Generalization and maintenance of treatment gains in primary progressive aphasia (PPA): a systematic review

Cadório, Inês; Lousada, Marisa; Martins, Paula; Figueiredo, Daniela

doi:10.1111/1460-6984.12310

Cited by 79 publications

(60 citation statements)

References 42 publications

(126 reference statements)

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“…The average number of sessions available for impairment‐focused interventions (2.8) reported by respondents is significantly less than the number of sessions reported to be effective in a recent review of impairment‐based interventions for PPA (Cadório et al . ). This review examined evidence from studies delivering interventions over a range of between five and 96 therapy sessions.…”

Section: Discussionmentioning

confidence: 97%

“…Despite there being little indication of the ‘optimal’ dose, longer interventions did result in better outcomes in people with svPPA (Cadório et al . ). It is possible that these SLT respondents deprioritize impairment‐based interventions knowing they are unable to deliver them at the intensity reported in the research literature.…”

Section: Discussionmentioning

confidence: 97%

“…, Cadório et al . ) and a research update (Croot 2018). A systematic review of the effects of functional communication‐focused interventions for people with PPA and their caregivers is currently in preparation by the authors (Volkmer et al .…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Speech and language therapy for primary progressive aphasia across the UK: A survey of current practice

Volkmer

Spector

Warren

et al. 2019

Intl J Lang & Comm Disor

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Background: Primary progressive aphasia (PPA) describes a heterogeneous group of language-led dementias. People with this type of dementia are increasingly being referred to speech and language therapy (SLT) services. Yet, there is a paucity of research evidence focusing on PPA interventions and little is known about SLT practice in terms of assessment and provision of intervention. Aims: To survey the practices of SLTs in the areas of assessment and intervention for people with PPA. Methods & Procedures:A 37-item, pilot-tested survey was distributed electronically through the Royal College of Speech and Language Therapists (RCSLT), Clinical Excellence Networks (CENs) and social media networks. Survey items included questions on care pathways, assessment and intervention approaches, and future planning. Analysis was conducted using descriptive statistics and thematic analysis. Outcomes & Results: A total of 105 SLTs completed the survey. Respondents reported more frequently using formal assessment tools designed for stroke-related aphasia than for dementia. Informal interviews were reportedly always used during assessment by almost 80% of respondents. Respondents were significantly more likely to use communication partner training than impairment-focused interventions. Goal attainment was the most commonly used outcome measure. Respondents provided 88 goal examples, which fell into six themes: communication aid; conversation; functional communication; impairment focused; specific strategy; and communication partner. Additionally, respondents reported addressing areas such as future deterioration in communication and cognition, decision-making and mental capacity, and driving. Ten (9.4%) respondents reported the existence of a care pathway for people with PPA within their service. Conclusions & Implications:This survey highlights the range of current PPA assessment and intervention practices in use by the respondents. Communication partner training is commonly used by the surveyed SLTs, despite the lack of research evidence examining its effectiveness for PPA. There is a need to develop evidence-based care pathways for people with PPA in order to advocate for further commissioning of clinical services. What this paper addsWhat is already known on the subject People with PPA present with communication difficulties, yet they find it difficult to access SLT services. Research literature examining the effectiveness of PPA interventions remains sparse and is dominated by impairment-based approaches to word relearning. Little is known about the nature of services delivered by SLTs to people with PPA in the UK.What this paper adds to existing knowledge SLT respondents report using informal assessment tools such as interviewing, or those designed for stroke-related aphasia, not for dementia. SLTs report that they were more likely to select communication partner training than

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 97%

See 1 more Smart Citation

Speech and language therapy for primary progressive aphasia across the UK: A survey of current practice

Volkmer

Spector

Warren

et al. 2019

Intl J Lang & Comm Disor

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“…A growing body of literature indicates that behavioral interventions in PPA can result in improvement of the targeted language function, although there are generalization and maintenance issues (Cadório et al, 2017). Research on bilingual aphasia rehabilitation after stroke has yielded inconsistent results regarding the pattern of cross-linguistic therapy effects (Goral and Conner, 2013).…”

Section: Discussionmentioning

confidence: 99%

Bilingualism in a Case of the Non-fluent/agrammatic Variant of Primary Progressive Aphasia

2018

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There is a growing body of research on language impairment in bilingual speakers with neurodegenerative diseases. Evidence as to which language is better preserved is rather inconclusive. Various factors seem to influence language performance, most notably age of acquisition, level of proficiency, immersion and degree of exposure to each language. The present study examined fluency, lexical, discourse and grammatical abilities of a Greek-French late bilingual man with the non-fluent/agrammatic variant of primary progressive aphasia (nfvPPA). Speech samples derived from three different narrative tasks in both languages were analyzed using quantitative production analysis (QPA) and fluency measures. The first aim of the study was to compare the participant's connected speech production to that of Greek-speaking normal controls. The second aim was to determine whether Greek (L1) and French (L2) were differentially impaired. To our knowledge, this is the first report of connected speech deficits in a Greek-speaking patient with PPA and the first study which uses QPA to compare L1 and L2 narratives in a bilingual speaker with PPA. Compared to neurologically healthy controls, our participant was impaired in lexical, discourse and grammatical productivity measures, but did not differ in measures of grammatical accuracy. The presence of dysfluencies, reduced speech rate and simplified syntax is consistent with the pattern of impairment reported for the nfvPPA. Results showed that narrative production measures did not differ significantly between languages. However, they suggest a slightly worse performance in his second, non-dominant, language despite a similar pattern of impairment in both languages. Lengthy exposure to L2 and regular activation of L2 through daily use may explain the preservation of discourse abilities in his non-dominant language. This study calls attention to factors such as language dominance, proficiency, patterns of use, and exposure to a language. These factors play a key role in assessing bilingual individuals with PPA and making clinical decisions.

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“…With specific regard to PWPPAs, aphasia treatment leads to long-term retention of baseline speech-language abilities as well as shortand long-term improvements in abilities. 10,17,[51][52][53][54][55] Treatment approaches have included computerized semantic naming treatment, lexical retrieval cascade treatment, reading treatment, script training, and more. Some of these approaches have been paired with errorless learning or noninvasive brain stimulation.…”

Section: Neuroplasticity and Automatizationmentioning

confidence: 99%

Can Script Training Improve Narrative and Conversation in Aphasia across Etiology?

2019

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Script training is an effective treatment of stable (e.g., stroke-induced) and progressive aphasia of varying severities and subtypes. The theoretical underpinnings of script training are discussed and include fluency-inducing conditions, speech shadowing, principles of neuroplasticity, and automatization. Script training outcomes are reviewed, with a focus on discourse in persons with stable aphasia (PWSAs) and in persons with primary progressive aphasia (PWPPAs). PWSAs and PWPPAs are able to acquire and maintain short scripted monologues or conversational dialogues, with some evidence of generalization to untrained topics and settings. Advances in both technology and access have enriched script training protocols, so they now range from no-tech written script approaches to high-tech audiovisual support and avatars. Advances in audio and/or visual support promote large amounts of practice of less errorful whole-message language processing during a fluent language inducing condition. With enough practice, users decrease reliance on supports and independently produce scripted content. Script training can be delivered in a variety of settings (individual, group, telepractice), lends itself well to homework programs, and is in accordance with the principles of neuroplasticity for neurorehabilitation. Incorporating script training into therapy programming is advantageous throughout aphasia recovery following brain injuries such as stroke. It is also beneficial for persons with progressive disease for prophylaxis, remediation, and compensation. Recommendations for implementing script training in clinical practice and future research directions are presented.

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Generalization and maintenance of treatment gains in primary progressive aphasia (PPA): a systematic review

Cited by 79 publications

References 42 publications

Speech and language therapy for primary progressive aphasia across the UK: A survey of current practice

Speech and language therapy for primary progressive aphasia across the UK: A survey of current practice

Bilingualism in a Case of the Non-fluent/agrammatic Variant of Primary Progressive Aphasia

Can Script Training Improve Narrative and Conversation in Aphasia across Etiology?

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