Audrey Holland

Background Effectiveness of early intensive aphasia rehabilitation after stroke is unknown. The Very Early Rehabilitation for SpEech trial (VERSE) aimed to determine whether intensive aphasia therapy, beginning within 14 days after stroke, improved communication recovery compared to usual care. Methods Prospective, randomized, single-blinded trial conducted at 17 acute-care hospitals across Australia/New Zealand from 2014 to 2018. Participants with aphasia following acute stroke were randomized to receive usual care (direct usual care aphasia therapy), or one of two higher intensity regimens (20 sessions of either non-prescribed (usual care-plus or prescribed (VERSE) direct aphasia therapy). The primary outcome was improvement of communication on the Western Aphasia Battery-Revised Aphasia Quotient (AQ) at 12 weeks after stroke. Our pre-planned intention to treat analysis combined high intensity groups for the primary outcome. Findings Among 13,654 acute stroke patients screened, 25...

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Clinicians generally have limited time to evaluate their aphasic clients, and thus are often unable to include discourse-level language in their assessments. Sampling and analyzing language at the discourse level by hand can be very time-consuming, but since it is the level at which day-to-day communication occurs, it provides important information about language use and competence in context. It can also point the way to functional goals for therapy. In this presentation we will illustrate the use of EVAL, a recent addition to the wide array of CLAN computerized language analysis programs freely available from TalkBank (MacWhinney, 2000). EVAL is designed for quick and simple use by clinicians. It measures 25 language characteristics in a transcription of discourse and displays them in an Excel spreadsheet. It can then compare the results with those of a comparison group selected from the AphasiaBank database, or it can compare the results with those of the same participant at earl...

ABSTRACT Primary objective: To investigate whether the degree of participation by people with severe Traumatic Brain Injury (TBI), and the degree of support by their communication partners (CPs) changes in conversation during subacute recovery. Methods and procedures: Seventeen pairs of participants with TBI and their CPs were video-recorded during a 10 min casual conversation at 3 and 6 months post-injury. Communication behaviors were rated using the adapted Measure of Participation in Conversation (MPC) and the adapted Measure of Support in Conversation (MSC) at both time points and compared. Results: Inferential analyses showed that there was no significant change in the degree of participation in conversation by participants with TBI and the degree of conversation support by their CPs from 3 to 6 months post. Comparison of qualitative field notes revealed that specific conversational behaviors changed over time, including better turn-taking and topic maintenance. Conclusion: Documenting early communication recovery is a complex and challenging endeavor. The lack of change in conversational effectiveness during the sub-acute period using global rating scales highlights the need for social communication tools that are sensitive to communication recovery following severe TBI.

The purpose of this study was to examine the relationship between picture naming performance and the ability to communicate the gist, or essential elements, of a story. We also sought to determine if this relationship varied according to Western Aphasia Battery-Revised (WAB-R; Kertesz, 2007) aphasia subtype. Demographic information, test scores, and transcripts of 258 individuals with aphasia completing 3 narrative tasks were retrieved from the AphasiaBank database. Narratives were subjected to a main concept analysis to determine gist production. A correlation analysis was used to investigate the relationship between naming scores and main concept production for the whole group of persons with aphasia and for WAB-R subtypes separately. We found strong correlations between naming test scores and narrative gist production for the large sample of persons with aphasia. However, the strength of the correlations varied by WAB-R subtype. Picture naming may accurately predict gist producti...

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This study examined discourse characteristics of individuals with aphasia who scored at or above the 93.8 cutoff on the Aphasia Quotient subtests of the Western Aphasia Battery-Revised (WAB-R; Kertesz, 2007). They were compared with participants without aphasia and those with anomic aphasia. Participants were from the AphasiaBank database and included 28 participants who were not aphasic by WAB-R score (NABW), 92 participants with anomic aphasia, and 177 controls. Cinderella narratives were analyzed using the Computerized Language Analysis programs (MacWhinney, 2000). Outcome measures were words per minute, percent word errors, lexical diversity using the moving average type-token ratio (Covington, 2007b), main concept production, number of utterances, mean length of utterance, and proposition density. Results showed that the NABW group was significantly different from the controls on all measures except MLU and proposition density. These individuals were compared to participants wi...

This work focuses on the twenty-six individuals who provided data to AphasiaBank on at least two occasions, with initial testing between 6 months and 5.8 years post-onset of aphasia. The data are archival in nature and were collected from the extensive database of aphasic discourse in AphasiaBank. The aim is to furnish data on the nature of long-term changes in both the impairment of aphasia as measured by the Western Aphasia Battery-Revised (WAB-R) and its expression in spoken discourse. AphasiaBank's demographic database was searched to discover all individuals who were tested twice at an interval of at least a year with either: 1) the AphasiaBank protocol; or 2) the AphasiaBank protocol at first testing, and the Famous People Protocol (FPP) at second testing. The Famous People Protocol is a measure developed to assess the communication strategies of individuals whose spoken language limitations preclude full participation in the AphasiaBank protocol. The 26 people with aphasia (PWA) who were identified had completed formal speech therapy before being seen for AphasiaBank. However, all were participants in aphasia centers where at least three hours of planned activities were available, in most cases, twice weekly. WAB-R Aphasia Quotient scores (AQ) were examined, and in those cases where AQ scores improved, changes were assessed on a number of measures from the AphasiaBank discourse protocol. Sixteen individuals demonstrated improved WAB-R AQ scores, defined as positive AQ change scores greater than the WAB-R AQ standard error of the mean (WAB-SEM); seven maintained their original WAB quotients, defined as AQ change scores that were not greater than the WAB-SEM; and the final three showed negative WAB-R change scores, defined as a negative WAB-R AQ change score greater than the WAB-SEM. Concurrent changes on several AphasiaBank tasks were also found, suggesting that the WAB-R improvements were noted in more natural discourse as well. These data are surprising, since conventional wisdom suggests that spontaneous improvement in language is unlikely to occur beyond one year. Long-term improvement or maintenance of early test scores, such as that shown here, has seldom been demonstrated in the absence of formal treatment. Speculations about why these PWA improved, maintained or declined in their scores are considered.

The efficacy of rehabilitation therapy for aphasia caused by stroke is uncertain. The Very Early Rehabilitation of Speech (VERSE) trial aims to determine if intensive prescribed aphasia therapy (VERSE) is more effective and cost saving than non-prescribed, intensive (usual care-plus) and non-intensive usual care (UC) therapy when started within 15 days of stroke onset and continued daily over four weeks. We hypothesize that aphasia therapy when started very early after stroke and delivered daily could enhance recovery of communication compared with UC. A total of 246 participants (82 per arm) will provide 80% power to detect a 4.4% improvement on aphasia quotient between VERSE and UC plus at a significance level of α = 0.05. Acute-care hospitals and accompanying rehabilitation services throughout Australia, 2014-2017. Three-arm, prospective, randomized, parallel group, open-label, blinded endpoint assessment (PROBE) trial. Acute stroke in previous 14 days and aphasia diagnosed by ap...

Language-impaired nursing home residents struggle not only with their own language difficulties but also with an environment that offers limited communication opportunities. This study attempts to define the communication needs of a subset of language-impaired nursing home residents, those with severe aphasia, by interviewing these residents’ communication partners. By contrasting reported communication needs with the actual observed communication environment, discrepancies are revealed that can be addressed clinically. The reported need for social communication versus the observed social communication, for example, supports clinical intervention efforts aimed at increasing opportunity and success in social interactions.

This session will examine the similarities and differences between coaching and more traditional counseling for families and persons with aphasia. Because of its emphasis on wellness and "moving on" with life, coaching presents some unique advantages for poststroke adjustment. (And incidentally, also for clinicians facing professional burnout.) Life coaching principles will be reviewed, and examples provided in an atmosphere that will encourage the participation and interchange that simulates good coaching at work.

Communication between long-term care residents with Alzheimer’s Disease (AD) and their professional caregivers is often inadequate and ineffective. This study investigates an established caregiver training program (ORegon Center for Applied Science [ORCAS]: Strategies for Dementia, Communication Skills for Professional Caregivers; Bourgeois & Irvine, 2000) designed to teach professional caregivers skills to improve communication with their residents with AD. Responses from caregivers who participated in the training program, as well as responses from the residents in their care, provide insight into the effectiveness of the program. Suggestions for improvement are provided.

This presentation describes the procedures and results of a systematic review of the literature on communication partner training in aphasia. A search of thirteen databases resulted in 28 relevant articles published in English between 1975 and April, 2008. These included 8 group studies varying from randomized controlled trials to uncontrolled pre-post studies, 7 single-subject experimental designs, 5 qualitative research designs and 8 case studies. Studies were independently reviewed by two reviewers. Results revealed a wide range of quality scores. Most studies fell in the weaker AAN evidence strength classes. However, 3 studies met the criteria for Class I research.

While there is substantial literature attesting to the benefits of music and art therapies for people with aphasia (PWA) (Hobson, 2006; Peterson, 2006), there is little concerning their participation in theater. Although the value of drama groups in increasing confidence, belonging, and group cohesion across a range of disabling conditions has been documented (Moreno, 1985; Landy, 1994), they are seldom undertaken with PWA. This paper describes a community based aphasia center’s theater program and provides qualitative data discussing the reasons PWA joined the program and the identified benefits gained from participation. Psychosocial, linguistic, and recreational/vocational benefits are discussed.

The use of the Nintendo Wii™ gaming system in a rehabilitative capacity is emerging in physical therapy rehabilitation journals and in news articles and releases from rehabilitation departments and centers across the world (Deutsch, Borbely, Filler, Huhn, & Guarrera-Bowlby, 2008; Tanner, 2008; Coyne, 2008). The incorporation of an Aphasia Wii™ Group at a community based aphasia center is examined. Systematic observation of aphasia groups using the Wii™ Sports game demonstrates that it provides opportunities for a variety of communicative acts and psychosocial benefits. Qualitative methods are used to analyze and discuss identified benefits, and areas for further research are identified.

This paper summarized data obtained by observing the functional communication of 40 adult aphasic subjects who lived at home. It describes typical communication patterns by presenting three case histories and detailed reports of the actual observations. It also summarizes effective communication strategies used by the subjects, and gives detailed examples of three successful strategy users.