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.
Highlights
Stroke is the leading cause of adult long-term disability worldwide (Whitall, 2004), and aphasia, a potentially debilitating language impairment, affects from 25 to 40% of stroke survivors
The current paper focuses on identifying potential ambient factors that may be influential in the language recovery of individuals with stroke-induced aphasia through a review of existing literature
Presented here is the evidence found to be related to each factor within the framework established for ambient environmental components
Summary
Stroke is the leading cause of adult long-term disability worldwide (Whitall, 2004), and aphasia, a potentially debilitating language impairment, affects from 25 to 40% of stroke survivors. In a paper describing neuroplasticity related to constraintinduced movement therapy (CIMT), Nadeau and Wu (2006) delineate two categories of experience that impact brain and behavior changes during the neurorehabilitative process following brain damage – therapeutic and ambient These researchers, citing both human and animal studies, suggest that the therapeutic environment consists of clinically based interventions provided and controlled by the rehabilitation professional for purposes of replacing knowledge and skills lost due to neurological insult. These findings from translational research inform the application of principles of neuroplasticity to humans, with the caveat that there are many factors, most poorly understood, that limit the applicability of animal studies to human subjects with brain injury
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