Demystifying the Complexity of Aphasia Treatment: Application of the Rehabilitation Treatment Specification Systemx

Fridriksson, Julius; Basilakos, Alexandra; Boyle, Mary; Cherney, Leora R.; DeDe, Gayle; Gordon, Jean; Harnish, Stacy M.; Hoover, Elizabeth; Hula, William D.; Pompon, Rebecca Hunting; Johnson, Lorelei Phillip; Kıran, Swathi; Murray, Laura L.; Rose, Miranda; Obermeyer, Jessica; Salis, Christos; Walker, Grant M.; Martin, Nadine

doi:10.1016/j.apmr.2021.08.025

Cited by 33 publications

(9 citation statements)

References 75 publications

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“…Where active ingredients of therapy were reported, descriptions were often generic (‘multimodal cueing’, ‘functional communication strategies’, ‘behavioural techniques’) and lacked the detail required for interrogation and replication. This may reflect publishing restrictions regarding word count, or the current lack of a common framework to conceptualize active ingredients of treatment (e.g., Fridriksson et al., 2022; Van Stan et al., 2019). Given the dynamic, multifaceted nature of co‐constructed communication interventions (targeting linguistic and interactional behaviours of individual participants and of the dyad), it is essential that future studies provide detailed descriptions of the hypothesized active ingredients, and experimentally test these.…”

Section: Discussionmentioning

confidence: 99%

Co‐constructed communication therapy for individuals with acquired brain injury: A systematic review

Hall

Elbourn

Togher

et al. 2023

Intl J Lang & Comm Disor

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BackgroundMeaningful, varied, joyful conversation is an important therapy target for adults with language or cognitive–communication disorders following acquired brain injury (ABI). However, the complexity of daily communication is often reduced to component parts within intervention programmes, with mixed evidence of generalization to everyday conversation. Interventions targeting co‐construction of communication within a dyad offer a structured way in which to retain and treat elements of everyday conversation for individuals and their communication partner (CP). Such interventions exist but they are variably labelled, target different ABI populations and have not been synthesized.AimsTo identify the nature, scope and effects of intervention studies targeting co‐constructed communication in adults with ABI.MethodThis systematic review was completed using PRISMA Guidelines. Six databases (MEDLINE, Embase, CINAHL, Scopus, LLBA, PsychInfo) were searched and 1210 studies were screened. Data were extracted and studies were rated for methodological quality and completeness of reporting. Outcome measures and effects of treatment were collated through descriptive synthesis.Main ContributionThis review highlights an emerging evidence base in relation to an intervention approach that targets everyday communication. Co‐constructed communication interventions have been reported by 13 studies, from a total of 206 participants with post‐stroke aphasia, traumatic brain injury and progressive language impairments. These interventions take a range of formats, including referential communication tasks, retell/recount therapies and communication training programmes. Methodological quality evaluation indicated mostly low‐level study designs. Heterogeneity was identified in primary outcome measures, with 28 unique primary outcome measures reported across studies. Most studies demonstrated change in task‐specific or broad communication outcome measures.ConclusionsCo‐constructed communication interventions may offer clinicians a systematic, protocolized, replicable way to target everyday communication for adults with ABI. More high‐quality, experimental designs with complete reporting and psychometrically sound outcome measures are needed to strengthen the evidence base.What This Paper AddsWhat is already known on this subjectEveryday conversation is an important therapy target for adults with ABI, but there is mixed evidence of therapy gains generalizing to everyday life. Many interventions reduce conversation to component parts such as naming or sentence construction. A different approach is needed to capture the social, dyadic, interactive and multifaceted nature of conversation. We propose the term ‘co‐constructed communication interventions’ as a therapy genre targeting semi‐structured dialogue. These interventions retain elements of everyday conversation (such as multimodal communication and situating tasks within dyads), combined with experimental elements (where stimuli prompt interactions and responses can be scored against normative data).What this paper adds to existing knowledgeThis review proposes and describes a distinct genre of discourse intervention within the current evidence base with a novel operational definition of ‘co‐constructed communication’.What are the potential or actual clinical implications of this work?Co‐constructed communication interventions directly target elements of everyday communication by situating the therapy goals within a dyadic, interactive, multimodal task. A range of intervention tasks have been identified, including collaborative storytelling and problem‐solving. This review will be of interest to clinicians working with adults with ABI; co‐constructed communication interventions may offer a useful, replicable way to target aspects of everyday communication. This synthesis of the current evidence base encourages clinicians’ informed, evidence‐based decisions around these interventions.

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Section: Discussionmentioning

confidence: 99%

Co‐constructed communication therapy for individuals with acquired brain injury: A systematic review

Hall

Elbourn

Togher

et al. 2023

Intl J Lang & Comm Disor

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“…Por otro lado, es necesario realizar estudios sistemáticos en cada uno de los enfoques terapéuticos, dosis de tratamiento, estrategias, y niveles de intervención reportados en estos estudios para lograr un mejor entendimiento de los mecanismos que influyen en la rehabilitación de la afasia en hispanohablantes. Recientemente, el campo de la afasia se ha interesado en entender los ingredientes activos de los tratamientos para la afasia usando el Sistema de Especificación de Tratamientos de Rehabilitación (en inglés, Rehabilitation Treatment Specification System; Cherney et al, 2022, Fridriksson et al, 2022. Este es un marco que permite describir los diferentes componentes de los tratamientos que se utilizan para la rehabilitación de la afasia con el fin de intentar explicar cómo y porqué funcionan los tratamientos existentes.…”

Section: Discussionunclassified

Tratamientos para la afasia en hispanohablantes

García

Castilla

Mejía

et al. 2023

Rev. investig. logop.

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Aunque existe un amplio desarrollo de tratamientos para la afasia para hablantes de inglés, se conoce poco de la existencia de tratamientos para la afasia específicos para personas hispanohablantes. Esta revisión panorámica tuvo como objetivo examinar la literatura que reporta tratamientos de afasia para hispanohablantes. Se realizó una revisión panorámica de los artículos publicados entre 2011 y 2021 que reportan tratamientos de afasia aplicados a hispanohablantes. La revisión incluyó una muestra final de 19 artículos que reportaron tratamientos de afasia específicos para hispanohablantes nativos o bilingües cuyo primer idioma fuera el español. La media de edad de los participantes incluidos en la muestra fue de 56.7 años. Nueve de los 19 artículos reportaron diseños de caso único y el resto estudios grupales. Así mismo, 12 estudios reportaron tratamientos individualizados, mientras que 7 estudios adaptaron tratamientos de afasia reportados previamente en otras lenguas. En promedio, la cantidad de tratamiento provista fue de 14 semanas y 26 sesiones (distribuidas 3 veces por semana) con una duración de 1.25 horas por sesión. Se resalta el esfuerzo investigativo realizado hasta la actualidad frente a tratamientos para la afasia en hispanohablantes. No obstante, se observa una cantidad extremadamente limitada de tratamientos desarrollados y adaptados para esta población en la última década. Se necesita continuar desarrollando investigaciones que sustenten tratamientos basados en la evidencia para responder a las necesidades de hispanohablantes con afasia, particularmente en Latinoamérica.

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“…Constant Therapy (CT) is an app-based, evidence-based digital therapeutic designed to improve multiple domains of language simultaneously using a self-managed approach ( www.constanttherapy.com ) ( 33 ). Figure 2 depicts the CT therapy program using a tripartite schema (i.e., therapy target(s), ingredients, and mechanisms of action) following the Rehabilitation Treatment Specification System (RTSS) ( 34 ). There are several unique ingredients of the program, including (1) task variety with 266 different task types spanning speech, language and cognitive domains and functional daily activities that encompass them (e.g., listening to a voicemail, reading a map); (2) personalized goal setting enabling patients and their clinicians to identify high-priority, functionally relevant therapy goals across multiple domains; (3) adaptive difficulty that enables self-paced progression from easier to harder tasks within each targeted domain using an algorithm based on performance accuracy and consistency, allowing for therapy scaffolding in a way that mirrors in-person therapy techniques employed by skilled clinicians; (4) consistent feedback that is provided to the patient after every item, therapy goal and session; (5) ease of access that allows patients to log in and practice therapy at their convenience and progress at their own pace; and (6) the recommended therapy regimen that can be self-managed, reducing the need for regular face-to-face interaction with a clinician.…”

Section: Methodsmentioning

confidence: 99%

Consistent long-term practice leads to consistent improvement: Benefits of self-managed therapy for language and cognitive deficits using a digital therapeutic

Liu

Cordella

Ishwar

et al. 2023

Front. Digit. Health

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BackgroundAlthough speech-language therapy (SLT) is proven to be beneficial to recovery of post-stroke aphasia, delivering sufficiently high amounts of dosage remains a problem in real-world clinical practice. Self-managed SLT was introduced to solve the problem. Previous research showed in a 10-week period, increased dosage frequency could lead to better performance, however, it is uncertain if dosage still affects performance over a longer period of practice time and whether gains can be seen following practice over several months.ObjectiveThis study aims to evaluate data from a health app (Constant Therapy) to investigate the relationship between dosage amount and improvements following a 30-week treatment period. Two cohorts of users were analyzed. One was comprised of patients with a consistent average weekly dosage amount and the other cohort was comprised of users whose practice had higher variability.MethodsWe conducted two analyses with two cohorts of post-stroke patients who used Constant Therapy. The first cohort contains 537 “consistent” users, while the second cohort contains 2,159. The 30-week practice period was split into three consecutive 10-week practice windows to calculate average dosage amount. In each 10-week practice period, patients were grouped by their average dosage into low (0–15 min/week), medium (15–40 min/week) and moderate dosage (greater than 40 min/week) groups. Linear mixed-effects models were employed to evaluate if dosage amount was a significant factor affecting performance. Pairwise comparison was also applied to evaluate the slope difference between groups.ResultsFor the consistent cohort, medium (β = .002, t17,700 = 7.64, P < .001) and moderate (β = .003, t9,297 = 7.94, P < .001) dosage groups showed significant improvement compared to the low dosage group. The moderate group also showed greater improvement compared to the medium group. For the variable cohort in analysis 2, the same trend was shown in the first two 10-week windows, however, in weeks 21–30, the difference was insignificant between low and medium groups (β = .001, t = 1.76, P = .078).ConclusionsThis study showed a higher dosage amount is related to greater therapy outcomes in over 6 months of digital self-managed therapy. It also showed that regardless of the exact pattern of practice, self-managed SLT leads to significant and sustained performance gains.

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Demystifying the Complexity of Aphasia Treatment: Application of the Rehabilitation Treatment Specification Systemx

Cited by 33 publications

References 75 publications

Co‐constructed communication therapy for individuals with acquired brain injury: A systematic review

Co‐constructed communication therapy for individuals with acquired brain injury: A systematic review

Tratamientos para la afasia en hispanohablantes

Consistent long-term practice leads to consistent improvement: Benefits of self-managed therapy for language and cognitive deficits using a digital therapeutic

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