Developments in the application of Intensive Comprehensive Aphasia Programs: an international survey of practice

Rose, Miranda; Pierce, John; Scharp, Victoria L.; Off, Catherine A.; Babbitt, Edna M.; Griffin-Musick, Jenna R.; Cherney, Leora R.

doi:10.1080/09638288.2021.1948621

Cited by 19 publications

(12 citation statements)

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“…Fifteen SLTs had been involved in ICAP provision reflecting a minimum of six individual ICAPs in England and at least one in Scotland. Previously research found two modified ICAPs and one ICAP running in the United Kingdom (Rose et al, 2021), so the numbers reported in this survey reflect growth.…”

Section: Icapsmentioning

confidence: 74%

“…A scoping review of 17 ICAPs with peer-reviewed published data found that although the basic parameters of an ICAP are defined, programmes vary widely in their interpretation and ratio of comprehensive content, and interventions are highly personalised, which brings into question the active ingredients of an ICAP (Monnelly et al, 2021). Rose et al (2021) found most ICAPs were funded by self-pay or insurance (9/14) or research funds (3/14), and donations were required to sustain 6/14 programmes. ICAP costs have been reported to vary between $70 and $5229 per week per person (Henson, 2016).…”

Section: Introductionmentioning

confidence: 99%

“…There are efforts underway in Australia to implement a well-researched university-based ICAP 'Aphasia LIFT' (Dignam et al, 2015;Rodriguez et al, 2013) into a clinical setting (Shrubsole et al, 2022). Currently, ICAPs are not mainstream approaches to aphasia rehabilitation, but are growing in popularity (Rose et al, 2021). Shrubsole et al (2019a) advise that to implement an aphasia intervention in a clinical context, due consideration must be given to addressing known barriers, and that for successful implementation, solutions must match the type of barriers which present.…”

Section: Introductionmentioning

confidence: 99%

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Intensive and comprehensive aphasia therapy—a survey of the definitions, practices and views of speech and language therapists in the United Kingdom

Monnelly

Marshall

Dipper

et al. 2023

Intl J Lang & Comm Disor

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BackgroundResearch evidence suggests aphasia therapy must be delivered at high intensity to effect change. Comprehensive therapy, addressing all domains of the International Classification of Functioning, Disability and Health, is also called for by people with aphasia and their families. However, aphasia therapy is rarely intense or comprehensive. Intensive Comprehensive Aphasia Programmes (ICAPs) were designed to address this challenge, but such programmes are not widely implemented.AimsThis study surveyed the views of UK‐based speech and language therapists (SLTs) regarding intensive and comprehensive aphasia therapy. It explored definitions of intensive and comprehensive therapy, patterns of provision, views about candidacy and barriers/facilitators. It also investigated awareness of ICAPs and perceived potential of this service model. Differences across UK regions and workplace settings were explored.Methods & ProceduresAn e‐survey ran for 5 months. Quantitative data were analysed using descriptive and inferential statistics. Qualitative free text comments were analysed using content analysis.Outcomes & ResultsTwo hundred twenty‐seven respondents engaged in the e‐survey. Definitions of intensive aphasia therapy did not reach UK clinical guideline/research‐level thresholds for most of the sample. Those providing more therapy provided definitions with higher standards of intensity. Mean therapy delivered was 128 min/week. Geographical location and workplace setting influenced the amount of therapy delivered. The most frequently delivered therapy approaches were functional language therapy and impairment‐based therapy. Cognitive disability and fatigue were concerns for therapy candidacy. Barriers included lack of resources and low levels of optimism that issues could be solved. 50% of respondents were aware of ICAPs and 15 had been involved in ICAP provision. Only 16.5% felt their service could be reconfigured to deliver an ICAP.Conclusions & ImplicationsThis e‐survey evidences a mismatch between an SLT's concept of intensity and that espoused by clinical guidelines/research. Geographical variations in intensity are concerning. Although a wide range of therapy approaches are offered, certain aphasia therapies are delivered more frequently. Awareness of ICAPs was relatively high, but few respondents had experience of this model or felt it could be executed in their context. Further initiatives are needed if services are to move from a low‐dose or non‐comprehensive model of delivery. Such initiatives might include but not be confined to wider uptake of ICAPs. Pragmatic research might also explore which treatments are efficacious with a low‐dose model of delivery, given that this model is dominant in the United Kingdom. These clinical and research implications are raised in the discussion.What this paper addsWhat is already known on this subject There is a gap between the high intensity of aphasia treatment provided in research versus mainstream clinical settings. A lower standard of 45 min/day set by UK clinical guidelines is also not achieved. Although speech and language therapists (SLTs) provide a wide range of therapies, they typically focus on impairment‐based approaches.What this study adds This is the first survey of UK SLTs asking about their concept of intensity in aphasia therapy and what types of aphasia therapy they provide. It explores geographical and workplace variations and barriers and facilitators to aphasia therapy provision. It investigates Intensive Comprehensive Aphasia Programmes (ICAPs) in a UK context.What are the clinical implications of this work? There are barriers to the provision of intensive and comprehensive therapy in the United Kingdom and reservations about the feasibility of ICAPs in a mainstream UK context. However, there are also facilitators to aphasia therapy provision and evidence that a small proportion of UK SLTs are providing intensive/comprehensive aphasia therapy). Dissemination of good practice is necessary and suggestions for increasing intensity of service provision are listed in the discussion.

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Section: Icapsmentioning

confidence: 74%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Intensive and comprehensive aphasia therapy—a survey of the definitions, practices and views of speech and language therapists in the United Kingdom

Monnelly

Marshall

Dipper

et al. 2023

Intl J Lang & Comm Disor

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“…Most notably, not all stroke survivors with aphasia have access to the ICAP service delivery model. The ICAPs remain relatively scarce worldwide (Rose et al, 2021) and the financial and operational costs of the ICAP model are high (Boyer et al, 2020). The ICAPs that use GSCs have the potential to increase access and to reduce costs associated with staffing.…”

Section: Discussionmentioning

confidence: 99%

“…The Intensive Comprehensive Aphasia Program (ICAP) service delivery model is growing worldwide as a preferred form of post–acute aphasia rehabilitation (Monnelly et al, 2021; Rose et al, 2013; Rose et al, 2021). By definition, ICAPs must include cohort-based individual and group therapy interventions, infusing evidence-based, patient-centered goals that target both the impairment and communicative participation levels of the WHO-ICF (Rose et al, 2013; World Health Organization [WHO], 2001).…”

Section: Introductionmentioning

confidence: 99%

Graduate Student Clinicians in Health Care Professions as Stakeholders in Intensive Comprehensive Aphasia Program (ICAP) Implementation and Research

Off

Scharp

Griffin-Musick

2023

Topics in Language Disorders

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Purpose: This article characterizes graduate student clinicians' (GSCs') understanding of their roles as stakeholders in clinical implementation and research before participating in an intensive comprehensive aphasia program (ICAP). Method: Seven GSCs participated in a pre-ICAP intervention focus group to characterize their perceived roles in stakeholder-engaged research. Following an extensive ICAP training orientation and clarification of key definitions, the focus group prompt asked GSCs to describe what they view as important issues for developing future research protocols that investigate student clinician outcomes in the context of an ICAP. Qualitative content analysis using an inductive coding approach was applied to the focus group transcript. Results: The GSCs preparing to participate in ICAPs report that they are highly invested in the clinical implementation and research of the ICAP service delivery model. Discussion/Conclusions: The GSCs are crucial stakeholders in the development of GSC-run ICAPs across clinical implementation and all phases of research.

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Comparative efficacy of non-invasive brain stimulation for post-stroke aphasia: A network meta-analysis and meta-regression of moderators

Ding¹,

Zhang²,

Huang³

et al. 2022

Neuroscience & Biobehavioral Reviews

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Developments in the application of Intensive Comprehensive Aphasia Programs: an international survey of practice

Cited by 19 publications

References 46 publications

Intensive and comprehensive aphasia therapy—a survey of the definitions, practices and views of speech and language therapists in the United Kingdom

Intensive and comprehensive aphasia therapy—a survey of the definitions, practices and views of speech and language therapists in the United Kingdom

Graduate Student Clinicians in Health Care Professions as Stakeholders in Intensive Comprehensive Aphasia Program (ICAP) Implementation and Research

Comparative efficacy of non-invasive brain stimulation for post-stroke aphasia: A network meta-analysis and meta-regression of moderators

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