Time Post Onset Research Articles

The validation of aphasia united best practice recommendations with people with aphasia and their caregivers in Vietnam: a nominal group technique study

ABSTRACT Background Speech and language therapy is a relatively new profession in Vietnam and to date, 79 individuals have graduated from Master and Bachelor programs. For the few therapists working with adult populations, clinical guidance tailored to the Vietnamese context is limited. The Aphasia United Best Practice Recommendations were developed to provide multi-national guidance for the management of post-stroke aphasia and have been translated into 29 languages, including Vietnamese. To date however, their applicability to low-middle income countries with emerging speech and language services such as Vietnam has not been explored. Aims To determine the relevance, comprehensibility, and comprehensiveness of the Aphasia United Best Practice Recommendations to people with aphasia and caregivers in Vietnam. Methods and Procedures People with aphasia and their caregivers participated in focus groups, utilising the nominal group technique. Participants were recruited from four hospitals in Ho Chi Minh City. Participants with aphasia were sampled for severity of aphasia, age, sex, time-post onset, geographic location, employment status, and relationship. Participants reviewed the recommendations, rated relevance and comprehensibility (clarity), and made suggestions for improvement. Participants assessed the comprehensiveness of the recommendations and additional items were generated and prioritised. Data were analysed using descriptive statistics and qualitative content analysis. Outcomes and Results People with aphasia (n = 11) and caregivers (n = 17) participated in one of nine focus groups. People with aphasia rated all recommendations as relevant. Levels of agreement varied for caregivers and fell < 85% for one recommendation only (Recommendation 4 – relating to the need for all people with aphasia to have some means of communication prior to discharge). Both participant groups suggested changes to content and wording to reflect the context and culture of Vietnam. Three common themes within the newly proposed recommendations were identified across both participants with aphasia and caregiver groups: (1) easier access to speech and language therapy services and information about aphasia, (2) the need for psychological and social support for people with aphasia and (3) the need for increased community awareness and supports for people with aphasia and their caregivers. Conclusions and Implications The Aphasia United Best Practice Recommendations were perceived to be relevant, however new recommendations reflecting the unique cultural, economic and healthcare environment of Vietnam were identified. Recommendations relating to access to services and community-based rehabilitation were prioritised, supporting the need for continued growth and advocacy for the speech and language therapy profession in Vietnam.

Comprehensive Study of the IBMP ELISA IgA/IgM/IgG COVID-19 Kit for SARS-CoV-2 Antibody Detection.

COVID-19 laboratory diagnosis primarily relies on molecular tests, highly sensitive during early infection stages with high viral loads. As the disease progresses, sensitivity decreases, requiring antibody detection. Since the beginning of the pandemic, serological tests have been developed and made available in Brazil, but their diagnostic performance varies. This study evaluated the IBMP ELISA IgA/IgM/IgG COVID-19 kit performance in detecting SARS-CoV-2 antibodies. A total of 90 samples, including 64 from COVID-19 patients and 26 pre-pandemic donors, were assessed based on time post symptom onset (0-7, 8-14, and 15-21 days). The kit showed 61% sensitivity, 100% specificity, and 72% accuracy overall. Sensitivity varied with time, being 25%, 57%, and 96% for 0-7, 8-14, and 15-21 days, respectively. Similar variations were noted in other commercial tests. The Gold ELISA COVID-19 (IgG/IgM) had sensitivities of 31%, 71%, and 100%, while the Anti-SARS-CoV-2 NCP ELISA (IgG) and Anti-SARS-CoV-2 NCP ELISA (IgM) showed varying sensitivities. The IBMP ELISA kit displayed high diagnostic capability, especially as the disease progressed, complementing COVID-19 diagnosis. Reproducibility assessment revealed minimal systematic and analytical errors. In conclusion, the IBMP ELISA IgA/IgM/IgG COVID-19 kit is a robust tool for detecting anti-SARS-CoV-2 antibodies, increasing in efficacy over the disease course, and minimizing false negatives in RT-PCR COVID-19 diagnosis.

The impact of a university-based intensive comprehensive aphasia programme (ICAP) on language, functional communication and quality of life in people with chronic aphasia

ABSTRACT Background Intensive Comprehensive Aphasia Programmes (ICAPs) are increasingly considered the preferred option for high intensity aphasia rehabilitation. This is due to the emerging evidence that shows the potential of the programme to improve language impairment as well as psychosocial wellbeing and quality of life (QoL) in persons with chronic aphasia. Aims The aim of the study was to investigate whether a university-based, student-led, online ICAP led to measurable improvements in language, functional communication and QoL in persons with aphasia (PwAs). Methods & Procedures Eleven PwAs (six women, five men; M age = 60.4 years; M time post onset = 14.6 months) participated in a 10-week ICAP that provided 36 hours of treatment in total. Outcome measures relating to language impairment, functional communication and QoL were administered before and after the ICAP and included a range of subtests of the Comprehensive Aphasia Test (CAT) and the Communication Activities of Daily Living – second edition (CADL-2), the Assessment for Living with Aphasia (ALA), the Aphasia Impact Questionnaire (AIQ-21) and the Communication Outcomes after Stroke Scale (Carer COAST). Pre- and post-ICAP performances were tested for significance using Wilcoxon signed-rank tests. In addition, effect sizes were calculated. Outcomes & Results Post-ICAP, significant gains occurred in the CAT subtests of auditory and reading comprehension as well as naming objects, with large effect sizes being noted for the subtests of reading comprehension and naming objects. Significant changes were also observed between the pre- and post-assessment scores for the AIQ-21 and the Carer COAST, whereby the latter yielded large effect sizes. By contrast, CADL-2 and ALA scores did not change significantly as a result of the ICAP intervention. Conclusions Results indicate that the ICAP effectively improved participants’ language and functional communication skills, as well as QoL for both PwAs and their communication partners. Findings further indicate that a student-led ICAP implemented in a university setting can be considered a viable and pragmatic solution to offering ICAPs to achieve the high intensity needed to effect positive changes in communication.

Success rates of intensive aphasia therapy: real-world data from 448 patients between 2003 and 2020.

Aphasia is a devastating consequence after stroke, affecting millions of patients each year. Studies have shown that intensive speech and language therapy (SLT) is effective in the chronic phase of aphasia. Leveraging a large single-center cohort of persons with aphasia (PWA) including patients also in the subacute phase, we assessed treatment effects of intensive aphasia therapy in a real-world setting. Data were collected at the Aachen aphasia ward in Germany between 2003 and 2020. Immediate treatment responses across different language domains were assessed with the Aachen Aphasia Test (AAT) using single-case psychometrics, conducted before and after 6-7 weeks of intensive SLT (10 h per week, median (IQR) dosage = 68 (61-76)). We adjusted for spontaneous recovery in subacute patients. Differential treatment effects between subgroups of chronicity and predictors of therapy response were investigated. A total of 448 PWA were included (29% female, median (IQR) age = 54 (46-62) years, median (IQR) time post-onset = 11 (6-20) months) with 12% in the early subacute, 15% in the late subacute and 74% in the chronic phase of aphasia. The immediate responder rate was 59%. Significant improvements in all AAT subtests und subscales were observed hinting at broad effectiveness across language domains. The degree of therapy-induced improvement did not differ between the chronicity groups. Time post-onset, dosage of therapy and aphasia severity at the beginning of treatment were predictors of immediate treatment response. Intensive therapy protocols for aphasia after stroke are yielding substantial responder rates in a routine clinical setting including a wide range of patients.

Social Networks and Communication Impairment: Racial Differences Among Stroke Survivors

Purpose: Recent evidence highlights the importance of social networks—the composition of social relationships—and their characteristics in stroke recovery. This study explores the relationship between social networks and poststroke communication outcomes. Method: A cohort of 30 non-Hispanic Black ( n = 12) and non-Hispanic White ( n = 18) adult stroke survivors completed the Stroke Impact Scale (SIS) Communication subtest and the Stroke Social Network Scale (SSNS). The SSNS captures elements of social networks including satisfaction and contact with friends, relatives, children, and groups. The relationship between the SIS Communication subtest scores and SSNS scores was explored using ordinal Bayesian regression estimation models adjusting for sex, age, time postonset, marital status, and stroke type. Results: Average SIS Communication scores differed ( t = 2.07, p = .335) between White ( M = 81.75, SD = 22.90) and Black ( M = 95.71, SD = 4.95) participants, but SSNS Comprehensive scores were similar between the two groups ( t = −0.89, p = 1.00). SSNS children subtest scores were higher among the Black than the White ( t = −1.73, p = .0473) participants. Similarly, satisfaction subtest scores were comparatively higher among Black than White participants ( t = 1.85, p = .451). SSNS Satisfaction, Friends, and Groups subtest scores were positively associated with SIS Communication, indicating strong associations with lower impairment. SSNS Children subtest scores were negatively related to SIS, indicating higher impairment. Although most subtest associations were similar for both groups, the associations with SSNS Children and Friends subtests differed between racial groups. Conclusions: Levels of communication impairment were correlated with child, friendship, and group attachments among participants. However, strong social ties to children and friends had different associations among racial groups.

The effects of demographic and clinical factors on the severity of poststroke aphasia

<p>Poststroke aphasia severity is related to several demographic, lesion-specific, and clinical factors. However, results about the importance of these factors are controversial. The aim of the current study was to investigate the effects of demographic and clinical factors on aphasia severity as well as on expressive and receptive language skills in a sample of Hungarian-speaking people with aphasia.&nbsp;</p>. <p>Ninety-four people with aphasia with mainly unilateral left-hemisphere stroke (87.88%) participated. We used multiple stepwise linear regression to investigate the relationships between potential predictors &ndash; i.e., sex, education, time postonset, etiology, lesion localisation, pathological changes in the brain caused by small vessel disease, and other neurogenic communication disorders/swallowing disorders &ndash; and language outcome. As outcome variables, we used the total score, the receptive score, and the expressive score of the Hungarian Aphasia Screening Test.</p>. <p>Less years of education, pathological changes in the brain (white matter hypodensities/hyperintensities and subcortical lacunar lesions) and apraxia of speech were associated with more severe aphasia. Pathological changes and apraxia of speech were also associated with lower expressive language skills in aphasia. Finally, education, pathological changes, and sex predicted receptive language skills in poststroke aphasia (p &lt; 0.05 in all three models). &nbsp;</p>. <p>Pathological changes, apraxia of speech, education, and sex may affect language outcome in poststroke aphasia. We discuss our findings in light of the results of previous studies.&nbsp;</p>.

Determinants of Healthcare Expenditures among People with Aphasia: Importance of Race, Sex, Residence, and Aphasia Type

ABSTRACT Introduction Roughly 30% of stroke survivors suffer from aphasia—a communication disorder that affects the ability to communicate effectively—but little is known about their healthcare expenditure or how it varies between aphasia subtypes. This study evaluates the relative differential in healthcare expenditure of anomic, Broca’s, Wernicke’s and Conduction aphasia and assesses expenditure between demographic cohorts Methods Individual level data from the 2010 Moss Aphasia Psycholinguistic Project Database was matched with the 2010 Medical Expenditure Panel Survey using a propensity score algorithm based on functional, health, and demographic characteristics. Multilevel, generalized, nonlinear regression models were applied to the resulting data set to assess the correlation between annual healthcare expenditure, time post onset (tpo), sex, race, family size, marital status, income, education, aphasia type, and region of residence. Results were used to predict expenditure by aphasia subtype, race, and sex. Multiple distributional specifications tested the sensitivity and ensured the robustness of estimates. Results Regression results indicate that individuals with Broca’s aphasia had statistically higher healthcare expenditures paying an average of $10,896.45 annually when compared to anomic ($7,927.60), Wernicke’s ($7,096.22), and Conduction ($9,447.19) aphasias. Additionally, healthcare expenditure increased with each year of age (β=0.004, SE=0.005), but decreased with each year after stroke (β=-0.002, SE=0.001). Females (β=0.358, SE=0.131) and Blacks (β=0.103, SE=0.200) paid significantly more annually compared to males and Whites, respectively. Neither region of residence, income, nor level of education were significantly correlated with healthcare expenditure. Conclusion This study showed that, while individuals with Broca’s aphasia had higher average healthcare expenditure than other subtypes, the differential was not statistically significant. Sex and race cohorts did, however, show statistically significant differences in healthcare expenditures. While causality is outside the scope of this analysis, additional work is needed to determine the best strategy to mitigate these disparities.

Metabolite abundance in bovine preovulatory follicular fluid is influenced by follicle developmental progression post estrous onset in cattle.

Introduction: Preovulatory follicle response to the luteinizing hormone (LH) surge leads to metabolic, molecular, and functional changes in the oocyte and somatic follicular cells from the onset of estrus to ovulation. Follicular fluid contains metabolites, miRNAs, proteins, and hormones that are byproducts of follicular metabolism and support cellular processes of oocyte, cumulus, and granulosa constituents. Numerous studies have highlighted the importance of follicular fluid composition to support fertility, but critical gaps exist toward understanding dynamic modifications in the follicular fluid metabolome from estrous onset to ovulation. The hypothesis was that abundance of follicular fluid metabolites is dependent on follicle progression post LH surge and variability in follicular fluid metabolome profiles indicate key processes required for preparation of the follicle and oocyte for optimal fertility. The objective was to generate preovulatory follicular fluid metabolome profiles and discern differences in the metabolome of preovulatory follicular fluid samples collected at onset of estrus, 11 h post estrous onset, and 18 h post estrous onset. Methods: Estrus was synchronized in non-lactating Jersey cows (n=40) and follicular fluid was collected immediately after the first observed standing mount (hr 0) or at approximately h 11 or 18 after the first standing mount. Ultra-High-Performance Liquid Chromatography-High Resolution Mass Spectrometry was performed on preovulatory follicular fluid samples (n = 9 collected at hr 0, 9 at h 11, and 10 at h 18) and a multiple linear model was performed to determine if time post estrous onset impacted metabolite abundance. Results: Metabolites influenced by time post estrous onset were tested for enrichment in KEGG pathways. Ninety metabolites were identified in follicular fluid samples. Twenty metabolites differed in abundance among timepoints post estrous onset (p ≤ 0.05). Pathways corresponding to amino acid and energy metabolism were enriched with metabolites impacted by time post estrous onset (FDR ≤ 0.10). Discussion: Results from the current study indicate early response to the LH surge to increase bioavailability of amino acids and metabolites used by the cumulus and granulosa cells for energy production and shuttled into the oocyte to support meiotic maturation. Such metabolites may later be used by the ovulatory follicle for protein production.

Shared Experience And Concerns After Concussion: A Mixed Methods Analysis Of The Concussion Subreddit

<h3>Research Objectives</h3> 1. Contrast concerns among concussion subgroups; 2. Describe important features of posts with strong emotional valence; 3. Discuss clinical implications of this study. <h3>Design</h3> Mixed method. Quantitative methods employed Latent Dirichlet Allocation (Blei et al., 2003) to identify dominant topics across posts. Valence Aware Dictionary and sEntiment Reasoner (Hutto & Gilbert, 2014) identified primary sentiments in each post. Qualitative content analysis generated sub-themes for individuals in acute versus chronic stages and individuals with first versus multiple concussions. <h3>Setting</h3> Social media. <h3>Participants</h3> Posts in the subreddit "r/Concussion" that did not include any text in the body, only shared technical information, or discussed moderate to severe traumatic brain injuries or other neurological disorders were excluded. <h3>Interventions</h3> N/A. <h3>Main Outcome Measures</h3> Dominant topics, primary sentiment, subordinate themes. <h3>Results</h3> Over 50% of posts expressed strong negative sentiment and were related to symptom experience, emotional responses, and care-seeking experience. Meta-themes identified through topic modeling were understanding symptoms and managing recovery. In terms of understanding symptoms, content analysis further identified that individuals with acute injuries were uncertain about whether they sustained a concussion, while individuals at chronic stages were concerned about persistent symptoms or links between their symptoms and concussion. Posts from individuals with multiple concussions revealed a possible tendency toward overattributing physical discomfort to concussion, strong fear toward receiving another concussion, and concerns about cumulative effects. Regarding managing recovery, all subgroups were seeking information about symptom management and expectations during recovery. Individuals at the acute stage were uncertain about their needs for care-seeking, while individuals in chronic stages or with multiple concussions were concerned about return-to-productivity and available treatments. <h3>Conclusions</h3> Educational needs shift post-concussion, suggesting that people may benefit from counseling and educational materials tailored to their time post onset and previous history of concussion. People with concussion also express a desire for more consistent follow-up of medical care and education. <h3>Author(s) Disclosures</h3> This project was supported by the Scott Lilienfeld Injury Prevention Scholarship. The authors have no other financial or non-financial conflicts of interests to disclose.

Use of Laryngeal Sensors To Monitor Talk Time in People With Aphasia

<h3>Research Objectives</h3> To investigate the feasibility of using laryngeal sensors to monitor the amount of time people with aphasia talk in day-to-day life. <h3>Design</h3> Feasibility study. <h3>Setting</h3> Data was collected by the participants during an average day at home and in the community. <h3>Participants</h3> 10 participants with aphasia participated. Participants (mean [SD] age = 57.3 [5.5] years, 9 male) were diagnosed with aphasia following a left hemisphere stroke (Mean [SD] time post-onset = 57.2 [40.44] months). <h3>Interventions</h3> Participants were provided with all necessary equipment and given a training session by a speech language pathologist. Equipment included a small laryngeal sensor, adhesives, and an iPhone with a custom app to record the sensor data. Participants were trained to apply the sensor and connect to the app. Participants wore the sensor over the laryngeal notch of the throat for 8 hours a day for 1-3 days. Participants completed a structured interview about their experience with the sensors and activity during the data collection period. <h3>Main Outcome Measures</h3> Seconds of talk time per hour. <h3>Results</h3> Mean talk time per hour was 54.97 seconds (SD = 76.29 seconds). Sensor data was collected for a total of 22, 8 hour days. Participants were successful in setting up and using equipment in their home environment. Results of the structured interview reflect that the equipment was easy to use. <h3>Conclusions</h3> This study demonstrates the feasibility of measuring talk time in people with aphasia using a laryngeal sensor. The resulting data provides information about real world communication in this population and highlights their limited talk time. We discuss potential factors that may drive variability in talk time including aphasia characteristics (i.e., type, severity), demographic and environmental factors (gender, living arrangement, time spent at home). <h3>Author(s) Disclosures</h3> The authors have no conflicts to disclose.

Benefits of Specialized Subacute Stroke Rehabilitation in a Skilled Nursing Facility: Comparison to Nationwide Outcomes

<h3>Research Objectives</h3> To characterize the benefits of specialized, multi-disciplinary, neuro-intensive rehabilitation provided to individuals with stroke in a Skilled Nursing Facility (SNF) evaluating change in Minimum Data Set (MDS) functional outcomes and discharge location. A descriptive comparison to national SNF data for individuals with stroke reported by the American Physical Therapy and American Occupational Therapy Association's "Therapy Outcomes in Post-Acute Care Settings" (TOPS) study is presented. <h3>Design</h3> Retrospective chart review using electronic medical records and MDS data. <h3>Setting</h3> SNF specializing in transitional rehabilitation for complex neurologic diagnoses. <h3>Participants</h3> 207 adults 21-92 years with an ICD-10 stroke diagnosis admitted after 1/1/18 and discharged before 3/14/20. <h3>Interventions</h3> N/A. <h3>Main Outcome Measures</h3> Discharge location and MDS G-codes: dressing, bathing, walking/locomotion (average of on and off unit walking), transferring, toileting, and feeding. Scores were inverted and multiplied by 1.5 to allow comparison to the TOPS data. <h3>Results</h3> Paired t-tests compared admission to discharge MDS change with an average gain of 8.2 points (95% CI 7.15-9.24) and average length of stay (LOS) of 9.38 weeks (95% CI 8.74-10.02). The top 34% of responders gained an average of 17.5 points. Several variables (age, sex, LOS, case mix index, therapy minutes, admission time post onset) correlated to improvements measured by the G-code change and discharge location, however, the correlations were weak (r=0.154-0.266, p<.001-.027) and explained little of the variability. Age had the strongest correlation (r=0.266). 84% of individuals discharged to a community setting. Intensity cannot be directly compared to the TOPS study as total hours of therapy were reported but LOS was not. TOPS reported an average 3.27 point gain for moderate (29.6 to 39 hours) and 3.09 point gain for high intensity (128 to 219.3 hours) interventions, which were 2.5 times less than average gains for our SNF patients. <h3>Conclusions</h3> A preliminary comparison to the TOPS study indicates potential superiority in functional improvement for individuals cared for in a specialized neuro-intensive rehabilitation program in a SNF. Identification of rehabilitation factors and patient characteristics of high responders is needed. <h3>Author(s) Disclosures</h3> None.

Measuring Aphasia-Related Quality of Life: Efficiency and Cost of Change

Purpose:Changes in quality of life (QoL) in persons with aphasia (PWA) has emerged as a key metric of aphasia treatment effectiveness. Several tools have been designed to measure aphasia related QoL and offer the appropriate compensation for communication issues that frequently exclude persons with aphasia (PWA) from participation of such studies. The purpose of this study was to measure post–aphasia treatment change in QoL and calculate the efficiency and cost of QoL change.Method:In this study, we measured change in aphasia-related QoL as a metric of post–aphasia treatment efficiency using the American Speech-Language-Hearing Association Quality of Communication Life Scale. We also calculated the associated cost of that change in relationship with the change of aphasia impairment using a sample of PWA who received community-based telerehabilitation. Cost of QoL improvement from the intervention was calculated accounting for differences in age, time post onset, aphasia severity, and aphasia type.Results:PWA that exhibited more severe aphasia impairment experienced larger QoL improvement than those at lower impairment levels. Similarly, the average cost of improvement in QoL was lower for those more severe aphasia.Conclusions:Changes in aphasia-related QoL captures the impact of communication disorders on QoL, and the cost associated with the change. Measurement of aphasia-related QoL will allow clinicians and researchers to measure aphasia treatment outcomes and the cost effectiveness of those treatments using a commonly reported patient outcome—QoL.

Associations among depression, demographic variables, and language impairments in chronic post-stroke aphasia

IntroductionDepression may influence treatment participation and outcomes of people with post-stroke aphasia, yet its prevalence and associated characteristics in aphasia are poorly understood. Using retrospective data from an overarching experimental study, we examined depressive symptoms and their relationship to demographic and language characteristics in people with chronic aphasia. As a secondary objective, we compared prevalence of depressive symptoms among the overarching study's included and excluded participants. MethodsWe examined retrospective data from 121 individuals with chronic aphasia including depression scale scores, demographic information (sex, age, time post onset of stroke, education, race/ethnicity, and Veteran status), and scores on assessments of general and modality-specific language impairments. ResultsApproximately 50% of participants reported symptoms indicative of depressive disorders: 23% indicative of major depression and 27% indicative of mild depression. Sex (males) and comparatively younger age emerged as statistically significant variables associated with depressive symptoms; naming ability was minimally associated with depressive symptoms. Time post onset of stroke, education level, race/ethnicity, Veteran status, and aphasia severity were not significantly associated with depressive symptoms. Depression-scale scores were significantly higher for individuals excluded from the overarching study compared to those who were included. ConclusionsThe rate of depressive disorders in this sample was higher than rates of depression reported in the general stroke literature. Participant sex, age, and naming ability emerged as factors associated with depressive symptoms, though these links appear complex, especially given variable reports from prior research. Importantly, depressive symptoms do not appear to diminish over time for individuals with chronic aphasia. Given these results and the relatively limited documentation of depression in aphasia literature, depression remains a pressing concern for aphasia research and routine clinical care.

Treatment of Underlying Forms: A Bayesian Meta-Analysis of the Effects of Treatment and Person-Related Variables on Treatment Response.

Purpose This meta-analysis synthesizes published studies using "treatment of underlying forms" (TUF) for sentence-level deficits in people with aphasia (PWA). The study aims were to examine group-level evidence for TUF efficacy, to characterize the effects of treatment-related variables (sentence structural family and complexity; treatment dose) in relation to the Complexity Account of Treatment Efficacy (CATE) hypothesis, and to examine the effects of person-level variables (aphasia severity, sentence comprehension impairment, and time postonset of aphasia) on TUF response. Method Data from 13 single-subject, multiple-baseline TUF studies, including 46 PWA, were analyzed. Bayesian generalized linear mixed-effects interrupted time series models were used to assess the effect of treatment-related variables on probe accuracy during baseline and treatment. The moderating influence of person-level variables on TUF response was also investigated. Results The results provide group-level evidence for TUF efficacy demonstrating increased probe accuracy during treatment compared with baseline phases. Greater amounts of TUF were associated with larger increases in accuracy, with greater gains for treated than untreated sentences. The findings revealed generalization effects for sentences that were of the same family but less complex than treated sentences. Aphasia severity may moderate TUF response, with people with milder aphasia demonstrating greater gains compared with people with more severe aphasia. Sentence comprehension performance did not moderate TUF response. Greater time postonset of aphasia was associated with smaller improvements for treated sentences but not for untreated sentences. Conclusions Our results provide generalizable group-level evidence of TUF efficacy. Treatment and generalization responses were consistent with the CATE hypothesis. Model results also identified person-level moderators of TUF (aphasia severity, time postonset of aphasia) and preliminary estimates of the effects of varying amounts of TUF for treated and untreated sentences. Taken together, these findings add to the TUF evidence and may guide future TUF treatment-candidate selection. Supplemental Material https://doi.org/10.23641/asha.16828630.

Cognitive-linguistic outcomes from an intensive comprehensive aphasia program implemented by graduate student clinicians

ABSTRACT Background Intensive Comprehensive Aphasia Programs (ICAPs) implement evidence-based, holistic therapies in a short-duration cohort model. ICAPs are growing in popularity, yet there are still relatively few programs, partially due to the high cost of running an ICAP. ICAPs implemented by graduate student clinicians can reduce the overall cost of an ICAP, but Phase I efficacy data for cognitive-linguistic outcomes for an ICAP carried out by graduate students has yet to be reported. Aims To investigate the impact of a graduate student-run ICAP on measures of cognitive-linguistic change, and to identify relationships between individual and treatment variables and cognitive-linguistic function across pre- and post-ICAP administration. Methods & Procedures Fifty-three stroke survivors with chronic aphasia (33 males, 20 females; 32 first-time participants and 21 repeat participants; mean age = 65 years; mean time post-onset = 34 months) participated in an ICAP implemented by graduate students across eight cohorts. Cognitive-linguistic outcome measures included: Western Aphasia Battery, Revised (WAB-R); Boston Naming Test, Second Edition (BNT-2); and Raven’s Coloured Progressive Matrices (RCPM). Paired samples t-tests were used to compare pre- and post-ICAP performance for each measure, and Pearson’s r correlation coefficients were used to evaluate relationships between measures, as well as individual and treatment variables. Outcomes & Results Statistically significant change was observed on all three measures post-treatment, with small to no effect size. Participants who had completed a previous ICAP showed greater change on the WAB-R and RCPM, but no other individual or treatment variables significantly predicted change on outcome measures. Conclusions Results provide Phase I, proof-of-concept evidence of positive cognitive-linguistic change in stroke survivors with aphasia following ICAP participation. An ICAP implemented by graduate student clinicians produced significant improvements for persons with chronic aphasia.

Diagnostic and analytical performance evaluation of ten commercial assays for detecting SARS-CoV-2 humoral immune response

ObjectiveAnalytical validation of newly released SARS-CoV-2 antibody assays in the clinical laboratory is crucial to ensure sufficient performance in respect to its intended use. We aimed to assess analytical and diagnostic performance of 8 (semi-)quantitative assays detecting anti-nucleocapsid IgG (Euroimmun, Id-Vet) or total Ig (Roche), anti-spike protein IgG (Euroimmun, Theradiag, DiaSorin, Thermo Fisher) or both (Theradiag) and 2 rapid lateral flow assays (LFA) (AAZ-LMB and Theradiag). MethodsSpecificity was evaluated using a cross-reactivity panel of 85 pre-pandemic serum samples. Sensitivity was determined at both the manufacturer's and a 95% specificity cut-off level, using 81 serum samples of patients with a positive rRT-PCR. Sensitivity was determined in function of time post symptoms onset. ResultsSpecificity for all assays ranged from 92.9% to 100% (Roche and Thermo Fisher) with the exception of the Theradiag IgM LFA (82.4%). Sensitivity in asymptomatic patients ranged between 41.7% and 58.3%. Sensitivity on samples taken <10 days since symptom onset was low (23.3%–66.7%) and increased on samples taken between 10 and 20 days and > 20 days since symptom onset (80%–96% and 92.9%–100%, respectively). From 20 days after symptom onset, the Roche, Id-vet and Thermo Fisher assays all met the sensitivity (>95%) and specificity (>97%) targets determined by the WHO. Antibody signal response was significantly higher in the critically ill patient group. ConclusionAntibody detection can complement rRT-PCR for the diagnosis of COVID-19, especially in the later stage, or in asymptomatic patients for epidemiological purposes. Addition of IgM in LFAs did not improve sensitivity.

Clinical Evaluation of an Immunochromatographic-Based IgM/IgG Antibody Assay (GenBody™ COVI040) for Detection of Antibody Seroconversion in Patients with SARS-CoV-2 Infection.

There is a need for accurate diagnostic tests for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the cause of coronavirus disease (COVID-19). This study aimed to evaluate the diagnostic accuracy of an immunochromatography-based immunoglobulin G (IgG)/immunoglobulin M (IgM) antibody assay (GenBody™ COVI040) for detecting SARS-CoV-2 antibody seroconversion in COVID-19 patients. A total of 130 samples, serially collected from patients with confirmed COVID-19, and 100 negative control samples were tested for anti-SARS-CoV-2 IgM and IgG using the GenBody™ COVI040 assay following the South Korean Ministry of Food and Drug Safety guidelines on the review and approval of in vitro diagnostic devices for COVID-19. Reverse-transcription polymerase chain reaction results were used as the comparator. The overall sensitivity of the GenBody™ COVI040 assay was 97.69% (95% confidence interval (CI): 93.40–99.52%). The sensitivity of the assay increased with time post symptom onset (PSO) (sensitivity ≤6 days PSO: 78.57%, 95% CI: 49.20–95.34%; sensitivity 7–13 days PSO: 100%, 95% CI: 87.23–100%; and sensitivity ≥14 days PSO: 100%, 95% CI: 95.94–100%). The specificity of the assay was 100% (95% CI: 96.38–100%). The GenBody™ COVI040 assay showed high sensitivity and specificity, making it a promising diagnostic test to monitor COVID-19.

Neutralizing Antibody Responses in COVID-19 Convalescent Sera.

Passive transfer of antibodies from COVID-19 convalescent patients is being used as an experimental treatment for eligible patients with SARS-CoV-2 infections. The United States Food and Drug Administration’s (FDA) guidelines for convalescent plasma initially recommended target antibody titers of 160. We evaluated SARS-CoV-2 neutralizing antibodies in sera from recovered COVID-19 patients using plaque reduction neutralization tests (PRNT) at moderate (PRNT50) and high (PRNT90) stringency thresholds. We found that neutralizing activity significantly increased with time post symptom onset (PSO), reaching a peak at 31–35 days PSO. At this point, the number of sera having neutralizing titers of at least 160 was approximately 93% (PRNT50) and approximately 54% (PRNT90). Sera with high SARS-CoV-2 antibody levels (>960 enzyme-linked immunosorbent assay titers) showed maximal activity, but not all high-titer sera contained neutralizing antibody at FDA recommended levels, particularly at high stringency. These results underscore the value of serum characterization for neutralization activity.

The impact of a university-based Intensive Comprehensive Aphasia Program (ICAP) on psychosocial well-being in stroke survivors with aphasia

ABSTRACT Background Stroke survivors with aphasia often experience reduced psychosocial well-being. Intensive comprehensive aphasia programs (ICAPs) are an ideal model in which to treat persons with aphasia (PWAs) to improve both cognitive-linguistic impairments and psychosocial well-being. Aims To investigate the impact of a university-based ICAP on psychosocial well-being using measures of depression, aphasia-related quality of life, and communicative participation. Methods & Procedures Thirty-seven PWAs (13 females, 24 males; mean age of 65 years; mean time post onset of 60 months) participated in a university-based ICAP across six ICAP sessions. Psychosocial outcome measures were administered before and after participating in an ICAP including: Geriatric Depression Scale (GDS), Assessment of Living with Aphasia (ALA), and Communicative Effectiveness Index (CETI). Paired samples t-tests were used to compare pre- and post-ICAP performance on each measure, and Pearson’s r correlation coefficients were used to evaluate potential relations between measures, as well as relations between measures and demographic and treatment variables. Outcomes & Results Depression, as measured by the GDS, significantly decreased pre- to post-ICAP. Pre-treatment scores for the GDS and ALA were significantly correlated. Change scores for the GDS were predictive of change scores for the ALA and CETI. PWAs who had the lowest educational attainment showed the greatest change on the GDS and ALA. Conclusions Results suggest that the ICAP service delivery model has the potential to improve psychosocial well-being by reducing depression and improving quality of life. Findings provide preliminary evidence that the ICAP model can be efficacious when implemented in a university setting.

White Matter Hyperintensities Predict Response to Language Treatment in Poststroke Aphasia

Background White matter hyperintensities (WMH) are a radiological marker of brain health that has been associated with language status in poststroke aphasia; however, its association with language treatment outcomes remains unknown. Objective To determine whether WMH in the right hemisphere (RH) predict response to language therapy independently from demographics and stroke lesion–related factors in poststroke aphasia. Methods We used the Fazekas scale to rate WMH in the RH in 30 patients with poststroke aphasia who received language treatment. We developed ordinal regression models to examine language treatment effects as a function of WMH severity after controlling for aphasia severity, stroke lesion volume, time post onset, age, and education level. We also evaluated associations between WMH severity and both pre-treatment naming ability and executive function. Results The severity of WMH in the RH predicted treatment response independently from demographic and stroke-related factors such that patients with less severe WMH exhibited better treatment outcome. WMH scores were not significantly correlated with pretreatment language scores, but they were significantly correlated with pretreatment scores of executive function. Conclusion We suggest that the severity of WMH in the RH is a clinically relevant predictor of treatment response in this population.