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

Technical features, feasibility, and acceptability of augmented telerehabilitation in post-stroke aphasia – experiences from a randomized control trial

Background: Post-stroke aphasia is a communication disorder where existing evidence favors intensive therapy methods. Telerehabilitation represents a service model for geographically remote settings, or other barriers to clinic attendance or to facilitate an augmentation of therapy across a continuum of care. Evidence to support efficiency, feasibility, and acceptability is however still scarce. Appraising aphasia telerehabilitation in controlled trials beyond its effectiveness, by investigating feasibility and acceptability, may facilitate implementation into clinical practice. Methods: In our pilot randomized controlled trial, we investigated the feasibility and acceptability of speech and language therapy by videoconference, in addition to usual care, in people with aphasia following stroke. To improve functional, expressive language, a tailored intervention was given 1 h per day, five times per week over four consecutive weeks. Feasibility measures included evaluation of technical setup using diary logs. Acceptability was investigated by examining adherence and satisfaction with therapy alongside evaluation of data safety and privacy. Results: Feasibility and acceptability data were collected in relation to 556.5 h of telerehabilitation delivered to 30 participants over a 2-years intervention period by three speech-language pathologists. Protocol adherence was high, with a tolerable technical fault rate; 86 faults were registered over 541 video sessions. Most (80%; n = 30) of the participants experienced zero to three faults. The main cause of technical failures was flawed internet connection, causing delayed or interrupted therapy. Total satisfaction with telerehabilitation was rated good or very good by 93.1% (n = 29) of participants and two of three speech-language pathologists. Within a moderate variance of technical failure, participants experiencing more faults were more satisfied. No serious events regarding security and privacy were reported. Our model is feasibly and ready to be implemented across a range of clinical settings and contexts. Conclusions: Synchronous telerehabilitation for post-stroke aphasia is feasible and acceptable and shows tolerable technical fault rates with high satisfaction among patients and pathologists. Within a low rate of faults, satisfaction was not negatively influenced by fault frequency. Access to clinical and technical expertise is needed when developing telerehabilitation services. Telerehabilitation may be a viable service delivery model for aphasia rehabilitation

The effect of augmented speech-language therapy delivered by telerehabilitation on post stroke aphasia – a pilot randomized controlled trial

Pilot a definitive randomized controlled trial of speech-language telerehabilitation in poststroke aphasia in addition to usual care with regard to recruitment, drop-outs, and language effects. Pilot single-blinded randomized controlled trial. Telerehabilitation delivered from tertiary rehabilitation center to participants at their home or admitted to secondary rehabilitation centers. People with naming impairment due to aphasia following stroke. Sixty-two participants randomly allocated to 5 hours of speech and language telerehabilitation by videoconference per week over four consecutive weeks together with usual care or usual care alone. The telerehabilitation targeted functional, expressive language. Main measures: Norwegian Basic Aphasia Assessment: naming (primary outcome), repetition, and auditory comprehension subtests; Verb and Sentence Test sentence production subtest and the Communicative Effectiveness Index at baseline, four weeks, and four months postrandomization. Data were analyzed by intention to treat. No significant between-group differences were seen in naming or auditory comprehension in the Norwegian Basic Aphasia Assessment at four weeks and four months post randomization. The telerehabilitation group ( n = 29) achieved a Norwegian Basic Aphasia Assessment repetition score of 8.9 points higher ( P = 0.026) and a Verb and Sentence Test score 3 points higher ( P = 0.002) than the control group ( n = 27) four months postrandomization. Communicative Effectiveness Index was not significantly different between groups, but increased significantly within both groups. No adverse events were reported. Augmented telerehabilitation via videoconference may be a viable rehabilitation model for aphasia affecting language outcomes poststroke. A definitive trial with 230 participants is needed to confirm results

What do people search for in stuttering therapy: personal goal-setting as a gold standard?

Purpose Stuttering affects people in individual ways, and there are multiple factors which may influence a person’s goals when seeking therapy. Even though there is a common consensus that speech-language pathologists should discuss the individual’s goals and expectations for stuttering therapy and outcomes, few studies have systematically investigated this issue. The aims of the present study were to investigate individual motivations and goal-setting related factors in stuttering therapy. The associations between self-reported impact of stuttering and the participants’ perceptions of stuttering interference in communication, speaking abilities, and relationships with other people were also investigated. Method This study is part of a wider-ranging treatment study of individualized stuttering management tailored to the participants’ personal goals and preferences. A mixed method, multiple single-case design was used to address the research questions. Twenty-one adults, age 21-61 years, took part in a pretherapy interview, which also included two quantitative measures: the Client Preferences for Stuttering Therapy-Extended version (CPST-E) and the Overall Assessment of Speakers’ Experience of Stuttering-Adult version (OASES-A). Findings from the study sample was compared with a Norwegian reference group, in order to check for the representativeness of the study sample. Results Quantitative data showed that most participants wanted to focus on both physical and psychological aspects of therapy, and that 95% considered ‘to gain a sense of control over the stuttering’ as important. Participants’ perspectives on their speaking ability and stuttering interference in communication were identified as central factors, particularly in social and professional settings. These outcomes aligned well with the finding of avoidance behaviors, such as avoiding words and speaking situations. Qualitative data identified four main areas that the participants wanted to improve: speech fluency, emotional functioning, activity and participation, and understanding of their stuttering. Conclusion The study confirms that multiple and individual factors may influence the person’s goals for therapy. Goals were mainly anchored in participants’ wish of better coping in real world settings. A high degree of avoidance behavior was reported, suggesting that anxiety, and in particular linguistic-related anxiety needs to be taken into account when addressing social anxiety in fluency disorders

The Applicability and Outcome of Constraint Induced Language Therapy (CILT) in Early Aphasia Rehabilitation

The purpose of this doctoral study was to explore the applicability and outcome of constraint induced language therapy (CILT) on verbal expressive speech in early aphasia rehabilitation, that is, one to four months post stroke. CILT is a behavioural approach based on the theories of neurological rehabilitation and experience-dependent brain plasticity. CILT-treatment emphasises expressive speech production for three hours a day for ten days with constraints to spoken language, and was carried out by speech and language pathologists. Ten persons with aphasia participated in a pre- and post-test intervention study with follow-up in local rehabilitation hospitals. The results of the study are presented in three papers. In the first paper, the first cases participating in an early aphasia rehabilitation CILT-study were described, and results revealed positive improvement on the treated language measures. The second paper explored and demonstrated treatment outcome generalisation to more complex oral text production (i.e. conversational interview) for three cases. The final paper presented statistical significant outcome changes post intervention on the individual and group level on several language tests, as well as continued statistical significant improvement at the follow-up. Consistent with the treatment focus, expressive tasks showed greater improvement than receptive tasks or reading/writing. Participant evaluation revealed positive experiences with CILT, thereby supporting the clinical relevance of CILT. In conclusion, the application and clinical relevance of CILT to early aphasia rehabilitation is supported with individual modification of the treatment schedule. The doctoral study was conducted at the Department of Special Needs Education, Faculty of Education, University of Oslo, 2006-2010

Afasi og flerspråklighet : hvilke faktorer påvirker logopedisk behandling av personer med afasi og flerspråklig bakgrunn? : en spørreundersøkelse fra Tyskland

Sammendrag Tittel Oppgavens overordnede tittel er Afasi og flerspråklighet . Undertittelen beskriver problemstillingen Hvilke faktorer påvirker logopedisk behandling av personer med afasi og flerspråklig bakgrunn? En spørreundersøkelse fra Tyskland . Bakgrunn og formål Med tysk som morsmål og norsk som hverdagsspråk har jeg en personlig interesse for problemstillinger innen flerspråklighet. Å miste språkferdigheter som følge av en hjerneskade forandrer hverdagen til den rammede. Det foreligger forholdsvis lite litteratur om emnet afasi og flerspråklighet, men fokuset har økt de siste årene, både internasjonalt og i Norge. Formålet med oppgaven er å se på erfaringer fra andre land og kunnskap innen dette området, for å utvide perspektiv og forståelsesramme for muligheter og utfordringer logopeden møter i klinisk rehabilitering. Problemstilling Hvilke faktorer påvirker logopedisk behandling av personer med afasi og flerspråklig bakgrunn? Følgende arbeidshypoteser dannet grunnlag for bearbeiding av problemstillingen: Hypotese 1: Flerspråklighet blant personer med afasi er et økende fenomen i Tyskland. Hypotese 2: Helsevesenets og klinikkens økonomiske rammer begrenser dagens behandling av flerspråklige pasienter. Hypotese 3: Logopeder i delstater med høy andel fremmedspråklige innbyggere har mer erfaring med pasienter med flerspråklig bakgrunn, fordi de møter pasientgruppen hyppigere. Hypotese 4: Logopeder med personlig flerspråklig bakgrunn er mer opptatt av flerspråklighet blant pasienter enn enspråklige kollegaer. Hypotese 5: Pårørende til flerspråklige pasienter har redusert tilbud sammenlignet med tysk-språklige familier. Metode For å prioritere bredde fremfor dybde ble den kvantitative forskningsmetoden survey valgt. Innsamling av datamateriell foregikk ved bruk av selvutfyllende spørreskjema. Gjennom bruk av internett fremkom to grupper som dannet oppgavens utvalg: utvalg 1: logopeder fra rehabiliteringsklinikker og utvalg 2: logopeder med flerspråklig bakgrunn og klinisk arbeidssted. Dataanalyse Dataanalysen baserer seg på 74 besvarte spørreskjema. Den ble gjennomført med dataprogrammet Statistical Packages for Social Sciences (SPSS11.0), med hovedvekt på deskriptiv statistikk, samt bruk av independent samples t-test og Pearson chi-square for evaluering av signifikans. Resultater Nesten alle informanter hadde erfaring med flerspråklige pasienter, med høyere antall pasienter i delstater med størst andel innvandrere. Bare et fåtall kjente til flerspråklige afasitester og enda færre brukte slike i år 2003. Samtidig foreligger det et variert spekter av behandlingsmetoder, som hovedsakelig tilpasses individuelle behov. Med få unntak benytter informantene egne fremmedspråk i utredning av pasienter, mens tolk brukes bare av to informanter regelmessig. Type arbeidssted (privat, offentlig) synes å påvirke behandlingsprosessen, både med hensyn til pasienttall, oppholdstid og terapitilbud. Egen flerspråklig kunnskap øker sensitivitet overfor problemstillingen, mens det foreligger et stort gap mellom språk pasienten har behov for og logopedens tilbud. Pårørende synes å spille en viktig rolle under utredning og behandling av pasienten. Tilbudet som gis til de pårørende beskrives som redusert sammelignet med det tyskspråklige familier får. Blant annet er flerspråklig informasjon om afasi begrenset. Konklusjon Informantene viser at interessen og bevisstgjøring for temaet afasi og flerspråklighet er tilstede. Mange ser utfordringene og ønsker mer kunnskap. Kartleggingsformer og behandlingsmetoder må tilpasses økende flerspråklige og flerkulturelle behov. Samfunnets forventning til effektivitet av rehabilitering preger afasifeltet og vil påvirke fremtidens forskning

Norske normer for OASES-A – et kartleggingsverktøy for voksne som stammer

I denne artikkelen presenteres en oppsummering av normeringsarbeidet for kartleggingsverktøyet the Overall Assessment of the Speakers Experience of Stuttering – Adult version (OASES-A). Utprøving av verktøyet var del av Bodil Nordbøs masteroppgavearbeid (Nordbø, 2016), og er tilknyttet Hilda Sønsteruds doktorgradsprosjekt: «Stammebehandling – hva hjelper for hvem? Individualisert stammebehandling for voksne»