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

Patient Perspectives & Patient Reported Outcomes of an Intensive Comprehensive Aphasia Program

The purpose of this project was to explore patient perspectives and PROMs for stroke survivors with aphasia who participate in an intensive comprehensive aphasia program (ICAP) that was developed by the PI and is delivered at the University of Montana (Off, et al., 2015; 2017). Patient perspectives and PROMs were used to complement traditionally administered psychometric measures to document patient speech, language, cognition, and psychosocial outcomes following the ICAP. To date, no researchers have documented patient perspectives of their outcomes in the context of an ICAP

Repetition Priming and Anomia: An Investigation of Stimulus Dosage

In a recent review of anomia management, Maher & Raymer reported that 30% of aphasia intervention research from 1946 to 2001 focused on naming; however, despite this proliferation of case reports and small group studies, there is still no clear agreement on how best to manage these deficits (Maher & Raymer, 2004, p. 13). The inconsistency of acquisition, maintenance, and generalization effects observed across participants and types of treatment protocols is likely to stem from an inadequate knowledge base about how subject and treatment variables influence learning. One treatment variable that has received increasing attention over the past two or three years is treatment intensity. Principles of neurobiological learning across both animal and human research suggest that the intensity of treatment is a significant factor for learning. Additional research exploring experience-dependent neural plasticity involved in memory and learning indicates that a large number of trials per session are required to elicit behavioral and/or neural change. Despite a considerable amount of literature examining overall treatment intensity, data are not available regarding the frequency (i.e., stimulus dosage) of treatment at which individuals with aphasia will maximally benefit. A single-subject A-B design with replication across four individuals with aphasia and one healthy non-brain injured gender-matched control participant was used to assess the influence of repeated attempts at picture-naming, coupled with repeated exposure to hearing and reading target words, on the acquisition and maintenance of trained stimuli, and generalization to untrained stimuli. Individuals with chronic aphasia participated in a multi-week repetition priming protocol designed to investigate the influence of stimulus dosage on naming accuracy and latency. Results revealed positive repetition priming effects for trained items across both acquisition and maintenance phases; such positive effects were not observed for untrained stimuli or alternate exemplars. Stimulus dosage manipulations did not consistently influence naming performance for individuals with aphasia

Subcortical Lesions and Language: A Conversational Discourse Analysis

The present study investigated the nature of conversational discourse data at the point of breakdown in specific neurologically compromised patients. Data were obtained during the observation and video recording of informal conversational situations (i.e., clinical settings or the patient’s natural environment). Three adult patients who had suffered neurological damage, at the site of the basal ganglia were assessed. Due to the inappropriateness of two of the patients, a case study was conducted on the remaining patient. In lieu of formal assessment via standardized instruments and test batteries, conversational discourse, in natural, non-artificial settings, were descriptively analyzed at the point of communication breakdown (e.g., decreased topic maintenance, lack of referents, etc.). Analysis of the patient’s conversational language abilities and deficits revealed short-term memory, referent, and coherence difficulties. The use of this descriptive conversational analysis of the patient’s language abilities and deficits sought to provide a more detailed and complete assessment of the patient’s communicative abilities for future remediation and treatment strategies

The impact of dose on naming accuracy with persons with aphasia

Background: Although aphasia rehabilitation has been shown to be efficacious, many questions remain regarding how best to deliver treatment to maximise functional gains for persons with aphasia. Treatment-delivery variables, such as intensity and dosage, are likely to influence both behavioural and structural changes during anomia treatment. While numerous protocols have concluded that treatment intensity positively impacts functional outcomes, few studies to date have examined the role that dose plays in patient outcomes for anomia treatment. Aims: This study sought to investigate how manipulating dose of repeated confrontation naming within sessions influences naming in persons with aphasia. Repeated practice of confrontation naming, without feedback, was hypothesised to improve trained but not untrained words, to be persistent after withdrawal, and to be sensitive to the number of trials (i.e., dose) within sessions. Methods and Procedures: A single-subject ABA design, with replication across seven participants with aphasia, was used to investigate the influence of repeated confrontation naming attempts on the acquisition and maintenance of trained pictures relative to untrained pictures. Training involved repeated attempts to name pictures, along with repeated exposure to pictures of objects (nouns) and their names, without feedback. The primary independent variable was within session dose; the dependent variable was naming accuracy. Outcomes and Results: Naming accuracy improved for all participants for trained pictures across both acquisition and maintenance phases per visual inspection; such positive effects were not observed for untrained pictures. Effect-size calculations indicate that three of seven participants demonstrated considerable change for trained items, while one of seven participants demonstrated meaningful change for untrained items. The high-dose condition elicited small effect sizes for one participant, and large effect sizes for two of seven participants, while the low-dose condition elicited small and medium effect sizes for two of seven participants. Conclusions: Participants across a variety of aphasia severity levels responded positively to two doses of repeated confrontation naming practice, without feedback, across phases of this naming protocol. Results are in line with principles of neuroplasticity and demonstrate that repeated practice, without feedback, can produce significant and persistent changes in naming ability for some persons with aphasia

Patient Perspectives of an Intensive Comprehensive Aphasia Program for Stroke Survivors

Introduction: Persons with aphasia (PWA) who participate in intensive comprehensive poststroke language rehabilitation programs make a variety of significant investments. While intensive aphasia programs and intensive comprehensive aphasia programs (ICAPs) are becoming increasingly prevalent across health care settings, patient perspectives of ICAPs have not been explored. The purpose of this qualitative study was to examine patient perspectives about the experience of participating in an ICAP at the University of Montana. The primary research question of this study was: “what is it like to be a PWA in an ICAP?” Methods: Researchers used an interpretive phenomenological approach to conduct nine structured interviews from PWAs who described their lived experiences in the ICAP. All interviews were audiovisually recorded and transcribed from the video recordings. Analysis involved an iterative and collaborative coding process. Transcripts were coded and themes were developed from the PWAs’ shared perspectives. Results: Three primary themes emerged from patient perspectives including: (1) experience with each of the ICAP components is generally positive, (2) we notice the impact of the ICAP on our communication, and (3) relationships with people in the ICAP are important. Discussion: Results support emerging evidence that ICAPs can be a positive experience for PWA due to the perceptible impact on communication improvement and frequent and varied opportunities to interact with others. ICAPs may be a worthwhile investment for PWA, thereby contributing to the cost-benefit utility and implementation feasibility of the service delivery model