Aphasia Outcome Research Articles

Role of tPA in Aphasia Recovery: A Meta-Analysis of Recent Studies

ABSTRACT Background Tissue plasminogen activator (tPA) is a common therapeutic agent approved to treat patients with stroke. When the agent is administered within 4.5 hours of stroke onset, tPA administration helps to restore blood flow to brain regions affected by a stroke, thereby limiting the risk of damage and functional impairment. However, research evaluating the use of tPA on aphasia – loss of the ability to understand or express speech – a common post-stroke condition is limited. A meta-analysis of available evidence was performed to assess the association between the use of tPA on aphasia post-stroke. Methods A literature search was performed using the PubMed, Web of Science, and SCOPUS electronic database using keywords “tPA”, “tissue plasminogen activator”, “aphasia”, and “stroke” published in English since 2010. An initial search revealed 7, 069, 6,682, and 289 studies in PubMed, Web of Science, and SCOPUS, respectively. Studies without a measure of aphasia impairment in adults as well as case studies and reviews were excluded. After quality assessment and a review of study abstracts, 14 relevant studies were identified for full text review. Among the 14, ten were deemed appropriate for inclusion and feature extraction. Results Associations between tPA and aphasia outcomes in each of the included studies were translated to odds ratios (ORs) and study features were coded for inclusion in a random effects meta regression. Results revealed a statistically significantly higher likelihood of improvement in the level of post-stroke aphasia among those receiving tPA compared with those not receiving tPA (odds ratio [OR], 2.1963, CI = 0.5994, 3.7932). Model statistics did however indicate substantial heterogeneity (I2 = 96.94%, Ƭ2 = 32.65) between studies. After removal of two outliers from the analysis set, the estimates improved substantially (OR = 1.8643, CI = 1.2131, 2.5155), and heterogeneity was reduced (I2 = 76.28%, Ƭ2 = 4.22). Estimates were robust to the inclusion of study location, metric used to measure aphasia, observed recovery duration, and size of the sample. Conclusion This meta-analysis found an increased likelihood of aphasia recovery in patients receiving tPA following stroke and significant improvement in communication from tPA receipt. However, further prospective studies with greater sample heterogeneity are needed to determine the appropriate window for tPA use, the duration of improvement, and the long-term effects on communication outcomes.

Clinico-radiological Factors Associated with Aphasia Outcome in Post-stroke Patients: A Prospective Follow Up Study (S16.008)

Clinico-radiological Factors Associated with Aphasia Outcome in Post-stroke Patients: A Prospective Follow Up Study (S16.008)

Clinico-radiological factors associated with aphasia outcome in post stroke patients: A prospective follow up study from eastern part of India

BackgroundAphasia is a language disorder acquired secondary to brain damage. This study aims to evaluate clinical and radiological profile of patients with post stroke aphasia and factors affecting its recovery. MethodsWe conducted a prospective study of patients with first left Middle or Anterior Cerebral Artery infarct or Intracerebral Hemorrhage (ICH) with aphasia admitted within 14 days of stroke onset. Aphasia Quotient (AQ) was assessed at 2 weeks (AQ1) and 3 months (AQ2) using Western Aphasia Battery-Hindi version. Magnetic Resonance Imaging of brain with Diffusion Tensor Imaging (DTI) of bilateral Arcuate Fasciculus (AF) and Corticospinal Tract was done at admission, and stroke volume, Laterality Indices of Fractional Anisotropy (LI-FA), Mean Diffusivity (LI-MD), Radial Diffusivity (LI-RD), Axial Diffusivity (LI-AD) and Apparent Diffusion Coefficient (LI-ADC) were obtained. Results36 patients [8 ICH and 28 Acute Ischemic Stroke (AIS)] were included. AQ1 and AQ2 were significantly higher in subcortical stroke than cortical. AQ2 and increase in AQ scores (including its subscores) were significantly higher in ICH than AIS. National Institutes of Health Stroke Scale score at admission and volume of stroke had significant negative correlation with AQ1 and AQ2. Laterality Index of Fractional Anisotropy of Arcuate Fasciculus [LI-FA (AF)] had significant positive correlation with AQ2 and naming score at 3 months. Laterality Index of Mean Diffusivity of Arcuate Fasciculus [LI-MD (AF)] had significant negative correlation with AQ1, AQ2 and all subcomponents of AQ2. Significant positive correlation was seen between improvements in Modified Rankin Scale score and AQ. ConclusionThe study shows that DTI can be used to predict severity of aphasia at follow up and recovery in language and motor functions occur in parallel

Comprehensive quality assessment for aphasia rehabilitation after stroke: protocol for a multicentre, mixed-methods study

IntroductionPeople with aphasia following stroke experience disproportionally poor outcomes, yet there is no comprehensive approach to measuring the quality of aphasia services. The Meaningful Evaluation of Aphasia SeRvicES (MEASuRES) minimum...

Abstract WP103: The Role of Social Determinants in Aphasia Outcomes

Introduction: Aphasia is a post-stroke communication disorder that negatively impacts quality of life and life satisfaction even in its mildest form. Traditionally predictors of aphasia outcomes have emphasized neurological factors and little is known about the role that the social, cultural, environmental, and economic determinants of aphasia outcomes. Hypothesis: We hypothesize that non-neurological social factors (social determinants) are linked to post-stroke aphasia outcomes in a large, diverse population of individuals with aphasia. Methods: Merged data from the AphasiaBank—a large database designed to explore aphasia outcomes using data collected from aphasia studies based on standardized protocols were matched with data from the National Health Interview Survey (NHIS) based on range of sociodemographic and clinical outcomes to create an integrated dataset to examine the association between social determinants and aphasia outcomes. Generalized log-linear regression models were utilized to examine the association between scores on the Western Aphasia Battery-Revised Aphasia Quotient (WAB-R AQ) and sociodemographic, economic, and environmental characteristics. Regression models accounted for geographic clustering of respondents and the stratification of data collection to ensure the robustness of estimates. Results: Blacks had 6.1% (SE=0.009) lower WAB-AQ scores compared to Whites as did those who were married (β-0.030, SE=0.004) and living in the Southern US (β=-0.013, SE=0.003) even after controlling forage, environment, and aphasia type. Individuals with aphasia and living in larger families (β=0.031,SE=0.004) and those who visited their medical provider regularly (β=0.051, SE=0.002) had higher scores compared to the reference group. Income-to-poverty ratio and home ownership were significantly correlated with impairment level. The analysis indicated that having available transportation did not influence observed outcomes. Finally racial disparities did not persist at the highest income levels. Conclusion: The findings of this study suggest researcher should look beyond neurologic correlates when exploring aphasia outcomes..

Looking Upstream to Understand Race/Ethnicity as a Moderator for Poststroke Neuroinflammation and a Social Determinant for Poststroke Aphasia Outcomes.

Over the past decade, the stroke literature has begun to acknowledge and explore explanations for longstanding racial/ethnic differences in stroke outcomes. Poststroke cognitive impairment (PSCI) and poststroke aphasia are two such negative poststroke outcomes where racial/ethnic differences exist. Physiological differences, such as stroke type and lesion size, have been used to partially explain the variation in PSCI and aphasia. However, there is some evidence, although limited, that suggests neuroinflammatory processes as part of allostatic load may be a key contributor to the observed disparities. In this tutorial, we explore the influence of race differences in inflammation on poststroke cognitive outcomes. We suggest lifetime stress and other external determinants of health such as neighborhood environment and discriminatory practices through "weathering" explain differences in inflammation. While using an allostatic load framework, we explore the literature focusing specifically on the role of neuroinflammation on poststroke outcomes. Examination of the immune response poststroke provides a foundation for understanding the mechanisms of PSCI and poststroke aphasia and the potential contributions of neuroinflammatory processes on poststroke cognitive outcomes. Furthermore, understanding of racial differences in those processes may contribute to a better understanding of racial disparities in general stroke outcomes as well as poststroke aphasia.

The volume and the distribution of premorbid white matter hyperintensities: Impact on post-stroke aphasia.

White matter hyperintensities (WMH) are a radiological manifestation of progressive white matter integrity loss. The total volume and distribution of WMH within the corpus callosum have been associated with pathological cognitive ageing processes but have not been considered in relation to post-stroke aphasia outcomes. We investigated the contribution of both the total volume of WMH, and the extent of WMH lesion load in the corpus callosum to the recovery of language after first-ever stroke. Behavioural and neuroimaging data from individuals (N = 37) with a left-hemisphere stroke were included at the early subacute stage of recovery. Spoken language comprehension and production abilities were assessed using word and sentence-level tasks. Neuroimaging data was used to derive stroke lesion variables (volume and lesion load to language critical regions) and WMH variables (WMH volume and lesion load to three callosal segments). WMH volume did not predict variance in language measures, when considered together with stroke lesion and demographic variables. However, WMH lesion load in the forceps minor segment of the corpus callosum explained variance in early subacute comprehension abilities (t = -2.59, p = .01) together with corrected stroke lesion volume and socio-demographic variables. Premorbid WMH lesions in the forceps minor were negatively associated with early subacute language comprehension after aphasic stroke. This negative impact of callosal WMH on language is consistent with converging evidence from pathological ageing suggesting that callosal WMH disrupt the neural networks supporting a range of cognitive functions.

Leukoaraiosis Is Not Associated With Recovery From Aphasia in the First Year After Stroke.

After a stroke, individuals with aphasia often recover to a certain extent over time. This recovery process may be dependent on the health of surviving brain regions. Leukoaraiosis (white matter hyperintensities on MRI reflecting cerebral small vessel disease) is one indication of compromised brain health and is associated with cognitive and motor impairment. Previous studies have suggested that leukoaraiosis may be a clinically relevant predictor of aphasia outcomes and recovery, although findings have been inconsistent. We investigated the relationship between leukoaraiosis and aphasia in the first year after stroke. We recruited 267 patients with acute left hemispheric stroke and coincident fluid attenuated inversion recovery MRI. Patients were evaluated for aphasia within 5 days of stroke, and 174 patients presented with aphasia acutely. Of these, 84 patients were evaluated at ∼3 months post-stroke or later to assess longer-term speech and language outcomes. Multivariable regression models were fit to the data to identify any relationships between leukoaraiosis and initial aphasia severity, extent of recovery, or longer-term aphasia severity. We found that leukoaraiosis was present to varying degrees in 90% of patients. However, leukoaraiosis did not predict initial aphasia severity, aphasia recovery, or longer-term aphasia severity. The lack of any relationship between leukoaraiosis severity and aphasia recovery may reflect the anatomical distribution of cerebral small vessel disease, which is largely medial to the white matter pathways that are critical for speech and language function.

Cerebral perfusion in post-stroke aphasia and its relationship to residual language abilities.

Stroke alters blood flow to the brain resulting in damaged tissue and cell death. Moreover, the disruption of cerebral blood flow (perfusion) can be observed in areas surrounding and distal to the lesion. These structurally preserved but suboptimally perfused regions may also affect recovery. Thus, to better understand aphasia recovery, the relationship between cerebral perfusion and language needs to be systematically examined. In the current study, we aimed to evaluate (i) how stroke affects perfusion outside of lesioned areas in chronic aphasia and (ii) how perfusion in specific cortical areas and perilesional tissue relates to language outcomes in aphasia. We analysed perfusion data from a large sample of participants with chronic aphasia due to left hemisphere stroke (n = 43) and age-matched healthy controls (n = 25). We used anatomically defined regions of interest that covered the frontal, parietal, and temporal areas of the perisylvian cortex in both hemispheres, areas typically known to support language, along with several control regions not implicated in language processing. For the aphasia group, we also looked at three regions of interest in the perilesional tissue. We compared perfusion levels between the two groups and investigated the relationship between perfusion levels and language subtest scores while controlling for demographic and lesion variables. First, we observed that perfusion levels outside the lesioned areas were significantly reduced in frontal and parietal regions in the left hemisphere in people with aphasia compared to the control group, while no differences were observed for the right hemisphere regions. Second, we found that perfusion in the left temporal lobe (and most strongly in the posterior part of both superior and middle temporal gyri) and inferior parietal areas (supramarginal gyrus) was significantly related to residual expressive and receptive language abilities. In contrast, perfusion in the frontal regions did not show such a relationship; no relationship with language was also observed for perfusion levels in control areas and all right hemisphere regions. Third, perilesional perfusion was only marginally related to language production abilities. Cumulatively, the current findings demonstrate that blood flow is reduced beyond the lesion site in chronic aphasia and that hypoperfused neural tissue in critical temporoparietal language areas has a negative impact on behavioural outcomes. These results, using perfusion imaging, underscore the critical and general role that left hemisphere posterior temporal regions play in various expressive and receptive language abilities. Overall, the study highlights the importance of exploring perfusion measures in stroke.

Radiological Assessment of Aphasia Outcome: A Case Report

Background Stroke is a leading cause of major adult disability, and aphasia is one of the most common consequences of stroke. It has been reported that 21%–38% of patients with stroke have aphasia in the acute stage. Case presentation A 64- year old Egyptian male diagnosed with recent ischemic stroke in the form of the form of inability to express himself in spoken words; Broca’s aphasia. Diffusion tensor tractography (DTT) was done to assess the integrity of the arcuate fasciculus in the acute stage as a method to predict the possible outcome of the patient aphasia. DTT showed affection of broca’s territory of the arcuate fasciculus (AF) and it could be reconstructed measured by fractionated anisotropy (0.469). The patient initial aphasia test measured (47). Three months later, the patient improved and follow up aphasia test measured (74.4). Results Reconstruction of the arcuate fasciculus by DTT in the early stage of aphasia as shown in our patient carries a good clinical prognosis. Our patient aphasia improved markedly at 3 months follow up visit. Conclusion DTT could be a helpful tool to assess the outcome of aphasia at the early stage of acute ischemic stroke.

Do social determinants influence post-stroke aphasia outcomes? A scoping review

Purpose To conduct a scoping review on five individual social determinants of health (SDOHs): gender, education, ethnicity, socioeconomic status, and social support, in relation to post-stroke aphasia outcomes. Materials and methods A comprehensive search across five databases was conducted in 2020 and updated in 2022. Twenty-five studies (3363 participants) met the inclusion criteria. Data on SDOHs and aphasia outcomes were extracted and analysed descriptively. Results Twenty studies provide information on SDOH and aphasia recovery outcomes. Five studies provide insights on SDOH and response to aphasia intervention. Research on SDOH and aphasia recovery has predominantly focussed solely on language outcomes (14 studies), with less research on the role of SDOH on activity, participation, and quality of life outcomes (6 studies). There is no evidence to support a role for gender or education on language outcomes in the first 3 months post stroke. SDOHs may influence aphasia outcomes at or beyond 12 months post onset. Conclusions Research on SDOHs and aphasia outcomes is in its infancy. Given SDOHs are modifiable and operate over a lifetime, and aphasia is a chronic condition, there is a pressing need to understand the role of SDOHs on aphasia outcomes in the long term.

Правое полушарие и восстановление речи при постинсультной афазии

<p style="text-align: justify;">The analytical review presents the clinical, neurobiological, and neuropsychological aspects of post-stroke aphasia as well as the role of the right hemisphere in speech recovery. The paper shows the influence of size, topography, lesion depth, cerebral hemodynamic plasticity, initial morphometric characteristics of the brain, and handedness on the functional recovery of aphasia. The review considers the typology and mechanisms of the appearance of "stealing symptoms" of homologous and non-homologous regions of the intact hemisphere. The "low-level" and "high-level" models of language competence of the right hemisphere are analyzed. The study describes the topography of the brain activation regions in the intact hemisphere during various speech task-solving. The paper shows the heterochrony between impressive and expressive speech recovery in aphasics and its bilateral inter-lateral distribution. The authors conclude that to clarify the mechanisms of aphasia recovery, it is necessary for a comprehensive account of clinical, neurobiological and neuropsychological patterns of speech disorder reparation in different post-stoke epochs. The paper notices that a deeper understanding of the impact of structural and functional repairment of speech processes on the aphasia outcome, it needs to assess the relationship between the degree of speech disorders reduction and the lateral vector of speech architectonics in the post-stroke period.</p>

Early Subacute White Matter Hyperintensities and Recovery of Language After Stroke

Background White matter hyperintensities (WMH) are considered to contribute to diminished brain reserve, negatively impacting on stroke recovery. While WMH identified in the chronic phase after stroke have been associated with post-stroke aphasia, the contribution of premorbid WMH to the early recovery of language across production and comprehension has not been investigated. Objective To investigate the relationship between premorbid WMH severity and longitudinal comprehension and production outcomes in aphasia, after controlling for stroke lesion variables. Methods Longitudinal behavioral data from individuals with a left-hemisphere stroke were included at the early subacute (n = 37) and chronic (n = 28) stage. Spoken language comprehension and production abilities were assessed at both timepoints using word and sentence-level tasks. Magnetic resonance imaging (MRI) was performed at the early subacute stage to derive stroke lesion variables (volume and proportion damage to critical regions) and WMH severity rating. Results The presence of severe WMH explained an additional 18% and 25% variance in early subacute (t = −3.00, p = .004) and chronic (t = −3.60, P = .001) language comprehension abilities respectively, after controlling for stroke lesion variables. WMH did not predict additional variance of language production scores. Conclusions Subacute clinical MRI can be used to improve prognoses of recovery of aphasia after stroke. We demonstrate that severe early subacute WMH add to the prediction of impaired longitudinal language recovery in comprehension, but not production. This emphasizes the need to consider different domains of language when investigating novel neurobiological predictors of aphasia recovery.

Systematic literature review of the effect of music therapy on psychological outcomes in aphasia

Aphasia is a language disorder caused most commonly by a stroke or traumatic brain injury, affecting approximately two million Americans in the United States.  Impaired language function hinders one’s ability to communicate and interact with others, leading to psychological changes, such as post-stroke depression. Music Therapy has been integral in post-stroke rehabilitation. Music-based interventions not only improve motor and cognitive functions but have also been shown to improve psychological outcomes. The purpose of this systematic literature review is to describe current research on psychological outcomes from music-based interventions for persons with aphasia, summarize therapy outcomes, and evaluate the quality of the research. Eight studies meeting criteria were included in this review. The participant characteristics, interventions, and formal and informal assessments were described for each study. The methodological quality across studies was highly varied. Overall, gains in psychological outcomes were demonstrated; however, outcomes varied within and among therapy approaches. We suggest that future research focus on continued attention to investigate the psychological impact of music-based interventions and improve overall methodological rigor through standardized protocols and assessments.

Baseline structural imaging correlates of treatment outcomes in semantic variant primary progressive aphasia.

Semantic variant primary progressive aphasia (svPPA) is a neurodegenerative disorder characterized by a loss of semantic knowledge in the context of anterior temporal lobe atrophy (left>right). Core features of svPPA include anomia and single-word comprehension impairment. Despite growing evidence supporting treatment for anomia in svPPA, there is a paucity of research investigating neural mechanisms supporting treatment-induced gains and generalization to untrained items. In the current study, we examined the relation between the structural integrity of brain parenchyma (tissue inclusive of gray and white matter) at pre-treatment and treatment outcomes for trained and untrained items in a group of 19 individuals with svPPA who completed lexical retrieval treatment. Two structural neuroimaging approaches were used: an exploratory, whole-brain, voxel-wise approach and an a priori region of interest (ROI) approach. Based on previous research, bilateral temporal (inferior, middle, and superior temporal gyri), parietal (supramarginal and angular gyri), frontal (inferior and middle frontal gyri) and medial temporal (hippocampus and parahippocampal gyri) ROIs were selected from the Automated Anatomical Labeling (AAL) atlas. Analyses revealed improved naming of trained items and generalization to untrained items following treatment, providing converging evidence that individuals with svPPA can benefit from treatment for anomia. Better post-treatment naming accuracy was associated with the structural integrity of inferior parietal cortex and the hippocampus. Specifically, improved naming of trained items was related to the left supramarginal (phonological processing) and angular gyri (phonological and semantic processing), and improved naming of trained and untrained items was related to the left hippocampus (episodic, context-based memory). Future research should examine treatment outcomes in relation to pre-treatment functional and structural connectivity as well as changes in network dynamics following speech-language intervention to further elucidate the neural mechanisms underlying treatment response in svPPA and related disorders.

Improving Functional Communication Outcomes in Post-Stroke Aphasia via Telepractice: An Alternative Service Delivery Model for Underserved Populations.

Many persons with aphasia (PWA) have limited access to speech-language treatment (SLT) due to limited funding, speech-language pathologist shortages, geographical barriers, physical disabilities, transportation barriers, and the COVID-19 pandemic. The purpose of this study was to determine if telepractice is an effective and feasible service delivery model for PWA. Ten PWA completed 8 hours of remote treatment over 4 weeks. Synchronous telepractice sessions employed Oral Reading for Language in Aphasia (ORLA) and Conversational Script Training (CST). Pre- and post-assessment outcome measures included the Communication Activities of Daily Living-3 (CADL-3) and the Communication Confidence Rating Scale for Aphasia (CCRSA). Participants completed a telepractice satisfaction survey following post-assessment. All participants demonstrated improvements in CCRSA scores, total words produced correctly on trained CST stimuli, and total words produced correctly on trained ORLA stimuli. No differences were noted in CADL-3 scores. All participants were highly satisfied with telepractice as a service delivery model.

Impact of COVID-19 on People With Aphasia: Emerging Rehabilitation Needs

Purpose:The purpose of this article is to address an emerging issue in rehabilitation counseling: The effect of the COVID-19 pandemic on people with aphasia (PWA).Method:Based upon a review of the literature this article provides an overview of (a) COVID-19 and emergent aphasia-related disability, (b) COVID-19 effects on stroke and aphasia services, (c) COVID-19 effects on mental health and employment of PWA.Results:This review of the impact of COVID-19 on PWA highlights the increased and emerging needs for rehabilitation counseling services related to an anticipated increase in incidence of aphasia related to COVID-19 illness and secondary impact of medical care for this population.Conclusion:The impact of COVID-19 on aphasia care in rehabilitation settings underscores the need for increased interprofessional education and collaboration to address the many gaps in aphasia care. Likewise, interdisciplinary research focused on rehabilitation outcomes in aphasia is needed to provide a foundation for evidence-based practice that conforms to the WHO-ICF framework.

Impact of Transcutaneous Vagal Nerve Stimulation (Tvns) Priming on Therapy Outcomes for People With Aphasia

<h3>Research Objectives</h3> To investigate the impact of tVNS on therapy outcomes for aphasia. <h3>Design</h3> A double-blind, crossover intervention study design was used to allow for both within-subject and between-subject comparison of tVNS vs. sham condition. Participants were randomly assigned to either the active tVNS priming condition or the sham priming condition for the first half of treatment (5-6 weeks) and switched condition for the second half with the sham group then receiving active tVNS and the formerly active tVNS group receiving sham stimulation. <h3>Setting</h3> University of Maryland Hearing and Speech Clinic, College Park, MD. <h3>Participants</h3> Participants with aphasia due to stroke were recruited from the Washington, DC area; Participants were ineligible if they had certain medical conditions (eg. cancer) or implanted devices (e.g. pacemaker). Participants with a history of cardiac disease or seizures required medical clearance out of an abundance of caution. Participants were excluded for severe apraxia of speech, cognitive deficits and hearing loss. Eight participants (3m, 5f) with mild to moderate aphasia completed the study, 7 did not meet inclusion criteria, withdrew or were disrupted. No one dropped due to adverse events. Participants ranged from 22 to 75 years-old (avg. 52.9) and were between 7 months and 15 years post-onset. <h3>Interventions</h3> Participants received five minutes of either active or sham tVNS via an earbud prior to word-finding therapy. <h3>Main Outcome Measures</h3> The Western Aphasia Battery, Test of Word Finding in Adults, Boston Naming Test, F-A-S Task, Communication Confidence Rating Scale for Aphasia were completed at baseline, midterm, and post-treatment. <h3>Results</h3> Results are still being collected but suggest that tVNS priming may have only minimal impact on outcomes; recent work from other labs suggests that tVNS at the moment of encoding may have stronger impact, whereas priming may be more facilitative of retrieval. <h3>Conclusions</h3> TVNS is a low cost, safe, accessible modality with the potential to improve aphasia outcomes, but further work is needed to identify if and how it can be best used with this population. <h3>Author(s) Disclosures</h3> See individual author disclosures.

Aphasia severity is modulated by race and lesion size in chronic survivors: A retrospective study

IntroductionIn stroke survivors with aphasia (SWA), differences in behavioral language performance have been observed between Black and White Americans. These racial differences in aphasia outcomes may reflect biological stroke severity, disparities in access to care, potential assessment bias, or interactions between these factors and race. Understanding the origin of disparities in aphasia outcomes is critical to any efforts to promote health equity among SWA. In this study, we explore aphasia outcomes by examining the relationship between race, socioeconomic status, and neurological factors in SWA. MethodEighty-five chronic left-hemisphere SWA (31 Black, 54 White) participated in the study. The primary aphasia outcome measure was the Western Aphasia Battery-Revised (WAB-R). Lesion size was measured based on manual lesion segmentations. FLAIR and T2 images were scored for severity of white matter disease. Independent sample t-tests were used to determine differences by race in education, age, income, aphasia severity, white matter disease, and lesion size. A linear regression model was used to explore factors that predicted aphasia severity on the WAB-R. ResultLevel of education and estimated income differed by race in our sample. For predictors of aphasia severity, the regression model revealed a significant effect of lesion size on WAB Aphasia Quotient and an interaction of race x lesion size, such that Black and White participants with small lesions had similar WAB scores, but in individuals with larger lesions, Black participants had lower WAB scores than White participants. ConclusionWe suggest two explanations for the difference between Black and White SWA in the relationship between lesion size and aphasia severity. First, the impact of disparities in access to rehabilitation after stroke may be more evident when a stroke is larger and causes significant aphasia. Additionally, an assessment bias in aphasia outcome measures may be more evident with increasing severity of aphasia. Future studies should further discern the drivers of observed disparities in aphasia outcomes in order to identify opportunities to improve equity in aphasia care.

Aphasia outcome measurement in clinical practice: An international survey

ABSTRACT Background Outcome measurement is recommended in stroke clinical practice guidelines, however there is considerable variability in how this activity is performed in clinical practice. Factors driving clinician behaviour have been explored in English-speaking countries, but little is known about the factors influencing clinical practice in non-English-speaking populations. Aims (1) To explore barriers and facilitators to aphasia outcome measurement from the perspective of international aphasia clinicians. (2) To determine whether barriers and facilitators to outcome measurement differ in English- and non-English- speaking countries. The primary hypothesis was that clinicians working with people with aphasia in non-English-speaking countries would experience more barriers to outcome measurement than those in English-speaking countries. Methods and Procedures An international sample of aphasia clinicians completed an online survey informed by the Theoretical Domains Framework. Quantitative data were analysed using descriptive statistics and a Mann-Whitney U Test to compare English- and non-English- speaking groups. TDF domains identified as influencing clinician behaviour were mapped to the Behaviour Change Wheel, producing theory-informed strategies to improve practice. Outcomes and Results A total of 208 clinicians from 25 countries completed the survey. Almost all (93.7%) reported measuring outcomes to some extent, most commonly to measure client progress. Facilitators to outcome measurement included “social/professional role and identity” (understanding that measuring outcomes is part of the clinicians’ role), “optimism” (feeling positive about measuring outcomes), and “emotion” (enjoying, and feeling comfortable measuring outcomes). Barriers were “environmental context and resources” (time and resource limitations, and competing caseload priorities), “behavioural regulation” (a lack of personal and workplace systems to measure outcomes) and “skills” (having insufficient training and experience in outcome measurement). There was no significant difference between the barriers and facilitators experienced by clinicians in English- and non-English- speaking countries. Implementation strategies, informed by Behaviour Change Techniques, were created to improve clinical practice. Conclusions Internationally, clinicians working with people with aphasia measure outcomes and believe that this is part of their role, and a positive aspect of their work. Common barriers to outcome measurement included insufficient time and access to resources, inadequate personal and workplace systems, and insufficient skills necessary for performing outcome measurement. Preliminary, theory-informed strategies (e.g., improving access to culturally and linguistically appropriate measurement instruments; developing protocols, templates or checklists guided by recommended practice; and providing training in outcome measurement) would assist with uptake of clinical practice guidelines in this area.