Possible reasons to explain this lack of data include i) a lack of understanding of the characteristics or natural history of dysarthria associated with this population; ii) the lack of a diagnostic classification system for children precluding the development of well targeted intervention programs; and iii) the heterogeneity of both the aetiologies and resultant possible dysarthria types of paediatric ABI. Efforts should first be directed at modest well-controlled studies to identify likely efficacious treatments that may then be trialed in multi-centre collaborations using quasi-randomised or RCT methodology.
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Affiliation(s)
- Angela T Morgan
- Healthy Development [Theme], Language & Literacy, Murdoch Childrens Research Institute, Parkville, Melbourne, Victoria, Australia, 3052.
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