Aphasia treatment: Intensity, dose parameters, and script training

Cherney, Leora R.

doi:10.3109/17549507.2012.686629

Cited by 85 publications

(66 citation statements)

References 22 publications

(52 reference statements)

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“…The problem, however, is that precisely identifying the dosage parameters can be challenging and complicated (Baker, 2012b;Kamhi, 2012). It has obvious application to computer-delivered aphasia treatment wherein the dose and dose form are fairly well prescribed (e.g., Cherney, 2012;Harnish et al, 2014;Off, Griffin, Spencer, & Rogers, 2015). For example, Harnish et al (2014) easily characterized the active ingredients (e.g., semantic, phonemic, and orthographic cues) and dose (50 pictures × 8 cues or presentations = 400 teaching episodes) within their dose form (computer-assisted picture naming).…”

Section: Mixed-model Analysesmentioning

confidence: 99%

Intensive Language Action Therapy in Chronic Aphasia: A Randomized Clinical Trial Examining Guidance by Constraint

Kurland

Stanek

Stokes

et al. 2016

Am J Speech Lang Pathol

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Purpose Intensive language action therapy (ILAT) can be effective in overcoming learned nonuse in chronic aphasia. It is suggested that all three guiding principles (constraint, communication embedding, massed practice) are essential to ILAT's success. We examined whether one of these, guidance by constraint, is critical. Method Twenty-four participants with aphasia (PWAs) were assigned to ILAT or a modified version of promoting aphasic communicative effectiveness (PACE) in a randomized block, single-blind, parallel-group treatment study. Blocking was by severity (mild/moderate, moderate to severe, severe). Both groups received intensive treatment in the context of therapeutic language action games. Whereas the ILAT group was guided toward spoken responses, the PACE group could choose any response modality. Results All participants, whether assigned to ILAT or PACE groups, improved on the primary outcome measure, picture naming. There was a Severity × Treatment interaction, with the largest effects estimated for PWAs with mild/moderate and moderate to severe aphasia. Regardless of severity, the ILAT group outperformed the PACE group on untrained pictures, suggesting some benefit of ILAT to generalization. However, this difference was not statistically significant. Conclusion Although the groups differed in subtle ways, including better generalization to untrained pictures for ILAT, the study was inconclusive on the influence of guidance by constraint.

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Section: Mixed-model Analysesmentioning

confidence: 99%

Intensive Language Action Therapy in Chronic Aphasia: A Randomized Clinical Trial Examining Guidance by Constraint

Kurland

Stanek

Stokes

et al. 2016

Am J Speech Lang Pathol

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“…56,57 Some treatment studies have directly compared conditions of higher and lower intensity treatment for aphasia. 11 Yet, optimal intensity has not been established for even one type of aphasia treatment.…”

Section: Dosagementioning

confidence: 99%

“…With respect to ICAPs in particular, the basic neuroscience literature on intensity and quantity of neurorehabilitation (reviewed in ref. 9) as well as the growing literature on intensity in aphasia treatment 5,[10][11][12] are directly relevant. Theory and basic research are important contributors to Discovery, but we believe that clinical experience can also be informative at this stage.…”

Section: Discovery Phasementioning

confidence: 99%

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Setting a Research Agenda to Inform Intensive Comprehensive Aphasia Programs

Hula¹,

Cherney²,

Worrall³

2013

Topics in Stroke Rehabilitation

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Research into intensive comprehensive aphasia programs (ICAPs) has yet to show that this service delivery model is effi cacious, effective, has cost utility, or can be broadly implemented. This article describes a phased research approach to the study of ICAPs and sets out a research agenda that considers not only the specifi c issues surrounding ICAPs, but also the phase of the research. Current ICAP research is in the early phases, with dosing and outcome measurement as prime considerations as well as refi nement of the best treatment protocol. Later phases of ICAP research are outlined, and the need for larger scale collaborative funded research is recognized. The need for more rapid translation into practice is also acknowledged, and the use of hybrid models of phased research is encouraged within the ICAP research agenda.

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“…36,37 Almost a decade later, evidence is still equivocal about the efficacy of intensive aphasia therapy and the specific ingredients that allow for the best outcomes for individual persons with aphasia. [38][39][40][41] Cherney et al examined 11studies and found no clear differences in outcomes between intensive and non-intensive treatment protocols. 41 The recommendations from their review were to examine the behavioural and neuroimaging results of intensive treatment independently and in combination with influencing factors.…”

Section: Intensity Of Aphasia Treatmentmentioning

confidence: 99%

Outcomes of an Intensive Comprehensive Aphasia Program

Babbitt¹

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Intensive comprehensive aphasia programs (ICAP) have increased over the last decade in the US and abroad. The increase in the number of clinical programs has outpaced the research that is necessary to establish the efficacy and effectiveness of these specialized treatment programs. The ICAP model incorporates principles from neuroplasticity, that is, intensive treatment provides a platform for the massed practice and repetition required to change the brain. It also incorporates comprehensive treatment that addresses not only impairment-based language deficits but also personal goals related to participation.Programs which offer intensive comprehensive treatment can provide up to 120 hours of treatment over several weeks (e.g., six hours a day, five days a week for four weeks). ICAPs are different from other types of aphasia services which generally provide two to three hours of therapy a week. This thesis examined one ICAP in depth to describe the structure, process, and outcomes using Donabedian's model of health care evaluation. This thesis also described the experiences of the ICAP from the perspectives of the primary stakeholders.Study One (Chapter Two) was a retrospective quantitative study using behavioral measures from an existing database that documented the outcomes of participants with aphasia. It found that first-time participants improved significantly in impairment-and participationbased measures, demonstrating moderate to large effect sizes. Participant characteristics were examined to determine if improvements were related to age, time post-onset, or type and severity of aphasia. None of these factors had an impact on the amount of change measured. Given that some participants did not make significant gains on a primary outcome measure, the Western Aphasia Battery -Revised Aphasia Quotient (WAB-R AQ), Study Two (Chapter Three) examined whether participant characteristics at baseline could predict who would make significant gains on the WAB-R AQ. Age and months post-onset were significantly different between the responder and the non-responder groups. Those who showed most gains on average were younger and a longer time post-onset. A logistic regression was performed and results indicated that only age (younger participants) predicted who would respond to treatment. Time post-onset, type and severity of aphasia, naming, non-verbal cognition, and communication confidence did not show significance in a predictive model. Studies Three and Four were qualitative studies involving interviews with therapists (Chapter Four) and people with aphasia and their families (Chapter Five). Both studies were 3 conducted using a phenomenological approach which allowed for the interviewees to describe their experiences in a semi-structured interview. The clinicians described the intensity of the therapy, the rewards, and challenges of the program. Therapists also considered that the ICAP model of service delivery had several positive benefits for them, but acknowledged that the intensity of therapy was challe...

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Aphasia treatment: Intensity, dose parameters, and script training

Cited by 85 publications

References 22 publications

Intensive Language Action Therapy in Chronic Aphasia: A Randomized Clinical Trial Examining Guidance by Constraint

Intensive Language Action Therapy in Chronic Aphasia: A Randomized Clinical Trial Examining Guidance by Constraint

Setting a Research Agenda to Inform Intensive Comprehensive Aphasia Programs

Outcomes of an Intensive Comprehensive Aphasia Program

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