Setting a Research Agenda to Inform Intensive Comprehensive Aphasia Programs

Hula, William D.; Cherney, Leora R.; Worrall, Linda

doi:10.1310/tsr2005-409

Cited by 19 publications

(13 citation statements)

References 67 publications

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“…71 The database analysis is the first stage of such a process, and has provided a proof-of-concept. 112 The main limitations in the quantitative analysis regarding scientific rigor are: no control group, no comparison to usual care, lack of blinding of the clinicians, and self-selection of the participants.…”

Section: Limitationsmentioning

confidence: 99%

“…112 The main limitations in the quantitative analysis regarding scientific rigor are: no control group, no comparison to usual care, lack of blinding of the clinicians, and self-selection of the participants. 71 Chapter Two describes in detail how the program structure was modified from traditional treatment provided by the hospital and highlights some of the obstacles in the logistics of implementing an intensive program. However, the issues that arise in continued research with the ICAP model are that there are multiple evidence-based treatments implemented and individualized for each participant, the staff are specifically trained in those treatments, and the treatment is administered for several hours a day.…”

Section: Limitationsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…71 With the increasing number of programs being established, it is important to begin to define the interventions, responders and outcomes from this unique therapy model. 71 An emerging body of literature is beginning to assess outcomes from clinical ICAPs. 57,[72][73][74] Hinckley and Craig (1998) retrospectively analysed the outcomes of an intensive comprehensive aphasia program in which participants received 23 hours of therapy per week over six weeks.…”

Section: Introductionmentioning

confidence: 99%

“…Therefore, a second aim of this paper is how the framework can apply to research on ICAPs has been described by several authors. 58,71,76 Investigating outcomes using retrospective data falls into Phase 1 in this framework: defining the components of the intervention, and examining proof-of-concept, safety, and feasibility and acceptability. The second aim of this Phase I study is to describe the outcomes of 12 cohort programs (implemented twice a year over six years) from the ICAP previously described.…”

Section: Introductionmentioning

confidence: 99%

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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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Section: Limitationsmentioning

confidence: 99%

Section: Limitationsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Outcomes of an Intensive Comprehensive Aphasia Program

Babbitt¹

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Evidence for Intensive Aphasia Therapy: Consideration of Theories From Neuroscience and Cognitive Psychology

Dignam

Rodriguez

Copland

2015

PM&R

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Treatment intensity is a critical component to the delivery of speech-language pathology and rehabilitation services. Within aphasia rehabilitation, however, insufficient evidence currently exists to guide clinical decision making with respect to the optimal treatment intensity. This review considers perspectives from 2 key bodies of research, the neuroscience and cognitive psychology literature, with respect to the scheduling of aphasia rehabilitation services. Neuroscience research suggests that intensive training is a key element of rehabilitation and is necessary to achieve functional and neurologic changes after a stroke occurs. In contrast, the cognitive psychology literature suggests that optimal long-term learning is achieved when training is provided in a distributed or nonintensive schedule. These perspectives are evaluated and discussed with respect to the current evidence for treatment intensity in aphasia rehabilitation. In addition, directions for future research are identified, including study design, methods of defining and measuring treatment intensity, and selection of outcome measures in aphasia rehabilitation.

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