An exploration of aphasia therapy dosage in the first six months of stroke recovery

Abstract

Aphasia research uses the length of time within rehabilitation sessions as the main measure of dosage. Few papers detail therapeutic ingredients or outline the number of times these were delivered over the treatment period. The present observational study identified therapeutic ingredients in the Very Early Rehabiltiation in SpEech (VERSE) trial and explored the dosage provided using a model of cumulative intervention intensity (CII). Therapists video recorded one therapy session per week and 53 (12%) randomly selected therapy videos were analysed. The videos were coded for number of error productions, self-corrections and type and frequency of therapist cueing. The Western Aphasia Battery Revised-Aphasia Quotient (WABR-AQ) was used for measuring patient outcome with total verbal utterances (p < 0.001) and cues used with success (p < 0.001) being independent positive predictors of WABR-AQ score at six months post stroke and hypothesized as key therapeutic ingredients. The CII was calculated by counting identified therapeutic ingredients and multiplying this by the number of sessions completed. Collectively, the key ingredients occurred on average 504 times per session and over 10,000 times per participant during the treatment period. This paper reports a novel approach for identifying key treatment ingredients and detailing the dosage delivered within an early aphasia rehabilitation trial.

Advancing Stroke Recovery Through Improved Articulation of Nonpharmacological Intervention Dose

“…• Motor rehabilitation: Scrivener et al 31 demonstrated that in a 30-minute observation period with early subacute stroke patients, exercise repetitions ranged from 4 up to 369. • Language rehabilitation: Brogan et al 32 showed that in a 51-minute session, use of 2 key ingredients was varied with total verbal utterances ranging from 21 to 944 and cues used with success ranging from 0 to 196. Therefore, we need an approach that captures the interrelatedness of the multiple dimensions of nonpharmacological intervention dose.…”

Treatment fidelity monitoring, reporting and findings in a complex aphasia intervention trial: a substudy of the Very Early Rehabilitation in SpEech (VERSE) trial

“…Further, the treatment fidelity reported here was completed at the macrostructure level. Previously published work [22,23] presents finer grained, utterance level analyses and adds nuanced therapeutic information to the efficacy picture. Finally, the receipt of treatment and enactment of treatment skills areas of Bellg et al [5] were not measured in this study and so cannot be commented on.…”

Better long-term speech outcomes in stroke survivors who received early clinical speech and language therapy: What’s driving recovery?

“…Further studies should i) focus on the proportion of time given to language-related therapeutic activities, rather than the less-exact 'number of hours' measure, ii) obtain more detail on the diverse contexts in which therapy may occur and (iii) ask patients to formally record their "therapy homework" and other language practice activities. By quantifying the number of specific therapeutic inputs, a measure of cumulative intervention intensity can be calculated (Brogan et al, 2020), and evaluated alongside all the other factors found to influence inter-patient variability in recovery (e.g., patients' physical and mental health, cognitive abilities, level of engagement, demographics, social support). Ultimately, this will improve predictions of outcomes and the response to therapy at the individual patient level (Aguilar et al, 2018).…”