ABSTRACT
CONTEXT: A standardized set of picture stimuli for neuro-language disorder has been long overdue. AIMS: To develop a standardized set of 303 pictures for use in experiments of Intensive Language Action Therapy (ILAT). METHODS AND MATERIAL: Several sources with standardized picture stimuli having culturally unbiased features were studied. Among those studies two prime sources (1) Snodgrass & Vanderwart (1980), 127 (89+37) items and (2) Neininger & Pulvermuller (2002), 147 (89+56) items were used extensively. Out of 303 stimuli, 89 items were common to both principle sources. An Indian study by George & Mathuranath (2007) has also been taken as an additional source. Line drawing stimuli were standardized on four variables of central relevance to memory and cognitive processing: name agreement, image agreement, familiarity, and visual complexity. STATISTICAL ANALYSIS USED: All measures related to 303 concepts i.e. % correct, H statistics, familiarity, image agreement and visual complexity were analysed descriptively. RESULTS: Low mean and positive skew on H statistics and visual complexity show that many concepts had a high name agreement (13 concepts have H values of .0, and 55 have H values of 0.68 or below, where 0.68 represents consensus among all but few of the subjects on a picture's name) and were visually simple line drawings. The intercorrelations among the four measures were low, suggesting that they are indices of different attributes of the pictures. CONCLUSIONS: Usage of appropriate items/stimuli has immense potential to influence aphasia therapy outcome. This set of pictures and its normative variable has enhanced the ILAT outcome. It could be generalised for other aphasia therapy too to understand its efficacy.
ABSTRACT
BACKGROUND: Aphasia is one of those clinical conditions, where the role of affiliated professionals, mainly speech language pathologists (SLPs) is substantial in diagnostic assessments, therapy, and rehabilitation. There is no study to focus on neurologists, with respect to their perceptions and practices about aphasia, the disease, as well as the profession of SLP. OBJECTIVE: To reach out to the neurologist community in India and learn about their perceptions and practices about the nature of the ailment and role of speech language therapy (SLT). Our premise was that observations and inferences from a questionnaire-based survey will be subsequently helpful in planning educational activities targeted to neurologists with more focus on specific gaps in perceptions and practices. MATERIAL AND METHODS: Three neurologists and two SLPs collaboratively developed the questionnaire. The aim was to probe the issues which were likely to have a bearing upon optimum service delivery to persons with aphasia by a dyad of neurologist and SLP. The survey was set in "Google Forms" and sent by "WhatsApp" and email to approximately 500 practicing neurologists in India. We employed a nonprobability sampling design for ease of administration with a combination of "chunk sampling" and "snowball sampling." Telephonic reminders were made to almost all. RESULTS AND DISCUSSION: We received 100 responses. The mean age of respondents was 50.64 (SD +/- 12.60) with a range of 28-78 years. The mean number of years of experience as a neurophysician was 19.88 (SD. +/- 12.72) with range of 1-47 years. Females were only 8%. Apparently, the proportion of neurologists working in large corporate and large public sector institutions from tier one and tier two cities was higher, who are more likely to have SLP and related rehabilitation facilities in their institutions and hence harbor more conducive attitudes to SLT in aphasia. The ground reality from tier three cities and small private and public sector hospital and solo practitioners may be somewhat worse than this. Many responses were in conformity with facts and in tune with desirable attitudes as per guidelines like aphasia being a detrimental factor in stroke recovery, doing assessment of handedness, paying attention to neuroimaging correlations and associated cognitive functions, not resorting to unnecessary pharmacotherapy, being aware about efficacy of SLT, and fairly good chances of recovery. However, many more answers highlighted a need for emphasis in Continuing Medical Education like not being aware about community burden of aphasia in comparison to a few better known neurological diseases, not paying attention to psychosocial aspects apart from biological ones in assessment and rehabilitation, not using a standardized and validated battery, not confidant about role of SLT in chronic stable aphasia and need for longer and intensive therapy, and being unconcerned for the value of advocacy for aphasia, like the role of Self-Help Groups. CONCLUSION: The thrust areas, pertaining to gaps in perception and practices identified through this study, can be viewed as "an in-time input." We hope that changes in some of the perceptions and practices can be attained through an emphasis on education and training at multiple levels right from the undergraduate to the practicing physicians. A few more themes and domains will need advocacy actions targeted to different stakeholders.
