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

Impact of Personalization on Acquisition and Generalization of Script Training: A Preliminary Analysis

Eight individuals with chronic aphasia underwent intensive computer-based script training. Trained and untrained generalization scripts, matched for length and complexity, were developed. The two scripts shared personalized and non-personalized words/phrases. Training lasted three weeks. Script performance was probed periodically. For acquisition, the gain from baseline to post-treatment for both personalized and non-personalized words/phrases on the trained script was significant; the effect size of personalization over non-personalization was moderate. For generalization, the gain for both personalized and non-personalized items was also significant, but the effect size of personalization over non-personalization was small. Limitations of the study are discussed

Intensive Language Therapy for Nonfluent Aphasia With And Without Surgical Implantation of an Investigational Cortical Stimulation Device: Preliminary Language and Imaging Results

This randomized clinical trial evaluated the feasibility of targeted epidural cortical stimulation delivered concurrently with speech-language therapy (SLT) in four subjects with chronic Broca’s aphasia. Four matched controls received identical SLT without stimulation. Investigational subjects showed a mean WAB-AQ change of 8.0 points immediately post-therapy and at 6-week follow-up, and 12.3 points at 12-week follow-up. The control group’s mean WAB-AQ change was 4.6, 5.5, and 3.6 points, respectively. Similar patterns of change were noted on the Communicative Effectiveness Index. fMRI changes suggested differential reorganization. Cortical stimulation in combination with intensive SLT may enhance language rehabilitation for chronic Broca’s aphasia

Acquisition, Maintenance and Generalization of Script Training: A Comparison of Errorful and Error-Reducing Conditions

Relatively few studies have investigated errorless versus errorful learning in aphasia, and most have focused on the single word level. In a review of a series of anomia studies, Fillingham et al. (2003) found that rate of success was equivalent for errorless and errorful conditions; the number of therapies using errorful techniques outweighed those based on errorless learning; errorless approaches were likely to achieve positive immediate effects, but many of the errorless studies did not report long term effects and generalization; and there was a lack of studies reporting a direct comparison of errorful and errorless learning. More recent work has continued to support the findings that there is no essential difference between error-free and errorless learning approaches (Middleton & Schwartz, 2012). However, none have investigated and contrasted the errorless/errorful learning paradigm in the production of phrases and sentences. This pilot study directly measures and compare the acquisition, maintenance and generalization of script-training under both error-reducing and errorful conditions. We hypothesized that error-reducing training would improve acquisition of a trained script while errorful learning would improve maintenance of the trained script and generalization to untrained scripts

Is More Better? Preliminary Results from a Computer Treatment Study for Aphasia

This randomized clinical trial evaluated the efficacy of an oral reading treatment provided via computer, and compared outcomes for 10-hours versus 4-hours of weekly practice. An intent-to-treat analysis showed subjects receiving 6-weeks of computer treatment improved significantly more on the Aphasia Quotient of the Western Aphasia Battery than subjects receiving no treatment. 10-hours of weekly practice resulted in a mean WAB AQ change of 6.76 (SD=7.63) compared to a mean change of 3.92 (SD=6.22) in the 4-hour group. However, after 24 treatment hours, language improvements were greater when practice was less intensive. Implications for clinical treatment and research are discussed

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

Aphasia Treatment over the Internet: A Randomized Placebo-Controlled Clinical Trial

We report results of a randomized placebo-controlled clinical trial evaluating an aphasia treatment provided over the internet. Thirty-two persons with aphasia were randomized to receive 6 weeks of practice with Oral Reading for Language in Aphasia (ORLA) (N=19) or a commercial computer game (N=13). Results indicated significant changes on WAB-R subtests (AQ, reading and writing) with web-based ORLA; changes were maintained for six weeks. There was no significant difference between ORLA versus the placebo computer program.  Findings support the feasibility and efficacy of providing ORLA over the internet. Reasons for improvements with the commercial computer program are discussed

Transcranial Direct Current Stimulation and Aphasia Treatment: A Pilot Study of Anodal, Cathodal and Sham Stimulation

Transcranial direct current stimulation (tDCS) may potentially enhance language therapy outcomes in aphasia. We report behavioral results for twelve participants with chronic aphasia matched for severity and randomized to receive anodal, cathodal or sham stimulation to the left hemisphere, concurrent with intensive speech-language therapy. Importantly, tDCS (1mA for 13 minutes) given 5 days a week over a prolonged period of time (6 weeks) was found to be safe. There was an advantage of both anodal and cathodal stimulation over sham stimulation. Cathodal stimulation to the left hemisphere may be a viable option and should not be overlooked in future research

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

Clinician Perspectives of an Intensive Comprehensive Aphasia Program

Background: Intensive comprehensive aphasia programs (ICAPs) have increased in number in recent years in the United States and abroad. Objective: To describe the experiences of clinicians working in an ICAP. Methods: A phenomenological approach was taken. Seven clinicians from 3 ICAPs were interviewed in person or on the phone. Their interviews were transcribed and coded for themes relating to their experiences. Results: Clinicians described 3 major themes. The first theme related to the intensity component of the ICAP that allowed clinicians to provide in-depth treatment and gave them a different perspective with regard to providing treatment and the potential impact on the person with aphasia. The second theme of rewards for the clinicians included learning and support, seeing progress, and developing relationships with their clients and family members. Third, challenges were noted, including the time involved in learning new therapy techniques, patient characteristics such as chronicity of the aphasia, and the difficulty of returning to work in typical clinical settings after having experienced an ICAP. Conclusions: Although there is a potential for bias with the small sample size, this pilot study gives insight into the clinician perspective of what makes working in an ICAP both worthwhile and challenging