Use and Perceived Effectiveness of Communication Modes Reported by Persons With Primary Progressive Aphasia.

PURPOSE: Primary progressive aphasia (PPA) is a clinical neurodegenerative dementia syndrome characterized by early, selective, and progressive language impairment. PPA onset is gradual, providing time to potentially identify additional or alternative expressive communication modes; however, reports of communication mode use and effectiveness by persons with PPA have not been described. This study characterized the use, frequency, and perceived effectiveness of communication modes reported by individuals with PPA. METHOD: Forty-one participants with mild-to-moderate PPA completed a structured interview detailing the type, frequency, and perceived effectiveness of 12 potential communication modes, categorized by technology required (no-tech, low-tech, and high-tech). The ratio of modes used was compared across technology categories with a repeated-measures generalized linear model assuming a binomial distribution with an overall Wald chi-square statistic, followed by pairwise post hoc t-test comparisons. RESULTS: Of the 12 communication modes assessed, participants reported using a median of eight (range: 5-10). All participants affirmed using speech, facial expressions, and talking on the phone. Frequency and perceived effectiveness ratings for these three modes were endorsed at the "some/most of the time" level for more than 80% of the participants. No-tech mode use was significantly higher than reported high-tech and low-tech modes (p = .004 and p < .0001, respectively). Even so, while some high-tech modes (apps) and some low-tech modes (nonelectronic augmentative and alternative communication) had fewer users, effectiveness ratings were moderate to high for all but one user. CONCLUSIONS: Persons with mild-to-moderate language impairment due to PPA report using a range of communication modes with moderate-to-high frequency and perceived effectiveness. These outcomes provide practical information when considering mode refinement or expansion during intervention to maximize communication participation. Barriers to modality use may include low awareness or access, which could be queried by future studies and supported by speech and language interventions. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.21614262.

Communication Partner Engagement: A Relevant Factor for Functional Outcomes in Speech-Language Therapy for Aphasic Dementia.

OBJECTIVES: Previous reports established the feasibility of a telehealth model for delivering speech-language therapy via Internet videoconferencing, which connects individuals with primary progressive aphasia (PPA) to an expert speech and language pathologist for treatment. This study reports feasibility of the same telehealth intervention in a larger set of progressive aphasia participants and explores factors potentially influencing functional intervention outcomes. METHODS: Participants with PPA or progressive aphasia in the context of a neurodegenerative dementia syndrome and their communication partners were enrolled into an 8-session intervention, with 3 evaluations (baseline, 2 months, and 6 months postenrollment). Half of the participants were randomized into a "check-in" group and received 3-monthly half-hour sessions postintervention. Mixed linear models with post hoc testing and percent change in area under the curve were used to examine communication confidence over time, as well as the influence of check-in sessions and the role of communication partner engagement on communication confidence. RESULTS: Communication confidence improved at the 2-month evaluation and showed no significant decline at the 6-month evaluation. Item-level analysis revealed gains in communication confidence across multiple communication contexts. Gains and maintenance of communication confidence were only present for the engaged communication partner group and were not bolstered by randomization to the check-in group. DISCUSSION: Internet-based, person-centered interventions demonstrate promise as a model for delivering speech-language therapy to individuals living with PPA. Maintenance is possible for at least 6 months postenrollment and is better for those with engaged communication partners, which supports the use of dyadic interventions.

A Life Participation Approach to Primary Progressive Aphasia Intervention.

Primary progressive aphasia (PPA) is a clinical neurodegenerative dementia syndrome characterized by deficits in spoken and written word retrieval, word usage, and/or word comprehension. Currently, there are no effective treatments to reverse or halt the underlying disease process; however, speech-language therapy may be helpful. The Communication Bridge Care Model was developed to address the unique communication and quality of life needs of individuals living with PPA. The core elements include person-centered care with dyadic instruction for disease education, and counseling, along with tailored levels of impairment- and compensatory-based communication strategy training. Our multicomponent approach incorporates guidance from the Life Participation Approach for Aphasia, including client-directed assessment and interventions that aim to maximize functional communication and participation in desired life activities. The direct and indirect use of technology is integrated into our tailored model of care to facilitate achievement of the client's functional goals. Here, we describe how to practically apply the Communication Bridge Care Model across treatment settings, including case examples from the Communication Bridge research study. This approach to care provides an opportunity to maximize communication effectiveness and quality of life for individuals living with PPA throughout the course of disease.

Communication Bridge: A pilot feasibility study of Internet-based speech-language therapy for individuals with progressive aphasia.

INTRODUCTION: Individuals with aphasia symptoms due to neurodegenerative dementia are under-referred for speech-language therapy (SLT) services. We sought to determine the feasibility of utilizing telepractice, via Internet video conferencing, to connect an individual with progressive aphasia due to dementia to a speech-language pathologist for treatment. METHODS: Participants received an Initial Evaluation, 8 person-centered Internet-based SLT sessions and two Post-Therapy Evaluations. The feasibility of providing web-based SLT, strategies used and their compliance, functional gains and the duration of benefit were assessed. RESULTS: Thirty-four participants from 21 states and Canada were enrolled. Thirty-one participants completed the 6-month Evaluation. Speech-language pathologist-assessed and self-reported functional gains, as well as increased confidence in communication were documented at 2-months and maintained at 6-months post-enrollment. DISCUSSION: Internet-based SLT using person-centered interventions provides a feasible model for delivering care to individuals with dementia and mild/moderate aphasia symptoms who have an engaged care-partner and prior familiarity with a computer.

Developing Personally Relevant Goals for People with Mild Dementia.

Many speech-language pathologists work in the skilled nursing facility setting and frequently treat patients in subacute rehabilitation who are experiencing mild cognitive deficits as a result of dementia. Treatment of these individuals needs to be carefully differentiated from rehabilitative treatment of a stroke or traumatic brain injury. A "habilitation" approach should be considered, focusing on an individual's preserved strengths and developing patient-centered goals that focus upon the integration of personally relevant stimuli into the care plan. Environmental modification, the use of visual memory aids, counseling, and ongoing family education are also essential components of this approach. This case study is a thorough example of how the habilitation approach can be used to provide intervention for a person with mild dementia. The case study will explain indication for treatment, assessment, goal selection, and research to support the treatment plan.

Developing Personally Relevant Goals for People with Moderate to Severe Dementia.

Many speech-language pathologists work in the skilled nursing facility setting and have a growing number of patients with moderate to severe dementia on their caseloads. Traditional rehabilitation interventions are often not appropriate for people with dementia due to the severity of their cognitive impairment and the progressive nature of dementia. Whereas a rehabilitation approach focuses on deficits (so they can be improved), a habilitation approach focuses on what strengths remain and who the patient is as a person. Through a habilitation approach, the goal is not to improve the patient's skills; the goal is to improve the environment (and the people in it), so the person with dementia can function at their highest possible level. This case study is a thorough example of how the habilitation approach can be used to provide intervention for a person with moderate to severe dementia. The case study will explain indication for treatment, assessment, goal selection, and research to support the treatment plan.

The CARE pathway model for dementia: psychosocial and rehabilitative strategies for care in young-onset dementias.

The goal of the Care Pathway Model for Dementia (CARE-D) is to improve quality of life and daily functioning both for individuals diagnosed with dementia and for their families or other caregivers. This is accomplished by developing individualized recommendations focused on a person's strengths and weaknesses as determined by formal neurocognitive and psychosocial evaluations. Careful attention is given to the stage of illness and an individual's stage in life, to connecting families with services that target an individual's cognitive and behavioral symptoms, and to providing education and emotional support specific to symptoms, clinical diagnosis, and prognosis.

Thinking Outside the Stroke: Treating Primary Progressive Aphasia (PPA).

In this article, we explore the symptoms, cause, treatment potential, and supportive services for individuals diagnosed with Primary Progressive Aphasia (PPA). Although it is possible to regain certain cognitive abilities with stroke or brain injury, in PPA, language abilities worsen and other symptoms emerge with time, shortening the lifespan. The goal of speech therapy for PPA is not to regain lost language, but rather to maximize communication for as long as possible. In this article, we offer information and tools for speech-language pathologists to help people living with PPA achieve these goals and improve overall quality of life.