Improving Functional Communication Outcomes in Post-Stroke Aphasia via Telepractice: An Alternative Service Delivery Model for Underserved Populations

Authors

  • Portia Carr University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
  • Dana Moser University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
  • Shana Williamson University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
  • Greg Robinson University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
  • Stephen Kintz University of Arkansas at Little Rock, Little Rock, Arkansas, USA

DOI:

https://doi.org/10.5195/ijt.2022.6531

Keywords:

Aphasia, Conversational script training, Oral reading for language in aphasia, Telepractice

Abstract

Many persons with aphasia (PWA) have limited access to speech-language treatment (SLT) due to limited funding, speech-language pathologist shortages, geographical barriers, physical disabilities, transportation barriers, and COVID-19 pandemic. The purpose of this study was to determine if telepractice is an effective and feasible service delivery model for PWA. Ten PWA completed 8 hours of remote treatment over 4 weeks. Synchronous telepractice sessions employed Oral Reading for Language in Aphasia (ORLA) and Conversational Script Training (CST). Pre- and post-assessment outcome measures included the Communication Activities of Daily Living-3 (CADL-3) and the Communication Confidence Rating Scale for Aphasia (CCRSA). Participants completed a telepractice satisfaction survey following post-assessment. All participants demonstrated improvements in CCRSA scores, total words produced correctly on trained CST stimuli, and total words produced correctly on trained ORLA stimuli. No differences were noted in CADL-3 scores. All participants were highly satisfied with telepractice as a service delivery model.

 

  

Author Biography

Portia Carr, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA

Assistant Professor 

References

Chapey, R., Duchan, J. F., Elman, R. J., Garcia, L. J., Kagan, A., Lyon, J. G., & Simmons Mackie, N. (2000). Life participation approach to aphasia: A statement of values for the future. The ASHA Leader, 5(3), 4–6. https://doi.org/10.1044/leader.ftr.05032000.4

Cherney, L. R. (1995). Efficacy of oral reading in the treatment of two patients with chronic Broca's aphasia. Topics in Stroke Rehabilitation, 2(1), 57–67. https://doi.org/10.1080/10749357.1995.11754055

Cherney, L. R. (2004). Aphasia, Alexia, and oral reading. Topics in Stroke Rehabilitation, 11(1), 22–36. https://doi.org/10.1310/vupx-wdx7-j1eu-00tb

Cherney, L. R. (2010). Oral reading for language in aphasia (ORLA): Evaluating the efficacy of computer-delivered therapy in chronic nonfluent aphasia. Topics in Stroke Rehabilitation, 17(6), 423–431. https://doi.org/10.1310/tsr1706-423

Cherney, L. R. (2012). Aphasia treatment: Intensity, dose parameters, and script training. International Journal of Speech-Language Pathology, 14(5), 424-431. DOI: https://doi.org/10.3109/17549507.2012.686629

Cherney, L. R., Babbitt, E. M., Kim, K.-Y., Hurwitz, R., Ngampatipatpong, N., & Van Vuuren, S. (2011). Aphasia treatment over the internet: A randomized placebo-controlled clinical trial. Clinical Aphasiology Paper. https://doi.org/http://aphasiology.pitt.edu/2326/

Cherney, L. R., Babbitt, E. M., Semik, P., & Heinemann, A. W. (2011). Psychometric properties of the communication confidence rating scale for aphasia (CCRSA): Phase 1. Topics in Stroke Rehabilitation, 18(4), 352–360. https://doi.org/10.1310/tsr1804-352

Cherney, L. R., Kaye, R. C., Lee, J. B., & Vuuren, S. V. (2015). Impact of personal relevance on acquisition and generalization of script training for aphasia: A preliminary analysis. American Journal of Speech-Language Pathology, 24(4), S913–S922. doi:10.1044/2015_ajslp-14-0162

Cherney, L. R., Merbitz, C. T., & Grip, J. C. (1986). Efficacy of oral reading in aphasia treatment outcome. Rehabilitation Literature, 47(5-6), 112-118.

Choi, Y.-H., Park, H. K., & Paik, N.-J. (2016). A telerehabilitation approach for chronic aphasia following stroke. Telemedicine and e-Health, 22(5), 434–440. https://doi.org/10.1089/tmj.2015.0138

Dekhtyar, M., Braun, E. J., Billot, A., Foo, L., & Kiran, S. (2020). Videoconference administration of the western aphasia battery–revised: Feasibility and validity. American Journal of Speech-Language Pathology, 29(2), 673-687. https://doi.org/10.1044/2019_ajslp-19-00023

Ertelt, B. (2020, November 4). New research documents how COVID-19 multiplies stress and trauma for people with disabilities. Retrieved October 24, 2021, from https://news.vanderbilt.edu/2020/11/04/new-research-documents-how-covid-19-multiplies-stress-and-trauma-for-people-with-disabilities/.

Goodglass, H., & Kaplan, E. (1983). Boston Diagnostic Aphasia Examination. Lea & Febiger.

Guo, Y. E., Togher, L., Power, E., Hutomo, E., Yang, Y., Tay, A., Yen, S., & Koh, G. C. (2017). Assessment of aphasia across the International Classification of Functioning, Disability and Health using an iPad-based application. Telemedicine and e-Health, 23(4), 313-326. https://doi.org/10.1089/tmj.2016.0072

Gustavson, A. M., Rauzi, M. R., Lahn, M. J., Olson, H. S. N., Ludescher, M., Bazal, S.,Roddy, E., Interrante, C., Berg, E., Wisdom, J. P., & Fink, H. A. (2021). Practice considerations for adapting in-person groups to telerehabilitation. International Journal of Telerehabilitation, 13(1), e6374. https://doi.org/10.5195/ijt.2021.6374

Hakim, A. M., Silver, F., & Hodgson, C. (1998). Organized stroke care. A new era in stroke prevention and treatment. Canadian Medical Association Journal. 15(9 suppl.), S1.

Hall, N., Boisvert, M., & Steele, R. (2013). Telepractice in the assessment and treatment of individuals with aphasia: A systematic review. International Journal of Telerehabilitation, 5(1), 27–38. https://doi.org/10.5195/ijt.2013.6119

Harvey, S., Carragher, M., Dickey, M. W., Pierce, J. E., & Rose, M. L. (2020). Dose effects in behavioural treatment of post-stroke aphasia: A systematic review and meta-analysis. Disability and Rehabilitation, 44(12), 2548–2559. https://doi.org/10.1080/09638288.2020.1843079

Holland, A., Milman, L., Muñoz, M., & Bays, G. (2002). Scripts in the management of aphasia. Paper presented at the World Federation of Neurology, Aphasia and Cognitive Disorders Section Meeting, Villefranche, France.

Holland, A. L., Wozniak, L., & Fromm, D. (2018). CADL-3: Communication Activities of Daily Living. Pro-Ed.

Jacobs, M., Briley, P. M., Wright, H. H., & Ellis, C. (2021). Marginal assessment of the cost and benefits of aphasia treatment: Evidence from community-based telerehabilitation treatment for aphasia. Journal of Telemedicine and Telecare, 0(0). https://doi.org/10.1177/1357633x20982773

Kaplan, E., Goodglass, H., & Weintraub, S. (2001). Boston Naming Test. Pro-Ed.

Kay, J., Coltheart, M., & Lesser, R. (2001). Palpa: Psycholinguistic assessments of language processing in aphasia. Erlbaum.

Kertesz, A. (2007). Western Aphasia Battery: Revised. Pearson.

Kiran, S. (2016). How does severity of aphasia influence individual responsiveness to rehabilitation? Using big data to understand theories of aphasia rehabilitation. Seminars in Speech and Language, 37(01), 048–060. https://doi.org/10.1055/s-0036-1571358

Lavoie, M., Macoir, J., & Bier, N. (2017). Effectiveness of technologies in the treatment of post-stroke anomia: A systematic review. Journal of Communication Disorders, 65, 43–53. https://doi.org/10.1016/j.jcomdis.2017.01.001

Lomas, J., Pickard, L., Bester, S., Elbard, H., Finlayson, A., & Zoghaib, C. (1989). The communicative effectiveness index. Journal of Speech and Hearing Disorders, 54(1), 113–124. https://doi.org/10.1044/jshd.5401.113

Macoir, J., Sauvageau, V. M., Boissy, P., Tousignant, M., & Tousignant, M. (2017). In-home synchronous telepractice therapy to improve functional communication in chronic poststroke aphasia: Results from a quasi-experimental study. Telemedicine and e-Health, 23(8), 630–639. https://doi.org/10.1089/tmj.2016.0235

Molini-Avejonas, D. R., Rondon-Melo, S., De La Higuera Amato, C. A., & Samelli, A. G. (2015). A systematic review of the use of telehealth in speech, language and hearing sciences. Journal of Telemedicine and Telecare, 21(7), 367–376. https://doi.org/10.1177/1357633x15583215

Munsell, M., De Oliveira, E., Saxena, S., Godlove, J., & Kiran, S. (2020). Closing the digital divide in speech, language, and cognitive therapy: Cohort study of the factors associated with technology usage for rehabilitation. Journal of Medical Internet Research, 22(2), e16286. https://doi.org/10.2196/16286

Parmanto, B., Lewis, A., Graham, K., & Bertolet, M. (2016). Development of the Telehealth Usability Questionnaire (TUQ). International Journal of Telerehabilitation, 21 (1), 3–10. https://doi:10.5195/ijt.2016.6196.

Rhodes, N. C., & Isaki, E. (2018). Script training using telepractice with two adults with chronic non-fluent aphasia. International Journal of Telerehabilitation, 10(2), 89–104. doi: 10.5195/ijt.2018.6259

Simic, T., Leonard, C., Laird, L., Cupit, J., Hobler, F., & Rocchon, E. (2016). A usability study of internet-based therapy for naming deficits in aphasia. American Journal of Speech-Language Pathology. 25, 642-653.

Simmons-Mackie, N. (2018). Aphasia in North America: A Comprehensive Report on Incidence, Causes and Impact. Aphasia Access: Moorestown, NJ.

Simmons-Mackie, N., Kagan, A., Victor, J. C., Carling-Rowland, A., Mok, A., Hoch, J. S., Huijbregts, M., & Streiner, D. L. (2013). The assessment for living with aphasia: Reliability and construct validity. International Journal of Speech-Language Pathology, 16(1), 82–94. https://doi.org/10.3109/17549507.2013.831484

Steele, R. D., Baird, A., McCall, D., & Haynes, L. (2015). Combining teletherapy and on-line language exercises in the treatment of chronic aphasia: An outcome study. International Journal of Telerehabilitation, 6 (2), 3–20. https://doi.org/10.5195/ijt.2014.6157

Swinburn, K., Porter, G., & Howard, D. (2004). Comprehensive Aphasia Test manual. Psychology Press.

Theodoros, D. (2014). Improving access to speech language pathology services via telehealth. Retrieved from file:///Users/portiacarr/Downloads/sub234_Theodoros%20(5).pdf

Theodoros, D., Hill, A., Russell, T., Ward, E., & Wootton, R. (2008). Assessing acquired language disorders in adults via the internet. Telemedicine and e-Health, 14(6), 552-559. https://doi.org/10.1089/tmj.2007.0091

Thomas, G. (2021, May 28). Aphasia FAQs. National Aphasia Association. Retrieved July 25, 2022, from https://www.aphasia.org/aphasia-faqs/

Tsao, C. W., Aday, A. W., Almarzooq, Z. I., Alonso, A., Beaton, A. Z., Bittencourt, M. S., Boehme, A. K., Buxton, A. E., Carson, A. P., Commodore-Mensah, Y., Elkind, M. S. V., Evenson, K. R., Eze-Nliam, C., Ferguson, J. F., Generoso, G., Ho, J. E., Kalani, R., Khan, S. S., Kissela, B. M., … Martin, S. S. (2022). Heart disease and stroke statistics—2022 update: A report from the American Heart Association. Circulation, 145(8). https://doi.org/10.1161/cir.0000000000001052

Weidner, K., & Lowman, J. (2020). Telepractice for adult-speech language pathology services: A systematic review. Perspectives of the ASHA Special Interest Groups, 5, 326-338.

World Health Organization. (2001). ICF: International Classification of Functioning, Disability and Health. Geneva: WHO

Woolf, C., Caute, A., Haigh, Z., Galliers, J., Wilson, S., Kessie, A., Hirani, S., Hegarty, B., & Marshall, J. (2016). A comparison of remote therapy, face to face therapy and an attention control intervention for people with aphasia: A quasi-randomised controlled feasibility study. Clinical Rehabilitation, 30(4), 359–373. https://doi.org/10.1177/0269215515582074

Youmans, G., Youmans, S. R., & Hancock, A. B. (2011). Script training treatment for adults with apraxia of speech. American Journal of Speech-Language Pathology, 20(1), 23–37. https://doi.org/10.1044/1058-0360(2010/09-0085)

Zheng, C., Lynch, L., & Taylor, N. (2016). Effect of computer therapy in aphasia: A systematic review. Aphasiology, 30(2-3), 211-244.doi: 10.1080/02687038.2014.996521

Downloads

Published

2022-12-13

How to Cite

Portia Carr, Moser, D., Shana Williamson, Greg Robinson, & Stephen Kintz. (2022). Improving Functional Communication Outcomes in Post-Stroke Aphasia via Telepractice: An Alternative Service Delivery Model for Underserved Populations. International Journal of Telerehabilitation, 14(2). https://doi.org/10.5195/ijt.2022.6531

Issue

Vol. 14 No. 2 (2022)

Section

Clinical Research

License

Copyright (c) 2022 Portia Carr, Ph.D., CCC-SLP, Dana Moser, Ph.D., CCC-SLP, Shana Williamson M.S.,CCC-SLP, Greg Robinson, Ph.D., CCC-SLP, Stephen Kintz, Ph.D

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

Authors who publish with this journal agree to the following terms:

  1. The Author retains copyright in the Work, where the term “Work” shall include all digital objects that may result in subsequent electronic publication or distribution.
  2. Upon acceptance of the Work, the author shall grant to the Publisher the right of first publication of the Work.
  3. The Author shall grant to the Publisher and its agents the nonexclusive perpetual right and license to publish, archive, and make accessible the Work in whole or in part in all forms of media now or hereafter known under a Creative Commons Attribution 4.0 International License or its equivalent, which, for the avoidance of doubt, allows others to copy, distribute, and transmit the Work under the following conditions:
    1. Attribution—other users must attribute the Work in the manner specified by the author as indicated on the journal Web site;
    with the understanding that the above condition can be waived with permission from the Author and that where the Work or any of its elements is in the public domain under applicable law, that status is in no way affected by the license.
  4. The Author is able to enter into separate, additional contractual arrangements for the nonexclusive distribution of the journal's published version of the Work (e.g., post it to an institutional repository or publish it in a book), as long as there is provided in the document an acknowledgement of its initial publication in this journal.
  5. Authors are permitted and encouraged to post online a prepublication manuscript (but not the Publisher’s final formatted PDF version of the Work) in institutional repositories or on their Websites prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work. Any such posting made before acceptance and publication of the Work shall be updated upon publication to include a reference to the Publisher-assigned DOI (Digital Object Identifier) and a link to the online abstract for the final published Work in the Journal.
  6. Upon Publisher’s request, the Author agrees to furnish promptly to Publisher, at the Author’s own expense, written evidence of the permissions, licenses, and consents for use of third-party material included within the Work, except as determined by Publisher to be covered by the principles of Fair Use.
  7. The Author represents and warrants that:
    1. the Work is the Author’s original work;
    2. the Author has not transferred, and will not transfer, exclusive rights in the Work to any third party;
    3. the Work is not pending review or under consideration by another publisher;
    4. the Work has not previously been published;
    5. the Work contains no misrepresentation or infringement of the Work or property of other authors or third parties; and
    6. the Work contains no libel, invasion of privacy, or other unlawful matter.
  8. The Author agrees to indemnify and hold Publisher harmless from Author’s breach of the representations and warranties contained in Paragraph 6 above, as well as any claim or proceeding relating to Publisher’s use and publication of any content contained in the Work, including third-party content.

Revised 7/16/2018. Revision Description: Removed outdated link.