Therapists' Perception on Quality of Provider Communication While Wearing a Mask: Impact of a Pandemic.

During the COVID-19 pandemic, the Centers for Disease Control and Prevention established infection prevention recommendations, resulting in hospital systems adopting universal mask-wearing. Mask-wearing and its impact on patient-provider communication have been highlighted, yet have not been systematically studied to date. The purpose of this study was to assess the impact of mask-wearing on provider communication during wheelchair education. Allied health professionals (65 physical and occupational therapists and 1 other) completed a 24-item, online self-report survey on the impact of provider mask-wearing on communication with patients and/or their caregivers during wheelchair education. This survey contained questions, graded on 5-point Likert-like scales, regarding the perceived impact of mask-wearing on the quality of communication efficiency and effectiveness, the types and frequency of communication strategies used to enhance communication during breakdowns, knowledge/confidence in implementing communication strategies, and preferences for additional training. Results indicated that mask-wearing impacted communication, yet clinicians made adaptations of various verbal and nonverbal communication strategies to avoid disruptions in providing education. Clinicians identified training preferences for additional support with provider communication. As the pandemic continues, patient-provider communication can be supported through targeted training in communication strategies.

Seafood dose parameters: Updating 210Po retention factors for cooking, decay loss and mariculture.

210Po has been identified as one of the main contributors to ingestion doses to humans, particularly from the consumption of seafood. The amount of 210Po activity concentration data for various types of seafood has increased greatly in recent times. However, to provide realistic seafood dose assessments, most 210Po data requires correction to account for losses that can occur before the seafood is actually consumed. Here we develop generic correction factors for the main processes associated with reduction of 210Po in seafood - leaching during cooking, radioactive decay between harvest and consumption, and sourcing from mariculture versus wild-caught. When seafood is cooked, the overall mean fraction of 210Po retained is 0.74 for all cooking and seafood types, with the means for various seafood types and cooking categories ranging from 0.56 to 1.03. When considering radioactive decay during the period between harvest and consumption, the overall mean fraction remaining is 0.81 across all seafood preservation/packaging types, with estimates ranging from 0.50 (canned seafood) to 0.98 (fresh seafood). Regarding mariculture influence, the available limited data suggest marine fish and crustaceans raised with processed feed have about one order of magnitude lower (×0.10) 210Po muscle content than wild-caught seafood of the same or similar species, although this ratio varies. Overall, this study concludes that 210Po activity concentrations in seafood at the time of ingestion may be reduced to only about 55% compared to when it was harvested. Therefore, correction factors must be applied to any data derived from environmental monitoring in order to achieve realistic dose estimates. The data also suggest lower 210Po ingestion doses for consumers who routinely favour cooked, long shelf-life and farmed fish/crustaceans. However, more data is needed in some categories, especially for cooking of molluscs and seaweed, and for the 210Po content in all farmed seafood.

Kirigami Makes a Soft Magnetic Sheet Crawl.

Limbless crawling on land requires breaking symmetry of the friction with the ground and exploiting an actuation mechanism to generate propulsive forces. Here, kirigami cuts are introduced into a soft magnetic sheet that allow to achieve effective crawling of untethered soft robots upon application of a rotating magnetic field. Bidirectional locomotion is achieved under clockwise and counterclockwise rotating magnetic fields with distinct locomotion patterns and crawling speed in forward and backward propulsions. The crawling and deformation profiles of the robot are experimentally characterized and combined with detailed multiphysics numerical simulations to extract locomotion mechanisms in both directions. It is shown that by changing the shape of the cuts and orientation of the magnet the robot can be steered, and if combined with translational motion of the magnet, complex crawling paths are programed. The proposed magnetic kirigami robot offers a simple approach to developing untethered soft robots with programmable motion.

Hierarchical Porous Monoliths of Steel with Self-Reinforcing Adaptive Properties.

Porous structures offer an attractive approach to reduce the amount of natural resources used while maintaining relatively high mechanical efficiency. However, for some applications the drop in mechanical properties resulting from the introduction of porosity is too high, which has limited the broader utilization of porous materials in industry. Here, it is shown that steel monoliths can be designed to display high mechanical efficiency and reversible self-reinforcing properties when made with porous architectures with up to three hierarchical levels. Ultralight steel structures that can float on water and autonomously adapt their stiffness are manufactured by the thermal reduction and sintering of 3D printed foam templates. Using distinct mechanical testing techniques, image analysis, and finite element simulations, the mechanisms leading to the high mechanical efficiency and self-stiffening ability of the hierarchical porous monoliths are studied. The design and fabrication of mechanically stable porous monoliths using iron as a widely available natural resource is expected to contribute to the future development of functional materials with a more sustainable footprint.

Behavioral interventions for poststroke aphasia.

There is a long history of behavioral interventions for poststroke aphasia with hundreds of studies supporting the benefits of aphasia treatment. However, interventions for aphasia are complex with many interacting components, and no one treatment is appropriate for all persons with aphasia. We present a novel, simple framework for classifying aphasia interventions. The framework is incorporated within the overarching International Classification of Functioning, Disability, and Health (ICF) model and is consistent with the commonly-held definition that aphasia is a multimodality disorder that impairs, in varying degrees, the understanding and expression of both oral and written language modalities. Furthermore, within the language impairment level, it distinguishes between the linguistic areas of phonology, semantics, and syntax that may be impaired individually or in combination. We define the terminology of the proposed framework and then categorize some common examples of behavioral interventions for post-stroke aphasia. We describe some of these interventions in greater detail to illustrate the extensive toolbox of evidence-based treatments for aphasia. We address some key issues that clinicians, usually speech-language pathologists, consider when selecting interventions for their specific patients with aphasia, including dose. Finally, we address various models of service delivery for persons with aphasia such as Intensive Comprehensive Aphasia Programs (ICAPs) and Aphasia Centers.

Dysphagia Characteristics of Patients Post SARS-CoV-2 During Inpatient Rehabilitation.

OBJECTIVE: To investigate dysphagia in patients recovering from SARS-CoV-2 admitted to acute inpatient rehabilitation by summarizing clinical swallow evaluation and videofluoroscopic swallow study findings. DESIGN: Retrospective cohort study. SETTING: Urban inpatient rehabilitation hospital. PARTICIPANTS: The first inpatients admitted with SARS-CoV-2 (N=40) who participated in a videofluoroscopic swallow study. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Patient characteristics upon admission (duration of intubation, tracheostomy status, comorbidities, videofluoroscopic swallow study (VFSS) completion at previous level of care); admission International Dysphagia Diet level (IDDSI); Mann Assessment of Swallowing Ability (MASA), Functional Oral Intake Scale (FOIS), dysphagia severity rating; penetration aspiration scale (PAS) rated during VFSS; and IDDSI level recommended after completion of VFSS. RESULTS: Twenty percent of patients had been evaluated by videofluoroscopy in acute care. Nineteen of 37 (51%) individuals were upgraded to IDDSI level 7 regular diet with level 0 thin liquids and achieved a FOIS of 7 after the completion of the VFSS. Five individuals (13%) received a diet downgrade or remained on the same diet recommendations from their admission. Total numerical score (TNS) of less than 170 on the MASA predicted presence of aspiration in 27% of patients (6 of 22). Seventy-two percent of the sample (16 of 22) had a TNS less than 170 but did not demonstrate any instances of aspiration. The odds of patients having a PAS of 3 or greater increased by approximately 15% (odds ratio, 1.15; 95% confidence interval, 1.03-1.27; P=.013). Thus, with each additional day of intubation during acute care stay, there was a 15% greater likelihood of having airway invasion. CONCLUSIONS: Instrumental swallow evaluations are imperative to diagnose and treat dysphagia in the post-coronavirus disease population. Because of the heterogeneity of this population, high incidence of prolonged intubation, and limitations of the clinical swallowing evaluation, instrumental assessments need to be performed on a more consistent basis as infection prevention protocols evolve.

Advanced Machine Learning Tools to Monitor Biomarkers of Dysphagia: A Wearable Sensor Proof-of-Concept Study.

INTRODUCTION: Difficulty swallowing (dysphagia) occurs frequently in patients with neurological disorders and can lead to aspiration, choking, and malnutrition. Dysphagia is typically diagnosed using costly, invasive imaging procedures or subjective, qualitative bedside examinations. Wearable sensors are a promising alternative to noninvasively and objectively measure physiological signals relevant to swallowing. An ongoing challenge with this approach is consolidating these complex signals into sensitive, clinically meaningful metrics of swallowing performance. To address this gap, we propose 2 novel, digital monitoring tools to evaluate swallows using wearable sensor data and machine learning. METHODS: Biometric swallowing and respiration signals from wearable, mechano-acoustic sensors were compared between patients with poststroke dysphagia and nondysphagic controls while swallowing foods and liquids of different consistencies, in accordance with the Mann Assessment of Swallowing Ability (MASA). Two machine learning approaches were developed to (1) classify the severity of impairment for each swallow, with model confidence ratings for transparent clinical decision support, and (2) compute a similarity measure of each swallow to nondysphagic performance. Task-specific models were trained using swallow kinematics and respiratory features from 505 swallows (321 from patients and 184 from controls). RESULTS: These models provide sensitive metrics to gauge impairment on a per-swallow basis. Both approaches demonstrate intrasubject swallow variability and patient-specific changes which were not captured by the MASA alone. Sensor measures encoding respiratory-swallow coordination were important features relating to dysphagia presence and severity. Puree swallows exhibited greater differences from controls than saliva swallows or liquid sips (p < 0.037). DISCUSSION: Developing interpretable tools is critical to optimize the clinical utility of novel, sensor-based measurement techniques. The proof-of-concept models proposed here provide concrete, communicable evidence to track dysphagia recovery over time. With refined training schemes and real-world validation, these tools can be deployed to automatically measure and monitor swallowing in the clinic and community for patients across the impairment spectrum.

Amphibious Transport of Fluids and Solids by Soft Magnetic Carpets.

One of the major challenges in modern robotics is controlling micromanipulation by active and adaptive materials. In the respiratory system, such actuation enables pathogen clearance by means of motile cilia. While various types of artificial cilia have been engineered recently, they often involve complex manufacturing protocols and focus on transporting liquids only. Here, soft magnetic carpets are created via an easy self-assembly route based on the Rosensweig instability. These carpets can transport not only liquids but also solid objects that are larger and heavier than the artificial cilia, using a crowd-surfing effect.This amphibious transportation is locally and reconfigurably tunable by simple micromagnets or advanced programmable magnetic fields with a high degree of spatial resolution. Two surprising cargo reversal effects are identified and modeled due to collective ciliary motion and nontrivial elastohydrodynamics. While the active carpets are generally applicable to integrated control systems for transport, mixing, and sorting, these effects can also be exploited for microfluidic viscosimetry and elastometry.

Rehabilitation of the former nuclear test site at Maralinga.

Large areas of the former British nuclear test site at Maralinga were contaminated by the explosive dispersal of plutonium. The Australian Government, in consultation with stakeholders, determined that the site should be cleaned-up so that it is fit for unrestricted habitation by the Aboriginal traditional owners (Maralinga Tjarutja). Engagement with the stakeholders, particularly the Maralinga Tjarutja, determined that the specific criterion for rehabilitation was 5 mSv y-1and that some restrictions on permanent occupancy should remain. Remediation of the site began in 1995, took 5 years and cost AU$106 million. The site was returned to its traditional owners in 2009 and is now the site of a flourishing tourism operation.

COSMIC RADIATION EXPOSURE TO THE AUSTRALIAN PUBLIC.

A component of natural background radiation is exposure to galactic cosmic radiation (GCR). Annual GCR doses to the Australian public at ground levels and at altitudes of commercial domestic and international flights were estimated using the cosmic radiation dose modelling tool CARI-6. The annual population weighted average dose to Australians from GCR was estimated to be 342 µSv, of which 14.7 µSv (5%) was from domestic travel, 30.7 µSv (10%) was from international travel and 297 µSv (85%) of the dose was received at ground level. This study showed that critical population groups that are frequent flyers may exceed reference levels where additional awareness or protection should be considered. The GCR dose portion is ~25% of the total annual background radiation dose received by the Australian public.

A Mobility Measure for Inpatient Rehabilitation Using Multigroup, Multidimensional Methods.

BACKGROUND AND PURPOSE: Inpatient rehabilitation facilities (IRFs) report patient functional status to Medicare and other payers using Quality Indicators (QI). While the QI is useful for payment purposes, its measurement properties are limited for monitoring patient progress. A mobility measure based on QI items and additional standardized assessments may enhance clinicians' ability to track patient improvement. Thus, we developed the Mobility Ability Quotient (Mobility AQ) to assess mobility during inpatient rehabilitation. METHODS: For 10 036 IRF inpatients, we extracted assessments from electronic health records, used confirmatory factor analysis to define subdimensions of mobility, and then applied multidimensional item response theory (MIRT) methods to develop a unidimensional construct. Assessments included the QI items and standardized measures of mobility, motor performance, and wheelchair and transfer skills. RESULTS: Confirmatory factor analysis resulted in good-fitting models (root-mean-square errors of approximation ≤0.08, comparative fit indices, and nonnormed fit indices ≥0.95) for 3 groups defined by anticipated primary mode of locomotion at discharge-walking, wheelchair propulsion, or both. Reestimation as a multigroup, MIRT model yielded scores more sensitive to change compared with QI mobility items (dlast-first = 1.08 vs 0.60 for the QI; dmax-min = 1.16 vs 1.05 for the QI). True score equating analysis demonstrated a higher ceiling and lower floor for the Mobility AQ than the QI. DISCUSSION AND CONCLUSIONS: The Mobility AQ demonstrates improved sensitivity over the QI mobility items. This MIRT-based mobility measure describes patient function and progress for patients served by IRFs and has the potential to reduce assessment burden and improve communication regarding patient functional status.Video Abstract available for more insights from authors (see the Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A341).

Development of a Multidimensional, Multigroup Measure of Self-Care for Inpatient Rehabilitation.

OBJECTIVE: To develop and evaluate a measure of clinician-observed and patient-performed self-care function for use during inpatient rehabilitation. DESIGN: Retrospective analysis of self-care assessments collected by therapists using confirmatory factor analysis (CFA) followed by multidimensional item response theory (MIRT). SETTING: Freestanding inpatient rehabilitation hospital in the Midwestern United States. PARTICIPANTS: Inpatients (N=7719) with stroke, traumatic brain injury, spinal cord injury, neurologic disorders, and musculoskeletal conditions. INTERVENTIONS: Not applicable MAIN OUTCOME MEASURES: A total of 19 clinician-selected self-care measures including the FIM and patient-performed, clinician-rated measures of balance, upper extremity function, strength, changing body position, and swallowing. Clinicians completed assessments on admission and at least 1 interim assessment. RESULTS: CFA was completed for 3 patient groups defined by their highest level of balance (sitting, standing, walking). We reduced the number of items by 47.5% while maintaining acceptable internal consistency; unidimensionality within each item set required development of testlets. A recursive analysis defined a self-care measure with sensitivity (Cohen dmax-min =1.13; Cohen dlast-first.=0.91) greater than the FIM self-care items (dmax-min.=0.94; dlast-first .=0.83). The CFA models provided good to acceptable fit (root mean square error of approximations 0.03-0.06). Most patients with admission FIM self-care ratings of total assistance (88%, 297 of 338) made improvements on the MIRT self-care measure that were undetected by the FIM; the FIM detected no change for 26% of these patients (78 of 297). The remaining 74% (219 of 297) improved on the MIRT-based measure an average of 14 days earlier than was detected by the FIM. CONCLUSIONS: This MIRT self-care measure possesses measurement properties that are superior to the FIM, particularly for patients near its floor or ceiling. Methods assure accommodation for multidimensionality and high levels of sensitivity. This self-care measure has the potential to improve monitoring of self-care and manage therapy effectively during inpatient rehabilitation.

Focal dynamic thermal imaging for label-free high-resolution characterization of materials and tissue heterogeneity.

Evolution from static to dynamic label-free thermal imaging has improved bulk tissue characterization, but fails to capture subtle thermal properties in heterogeneous systems. Here, we report a label-free, high speed, and high-resolution platform technology, focal dynamic thermal imaging (FDTI), for delineating material patterns and tissue heterogeneity. Stimulation of focal regions of thermally responsive systems with a narrow beam, low power, and low cost 405 nm laser perturbs the thermal equilibrium. Capturing the dynamic response of 3D printed phantoms, ex vivo biological tissue, and in vivo mouse and rat models of cancer with a thermal camera reveals material heterogeneity and delineates diseased from healthy tissue. The intuitive and non-contact FDTI method allows for rapid interrogation of suspicious lesions and longitudinal changes in tissue heterogeneity with high-resolution and large field of view. Portable FDTI holds promise as a clinical tool for capturing subtle differences in heterogeneity between malignant, benign, and inflamed tissue.

Intracranial glioma xenograft model rapidly reestablishes blood-brain barrier integrity for longitudinal imaging of tumor progression using fluorescence molecular tomography and contrast agents.

SIGNIFICANCE: The blood-brain barrier (BBB) is a major obstacle to detecting and treating brain tumors. Overcoming this challenge will facilitate the early and accurate detection of brain lesions and guide surgical resection of tumors. AIM: We generated an orthotopic brain tumor model that simulates the pathophysiology of gliomas at early stages; determine the BBB integrity and breakdown over the time course of tumor progression using generic and cancer-targeted near-infrared (NIR) fluorescent molecular probes. APPROACH: We developed an intracranial tumor xenograft model that rapidly reestablished BBB integrity and monitored tumor progression by bioluminescence imaging. Sham control mice were injected with phosphate-buffered saline only. Fluorescence molecular tomography (FMT) was used to quantify the uptake of tumor-targeted and passive NIR fluorescent imaging agents in orthotopic glioma (U87-GL-GFP PDE7B H217Q cells) tumor model. Cancer-induced and transient (with focused ultrasound, FUS) disruption of BBB integrity was monitored with NIR fluorescent dyes. RESULTS: Stereotactic injection of 50,000 cells into mouse brain allowed rapid reestablishment of BBB integrity within a week, as determined by the inability of both tumor-targeted and generic NIR imaging agents to extravasate into the brain. Tumor-induced BBB disruption was observed 7 weeks after tumor implantation. FUS achieved a similar effect at any time point after reestablishing BBB integrity. While tumor uptake and retention of the passive NIR dye, indocyanine green, was negligible, both actively tumor-targeting agents exhibited selective accumulation in the tumor region. The tumor-targeting molecular probe that clears rapidly from nontumor brain tissue exhibits higher contrast than the analogous vascular-targeting agent and helps delineate tumors from sham control. CONCLUSIONS: We highlight the utility of FMT imaging for longitudinal assessment of brain tumors and the interplay between the stages of BBB disruption and molecular probe retention in tumors, with potential application to other neurological diseases.

Whole organism concentration ratios in freshwater wildlife from an Australian tropical U mining environment and the derivation of a water radiological quality guideline value.

More than 10,000 whole organism concentration ratio (CRwo-water) values for freshwater wildlife were derived from radionuclide and stable element data representing an Australian tropical U mining environment. The CRwo-water values were summarised into five wildlife groups (bird, fish, mollusc, reptile and vascular plant). The summarised CRwo-water values represented 77 organism-element combinations. The CRwo-water values for U decay series elements were used in a tier 3 ERICA assessment. The assessment results were used to derive a water radiological quality guideline value (GV) for radiation protection of freshwater ecosystems in the context of the planned remediation of the Ranger U mine. The GV was an above-background water 226Ra activity concentration of 14 mBq L-1 (filtered fraction) or approximately 22 mBq L-1 (total fraction). The GV was based on the results of mollusc-bivalve as the limiting organism for the freshwater ecosystem.

Validity, reliability and sensitivity of the NORLA-6: Naming and oral reading for language in aphasia 6-point scale.

PURPOSE: Evaluation of the Naming and Oral Reading for Language in Aphasia 6-point scale (NORLA-6), a scoring system of oral reading and naming performance in aphasia. METHOD: Data were drawn from 91 participants with non-fluent aphasia secondary to left-hemisphere stroke across four treatment studies. To assess validity, Spearman's correlations were calculated between the NORLA-6 and the Gray Oral Reading Test-Fourth Edition (GORT-4) Accuracy score, GORT-4 Rate score and the Boston Naming Test (BNT). Inter-rater and test-retest reliability were evaluated using correlations. Sensitivity to change following oral reading intervention was analysed using Wilcoxon Signed Rank tests between pre- and post-treatment NORLA-6 scores. RESULT: NORLA-6 performance was significantly correlated (p < 0.001) with all reference tests (GORT-4 Accuracy, rs=0.84; GORT-4 Rate, rs= 0.61; and BNT, rs= 0.92). Inter-rater (ICC ≥0.90) and test-retest (r > 0.92) reliability were both excellent. Sensitivity following oral reading intervention was demonstrated in both oral reading accuracy and rate (p < 0.004). CONCLUSION: The NORLA-6 is a valid and reliable measure of oral reading and naming performance. It also demonstrates sensitivity to change in treatment-targeted behaviours. Therefore, the NORLA-6 scale may enhance outcome measurement in both clinical practice and aphasia research.

Development, Implementation, and Use of a Process to Promote Knowledge Translation in Rehabilitation.

OBJECTIVE: To examine the use and effect of the Battery of Rehabilitation Assessments and Interventions on evidence-based practice (EBP) over 6 years. DESIGN: Successive independent samples study. SETTING: Large rehabilitation system. PARTICIPANTS: Successive samples of allied health clinicians (N=372) in 2009 (n=136), 2012 (n=115), and 2015 (n=121). INTERVENTIONS: The Battery of Rehabilitation Assessments and Interventions includes 2 components: (1) a process to synthesize, adapt, and make recommendations about the application of evidence; and (2) a process to implement the recommended practices in 3 levels of care. MAIN OUTCOME MEASURES: To assess the effect of the project, surveys on EBP perspectives, use, and barriers were conducted before Battery of Rehabilitation Assessments and Interventions implementation and 3 and 6 years after implementation. Questions about effect of the project on clinical practice were included 3 and 6 years postimplementation. RESULTS: Survey data indicate the Battery of Rehabilitation Assessments and Interventions resulted in a significant increase in use of EBPs to make clinical decisions and justify care. As a result of the project, survey participants reported a substantial increase in use of outcome measures in 2012 (74%) and 2015 (91%) and evidence-based interventions in 2012 (62%) and 2015 (82%). In 2012, significant differences (P≤.01) in effect of the Battery of Rehabilitation Assessments and Interventions on practice were identified between therapists who were directly involved in the project and Interventions compared with uninvolved therapists. In 2015, no significant differences existed between involved and uninvolved therapists. CONCLUSIONS: After 6 years of sustained implementation efforts, the Battery of Rehabilitation Assessments and Interventions expedited the adoption of EBPs throughout a large system of care in rehabilitation.

Whole-organism concentration ratios in wildlife inhabiting Australian uranium mining environments.

Wildlife concentration ratios for 226Ra, 210Pb, 210Po and isotopes of Th and U from soil, water, and sediments were evaluated for a range of Australian uranium mining environments. Whole-organism concentration ratios (CRwo-media) were developed for 271 radionuclide-organism pairs within the terrestrial and freshwater wildlife groups. Australian wildlife often has distinct physiological attributes, such as the lower metabolic rates of macropod marsupials as compared with placental mammals. In addition, the Australian CRswo-media originate from tropical and semi-arid climates, rather than from the temperate-dominated climates of Europe and North America from which most (>90%) of internationally available CRwo-media values originate. When compared, the Australian and non-Australian CRs are significantly different for some wildlife categories (e.g. grasses, mammals) but not others (e.g. shrubs). Where differences exist, the Australian values were higher, suggesting that site-, or region-specific CRswo-media should be used in detailed Australian assessments. However, in screening studies, use of the international mean values in the Wildlife Transfer Database (WTD) appears to be appropriate, as long as the values used encompass the Australian 95th percentile values. Gaps in the Australian datasets include a lack of marine parameters, and no CR data are available for freshwater phytoplankton, zooplankton, insects, insect larvae or amphibians; for terrestrial environments, there are no data for amphibians, annelids, ferns, fungi or lichens & bryophytes. The new Australian specific parameters will aide in evaluating remediation plans and ongoing operations at mining and waste sites within Australia. They have also substantially bolstered the body of U- and Th-series CRwo-media data for use internationally.

Increasing aphasia treatment intensity in an acute inpatient rehabilitation program: A feasibility study.

BACKGROUND: Intensity of therapy is a critical factor influencing outcomes in aphasia. However, there are many barriers to increasing treatment intensity for those with acute/subacute aphasia including the demands of the inpatient medical facilities and the endurance of the participants. Nevertheless, with some modifications to its original procedures, evidence suggests that Constraint Induced Language Therapy (CILT) may yield positive outcomes when given in the early stages of recovery. AIMS: To investigate the feasibility of increasing the amount of therapy provided to individuals with aphasia on an inpatient rehabilitation unit by adding CILT at a modified intensity, and to assess whether those receiving two weeks of the additional CILT show more improvement than control participants who did not receive the additional treatment. METHODS AND PROCEDURES: A case-series single-subject design study was conducted. All participants received usual care of approximately an hour of speech and language treatment, five to six days a week. Participants in the experimental condition received an additional hour-long CILT session, five days per week, for two weeks. Trained, untrained, and generalization probes comprising naming of pictured items and oral reading of sentences were taken at baseline, during treatment, and at post-treatment. All participants were probed equally. Probe performance was scored and effect sizes were calculated and compared. Performance gains from pre- to post-treatment on subtests of the Boston Diagnostic Aphasia Examination were also compared. OUTCOMES AND RESULTS: Thirteen individuals with aphasia onset ranging from 7 to 68 days were recruited, with 6 allocated to the experimental Usual Care + CILT condition and 7 allocated to the control Usual Care condition. Increasing the amount of speech and language therapy by adding an hour of daily CILT was feasible. Individual performance varied within and across conditions with large gains noted in some, but not all participants. As a group, there was a small to medium effect size of the Usual Care + CILT condition over Usual Care alone for trained and untrained oral reading probes and untrained naming probes. CONCLUSIONS: It is feasible to increase the amount of treatment provided to participants with aphasia on an acute inpatient rehabilitation unit. Preliminary results suggest that there may be better outcomes for those who receive more treatment. Further research using larger numbers of homogeneous participants and controlling for content of therapy as well as amount of therapy is warranted.