Browsing by Subject "afasia"
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(2016)Background and aims: Aphasia is commonly associated with deficits in all linguistic modalities.In mild, chronic aphasia syndromes difficulties in reading can interfere with tasks of everyday life. The rehabilitation of reading difficulties caused by a general linguistic deficit is closely related to the rehabilitation of spoken language, especially in the early stages. Partly due to the limited resources granted to speech therapy, rehabilitation seldom proceeds to reading in its own right. Research has shown that rehabilitation of reading as such can however be beneficial to more general linguistic abilities. In this study, the quality and responsiveness to treatment of a sublexical reading deficit related to mild, chronic conduction aphasia were examined. The aim was to investigate, whether a sublexical therapy method and in particular text-level reading practice were effective in enhancing the fluency of reading or more general linguistic abilities. Methods: A 37-year-old man with mild, chronic conduction aphasia and resulting phonological alexia participated in the study. The intervention consisted of 17 training sessions (total of40 hours) of speech therapy, during which independent practice of repetitive reading that lasted for 11 weeks was started. Therapy consisted of phonological and word-level repetition and naming tasks combining the auditive and written modalities. Data consisted of linguistic tasks collected before, during and after the practice period. The effects of the intervention were evaluated by examining oral reading speed and accuracy of connected text and nonwords. More general phonological and linguistic abilities were examined through auditive repetition and auditive memory tasks. Results and discussion: The reading deficit reflected a more general linguistic difficulty that seemed to originate in auditive processing. Difficulties in reading seemed to arise from weakened phonological activation of word forms. No clinically significant changes were observed after the rehabilitation period. Still, positive changes were noted that imply the rehabilitation can be efficient when carried out through a longer period. Reading speed increased in nonword reading task, but speed of reading connected text increased steadily through the whole study period. A positive change in oral reading speed was observed in first readings of practice texts that might imply a more consistent enhancement during a longer training interval. No rehabilitative effect was apparent in auditive repetition or auditive memory, even though individual tasks improved. The results of this case study imply that repetitive reading ought to be further investigated as a reading rehabilitation method for persons with mild phonological reading deficits. Considering more general phonological rehabilitation, systematic methods could enhance the effectiveness of practice.
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(2015)Aims: Embodied practices among people with aphasia remain relatively little known until now. The aim of this study was to describe free conversation interaction between a seriously aphasic speaker and his wife. This study aims to explore what kinds of nonverbal elements appear during the conversation of the aphasic person, and how the nonverbal elements arise in different conversational turns. The main focus of this study is on the substitutive and the complementary gestures of the speech. Earlier studies on aphasia interaction suggest that gestures are an important resource to construct meanings in turns of an aphasic speaker. Data and methods: This is a qualitative study where conversational analysis is used as a research method. Data consists of two videotaped recordings of the couples' free conversation at home settings. Results and conclusions: Several nonverbal elements, which had a significant influence for the conversation interaction of this couple, appeared in the data of this study. The wife interpreted aphasic person's nonverbal elements in the conversation as meaningful elements. The wife gave time and space for the aphasic person to participate in conversation. The aphasic speaker took advantage of the gestures in order to compensate speech loss. In fact, he almost completely relied on the substitutive and complementary gestures in conversation. He used the gestures in many ways and combined gestures skillfully to his limited verbal elements. A significant result in the study was that the aphasic speaker hardly showed any signs for verbal word search before expressing nonverbal elements. He started gesturing often seamlessly just before of his typical turn initiator verbal expressions yeah yes and yeah but or simultaneously with them. Aphasic person's expression were built fast and effortlessly despite the loss of speech. It can be said that aphasic person had adapted to his handicap caused by aphasia by taking advantage from gesturing.
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(2014)Aims. Improved quality of life is considered to be the overarching goal of aphasia rehabilitation based on the social model. Around the world research has been done on the factors that affect the quality of life with people with aphasia. Different kinds of structured quality of life measurements have been developed that aim to enable people with aphasia to self-report quality of life. In Finland research on the subject has been scarce. The aim of this study was to explore the views of Finnish speech and language therapists (SLT) on the quality of life in aphasia rehabilitation and the prevailing clinical practices as well as to investigate how they compare internationally. Methods. For the purposes of this study a questionnaire composed by the Aphasia Committee of the International Association of Logopedics and Phoniatrics (IALP) was translated into the Finnish language. 64 questionnaires were filled out. The Finnish data was analysed by using descriptive statistics and content analysis. The data collected in this survey formed Finland's part of an international survey conducted by IALP, which allowed the comparison between the Finnish and international results. The international survey contained 581 respondents from 16 countries including Finland. The Finnish and international data were compared by cross tabulation and Chi Squared -test. Results and conclusions. According to Finnish SLTs it is important to incorporate into practice with aphasia several quality of life domains, such as communication, affect, in/dependence, social activities, personal outlook and in addition to consider life satisfaction, social support and environment. Almost all of the Finnish SLTs used interviewing as their primary method for assessing the quality of life, only four used structured quality of life measures. Internationally there were mentioned many different structured quality of life assessments. This study indicates explicitly that there is a demand for structured quality of life assessments in Finland. The results can be applied in developing education, research and clinical practice.
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Intensiivinen tablettitietokoneharjoittelu lievän kroonisen afasian kuntoutuksessa : tapaustutkimus (2015)Aims. The purpose of this single-case study was to investigate the effects of intensive tablet-based treatment in overall language performance level and in reading and writing processes in mild aphasia. The communicative effectiveness and task performances on the tablet software were also studied. The tablet software included tasks where semantic, syntactic and phonological processing were required; written naming, sentence writing and reading comprehension. Previous studies have indicated improvements in language skills after computer-based treatment (Katz & Wertz, 1997; Wade, Mortley & Enderby, 2003). Especially reading and writing skills can be treated by the computer-based softwares (Katz, 2008). Methods & Procedures. In this single subject research the ABA design was used. The participant in this study was a 47 year old man who had a stroke 2.5 years earlier. He had a mild chronic aphasia with difficulties in writing, reading and naming. The data of this study was formed by linguistic tests and by a self-assessment method as the participant evaluated his communicative effectiveness (CETI). The methods used in the analysis of written and read narratives included assessing rate, authenticity and the types of errors. The analysis of written narratives also included assessing word classes and type-token –ratio. Based on the data by the tablet-based software the rate and the share of errors of task performances were assessed. Results & Conclusions. Based on the Western Aphasia Battery (WAB) results, the severity of the aphasia decreased but the change was not clinically significant. Naming improved but the change wasn't stable until the follow-up. The participant showed positive development in his written and reading production; he made less spelling and reading errors after the treatment. At the same time reading and writing processes became slower. The share of lexical verbs, adjectives, pronouns and numerals increased in written narratives. The communicative effectiveness improved. The task performance on the tablet software was faster during the fourth week compared to the first week. Also the amount of incorrect performances decreased or remained the same. Based on the results, an intensive self-monitored tablet-based language treatment was effective to the subject.
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(2015)Aims. In the last few years there have been studies that use multi-level approaches in the analysis of narrative language in aphasia. In Finland there is no established method for assessing the narration of aphasic persons. The literature provides different models but there is not commonly approved system. The purpose of this study was to examine how aphasic persons perform in cartoon story description tasks and to apply a multi-level method for assessing their narrative speech. The aim is to find an appropriate model that discovers change in narrative speech. Method. Six aphasic persons participated in this research where they received transcranial magnetic stimulation or the placebo version of it and ILAT rehabilitation. The narrative speech of the participants was assessed by using to picture sequence tasks in four different times during the research: before the rehabilitation, during it, immediately after it and after 3 months. The analysis focused on 1) productivity, 2) lexical and grammatical processing and 3) informativeness. In addition their performance in narrative task was compared to performance scores in Western Aphasia Battery. The methods of analysis were adapted from methods used by Marini et al. (2011). Results and conclusions. In five out of the six persons who participated in this study there was some positive change in narration at least in one aspect of the analysis. Only one participant showed overall improvement. The participants who had fluent aphasia, had more clear changes in the results that the subjects who had non-fluent aphasia. The definition of the analyzing method was challenging but it is important to unravel these multi-level analyzing methods in Finland in future. The picture sequence task is a functional means to elicit narrative speech but instead of using sequences with small number of pictures sequences with more pictures should perhaps be used. It would also be important to collect normative data from Finnish speaking people using these multi-level methods. It would enable the comparison of aphasic person's narratives to the normative data.
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(2015)Aim. Aphasia impacts not only the aphasic person, but also the significant others. There has been a largely grown interest on different types of intervention and services directed to significant others. However, there is little evidence how SLPs implement these practices in the clinical rehabilitation process. The aim of this study was to investigate how significant others participate in the rehabilitation process for people with aphasia in the SLPs point of view. Also, the resources and the causes behind these practices were studied. Methods. This study was carried out as a survey for Finnish speech and language therapists working with people with aphasia. The questionnaire was conducted in e-form and sent via the Finnish Association of Speech Therapists to its members. A total of 56 SLPs participated in the survey. The closed questions of the questionnaire were analyzed quantitatively, by representing percentages and frequencies of the answers. The qualitative analysis was based on the classification of recurring themes in the open-ended questions. Results and conclusions. According to 60 % of the respondents, significant others were part of the evaluation process frequently or always. In planning the rehabilitation, significant others were involved frequently or always according to 68 % of the respondents. Significant others were frequently or always part of the rehabilitation according to 58 % of the respondents. SLPs used varying methods working with significant others, although structured methods described in the literature were seldom used. The participation of significant others was considered fairly important. SLPs recognized the importance of significant others in supporting communication and overall progress in rehabilitation. Structural/organizational constraints were often mentioned and SLPs also felt that significant others weren't always motivated to participate in the rehabilitation process. Time, therapy materials and education were among the resources that were needed more. As a conclusion, this study shows that practices concerning participation of significant others in the aphasia rehabilitation process are somewhat unestablished in Finland, and that communication partner training hasn't quite yet reached clinicians. There are no clinical guidelines concerning aphasia therapy and significant others participation in it, which based on the results, would be needed.
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(2016)Background and aims. The most common and persistent symptom of aphasia is word retrieval deficit, anomia. There is evidence of selective verb retrieval problems amongst non-fluent aphasic speakers. Training verbs in sentence context increases verb naming accuracy in naming tests and enhances verb usage and the use of well-formed syntactic structures in connected speech. Especially intensive interventions in which training takes place in communicative contexts may be beneficial. The aim of this study was to investigate whether a sentence-level verb intervention affects verb naming and the structures and vocabulary of the connected speech of Finnish non-fluent aphasic speakers. Methods. Two speakers with chronic Broca's aphasia participated in this study. Markku, a 35-year-old man, and Annikki, a 72-year-old woman, had both become aphasic due to a single stroke in the left hemisphere. The intervention programme lasted 6–7 weeks and consisted of 15 training sessions of 90 minutes (a total of 22,5 hours). In six different speech production tasks the participants were trained to place obligatory and optional sentence elements around a verb. The target was to promote verb usage in narratives. The effects of the intervention were evaluated by examining verb naming accuracy and speed in a naming test, by calculating the mean length of utterances and the proportion of empty speech in connected speech, and analysing the syntax and the vocabulary of narratives. Results. Markku's aphasia quotient (WAB) increased by 20 points after the intervention as his speech became more fluent and informative. There were no changes in Annikki's aphasia quotient. The intervention had no effect on verb naming in a verb naming test. Both participants produced longer narratives after the intervention, but at the same time the proportion of empty speech increased in Annikki's speech. The mean lengths of utterances didn't change after the intervention. The proportion of utterances including a finite verb increased slightly in Markku's narratives. Simultaneously, the proportion of clauses with an incomplete verb phrase or no verb phrase decreased slightly. The intervention had no effect on syntactic structures in Annikki's case. The number of different verbs increased in both participants' picture description narratives, although the change was much smaller in Annikki's case. There was some evidence in Markku's case that the intervention had a small effect on the vocabulary of personal narratives and descriptions of event sequences. Discussion. The results of this study provide preliminary support for the usefulness of sentence-level verb interventions in aphasia rehabilitation in Finland. The results indicate that this intervention can have a positive effect on the number of different verbs and the number of finite verbs used in non-fluent narratives. However, the response to the intervention seems to be highly individual. The next step would be to examine the efficacy of the intervention method in a larger scale study. The intervention could be modified by increasing the intensity of training and increasing the amount of training without picture support. The intervention method is applicable in the clinical world. In addition, an aphasic speaker and their significant other can train at home using the intervention tasks, so that possible intervention results could be better maintained after the intervention is withdrawn.
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(2016)Aims. Every person with aphasia has some kind of problems with finding words. The aim of this multi-case study was to find out how people with aphasia (PWA) and their conversation partners (CP) adapt to aphasic conversation and collaboratively participate in word search. The emphasis was on the ways the CPs act on the word searches. Word finding difficulties are highlighted in aphasic interaction which can lead to problems with maintaining self-esteem and social relationships in life. Conversation is always a collaborative phenomenon which is why it is important to examine the actions of the CPs of PWA. Methods. This study was a combination of qualitative and quantitative analysis. The participants were 3 dyads: 53 years old man with fluent moderate aphasia and his conversation partners (wife and daughter) and 61 year old woman with fluent severe aphasia and her husband. The data consisted 105 minutes of video material where the aphasic people were having everyday conversation with their CPs. The videos were transcripted and all the word searches were identified. Word searches that expanded into collaborative activity were analyzed with conversation analysis and the ways of CPs participated in them were categorized. The most commonly used categories of participation in conversation were analyzed more in detail. Results and conclusions. Altogether 82 word searches were identified from the data from which 50 of them were analyzed as collaborative word searches. Nine categories of participation were identified from the turns of CPs from which completion, interrogative word offer and specified question were the most commonly used. Also actions that enhanced the asymmetry of the conversation were identified and one dyad had more of those than the other dyads. Both of the PWAs used verbal and nonverbal behavior in the word searches. This shows that it is important to offer as addition to indirect therapy, also interaction based therapy for the PWA and the CP for them to learn and practice communication skills in everyday life. In the field of language and speech therapy PWA are the biggest group of adults who need rehabilitation. Because of the great need of rehabilitation it is important for the individual and for the society that we develop intervention methods and increase the knowledge about aphasia.
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(2015)Objective: Previous studies suggest that outcomes in aphasia therapy are not often routinely measured in the clinical practice. On the other hand, there has been little research on the views of speech and language therapists (SLT) on the outcome evaluation. The objective of this study was to gather information about the opinions of SLT's when it comes to the role, need and value of the outcome evaluation in the clinical practice. Methods: A conceptual framework called theory of alignment was used in this study. The data were collected by interviewing ten SLTs practicing aphasia therapy. The interviews were transcribed and the data were analyzed using qualitative content analysis. Results and conclusions: According to the results SLTs evaluate the outcomes of aphasia therapy for themselves, for the patients and their significant others and for external stakeholders. The role of the outcome evaluation is different depending on the stakeholder needing evaluation. SLTs may consider routine evaluation of the outcomes unnecessary since the different stakeholders do not always create a need for the outcome evaluation. When it comes to the outcomes of aphasia therapy, STLs found it important to get information on their patient's improvement in different contexts. SLTs also valued other persons' opinions of the outcomes as well as information on the patient's symptoms and their further need for aphasia therapy. Furthermore, SLTs considered that the extent and form of information were important when assessing outcomes. Acknowledging the views of SLTs on the outcome evaluation may help to develop the evaluation practices by resolving some problems relating to the evaluation. In case the routine evaluation of outcomes is desired nationally in aphasia therapy, the SLTs should find that there are different stakeholders needing evaluation for a certain reason. When new tests and assessment tools are developed and translated into Finnish language, it should be considered that they will provide information SLTs find worth collecting.
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(2016)Objectives: Intensive language action therapy (ILAT/CILT) has been found to be effective in the treatment of aphasia, even in the chronic state of aphasia. It is based on three principles emphasising several components of therapy: massed practise, functional communicative contexts, and restriction to verbal output only. ILAT is typically practiced in group settings, but in this investigation it was performed on a single-participant design. Studies have shown that verbs and nouns can be separately impaired in aphasia, partly because of the concreteness effect: nouns are more imageable than verbs. The concreteness effect also explains that certain types of verbs are easier to produce than others (concrete versus more abstract verbs). The objective of this study was to measure the increase of concrete and more abstract verb production after the ILAT-intervention. In addition, there has been discussion about functional communication outcomes of aphasia therapy. Therefore, this study also takes into account the measurement of aphasic speaker's everyday communication using self-evaluation (Communicative Activity Log, CAL). Method: The participant of this study was a non-fluent speaker with Broca's aphasia. The quality and the amount of communication was measured two times before the treatment phase and two times after it. The treatment phase included intervention approximately four times per week for six weeks about 1,5 hours each time (30 hours in total). The changes in measured communication were evaluated with statistical tests for effect size. The functional communication was assessed with Communicative Activity Log (CAL). Results and conclusions: The results showed improvement in the production of concrete verbs. The production of abstract verbs did not increase significantly. Functional-communication measure did not demonstrate increase in communication amount and quality right after the therapy, but in the follow-up it did increase. Intensive language action method was found to be an effective treatment also as an individual therapy.
Now showing items 1-10 of 10