Crossroads in aphasia rehabilitation

This thesis focusses on two types of aphasia rehabilitation, cognitive linguistic treatment (CLT) and AAC (Augmentative and Alternative Communication) training. In a study of the effect of nonlinguistic variables on the outcome of CLT, it was shown, that neuropsychological data contributed significantly to the prediction of verbal communicative ability after treatment. It is concluded that a neuropsychological assessment is needed in all aphasic patients before treatment is started. In a study of the efficacy of AAC in people with a severe aphasia, a computerised communication aid, TouchSpeak (TS), was developed and tested in 34 aphasic patients. 57 % of the participants used the device in everyday life scenarios and overall communicative abilities improved with TS training. The final chapter presents a new test for overall (verbal and nonverbal) communication in people with a severe aphasia. In a pilot group, patients with a severe aphasia showed large variation in overall scores. In addition, several communicative patterns could be described

Production and Comprehension of Pantomimes Used to Depict Objects

Pantomime, gesture in absence of speech, has no conventional meaning. Nevertheless, individuals seem to be able to produce pantomimes and derive meaning from pantomimes. A number of studies has addressed the use of co-speech gesture, but little is known on pantomime. Therefore, the question of how people construct and understand pantomimes arises in gesture research. To determine how people use pantomimes, we asked participants to depict a set of objects using pantomimes only. We annotated what representation techniques people produced. Furthermore, using judgment tasks, we assessed the pantomimes' comprehensibility. Analyses showed that similar techniques were used to depict objects across individuals. Objects with a default depiction method were better comprehended than objects for which there was no such default. More specifically, tools and objects depicted using a handling technique were better understood. The open-answer experiment showed low interpretation accuracy. Conversely, the forced-choice experiment showed ceiling effects. These results suggest that across individuals, similar strategies are deployed to produce pantomime, with the handling technique as the apparent preference. This might indicate that the production of pantomimes is based on mental representations which are intrinsically similar. Furthermore, pantomime conveys semantically rich, but ambiguous, information, and its interpretation is much dependent on context. This pantomime database is available online: https://dataverse.nl/dataset.xhtml?persistentId=hdl:10411/QZHO6M. This can be used as a baseline with which we can compare clinical groups

Communication profiles in severe aphasia: the roles of supportive strategies and of the communication partner

In communication, aphasic persons with limited speech rely on supportive strategies and on the help of the communication partner. The RIJST is a new tool assessing both aspects of aphasic communication. In a group of patients with similar severe verbal deficits four different communication profiles were observed. These profiles differ both in the use of supportive strategies and in the amount of help needed from the partner. The results are highly relevant for communication therapy and offer insight in the discussion concerning the relation between verbal deficits and communicative abilities in severe aphasia

Candidacy for conversation partner training in aphasia: findings from a Dutch implementation study

Background: Aphasia rehabilitation should comprise a family-centred approach, involving main conversation partners in the rehabilitation process as soon as possible. A standardised approach to conversation partner training (CPT) became available in the Netherlands with the release of Partners of Aphasic clients Conversation Training (PACT). PACT was introduced in clinical practice in a multicentre implementation study with 34 participating dyads. Aims: To explore candidacy for CPT by describing the characteristics of dyads where the conversation partner engaged in CPT and to identify which characteristics had the potential to predict benefit of PACT. Methods & procedures: A multicentre study with pre-post treatment design. Pre and post CPT measures of psychosocial characteristics (caregiver burden, depression, coping) from the partner and behavioural characteristics (cognitive, linguistic and communicative) from the person with aphasia were collected. Partner experience was assessed using four scales from the Intrinsic Motivation Inventory and a generic satisfaction rating (1-10). Pre-post measures were analysed using paired T-tests and Wilcoxon signed ranks tests. Multiple regression analyses were used to assess potential predictors of training outcomes. Outcomes & results: Partners of people with moderate to severe aphasia engaged in PACT when it was first introduced in clinical practice (N=34 dyads). Mean time post onset was 11.5 months. Partners enjoyed the practical training in which they actively engaged through experiential learning methods. Partner scores increased significantly over the intervention time on task-oriented and avoidance-oriented coping skills and their symptoms of depression lowered significantly. Caregiver esteem was found to be a positive predictor of feelings of competence and enjoyment with the training. Older partners enjoyed the training less. More effort was given to the training by the partner when the aphasia was more severe. Conclusions: This study underlined the importance of partner characteristics, such as motivation, coping style and a positive outlook on caregiving as possible selection criteria for conversation partner training

Transcranial direct current stimulation in post-stroke sub-acute aphasia: Study protocol for a randomized controlled trial

Background: Transcranial direct current stimulation (tDCS) is a promising new technique to optimize the effect of regular Speech and Language Therapy (SLT) in the context of aphasia rehabilitation. The present study focuses on the effect of tDCS provided during SLT in the sub-acute stage after stroke. The primary aim is to evaluate the potential effect of tDCS on language functioning, specifically on word-finding, as well as generalization effects to verbal communication. The secondary aim is to evaluate its effect on social participation and quality of life, and its cost-effectiveness. Methods: We strive to include 58 stroke patients with aphasia, enrolled in an inpatient or outpatient stroke rehabilitation program, in a multicenter, double-blind, randomized controlled trial with two parallel groups and 6 months' follow-up. Patients will participate in two separate intervention weeks, with a pause of 2 weeks in between, in the context of their regular aphasia rehabilitation program. The two intervention weeks comprise daily 45-minute sessions of word-finding therapy, combined with either anodal tDCS over the left inferior frontal gyrus (1 mA, 20 minutes; experimental condition) or sham-tDCS over the same region (control condition). The primary outcome measure is word-finding. Secondary outcome measures are verbal communication, social participation, quality of life, and cost-effectiveness of the intervention. Discussion: Our results will contribute to the discussion on whether tDCS should be implemented in regular aphasia rehabilitation programs for the sub-acute post-stroke population in terms of (cost-)effectiveness. Trial registration: Nederlands Trail Register: NTR4364. Registered on 21 February 2014

Recovery of linguistic deficits in stroke patients: a three-year-follow-up study

In a three-year-follow-up study aphasic patients (n=17) received the ScreeLing, a screeningstest for semantic, phonological and syntactic processing, the Token Test and an interview at 2-4 days, 9-12 days, 2 months, 3 months, 6 months and 3 years post onset. The greatest improvement on all measures occurred between 9-12 days and 2 months post onset. The severity at 2 months post onset was decisive for the final outcome at 3 years p.o

Comparison of two configurations of transcranial direct current stimulation for treatment of aphasia

Objective: To compare 2 configurations of transcranial direct current stimulation (tDCS) for treatment of aphasia. Design: Randomized cross-over study. Subjects: Patients with chronic post-stroke aphasia (n = 13). Methods: TDCS was combined with word-finding therapy in 3 single sessions. In session 1, sham-tDCS/ pseudo-stimulation was applied. In sessions 2 and 3, 2 active configurations were provided in random order: Anodal tDCS over the left inferior frontal gyrus (l-IFG) and anodal tDCS over the left posterior superior temporal gyrus (l-STG). The optimal configuration was determined per individual based on a pre-set improvement in naming trained (> 20%) and untrained picture items (> 10%). Results: Overall, participants improved on trained items (median = 50%; interquartile range = 20-85) and post-treatment performance was highest in the active l-IFG condition (p = 0.040). Of the 13 participants, 6 (46%) showed relevant improvement during active tDCS; either in the l-IFG condition (n = 4; 31%) or in both the l-IFG and l-STG conditions (n = 2; 15%). On the untrained items there was no improvement (median = 0%; interquartile range = 0-0). Conclusion: This randomized cross-over single-session protocol to determine an optimal tDCS configuration for treatment of aphasia suggests that only performance on trained items can be used as guidance for configuration, and that it is relevant for half of the patients. For this subgroup, the l-IFG configuration is the optimal choice