Factors associated with social isolation in people with aphasia: a cross-sectional study

Achieving activity participation goals is a key factor in quality of life (QOL) for people with aphasia (PWA), but expressing participation goals can be difficult for many of them. Proxy reports by caregivers may not accurately reflect the interests and participation goals of PWA, and discrepancies in these goals between PWA and their caregivers may affect QOL, based on the assumption that caregivers' awareness of their loved ones' unique participation goals may be important to increasing PWA activity participation. To examine everyday activities valued by PWA using the Life Interests and Values (LIV) Cards; to measure congruence between PWA and their caregivers on life participation goals; and to measure how congruence of PWA-caregiver participation goals related to QOL. A convenience sample of 25 PWA completed the LIV Card assessment and the Stroke Aphasia Quality of Life Scale-39 to assess participation goals and QOL. Participation goals were also evaluated with respect to age, time post-onset and aphasia severity. A total of 12 caregivers were administered the LIV Cards to calculate agreement between PWA-proxy activity reports and the relationship between agreement and QOL. PWA endorsed wanting to participate more in a wide range of activities, with common interests in walking/running, going to the beach and eating out, among others. PWA-caregiver activity agreement was fair to moderate with point-to-point agreement averaging 70%. However, no relationship between degree of congruence in PWA-proxy pairs and QOL was found. PWA have a variety of activity participation goals that can be integrated into intervention plans. Dependence on proxy respondents should be reduced as much as possible to support self-determination for PWA. What this paper adds What is already known on the subject Achieving activity participation goals is a key factor in QOL for PWA, but communicating about participation goals can be difficult for many of them. Because proxy reports by caregivers may not accurately reflect the interests and participation goals of PWA, this study examined how both PWA and their caregivers responded to an aphasia-friendly assessment for determining participation goals, and then compared level of agreement about these goals to QOL. Because activity participation is known to be an important factor in QOL, the reason for investigating how agreement relates to QOL is that caregivers' awareness of their loved ones' unique participation goals likely facilitates increased participation by PWA in their ongoing desired activities. The relationship between PWA-caregiver agreement regarding participation goals and QOL in PWA had not yet been investigated before this study. What this paper adds to existing knowledge This study adds additional as well as confirmatory information to the existing literature about life participation goals of community-dwelling individuals with chronic aphasia. Top activities endorsed by a group of 25 PWA are reported within four activity domains (home and community activities, creative and relaxing activities, physical activities, and social activities). Results indicated that agreement between PWA and their caregiver proxies on PWA's most desired activities was < 50%. However, the level of agreement between caregivers and proxies on participation goals was not significantly related to QOL in this sample. What are the potential or actual clinical implications of this work? PWA have a variety of participation goals that can be integrated into intervention plans to be carried out with clinicians, caregivers and family members. The use of proxy respondents when determining participation goals should be reduced as much as possible to support self-determination for PWA. Use of the LIV Cards, a picture-based sorting-task assessment, reduces the need for proxy responders and guesswork about the specific participation goals of PWA.

People with aphasia (PWA) can experience functional numeracy difficulties, that is, problems understanding or using numbers in everyday life, which can have numerous negative impacts on their daily lives. There is growing interest in designing functional numeracy interventions for PWA; however, there are limited suitable assessments available to monitor the impact of these interventions. Existing functional numeracy assessments lack breadth and are not designed to be accessible for PWA, potentially confounding their performance. Additionally, they do not include real-life demands, such as time pressure, which may affect their ecological validity. Thus, there is a crucial need for a new assessment to facilitate further research of PWA's functional numeracy. To develop, validate and pilot a wide-ranging, aphasia-friendly functional numeracy assessment to investigate how functional numeracy is impacted by aphasia severity and time pressure demands, and to explore predictors of PWA's functional numeracy. To develop the Functional Numeracy Assessment (FNA), 38 items inspired by the General Health Numeracy Test (GHNT) and Excellence Gateway were adapted for suitability for PWA and entered in a computerized psychometric-style test. The final 23 items (FNA23) were selected based on 213 neurotypical controls' performance, and controlled for difficulty, response modality and required numeracy skills. Aphasia-friendly adaptations of the GHNT and Subjective Numeracy Scale were used to examine the FNA23's concurrent validity. Internal consistency reliability and interrater reliability (for spoken responses) were also examined. A novel Time Pressure Task was created by slight adaptation of seven FNA23 questions to explore the effects of time pressure on functional numeracy performance. A total of 20 PWA and 102 controls completed all measures on an online testing platform. The FNA23 demonstrated acceptable internal consistency reliability (KR-20 = 0.81) and perfect interrater reliability (for spoken responses). FNA23 and GHNT scores were positively associated, suggesting satisfactory concurrent validity. PWA demonstrated poorer functional numeracy than controls and took longer to complete assessments, indicating that aphasia impacts functional numeracy. Time pressure did not significantly impact performance. PWA demonstrated a wide range of functional numeracy abilities, with some performing similarly to controls. The FNA23 is a wide-ranging, valid and reliable assessment which, with further development, will be a useful tool to identify and monitor PWA's functional numeracy difficulties in research and clinical practice. Considering PWA's widespread functional numeracy difficulties evidenced by this study, all PWA would likely benefit from routine evaluation for functional numeracy difficulties as part of their neurorehabilitation journeys. What is already known on this subject Few studies have investigated functional numeracy difficulties in PWA. No published functional numeracy assessments exist that have been specifically designed to be accessible for PWA. What this paper adds to existing knowledge The newly developed FNA23 is a valid and reliable tool to extensively assess PWA's functional numeracy. This study confirmed previous findings of widespread functional numeracy difficulties in PWA that are related to their aphasia severity. What are the potential or actual clinical implications of this work? The FNA23 can be used to assess PWA's functional numeracy to inform areas of strengths and difficulties to target in intervention, and to monitor progress towards achieving intervention objectives. All PWA should be routinely evaluated for functional numeracy difficulties.

In everyday communication, word retrieval is semantically driven. A similar processing mechanism can be assumed for category fluency tasks. In contrast, in phonemic fluency tasks or rhyme production, the retrieval process must be based on the word form. In phonemic fluency, executive and language functions have been discussed as influencing this specific retrieval mechanism. In addition, studies of adults with developmental dyslexia and non-literate individuals have shown that deficits in written language processing are associated with poorer performance in phonemic fluency; a relationship that is not evident for category fluency. In people with aphasia (PWA), there is a lack of research on the possible relationship between written language skills and word form based word retrieval performance, although PWA often have acquired dyslexia/dysgraphia. There is also a paucity of data on possible effects on rhyme production. The aim of the present study was to investigate the effects of written language skills, word retrieval performance, aphasia severity and executive function on phonemic fluency, rhyme production and category fluency. It is hypothesised that phonemic fluency and rhyme production are associated with written language skills, while this is not assumed for category fluency. Word retrieval performance, aphasia severity and executive functions could have an impact on all three tasks. The study was conducted with 19 PWA (13f, 6m), showing predominantly post-semantic word retrieval disorders. The assessment included the following tasks: phonemic fluency, rhyme production, category fluency, reading and writing of nonwords (sub-lexical written language), reading and writing of unregular words (lexical written language), oral naming in the Boston Naming Test (word retrieval), Token Test (aphasia severity) and two visual-spatial tasks, spatial 2-back (executive function: updating) and antisaccade (executive function: inhibition). Descriptive analyses included correct responses and errors. In a second step, data were analysed by using hierarchical regression analyses. For both phonemic fluency and rhyme production, reading/writing of nonwords showed the strongest explanatory power. In contrast, for category fluency, the strongest predictor was oral naming performance in the Boston Naming Test. The results of the current study indicate that sub-lexical written language abilities are associated with phonemic fluency and rhyme production performance. In light of these results, it must be critically discussed whether phonemic fluency and rhyme production are appropriate tasks in the diagnosis and therapy of post-semantic word retrieval disorders, particularly in PWA with acquired dyslexia/dysgraphia. What is already known on this subject So far, it has been discussed that language functions, e.g., confrontation naming performance or vocabulary size, and executive functions have an impact on phonemic fluency in people with aphasia (PWA). In addition, studies with people with developmental dyslexia and non-literate people have shown that phonemic fluency performance is strongly influenced by segmental written language skills. What this paper adds to the existing knowledge The present study has shown that in PWA with post-semantic word retrieval disorders, segmental written language skills, i.e., reading/writing of nonwords, are associated with their performance in phonemic fluency and rhyme production. In contrast, performance in category fluency showed a relationship with spoken word retrieval abilities as measured by confrontation naming. What are the potential or actual clinical implications for this work? At least for PWA with dyslexia/dysgraphia, word form-based tasks such as phonemic fluency and rhyme production may not be appropriate for assessing or treating word retrieval disorders, as performance on these tasks, which rely on phonological strategies, appears to be related to deficits in segmental written language skills. Alternatively, tasks that also require semantic references may be more appropriate.

Event Abstract Back to Event Investigating the Efficiency of Group Therapy on Improving Conversational Skills in People with Aphasia Yael Neumann-Werth1* 1 Queens College (CUNY), United States Group therapy provides a naturalistic setting to enhance functional communication skills, e.g., conversational abilities, in people with aphasia (PWA). The Life Participation Approach to Aphasia (LPAA) supports the view of treating PWA as members of a social unit with his/her conversational partner(s). Therefore, group aphasia therapy is a highly beneficial approach to achieving this goal as it provides a natural forum for supporting conversational practice. There are numerous studies that have looked at various contributors to group therapy outcomes, namely, transactional and interactional assessment, in addition to linguistic, functional/social, quality of life, psychological, and cognitive/executive functioning measures. However, these variables have not been studied collectively in one in-depth study. This project intends to enhance our understanding of the effectiveness of group therapy on conversation skills using a multitude of measurement outcomes. Findings from this pilot study will then be used to develop a comprehensive standardized tool for eventual professional use in various rehabilitation settings. The participant in this study was a non-fluent aphasic due to a unilateral cerebrovascular accident. He was 2-year post-onset, had no symptoms of dementia, adequate hearing and vision, used English as his primary language, and had adequate communicative abilities to engage in conversation. The subject participated in a group therapy which consisted of three other members with a variety of different types of aphasia. The subject was tested on an array of standardized tests and functional rating scales to study conversational changes pre-and post-group therapy. This included assessment of: transactional analysis, conversational analysis, interactional aspects in conversations (Measure of Interaction in Communication - MIC), language abilities using the Boston Diagnostic Aphasia Examination (BDAE-Short Form), comprehension through the use of the Token Test (Short Version), linguistic and executive functions by using Word Fluency, functional communication skills using the Communication Activities in Daily-Living (CADL-2), quality of life (Stroke and Aphasia Quality of Life Scale -SAQOL-39), psychological well-being (Geriatric Depression Scale - GDS), and executive function skills like planning, impulse inhibition, and the ability to shift cognitive focus (Delis-Kaplan Executive Function System). The group therapy was run once a week for 45 minutes over the course of 12 weeks. The sessions focused on discussing current event topics and group games with the overall goal of creating a social, supportive, and therapeutic community. Therapeutic principles were largely taken from Promoting Aphasic’s Communicative Effectiveness (PACE; Davis, 2005) where the conversational partner and the study participant took equal turns in the exchange of information, shared novel information, and were encouraged to use multi-modalities in communication, e.g. using gestures, pointing, an ABC board, writing. Pre-testing results indicate the participant’s performance was generally mild. Transactional success measured the participant’s ability to yield information regarding three short clips played from the Mr. Bean television show. We identified the main ideas for each clip and determined target words for the structure of the main ideas. On average, the subject was able to identify at least one target component from each main idea, however his overall performance level was low. When assessing interactional success, we observed the participant interact with a conversational partner. In this testing, the participant received a higher score for his interactional skills than his transactional skills. He did not demonstrate a verbal/vocal attempt to engage his communication partner or respond to interactional attempts; however, he scored much higher in his nonverbal communication (i.e. gesture, writing, drawing, etc.) attempt where he showed full and appropriate participation. While observing his transactional skills with a communicative partner, he scored the same on verbal/vocal and nonverbal communication; he exhibited adequate participation. With regards to his language abilities, he scored high in auditory comprehension with the Token test – SF. Other tests where the subject received a low score on were in the quality of life and geriatric depression scale. Initial analyses of post-therapy findings are currently being analyzed and will be completed prior to the conference date. References American Speech-Language-Hearing Association. (1998). The role of speech-language pathologists in identification, diagnosis, and treatment of individuals with cognitive-communication impairments. ASHA, 30, 79. Cruice, M., Worrall, L., Hickson, L., & Murison, R. (2003). Finding a focus for quality of life with aphasia: Social and emotional health, and psychological well-being. Aphasiology, 17(4), 333-353. Damico, J.S., Oelschlaeger, M., & Simmons-Mackie, N. (1999). Qualitative methods in aphasia research: Conversation analysis. Aphasiology, 13(9–11), 667–680. Davis, G. A. (2005). PACE revisited. Aphasiology, 19, 21-38. Delis, D. C., Kaplan, E., & Kramer, J. H. (2001). Delis – Kaplan Executive Function System (D-KEFS). San Antonio, TX: The Psychological Corporation. De Renzi, E., & Vignolo, LA. (1962). The Token test: A sensitive test to detect receptive disturbances in aphasia. Brain, 85, 665–678. Frattali, C.M., Thompson, C.K., Holland, A.L., Wohl, C.B., & Ferketic, M.M. (1995). Functional Assessment of Communication Skills for Adults: Manual. Rockville, MD: American Speech- Language-Hearing Association. Goodglass, H., Kaplan, E., & Barresi, B. (2001). The assessment of aphasia and related disorders. Lippincott Williams & Wilkins. Hilari, K., & Byng, S. (2001). Measuring quality of life in people with aphasia: the Stroke Specific Quality of Life Scale. International Journal of Language & Communication Disorders, 36(1), 86-91. Hilari, K., Wiggins, R., Roy, P., Byng, S., & Smith, S. (2003). Predictors of health-related quality of life (HRQL) in people with chronic aphasia. Aphasiology, 17(4), 365-381. Holland, A., Frattali, C., & Fromm, D. (1999). Communication Activities of Daily Living (2nd ed.). Austin, TX: Pro-Ed. Kagan, A. (1998). Supported conversation for adults with aphasia: Methods and resources for training conversation partners. Aphasiology, 12,9, 816-830. Pound C, Parr S, Lindsay J, Woolf C. Beyond aphasia: Therapies for Living with Communication Disability. Bicester, UK: Speechmark; 2000. Ramsberger, G. (2005). Achieving conversational success in aphasia by focusing on non-linguistic cognitive skills: A potentially promising new approach. Aphasiology, 19, 1066–1073. Ramsberger, G., and Rende, B. (2002). Measuring transactional success in the conversation of people with aphasia. Aphasiology, 16(3), 337-353. Saldert, C., Backman, E., and Hartelius, L. (2013). Conversation partner training with spouses of persons with aphasia: A pilot study using a protocol to trace relevant characteristics. Aphasiology, 27,3, 271-292. Schegloff, E.A. (1988) . Discourse as an interactional achievement II: An exercise in conversation analysis. In D. Tanner (Ed.), Linguistics in context: Connecting observation and understanding (pp. 135–158). Norwood, NJ: Ablex. World Health Organization. (2001). International classification of functioning, disability, and health. Retrieved April 30, 2003, from http://www.who.int/gb/EB_WHA/PDF/WHA54/ea5418.pdf Yesavage, J. A., Brink, T. L., Rose, T. L., Lum, O., Huang, V., Adey,M., & Leirer, V. O. (1983).Development and validation of a geriatric depression rating scale: A preliminary report. Journal of Psychiatric Research, 17, 37–49. Keywords: Aphasia, Group Therapy, Conversational skills, adults population, aphasia therapy Conference: Academy of Aphasia 55th Annual Meeting , Baltimore, United States, 5 Nov - 7 Nov, 2017. Presentation Type: poster presentation Topic: General Submission Citation: Neumann-Werth Y (2019). Investigating the Efficiency of Group Therapy on Improving Conversational Skills in People with Aphasia. Conference Abstract: Academy of Aphasia 55th Annual Meeting . doi: 10.3389/conf.fnhum.2017.223.00043 Copyright: The abstracts in this collection have not been subject to any Frontiers peer review or checks, and are not endorsed by Frontiers. They are made available through the Frontiers publishing platform as a service to conference organizers and presenters. The copyright in the individual abstracts is owned by the author of each abstract or his/her employer unless otherwise stated. Each abstract, as well as the collection of abstracts, are published under a Creative Commons CC-BY 4.0 (attribution) licence (https://creativecommons.org/licenses/by/4.0/) and may thus be reproduced, translated, adapted and be the subject of derivative works provided the authors and Frontiers are attributed. For Frontiers’ terms and conditions please see https://www.frontiersin.org/legal/terms-and-conditions. Received: 03 May 2017; Published Online: 25 Jan 2019. * Correspondence: Dr. Yael Neumann-Werth, Queens College (CUNY), Queens, United States, rodriguez.janice88@gmail.com Login Required This action requires you to be registered with Frontiers and logged in. To register or login click here. 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ABSTRACTBackground: The term “communicative participation” refers to participation in the communication aspects of life roles at home, at work and in social and leisure situations. Participation in life roles is a key element in biopsychosocial frameworks of health, such as the World Health Organization’s International Classification of Functioning, Disability and Health (ICF) and the Aphasia Framework for Outcomes Measurement. The Communicative Participation Item Bank (CPIB) was developed as a patient-reported measure of communicative participation for adults. Initial validation focused on adults with motor speech or voice disorders. No prior studies have conducted quantitative validation analyses for the CPIB for people with aphasia (PWA).Aims: The primary purpose of this study was to begin validation of the CPIB for PWA by conducting an analysis of differential item functioning (DIF). A DIF analysis was used to identify whether item parameters of the CPIB differed between PWA and the populations used in prior CPIB calibration. Secondary analyses evaluated the level of assistance needed by PWA to complete the CPIB, relationships between the CPIB and a gold-standard patient-reported instrument for PWA—American Speech-Language-Hearing Association Quality of Communication Life Scale (ASHA-QCL) and relationships between PWA and family proxy report on the CPIB.Methods & Procedures: This study included 110 PWA and 90 proxy raters. PWA completed a battery of patient-reported questionnaires in one face-to-face session. Speech-language pathologists provided communication support. Data on aphasia severity from the Western Aphasia Battery—Revised (WAB-R) and demographic data either existed from prior research or were collected during the session. Proxy raters completed a similar battery of self-report questionnaires.Outcomes & Results: Results of the DIF analysis suggested statistically significant DIF on two of the 46 items in the CPIB, but the DIF had essentially no impact on CPIB scores. PWA with WAB-R Aphasia Quotient scores above 80 appeared comfortable reading the CPIB items, although required occasional assistance. Most participants who were unable to complete the CPIB had WAB-R Aphasia Quotient scores lower than 50. Correlation between the CPIB and ASHA-QCL was moderate; and correlation between PWA and proxy scores was low.Conclusions: Most PWA were able to respond to CPIB items, although most required or requested support. Although these results are preliminary due to a small sample size, the data support that the CPIB may be valid for PWA. Caution is warranted regarding proxy report because of low correlation between PWA and proxy ratings.

Background The most effective model for achieving therapist-delivered, high-dose SLT for People with Aphasia (PWA) is through Intensive Comprehensive Aphasia Programmes (ICAPs). ICAPs are often assessed using standardised outcome measures; however, as SLT is personalised, it is of interest to examine individualised goal-based outcome measures as well. In the Queen Square ICAP, we use a goal-setting approach (Goal Attainment Setting [GAS]) where the PWA and their therapist negotiate which goals to work on and over what timescales. This process involves recording and scoring the agreed goals, which makes them amenable to formal quantitative and qualitative analysis. Aims The aim of this study was twofold. Firstly, to test the hypothesis that a pre- versus post- ICAP analysis of individual’s goal scores would show statistically significant and clinically meaningful improvements. Secondly, to better understand what PWA wanted to achieve from the ICAP service, we performed a qualitative analysis across all agreed goals. Methods & Procedures Forty-four PWA who varied in aphasia severity from mild to severe took part. PWA jointly set goals with their therapists using the SMART framework (Specific, Measurable, Achievable, Relevant, and Time-Bound). The goals were split into four categories: short (3 weeks), medium (3-6 months), long-term (12 months) and economic, (defined as any outcome that will improve, either directly or indirectly, the economic system that the PWA lives within). Quantitative scores were obtained for each PWA both pre- and post- ICAP and were analysed using paired t-tests, with subsequent ANOVAs to investigate possible confounding factors. The qualitative analysis was carried out by two researchers not involved in delivering the ICAP. Data was collapsed across all goal categories and analysed using thematic analysis. Outcomes & Results Quantitatively, statistically significant gains were made across all four goal categories (ps < 0.001). Unstandardized effect-sizes were clinically significant (ΔGAS ~16). Qualitatively, we identified five main themes: staying connected with the world, understanding aphasia better, raising awareness, the importance of having a work identity and managing personal relationships. Conclusions Quantitative goal-setting for PWA in the context of an ICAP provides robust evidence that PWA can achieve a variety of aspirational goals given high enough doses of specialist input from SLTs and a clinical psychologist. Although the ICAP only spanned 3 weeks, PWA continued to reach medium, long-term and even economic goals up to a year post-recruitment. This is the first time that economic goals have been captured in PWA using GAS. The qualitative analysis describes what the PWA wanted to achieve from participating in our ICAP, while the quantitative analyses demonstrate how much they succeeded in doing so.

Background Tense production is often impaired in people with aphasia (PWA). Interestingly, the literature suggests that not all tenses are affected in the same way, although the pattern of dissociation is still debated in the literature. The heterogeneity of tense production deficits in PWA might partly explain this lack of consensus in the literature. While this heterogeneity has been demonstrated by descriptive statistics or double dissociations in several studies, no study has used cluster analyses to highlight the main patterns of tense dissociation. Furthermore, the factors underlying this heterogeneity have been little explored. Aims Our study aimed to use cluster analyses on tense production performance to (1) identify the main patterns of dissociation between tenses in PWA and (2) explore the clinical (aphasia type and severity) and cognitive (executive disorders and temporality) factors that may underlie these patterns. Methods & procedures Twenty-one French-speaking participants with fluent and non-fluent aphasia completed a verb inflection production task, as well as language and cognitive tests. Cluster analyses were performed on the differences in performance between the tenses on the verb inflection production task. Generalized linear mixed models and nonparametric statistics were used to analyze the effect of tense and its interaction with the clusters, and to compare the clusters on the clinical and cognitive variables. Outcomes & results Cluster analyses revealed two main clusters, one with worse performances in the past and future than in the present (PWA_1 – 70% of the PWA), and the other with worse performances in the past and present than in the future (PWA_2 – 30%). The type and severity of aphasia, and cognitive test performance did not differ between the two clusters. On the other hand, the PWA_2 cluster had a longer time post-onset than the PWA_1 cluster. Conclusions Our results confirm the heterogeneity of verb inflection deficits in PWA. They suggest that most PWA would have difficulties with past and future tenses, questioning the presence of discourse linking in these two tenses. However, a minority of PWA, who are clinically and cognitively indistinguishable from the others, do not follow this pattern. Adopting the strategy of producing a morphologically simple tense in French – future – could explain the high performance in the future tense and the errors in substituting other tenses with the future in this subgroup. Finally, the clinical and research implications of this heterogeneity, in relation to therapies and the lack of consensus in the literature, are discussed.

Defined as having few social relationships or infrequent social contact with family, friends, and the community, social isolation is a public health crisis. We aimed to evaluate the prevalence of social isolation and explore the association between social isolation and health status among community-dwelling Chinese Older Adults living with homecare services. This is a cross-sectional survey with a structured questionnaire conducted among older adults aged ≥60 in the Central Kowloon District of Hong Kong during 2017-2018. Social isolation was assessed by the Lubben Social Network Scale-6 and a score less than 12 was defined as socially isolated. Six aspects of health status including fall risk, cognitive function, depression, activities of daily living (ADL), instrumental activities of daily living (IADL), and functional mobility were measured by standardized instruments. Multi-criteria decision analysis (MCDA) was applied to estimate an index to represent the overall health status of the respondents. Multivariate logistic/linear regression models were applied to examine the associations between social isolation and health status after adjusting the sociodemographic characteristics. Among the 1,616 participants included in this analysis, the mean age was 80.9 years, 66.3% were female and 41.4% were identified as socially isolated. Compared with the non-isolated group, the socially isolated group had higher proportions of males, divorced or unmarried, ever smoking and drinking, living alone, and living in public housing without religion. After adjusting for confounders, the odds ratios (OR) comparing the socially isolated vs. non-isolated groups were 2.52 (95%CI: 1.79, 3.56) for high fall risk, 1.51 (1.17, 1.94) for cognitive impairment, and 1.78 (1.31, 2.43) for depression. The socially isolated group increased the odds of abnormal ADL, IADL, and functional mobility by 105-150%, and decreased the overall health score by 5.30 (3.42, 7.18). We demonstrated the association of social isolation with poorer physical function and mental health and overall health status among the community-dwelling Chinese older adults living with homecare services. These findings provided new knowledge about the association of social isolation with both physical and mental function for daily living even for those receiving an integrated homecare service in the community. It implies that an unmet healthcare need existed when comparing the service scope of the current homecare services in the community. It also highlighted the need for targeted prevention and intervention initiatives among community-dwelling old adults to alleviate social isolation for better health and good functioning in the community.

This study aimed to explore the effect of new software targeting naming deficits in Turkish-speaking people with aphasia. The study included seven Turkish people with aphasia. These participants took the Aphasia Language Assessment Test (ADD), Turkish Picture-Naming Test (T-RAT), and Technology Familiarity Assessment, and the words for therapy were determined. The selection of categories and words for inclusion in the application was based on the frequency and typicality features. The 12-week speech-language treatment sessions were divided into two sections. During the first six weeks, a speech-language pathologist (SLP) used the software to train people. After the first part, the SLP applied the T-RAT. Participants utilized the software at home in the second part. All participants took the ADD, T-RAT, and Software Evaluation Questionnaire following the second part. Participants’ naming abilities improved in all tests. Both therapy sessions with the SLP and those in which participants used the program independently demonstrated this improvement. Participants also reported high levels of treatment satisfaction. Cueing hierarchy approaches used in the software helped to improve naming skills in people with aphasia (PWA), independent of type, stage, or severity of aphasia. The findings of this study indicate that both sessions directed by an SLP and independent use of the software by participants can positively impact the therapy process with the developed software.

st , 2012; revised July 2 nd , 2012; accepted August 3 rd , 2012 Health related quality of life (HRQL) measures are increasingly used to evaluate stroke interventions. People with severe aphasia after stroke may be unable to self-report on such measures, necessitating the use of proxy respondents. This study explored the level of agreement between people with aphasia and their proxies on the Greek Stroke and Aphasia Quality of Life Scale-39 generic version (SAQOL-39g) and whether this agreement was influenced by proxy levels of depression and carer strain. Methods: Participants were people with aphasia (PWA) who were over six months post-stroke and medically stable. Proxies were nominated by the PWA and had to see them at least twice a week. PWA completed the Frenchay Aphasia Screening Test and the Greek SAQOL-39g. Proxies completed the Greek SAQOL-39g proxy version, the General Health Questionnaire-12 and the Caregiver Strain Index. Results: 23 pairs of people with aphasia and their proxies took part. Proxies rated people with aphasia as more severely affected than they rated themselves. The difference was significant for the overall scale and the physical and communication domains (p < 0.05); yet the bias introduced by these differences was small to moderate, with effect sizes ranging from 0.15 to 0.47. The strength of the agreement between people with aphasia and proxies was excellent for the overall scale and all three domains (ICC = 0.79 - 0.97). The level of agreement was not associated with carer strain or emotional distress. We conclude that clinicians and researchers can use proxy ratings to evaluate the quality of life of people with severe aphasia but need to be aware of trends in proxy reporting and take these into account when interpreting data.

Stroke care in the UK was significantly affected by the COVID-19 pandemic, with many services switching to telehealth. Post-pandemic, a UK survey of speech and language therapists (SLTs) working with people with aphasia (PWA) showed the vast majority planned to continue to use telehealth alongside in-person intervention. Telehealth is considered a cost-effective and feasible method of service delivery; however, there is limited evidence to support its use in the assessment of people with post-stroke aphasia. To investigate what barriers and facilitators SLTs experience when administering telehealth assessments to PWA and to explore SLTs' perspectives on what makes for a positive patient experience. Focus groups (dyadic/triadic) were conducted via videoconferencing. Transcripts were analysed using framework analysis. Inclusion criteria for participants were SLTs working in the UK with PWA, with experience of using telehealth assessment. A total of 14 SLTs participated across six groups. Seven themes were identified: assessment; technology; factors specific to PWA; factors specific to family, carers and their environment; factors specific to SLTs; benefits of telehealth assessment; and what telehealth would look like in an ideal world. Facilitators to telehealth assessment included good internet connectivity, access to a helper, adapted assessments, preparation and training PWA to use telehealth platforms. Barriers included reduced control over the environment, having a cognitive impairment, aphasia severity, low beliefs in competence using technology and challenges with managing the emotional needs of PWA during telehealth assessment. A strong therapeutic relationship, offering choice and flexibility in assessment administration, promoted a positive patient experience. This study provides new insights into the current use of telehealth assessment with PWA by SLTs in the UK. Barriers and facilitators identified can support the implementation of telehealth assessment in SLT services. Providing a positive patient experience when using telehealth assessment is important to SLTs, with patient choice a key factor. Further research is indicated to increase the range of standardized assessments for telehealth assessment and investigate the efficacy of a hybrid model approach to service delivery. What is already known on the subject There is emerging evidence for the use of telehealth assessment as a feasible and appropriate means of service delivery for SLTs. However, little is known about SLTs' experience of delivering telehealth assessments to PWA. What this paper adds to existing knowledge This study identified both the facilitators and barriers experienced by SLTs when using telehealth assessment with PWA. Practical advice and considerations for telehealth administration are provided. What are the potential or actual clinical implications of this work? Resources are required for the implementation of SLT telehealth assessments, particularly in training for both PWA and SLTs, assessments designed for telehealth and accessible telehealth platforms. A hybrid approach to assessment could be beneficial for both PWA and clinicians, retaining the advantages with the acknowledgement that telehealth may not be suitable for all.

Event Abstract Back to Event Sensitivity to verb-argument anomalies in aphasia is driven by event knowledge Michael W. Dickey1, 2*, Michelle Holcomb2 and Tessa Warren2 1 VA Pittsburgh Healthcare System, United States 2 University of Pittsburgh, United States Both event-related world knowledge (McRae & Matsuki, 2009) and verb-specific constraints (Paczynski & Kuperberg, 2012; Warren & McConnell, 2007) rapidly influence verb-argument processing. However, Warren, Milburn, Patson & Dickey (2015) showed that verb-specific constraints may play a special role. They compared eye-movement disruption as young neurotypical adults read sentences that were either impossible due to a selectional restriction violation (SRV: 1c), impossible due to a severe violation of event-based knowledge (1b), or plausible (1a; see Table 1a). Readers showed strong disruption in (1c) but little evidence of disruption in (1b). Thus, SRVs can be dissociated from violations of event-related knowledge (cf. McRae & Matsuki, 2009), suggesting that language-related representations play a critical role in verb-argument integration in healthy adults. Dickey and Warren (2015) explored the influence of these sources of knowledge on verb-argument integration in aphasia. They had people with aphasia (PWA) and varying degrees of language-processing impairments (WAB Aphasia Quotients) and conceptual-semantic impairments (access to event-related world knowledge) read sentences involving severe event-related knowledge violations (EKVs: Mary used bleach to clean the large carrots) or SRVs (Mary used a pump to inflate the large carrots). In two self-paced reading tasks, the PWA showed significant disruption for both EKVs and SRVs. However, sensitivity to these violations was modulated by impairment: PWA with milder language impairments but greater conceptual-semantic impairments showed on- and off-line disruption for EKVs and SRVs. PWA with greater language impairments but milder conceptual-semantic impairments did not. Dickey and Warren’s (2015) results suggest that language-processing ability may be more important than access to event-related knowledge for verb-argument integration among PWA. However, Dickey and Warren (2015) tested only a small sample of PWA (n=8), and their items were not as well designed for distinguishing between EKVs and SRVs as those in Warren et al. (2015). The current self-paced reading study tested 17 PWA on the Warren et al. (2015) stimuli. Condition was tested as two orthogonal contrasts: a possibility contrast, comparing condition (a) to the mean of conditions (b) and (c), and an EKV-SRV contrast, comparing (b) to (c). At the post-critical region (and filled), LMERs showed an interaction of possibility and conceptual-semantic impairments, indexed by the ability to judge the likelihood of pictured events (Dickey & Warren, 2015). Participants with milder conceptual-semantic impairments showed elevated reading times for the impossible conditions compared to the plausible baseline (Table 1b), whereas participants with more severe conceptual-semantic impairments did not (Table 1c). There was no evidence of a special penalty for SRVs, nor of an interaction between degree of language impairments and either of the condition contrasts (either overall aphasia severity or verb-processing performance on the NAVS; Cho-Reyes & Thompson, 2012). These results replicate Dickey & Warren’s (2015) finding that PWA may be sensitive to verb-argument anomalies. However, they suggest that the ability to judge event likelihood is the primary driver of this sensitivity. This finding highlights the importance of event-related knowledge in verb-argument integration among PWA, in contrast to neurotypical adults (Warren, et al., 2015). Figure 1 Acknowledgements This research was supported by the National Institutes of Health through grant number R01DC011520 to the first and third authors. It is the result of work supported with resources and the use of facilities at the VA Pittsburgh Healthcare System. References Cho-Reyes, S., & Thompson, C. K. (2012). Verb and sentence production and comprehension in aphasia: Northwestern Assessment of Verbs and Sentences (NAVS). Aphasiology, 26(10), 1250–1277. Dickey, M. W., & Warren, T. (2015). The influence of event-related knowledge on verb-argument processing in aphasia. Neuropsychologia, 67(0), 63–81. McRae, K., & Matsuki, K. (2009). People use their knowledge of common events to understand language, and do so as quickly as possible. Language and Linguistics Compass, 3(6), 1417–1429. Paczynski, M., & Kuperberg, G. R. (2012). Multiple influences of semantic memory on sentence processing: Distinct effects of semantic relatedness on violations of real-world event/state knowledge and animacy selection restrictions. Journal of Memory and Language, 67(4), 426–448. Warren, T., & McConnell, K. (2007). Investigating effects of selectional restriction violations and plausibility violation severity on eye-movements in reading. Psychonomic Bulletin & Review, 14(4), 770–775. Warren, T., Milburn, E., Patson, N. D., & Dickey, M. W. (2015). Comprehending the impossible: what role do selectional restriction violations play? Language, Cognition and Neuroscience, 30(8), 932–939. Keywords: verb-argument structure, Aphasia, semantics, events memory, world knowledge Conference: 54th Annual Academy of Aphasia Meeting, Llandudno, United Kingdom, 16 Oct - 18 Oct, 2016. Presentation Type: Poster Sessions Topic: Academy of Aphasia Citation: Dickey MW, Holcomb M and Warren T (2016). Sensitivity to verb-argument anomalies in aphasia is driven by event knowledge. Front. Psychol. Conference Abstract: 54th Annual Academy of Aphasia Meeting. doi: 10.3389/conf.fpsyg.2016.68.00079 Copyright: The abstracts in this collection have not been subject to any Frontiers peer review or checks, and are not endorsed by Frontiers. They are made available through the Frontiers publishing platform as a service to conference organizers and presenters. The copyright in the individual abstracts is owned by the author of each abstract or his/her employer unless otherwise stated. Each abstract, as well as the collection of abstracts, are published under a Creative Commons CC-BY 4.0 (attribution) licence (https://creativecommons.org/licenses/by/4.0/) and may thus be reproduced, translated, adapted and be the subject of derivative works provided the authors and Frontiers are attributed. For Frontiers’ terms and conditions please see https://www.frontiersin.org/legal/terms-and-conditions. Received: 29 Apr 2016; Published Online: 15 Aug 2016. * Correspondence: Dr. Michael W Dickey, VA Pittsburgh Healthcare System, Pittsburgh, PA, United States, mdickey@pitt.edu Login Required This action requires you to be registered with Frontiers and logged in. To register or login click here. Abstract Info Abstract The Authors in Frontiers Michael W Dickey Michelle Holcomb Tessa Warren Google Michael W Dickey Michelle Holcomb Tessa Warren Google Scholar Michael W Dickey Michelle Holcomb Tessa Warren PubMed Michael W Dickey Michelle Holcomb Tessa Warren Related Article in Frontiers Google Scholar PubMed Abstract Close Back to top Javascript is disabled. Please enable Javascript in your browser settings in order to see all the content on this page.

People with aphasia (PWA) often experience higher levels of anxiety and social isolation than people without aphasia. Although the presence of anxiety is appreciated in PWA, literature examining the etiology and persistent nature of anxiety in PWA is underdeveloped. Safety-seeking behaviors, or maladaptive acts used by individuals to decrease anxiety from a feared outcome, have been reported as key facilitators of long-term anxiety toward feared situations across a variety of clinical populations. The purpose of this viewpoint is to explore the concept of safety-seeking behaviors and discuss their potential relevance to the maintenance of anxiety in PWA. We further discuss the distinction between maladaptive (i.e., safety seeking) and adaptive (i.e., coping) behaviors and how this knowledge may improve the quality of clinical services for PWA. The present review advocates for further exploration of the safety-seeking behaviors that are used by PWA. Until critical attention is given to this subject, clinicians may remain ill-equipped to identify and depict whether a self-management strategy is facilitative or inhibitive to PWA's communicative participation goals. Critically, a behavior that may be "maladaptive" for one individual may be "adaptive" for another. Future research should seek to identify common behavioral and cognitive strategies that PWA implement to reduce acute perceptions of anxiety. This knowledge may help facilitate holistic aphasia rehabilitation by allowing clinicians to foster conversations around behaviors that inhibit or promote successful communicative participation.

Cross-situational word learning in aphasia

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