Health-related quality of life in people with severe aphasia

Background: Health-related quality of life (HRQL) measures are increasingly used to help us understand the impact of disease or disability on a person's life and to measure the effectiveness of interventions. A small number of studies have looked at perceived HRQL in people with mild or moderate aphasia. They report that reduced HRQL is associated with low psychological well-being and depression, reduced activity levels and high levels of communication disability. Still, very little is known about the quality of life of people with severe aphasia. Aims: This study aimed to evaluate the HRQL of people with severe aphasia as rated by their proxy respondents. To increase our understanding of these proxy evaluations, the findings were compared with those of two other studies of HRQL in people with moderate or mild aphasia, using proxy and self-report respondents. Methods & Procedures: A questionnaire-based cross-sectional survey was carried out where proxies of people with severe aphasia reported on their HRQL. The people with severe aphasia who took part in this study were part of a larger cohort of people with aphasia who were able to self-report on their HRQL. Aphasia was assessed with the American Speech and Hearing Association Functional Assessment of Communication Skills for Adults (ASHA-FACS) and the Frenchay Aphasia Screening Test (FAST) and HRQL with the Stroke and Aphasia Quality of Life (SAQOL) scale (proxy-reported). SAQOL-39 scores were derived from the SAQOL. Results & Results: People with severe aphasia's quality of life, as measured by their proxies (n = 12), was low and more than one standard deviation below that of the standardization sample of the SAQOL. The overall mean score for the SAQOL-39 and the means for its physical and communication domains were below the 20th centile. They were also significantly lower that those of the comparison studies of self-reports (n = 83) and proxy ratings (n = 50) of people with mild or moderate aphasia (p0.003). In the comparison studies there were no significant differences between the self-report and proxy ratings of people with mild or moderate aphasia. Conclusions & Implications: This small study suggests that the HRQL of people with severe aphasia, as reported by their proxies, is severely compromised. Further research, using a wide range of methodologies, is needed in order to address the challenge of understanding better the quality of life of people with severe aphasia

Crossed Aphasia in a Patient with Anaplastic Astrocytoma of the Non-Dominant Hemisphere

Aphasia describes a spectrum of speech impairments due to damage in the language centers of the brain. Insult to the inferior frontal gyrus of the dominant cerebral hemisphere results in Broca\u27s aphasia - the inability to produce fluent speech. The left cerebral hemisphere has historically been considered the dominant side, a characteristic long presumed to be related to a person\u27s handedness . However, recent studies utilizing fMRI have shown that right hemispheric dominance occurs more frequently than previously proposed and despite a person\u27s handedness. Here we present a case of a right-handed patient with Broca\u27s aphasia caused by a right-sided brain tumor. This is significant not only because the occurrence of aphasia in right-handed-individuals with right hemispheric brain damage (so-called crossed aphasia ) is unusual but also because such findings support dissociation between hemispheric linguistic dominance and handedness. © 2017, EduRad. All rights reserved

An Exploratory Study into the Accessibility of a Multi-User Virtual World for Young People with Aphasia

This paper describes an exploratory study into the accessibility of the virtual world Second Life for two young people with aphasia. Aphasia is a communicative disorder most commonly caused by a stroke. It affects both written and spoken language, is frequently accompanied by right-sided paralysis and people with aphasia can experience isolation and social exclusion. Multi-user virtual worlds are a potential source of fun and contact with others, but how accessible are such worlds to those with communication issues? We report an investigation into the accessibility and potential of Second Life for people with aphasia. This was accomplished through a critique and an empirical study involving two young people: Ann was in her mid twenties and Bob in his early thirties. They were selected because both were comfortable with computer technologies before their strokes and each continues to use them, albeit in a more limited capacity. We discuss implications of the results for people with aphasia interacting with multi-user virtual worlds

Accessibility of 3D Game Environments for People with Aphasia: An Exploratory Study

People with aphasia experience difficulties with all aspects of language and this can mean that their access to technology is substantially reduced. We report a study undertaken to investigate the issues that confront people with aphasia when interacting with technology, specifically 3D game environments. Five people with aphasia were observed and interviewed in twelve workshop sessions. We report the key themes that emerged from the study, such as the importance of direct mappings between users’ interactions and actions in a virtual environment. The results of the study provide some insight into the challenges, but also the opportunities, these mainstream technologies offer to people with aphasia. We discuss how these technologies could be more supportive and inclusive for people with language and communication difficulties

Reporting on psychological well-being of older adults with chronic aphasia in the context of unaffected peers

Abstract Purpose: It is important that professionals working with individuals with acquired neurogenic communication disorders consider their clients’ psychological wellbeing. Much is known about the significant emotional, social and psychological consequences of aphasia after stroke, however little is known about individuals’ psychological wellbeing. This paper reports the psychological wellbeing of community-dwelling older adults with chronic aphasia in the context of their unaffected peers. Method: Thirty participants affected by aphasia and 75 unaffected participants completed the 24-item measure How I Feel About Myself drawn originally from Ryff (1989) and the Geriatric Depression Scale (Sheikh & Yesavage, 1986). Results: Individuals with aphasia after stroke had statistically similar range and average psychological wellbeing as the unaffected population, with the exception of lower environmental mastery (independence) and lower mood. Furthermore, a substantial number of individuals (affected and unaffected) reported lower than average psychological wellbeing. Conclusions: Many persons with chronic aphasia need support to manage the demands and responsibilities of their everyday lives and raise their mood. Clinicians need to be aware of this possibility and formally assess all persons with aphasia, as well as explore the potential impact of physical limitations. Identifying low well-being in older adults is important for all professionals working with the ageing population. The implications for speech and language therapy and for multi-disciplinary research and cross-sector joint working (health, social and community services) are discussed

Psychological distress after stroke and aphasia: the first six months

Objective: We explored the factors that predicted psychological distress in the first six months post stroke in a sample including people with aphasia. Design: Prospective longitudinal observational study. Setting and subjects: Participants with a first stroke from two acute stroke units were assessed while still in hospital (baseline) and at three and six months post stroke. Main measures: Distress was assessed with the General Health Questionnaire-12. Other measures included: NIH Stroke Scale, Barthel Index, Frenchay Aphasia Screening Test, Frenchay Activities Index, MOS Social Support Scale and social network indicators. Logistic regression was used to identify predictors of distress at each stage post stroke; and to determine what baseline factors predicted distress at six months. Results: Eighty-seven participants were able to self-report on measures used, of whom 32 (37%) had aphasia. 71 (82%) were seen at six months, including 11 (16%) with aphasia. Predictors of distress were: stroke severity at baseline; low social support at three months; and loneliness and low satisfaction with social network at six months. The baseline factors that predicted distress at six months were psychological distress, loneliness and low satisfaction with social network (Nagelkerke R2 = 0.49). Aphasia was not a predictor of distress at any time point. Yet, at three months post stroke 93% of those with aphasia experienced high distress, as opposed to 50% of those without aphasia (χ2 (1) = 8.61, P<0.01). Conclusions: Factors contributing to distress after stroke vary across time. Loneliness and low satisfaction with one’s social network are particularly important and contribute to long-term psychological distress

Telerehabilitation for aphasia – protocol of a pragmatic, exploratory, pilot randomized controlled trial

Background The Cochrane review on the effectiveness of speech and language therapy for aphasia following stroke suggests intensity of therapy is a key predictor for outcome. Current aphasia services cannot provide intervention at the intensity observed within trial contexts because of resource limitations. Telerehabilitation could widen access to speech-language pathologists (SLPs) in geographically remote contexts and reduce the time spent on travel by the therapist and patient. The current academic literature within this field is in its infancy, with few trials of speech and language therapy (SLT) delivered by videoconference. Our pilot randomized controlled trial (RCT) will explore feasibility aspects and effectiveness of telerehabilitation for aphasia in addition to standard SLT. Method/design Our study is a pragmatic, exploratory, pilot randomized controlled trial, where participants will be randomized to a telerehabilitation group or a control group. Both groups receive standard SLT (usual care) but the telerehabilitation group receives an additional 5 h of telerehabilitation per week over 4 weeks through videoconference. This additional telerehabilitation focuses on spoken language with an emphasis on word naming. We aim to include 40 patients in each group, with inclusion criteria being aphasia any time post stroke. Participants will be assessed blindly at pre-randomization (baseline), and 4 weeks and 4 months after randomization. The primary endpoint is naming ability 3 months after the completed intervention, measured by the Norwegian Basic Aphasia Assessment (NGA) naming subtest. Secondary endpoints include other subtests of the NGA, the VAST (Verb and Sentence Test) subtest sentence production, Communicative Effectiveness Index (CETI) and the Stroke and Aphasia Quality of Life scale (SAQOL-39). Experiences of patients and SLPs with telerehabilitation are assessed using questionnaires and semi-structured interviews. Statistical between group comparisons will be in line with an intention-to-treat analysis. Discussion This pilot RCT of intensive language training by videoconference will contribute new scientific evidence to the field of aphasia telerehabilitation. Here, we describe our trial which will explore the feasibility of telerehabilitation for aphasia as an intervention, our choice of primary and secondary outcome measures and proposed analyses. Our trial will provide information for the development and delivery of future definitive RCTs. Trial registration ClinicalTrials.gov, ID: NCT02768922 . Registered on 11 May 2016. Last updated on 17 November 2017

CreaTable Content and Tangible Interaction in Aphasia

Multimedia digital content (combining pictures, text and music) is ubiquitous. The process of creating such content using existing tools typically requires complex, language-laden interactions which pose a challenge for users with aphasia (a language impairment following brain injury). Tangible interactions offer a potential means to address this challenge, however, there has been little work exploring their potential for this purpose. In this paper, we present CreaTable – a platform that enables us to explore tangible interaction as a means of supporting digital content creation for people with aphasia. We report details of the co-design of CreaTable and findings from a digital creativity workshop. Workshop findings indicated that CreaTable enabled people with aphasia to create something they would not otherwise have been able to. We report how users’ aphasia profiles affected their experience, describe tensions in collaborative content creation and provide insight into more accessible content creation using tangibles

Conversation therapy for agrammatism: exploring the therapeutic process of engagement and learning by a person with aphasia.

A recent systematic review of conversation training for communication partners of people with aphasia has shown that it is effective, and improves participation in conversation for people with chronic aphasia. Other research suggests that people with aphasia are better able to learn communication strategies in an environment which closely mirrors that of expected use, and that cognitive flexibility may be a better predictor of response to therapy than severity of language impairment. This study reports results for a single case, one of a case series evaluation of a programme of conversation training for agrammatism that directly involves a person with aphasia (PWA) as well as their communication partner. It explores how a PWA is able to engage with and learn from the therapy, and whether this leads to qualitative change in post-therapy conversation behaviours