Intensive Comprehensive Aphasia Programs: An International Survey of Practice

Background: In response to the need to simultaneously address multiple domains of the International Classification of Functioning, Disability and Health (ICF) in aphasia therapy and to incorporate intensive treatment doses consistent with principles of neuroplasticity, a potentially potent treatment option termed intensive comprehensive aphasia programs (ICAPs) has been developed. Objective: To conduct an international survey of ICAPs to determine the extent of their use and to explore current ICAP practices. Methods: A 32-item online survey was distributed internationally through Survey Monkey between May and August 2012. The survey addressed ICAP staffing, philosophy, values, funding, admission criteria, activities, family involvement, outcome measures, and factors considered important to success. Results: Twelve ICAPs responded: 8 from the United States, 2 from Canada, and 1 each from Australia and the United Kingdom. The majority of ICAPs are affiliated with university programs and are funded through participant self-pay. ICAPs emphasize individualized treatment goals and evidence-based practices, with a focus on applying the principles of neuroplasticity related to repetition and intensity of treatment. On average, 6 people with aphasia attend each ICAP, for 4 days per week for 4 weeks, receiving about 100 hours of individual, group, and computer-based treatment. Speech-language pathologists, students, and volunteers staff the majority of ICAPs. Conclusions: ICAPs are increasing in number but remain a rare service delivery option. They address the needs of individuals who want access to intensive treatment and are interested in making significant changes to their communication skills and psychosocial well-being in a short period of time. Their efficacy and cost-effectiveness require future investigation

Setting a research agenda to inform intensive comprehensive aphasia programs

Research into intensive comprehensive aphasia programs (ICAPs) has yet to show that this service delivery model is efficacious, effective, has cost utility, or can be broadly implemented. This article describes a phased research approach to the study of ICAPs and sets out a research agenda that considers not only the specific issues surrounding ICAPs, but also the phase of the research. Current ICAP research is in the early phases, with dosing and outcome measurement as prime considerations as well as refinement of the best treatment protocol. Later phases of ICAP research are outlined, and the need for larger scale collaborative funded research is recognized. The need for more rapid translation into practice is also acknowledged, and the use of hybrid models of phased research is encouraged within the ICAP research agenda

Outcomes from an intensive comprehensive aphasia program (ICAP): A retrospective look

Intensive comprehensive aphasia programs (ICAPs) are increasingly sought-after by consumers. It is important to examine outcomes from this unique clinical service model to determine feasibility, effectiveness, and potentially, to determine profiles of patient recovery. This poster presents retrospective data from first time participants in one ICAP over a 5 year period. Findings demonstrate significant improvements on language and activity/participation measures from pre-treatment to post-treatment

The Big Sky Aphasia Program: Patient and Student Training Outcomes

Intensive comprehensive aphasia programs (ICAPs) are a relatively new service delivery model for stroke rehabilitation (Rose, Cherney, & Worrall, 2013). The Big Sky Aphasia Program at the University of Montana meets the criteria for an ICAP and has been intentionally designed with clearly defined intensity parameters, a concern for client, caregiver, and clinician perspectives, and a focus on comprehensive therapy that addresses multiple modalities using strategies and recreational opportunities individualized to the patient

Increasing the intensity and comprehensiveness of aphasia services: identification of key factors influencing implementation across six countries

Background: Aphasia services are currently faced by increasing evidence for therapy of greater intensity and comprehensiveness. Intensive Comprehensive Aphasia Programs (ICAPs) combine these elements in an evidence-based, time-limited group program. The incorporation of new service delivery models in routine clinical practice is, however, likely to pose challenges for both the service provider and administering clinicians. This program of research aims to identify these challenges from the perspective of aphasia clinicians from six countries and will seek to trial potential solutions. Continual advancements in global communication technologies suggest that solutions will be easily shared and accessed across multiple countries. Aims: To identify the perceived and experienced barriers and facilitators to the implementation of 1) intensive aphasia services, 2) comprehensive aphasia services, and 3) ICAPs, from aphasia clinicians across six countries. Methods and procedures: A qualitative enquiry approach included data from six focus groups (n = 34 participants) in Australia, New Zealand, Canada, United States of America (USA), United Kingdom (UK), and Ireland. A thematic analysis of focus group data was informed by the Theoretical Domains Framework (TDF). Outcomes and results: Five prominent theoretical domains from the TDF influenced the implementation of all three aphasia service types across participating countries: environmental context and resources, beliefs about consequences, social/professional role and identity, skills, and knowledge. Four overarching themes assisted the identification and explanation of the key barriers and facilitators: 1. Collaboration, joint initiatives and partnerships, 2. Advocacy, the promotion of aphasia services and evidence-based practice, 3. Innovation, the ability to problem solve challenges, and 4. Culture, the influence of underlying values. Conclusions: The results of this study will inform the development of a theoretically informed intervention to improve health services’ adherence to aphasia best practice recommendations

Caregiver Outcomes in the Context of Telehealth and In-Person Applications of an Intensive Comprehension Aphasia Program

Title: Caregiver Outcomes in the Context of Telehealth and In-Person Applications of an Intensive Comprehension Aphasia Program. Purpose: The purpose of this study is to explore perceived stress for caregivers of stroke survivors with aphasia who participated in telehealth and in-person delivery models of a high-intensity, short duration stroke rehabilitation program, as measured by the Perceived Stress Scale (PSS; Cohen et al., 1983). Method: During in-person Intensive Comprehensive Aphasia Programs (ICAPs; Rose et al., 2013; 2021) in 2017 and 2018, and a tele-health ICAP in 2020, caregiver-reported outcomes were assessed using the PSS, a measure of perceived stress across life situations. During the ICAP intervention, caregivers participated in psychoeducation sessions, group counseling sessions, and individualized communication skill and strategy use training sessions. Interventions were delivered by a family counselor and speech-language pathologists. The PSS was administered before the caregivers began the ICAP and again after its completion (n=13 for in-person pre-ICAP, n=12 for in-person post-ICAP; n=3 for telehealth ICAP). PSS outcomes data will be analyzed using descriptive statistics to assess and interpret change scores. PSS item analyses will be conducted to assess the influence of item on pre/post change. Significance: Caregivers play a significant role during rehabilitation for stroke survivors with aphasia (i.e., a communication and language disorder). Caregivers are involved in supporting aphasia rehabilitation outside of clinical settings and are responsible for the patient’s overall wellbeing. Caregivers frequently experience third-party disability, including high levels of stress and isolation (Grawburg et al., 2013, Off et al., 2019). Caregivers should be considered as part of the treatment team as their wellbeing is intertwined with the stroke survivor’s wellbeing. This study is multifaceted: (1) it explores the changes of perceived stress for caregivers of stroke survivors with aphasia, and (2) it investigates the impact of delivery methods (i.e., in-person and telehealth) on changes of perceived stress. This study has the potential to contribute to the limited research based regarding caregiver health. References Cohen, S., Kamarck, T., & Mermelstein, R. (1983). Perceived Stress Scale. APA PsycTests. Grawburg, M., Howe, T., Worrall, L., Scarinci, N. (2013). Third party disability in family members of people with aphasia: A systematic review. Disability and Rehabilitation,35(16), 1324-1341. Off, C.A., Griffin, J.R., Murray, K.W., & Milman, L. Interprofessional Caregiver Education, Training, and Wellness in the Context of a Cohort Model for Aphasia Rehabilitation Top Language Disorders, 39(1), 5–28. Rose, M., Cherney, L., & Worrall, L. (2013). Intensive comprehensive aphasia programs: An international survey of practice. Topics in stroke rehabilitation, 20(5), 379-387. Rose ML, Pierce JE, Scharp VL, Off CA, Babbitt EM, Griffin-Musick JR, Cherney LR. (2021). Developments in the application of Intensive Comprehensive Aphasia Programs: an international survey of practice. Disability and Rehabilitation (10), 1-15. doi: 10.1080/09638288.2021.1948621

Comparing Preliminary Telehealth Outcomes to In-Person Delivery of a Rehabilitation Program for Stroke Survivors with Aphasia

Background. Aphasia is a language impairment, typically resulting from left hemisphere strokes. Aphasia impairs the neural networks that allow individuals to read, write/type, speak, and understand spoken information, negatively impacting daily communication and quality of life. Intensive Comprehensive Aphasia Programs (ICAPs) are stroke rehabilitation programs that help people living with aphasia improve their language function, communicative participation, and quality of life. In response to COVID-19, ICAPs could no longer take place in-person, necessitating a rapid move to telehealth models. No evidence has been provided in the literature to demonstrate the efficacy or effectiveness of telehealth ICAPs. Purpose. The purpose of this project was to compare language outcomes across two methods of ICAP delivery: telehealth (summer 2020) and in-person (summers 2014-2019). Methods. Participants. Stroke survivors with chronic aphasia participated in in-person or telehealth ICAPs at the University of Montana (UMT). Five stroke survivors participated in the novel summer 2020 UMT telehealth ICAP (IRB #87-20). Fifty-three stroke survivors participated in 2014-2019 UMT in-person ICAPs (IRB #116-14). Procedures. Language outcomes were evaluated using the Western Aphasia Battery-Revised (WAB-R) aphasia quotient (AQ). Individual characteristics of the telehealth participants were matched with participants from the 2014-2019 in-person data set. Three participant characteristics were considered during this matching process: (1) age (+/- 10 years), (2) biological sex, and (3) time post-stroke (+/- 6 months). Pre- and post-ICAP WAB-R AQ scores were compared across telehealth and in-person participants to assess telehealth ICAP efficacy. Results & Conclusions. The average change score on the WAB-R AQ for the telehealth cohort (5.42) was similar to the in-person cohorts (5.28), suggesting that telehealth delivery for ICAPs may be as efficacious as in-person delivery. Significance. COVID-19 has changed the landscape of stroke rehabilitation for people living with aphasia – particularly for those living in rural regions like the Mountain West. Telehealth models of service delivery have the potential to increase access to post-stroke services for rural residents beyond the pandemic era. Preliminary evidence suggests that telehealth delivery of an ICAP has the potential to result in similar language outcomes as in-person ICAP delivery

The Intensive Cognitive-Communication Rehabilitation Program for young adults with acquired brain injury

PURPOSE: This study investigated the effects of an intensive cognitive-communication rehabilitation (ICCR) program for young individuals with chronic acquired brain injury. METHOD: ICCR included classroom lectures; metacognitive instruction, modeling, and application; technology skills training; and individual cognitive-linguistic therapy. Four individuals participated in the intensive program (6 hr with 1-hr lunch break × 4 days × 12 weeks of treatment): 3 participants completed 3 consecutive semesters, and 1 participant completed 1 semester. Two controls did not receive treatment and completed assessments before and after the 12-week treatment interval only. RESULTS: All 4 experimental participants demonstrated significant improvements on at least 1 standardized cognitive-linguistic measure, whereas controls did not. Furthermore, time point significantly predicted participants' scores on 2 of the 4 standardized outcome measures, indicating that as duration in ICCR increased, scores also increased. Participants who completed multiple semesters of ICCR also improved in their therapy and personal goals, classroom behavior, life participation, and quality of life. CONCLUSION: After ICCR, participants showed gains in their cognitive-linguistic functioning, classroom participation, and individual therapy. They also demonstrated improvements outside the classroom and in their overall well-being. There is a gap between the large population of young adults with acquired brain injury who wish to return to higher education and a lack of rehabilitation programs supporting reentry into academic environments; ICCR is a first step in reducing that gap.T32 DC013017 - NIDCD NIH HHSAccepted manuscrip

Language and Psychosocial Outcomes for Stroke Survivors with Aphasia Following an Intensive Comprehensive Aphasia Program

Purpose: Intensive comprehensive aphasia programs (ICAPs) are community-based rehabilitation programs designed to improve the speech, language, cognition, and psychosocial well-being of stroke survivors. ICAPs integrate individual and group therapy, current technologies, and client/family wellness and education. Although many aphasia treatment programs exist, traditional therapy models lack the therapeutic intensity and holistic intervention approach that ICAPs provide. The intensity of ICAPs allows the patients with aphasia (PWA) to engage in 72 hours of therapy in four weeks compared to traditional aphasia therapy which offers 30 hours in 10 weeks. The purpose of this retrospective study is to examine language impairment and psychosocial outcomes of PWA following participation in an ICAP at the University of Montana. Methods: Approximately 40 PWA participated in at least one of six ICAP sessions that occurred between 2014 and 2017. Treatment delivery included: individual evidence-based language impairment treatment, conversation groups, a weekly large group with focus on psychosocial well-being, and weekly community outings to facilitate social communication. The treatment intensity was 4-4.5 hours of therapy per day, 4 days per week, for 4 weeks. Both pre- and post-treatment assessments of language and psychosocial well-being were administered including: the Western Aphasia Battery- Revised, the Boston Naming Test-second edition, the Assessment for Living with Aphasia, and the Geriatric Depression Scale. Outcome data from the six ICAPs is currently being organized for analysis. Preliminary analyses will be presented. Significance: Evidence suggests that the therapeutic intensity and the holistic intervention approach offered by ICAPs are beneficial to improving quality of life and communicative rehabilitation for stroke survivors with aphasia. Future service delivery models should consider this multifaceted approach as well as ways to better support autonomy and sense of respect and dignity throughout therapy

Patient Perspectives of an Intensive Comprehensive Aphasia Program for Stroke Survivors

Individuals with aphasia who participate in intensive post-stroke language rehabilitation programs make a variety of significant investments. Investments involve commitment across many domains including: time, finance, family participation, temporary relocation, as well as cognitive, physical, and emotional exertion. While intensive aphasia programs and intensive comprehensive aphasia programs (ICAPs) are becoming increasingly prevalent across health care settings (Rodriguez et al., 2017; Rose, et al 2013), and language-based and psychosocial outcomes are beginning to be reported in the literature (e.g., Babbitt, Worrall, & Cherney, 2015; Hoover, Caplan, Waters, & Carney, 2017), patient perspectives have yet to be explored. As health care moves towards patient centered care (Robinson et al., 2008), persons with aphasia (PWA)’s perspectives of their rehabilitation experience should inform current research and intervention approaches (e.g., Barrett, 2010). The purpose of this qualitative study is to examine patient perspectives on the experience of participating in an intensive comprehensive aphasia program (ICAP), specifically the Big Sky Aphasia Program (BSAP) at University of Montana. Investigating what it is like for a person with aphasia (PWA) to participate in an ICAP will contribute to the exploration of the worthwhileness of the ICAP model. The primary research question of this study was: “what is it like to be a PWA in an ICAP?” Investigators conducted nine, face-to-face, semi-structured interviews to collect narrative data from PWA who participated in the BSAP ICAP. The researchers asked the participants to describe their experiences and perspectives of the ICAP All interviews were audiovisually recorded and transcribed from the video recordings. Spoken production was transcribed verbatim and meaningful non-verbal communication (e.g., pointing) was also documented in the transcripts. Both researchers present during interviews took field notes on topics interviewees emphasized as important. Transcripts and field notes will be analyzed to create codes (i.e., phrases with keywords that represent significant concepts in participants’ experiences). Data will be analyzed for themes and conclusions will be made about participants’ experiences in the BSAP ICAP. Implications of these perspectives for future ICAP implementation and research will be discussed