Ambient Experience in Restitutive Treatment of Aphasia

Abstract

One of the greatest challenges to language rehabilitation is reconciling the fact that the same therapeutic intervention, provided to different individuals with similar types of stroke-induced aphasia, may result in divergent outcomes. In this paper, the authors reviewed existing literature to identify relevant ambient factors – those outside the control of the clinician – that may potentially influence functional language recovery in aphasia and response to treatment. The goal was to develop a clinical history-taking tool to assist clinicians in gathering information germane to each individual's unique circumstances and environment, elements that may have previously been underestimated, to provide a complete inventory of potentially potent prognostic factors. First, two of the authors, speech–language pathologists experienced in aphasia rehabilitation, identified and categorized factors that seemed likely to influence aphasia outcomes. Then, a wide range of literature was reviewed in an effort to identify factors empirically found to be potent influences on aphasia recovery. Where studies relating these factors to aphasia were not found, relevant research from allied fields that examined recovery from brain injury is reported. Moreover, some factors thought to be potentially potent have yet to be examined. Finally, the ambient factors supported by evidence were categorized as facilitators or barriers to functional improvement, and the Ambient Influences on Outcome Checklist (AOC) was developed, including only those factors shown to be potent in the recovery process. It is hoped that this checklist can be used to more broadly assess potential prognostic influences in aphasia restitution, as well as spawn further research.

Drug Therapy of Post-Stroke Aphasia: A Review of Current Evidence

“…1). As already stated, host's characteristics (gender, age, education, handedness, premorbid language and cognitive competence, motivation, mood, personality) and ambient factors (occupational and leisure status, communication partners) can also be determinants for recovery (Cramer and Riley 2008;McClung et al 2010;Price et al 2010) and their influence explain the commonly observed heterogeneous patterns of spontaneous or therapy-induced recovery across individuals.…”

“…Furthermore, individual recovery from aphasia is a multifactorial process that is contingent on the localization and extension of the lesion (Heiss and Thiel 2006; (Fig. 1) as well as on biographical factors of the host (gender, age, educational level, handedness, and so forth) and environment circumstances (family support, occupational and leisure status) (Code 2001;McClung et al 2010). Of these factors, one that deserves special consideration here is the cognitive aging process (Nicholas et al 1998;Li et al 2001;Greenwood 2007) since most victims of PSA are elderly individuals.…”

“…One possible clinical correlate of the aginginduced inter-hemispheric imbalance is the relatively frequent occurrence of unexpected brain and language relationships (e.g., fluent aphasia and frontal lobe lesions) in old PSA patients (Eslinger and Damasio 1981;Basso et al 1987;Nicholas et al 1998). Moreover, aging is associated with alterations in cerebral vasoregulation and parenchymal integrity (Peisker et al 2010), and in concert with early Alzheimer's disease pathology with subtle cognitive deficits (Price et al 2009), may play a detrimental role in plastic reorganization of the neural substrate underlying functional recovery (Li et al 2001;Greenwood 2007;McClung et al 2010). Therefore, the role of aging on aphasia recovery needs to be reappraised to disentangle whether the elderly population is at higher risk to show both poorer spontaneous recovery and response to different rehabilitation approaches (speech-language therapy or drugs) than younger patients.…”

Adjustment processes in chronic aphasia after stroke: Exploring multiple perspectives in the context of a community-based intervention

“…Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. Terms People with chronic aphasia following stroke clearly undergo processes of adjustment in living with this condition (see Gordon, 1997;McClung, Gonzalez Rothi, & Nadeau, 2010) and yet the broader studies of adjustment to stroke do not specifically address aphasia (McKevitt, Redfern, Mold, & Wolfe, 2004). People with aphasia are often excluded from studies of stroke because of their communication difficulties (e.g., D'Alisa, Baudo, Mauro, & Miscio, 2005;Daniel, Wolfe, Busch, & McKevitt, 2009), preventing a deeper understanding of the adjustment processes with this population that would, in turn, inform longer-term interventions.…”

“…Other frameworks have also been proposed for understanding the influences of extralinguistic factors on outcomes for aphasia post-stroke. McClung et al (2010), for example, provided a clinician checklist based on "ambient factors", such as "spirituality", "leisure activities" and "communication partners", although the authors conceded that few of these factors, identified by speech-language pathologists as potential factors influencing language recovery, had been adequately studied. Code (2001) reported a multilevel model for considering recovery in aphasia, including emotional and psychosocial factors, but this has yet to be systematically supported by research evidence.…”