Fatigue Influences Social Participation in Aphasia: A Cross-sectional and Retrospective Study Using Patient-Reported Measures.

OBJECTIVE: To examine associations between social participation, fatigue, and aphasia severity using patient-reported outcome measures and to examine associations between demographic/diagnostic variables and fatigue in people with aphasia. DESIGN: Retrospective analysis of patient-reported outcome measures using a Bayesian framework. SETTING: Urban rehabilitation research hospital. PARTICIPANTS: 67 participants (N=67) with chronic aphasia (mean age=54.1 years) as a consequence of stroke. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Ability to Participate in Social Roles and Activities, Fatigue, and Global Health Questionnaire scales from the Patient-Reported Outcomes Measurement Information System initiative and the Western Aphasia Battery-Revised. We hypothesized an association between social participation and fatigue in people with aphasia. RESULTS: People with aphasia with higher fatigue levels tended to report less social participation. Also, people with aphasia who were a longer time post-stroke tended to report higher social participation. People with aphasia who reported better physical health were more likely to report higher social participation. CONCLUSIONS: There is an association between fatigue and social participation in people with aphasia. Fatigue should be considered in clinical assessments and treatments for this population.

Depression and Subthreshold Depression in Stroke-Related Aphasia.

OBJECTIVE: To investigate the prevalence of depression and subthreshold depression in persons with aphasia. To investigate whether there are linguistic and cognitive differences between those with depression, subthreshold depression, and no depression. DESIGN: Survey. SETTING: Rehabilitation hospital. PARTICIPANTS: Participants with chronic aphasia due to a single left-hemisphere stroke (N=144). MAIN OUTCOME MEASURES: Center for Epidemiologic Studies Depression Scale to assess the prevalence of depression. The Western Aphasia Battery-Revised (WAB-R) to evaluate the type of aphasia; the Aphasia Quotient measured the severity of linguistic deficits. RESULTS: The prevalence of depression in our participants was 19.44% while that of subthreshold depression was 22.22%. Depressed persons with aphasia had significantly lower WAB-R reading scores than those without depression. CONCLUSIONS: Findings suggest that persons with aphasia who have depressive symptoms may do worse on some linguistic measures than those with no depression. Since subthreshold depression can progress to depression, clinicians should routinely screen for depressive symptoms.

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.

Transcranial direct current stimulation and aphasia: the case of mr. C.

PURPOSE: To illustrate the ethical challenges that arose from investigating a novel treatment procedure, transcranial direct current stimulation (tDCS), in a research participant with aphasia. METHOD: We review the current evidence supporting the use of tDCS in aphasia research, highlighting methodological gaps in our knowledge of tDCS. Then, we examine the case of Mr. C, a person with chronic aphasia who participated in a research protocol investigating the impact of tDCS on aphasia treatment. We describe the procedures that he underwent and the resulting behavioral and neurophysiological outcomes. Finally, we share the steps that were taken to balance beneficence and nonmaleficence and to ensure Mr. C's autonomy. RESULTS: The objective data show that while Mr. C may not have benefitted from participating in the research, neither did he experience any harm. CONCLUSION: Researchers must consider not only the scientific integrity of their studies, but also potential ethical issues and consequences to the research participants.

Epidural cortical stimulation and aphasia therapy.

BACKGROUND: There are several methods of delivering cortical brain stimulation to modulate cortical excitability and interest in their application as an adjuvant strategy in aphasia rehabilitation after stroke is growing. Epidural cortical stimulation, although more invasive than other methods, permits high frequency stimulation of high spatial specificity to targeted neuronal populations. AIMS: First, we review evidence supporting the use of epidural cortical stimulation for upper limb recovery after focal cortical injury in both animal models and human stroke survivors. These data provide the empirical and theoretical platform underlying the use of epidural cortical stimulation in aphasia. Second, we summarize evidence for the application of epidural cortical stimulation in aphasia. We describe the procedures and primary outcomes of a safety and feasibility study (Cherney, Erickson & Small, 2010), and provide previously unpublished data regarding secondary behavioral outcomes from that study. MAIN CONTRIBUTION: In a controlled study comparing epidural cortical stimulation plus language treatment (CS/LT) to language treatment alone (LT), eight stroke survivors with nonfluent aphasia received intensive language therapy for 6 weeks. Four of these participants also underwent surgical implantation of an epidural stimulation device which was activated only during therapy sessions. Behavioral data were collected before treatment, immediately after treatment, and at 6 and 12 weeks following the end of treatment. The effect size for the primary outcome measure, the Western Aphasia Battery Aphasia Quotient, was benchmarked as moderate from baseline to immediately post-treatment, and large from baseline to the 12-week follow-up. Similarly, effect sizes obtained at the 12-week follow-up for the Boston Naming Test, the Communicative Effectiveness Index, and for correct information units on a picture description task were greater than those obtained immediately post treatment. When effect sizes were compared for individual subject pairs on discourse measures of content and rate, effects were typically larger for the investigational subjects receiving CS/LT than for the control subjects receiving LT alone. These analyses support previous findings regarding therapeutic efficacy of CS/LT compared to LT i.e. epidural stimulation of ipsilesional premotor cortex may augment behavioral speech-language therapy, with the largest effects after completion of therapy. CONCLUSIONS: Continued investigation of epidural cortical stimulation in combination with language training in post-stroke aphasia should proceed cautiously. Carefully planned studies that customize procedures to individual profiles are warranted. Information from research on non-invasive methods of CS/LT may also inform future studies of epidural cortical stimulation.