Predicting Outcomes of Language Rehabilitation: Prognostic Factors for Immediate and Long-Term Outcomes After Aphasia Therapy

Kristinsson, Sigfus; Basilakos, Alexandra; Ouden, Dirk-Bart den; Cassarly, Christy; Spell, Leigh Ann; Bonilha, Leonardo; Rorden, Chris; Hillis, Argye E.; Hickok, Gregory; Johnson, Lisa; Busby, Natalie; Walker, Grant M.; McLain, Alexander C.; Fridriksson, Julius

doi:10.1044/2022_jslhr-22-00347

Cited by 10 publications

(5 citation statements)

References 109 publications

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“…These results should be interpreted with caution because the length of the follow-up period varied substantially and we do not have any detailed information about SLT intensity or extra access to community-based aphasia programs during that time. Still, these data indicate the long-term stability of treatment effects in a real-world setting, similar to the 6-month follow-up data of previous studies [11,28]. Assuming a less intensive treatment period between post-treatment and follow-up assessment, the percentage of even more improvements at the individual level was surprisingly high (63%).…”

Section: Discussionsupporting

confidence: 87%

“…In our dataset, we had more than 10% missing data on handedness and education. Correlation analyses did not indicate any significant relationships with therapy outcome (see Supplementary Table 5), in accordance with previous literature [11,27,28]. Consequently, handedness and education were removed from further statistical analyses.…”

Section: Missing Data and Outlierssupporting

confidence: 75%

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Success rates of intensive aphasia therapy: real-world data from 448 patients between 2003 and 2020

Peitz,

Schumann-Werner,

Hussmann

et al. 2024

J Neurol

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Background Aphasia is a devastating consequence after stroke, affecting millions of patients each year. Studies have shown that intensive speech and language therapy (SLT) is effective in the chronic phase of aphasia. Leveraging a large single-center cohort of persons with aphasia (PWA) including patients also in the subacute phase, we assessed treatment effects of intensive aphasia therapy in a real-world setting. Methods Data were collected at the Aachen aphasia ward in Germany between 2003 and 2020. Immediate treatment responses across different language domains were assessed with the Aachen Aphasia Test (AAT) using single-case psychometrics, conducted before and after 6–7 weeks of intensive SLT (10 h per week, median (IQR) dosage = 68 (61–76)). We adjusted for spontaneous recovery in subacute patients. Differential treatment effects between subgroups of chronicity and predictors of therapy response were investigated. Results A total of 448 PWA were included (29% female, median (IQR) age = 54 (46–62) years, median (IQR) time post-onset = 11 (6–20) months) with 12% in the early subacute, 15% in the late subacute and 74% in the chronic phase of aphasia. The immediate responder rate was 59%. Significant improvements in all AAT subtests und subscales were observed hinting at broad effectiveness across language domains. The degree of therapy-induced improvement did not differ between the chronicity groups. Time post-onset, dosage of therapy and aphasia severity at the beginning of treatment were predictors of immediate treatment response. Discussion Intensive therapy protocols for aphasia after stroke are yielding substantial responder rates in a routine clinical setting including a wide range of patients.

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Section: Discussionsupporting

confidence: 87%

Section: Missing Data and Outlierssupporting

confidence: 75%

Success rates of intensive aphasia therapy: real-world data from 448 patients between 2003 and 2020

Peitz,

Schumann-Werner,

Hussmann

et al. 2024

J Neurol

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“…for detailed protocol). 25 Language testing included the Western Aphasia Battery (WAB), from which an overall aphasia severity score [Aphasia Quotient (WAB AQ)] was calculated for each participant. Behavioural tests were administered on a laptop (MacBook Pro) or an iPad by ASHA-certified speech and language pathologists with experience working with individuals with aphasia.…”

Section: Methodsmentioning

confidence: 99%

Under pressure: the interplay of hypertension and white matter hyperintensities with cognition in chronic stroke aphasia

Hannan,

Busby,

Roth

et al. 2024

Brain Communications

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While converging research suggests that increased white matter hyperintensity load is associated with poorer cognition, and the presence of hypertension is associated with increased white matter hyperintensity load, the relationship among hypertension, cognition and white matter hyperintensities is not well understood. We sought to determine the effect of white matter hyperintensity burden on the relationship between hypertension and cognition in individuals with post-stroke aphasia, with the hypothesis that white matter hyperintensity load moderates the relationship between history of hypertension and cognitive function. Health history, Fazekas scores for white matter hyperintensities and Wechsler Adult Intelligence Scale Matrix Reasoning subtest scores for 79 people with aphasia collected as part of the Predicting Outcomes of Language Rehabilitation study at the Center for the Study of Aphasia Recovery at the University of South Carolina and the Medical University of South Carolina were analysed retrospectively. We found that participants with a history of hypertension had increased deep white matter hyperintensity severity (P < 0.001), but not periventricular white matter hyperintensity severity (P = 0.116). Moderation analysis revealed that deep white matter hyperintensity load moderates the relationship between high blood pressure and Wechsler Adult Intelligence Scale scores when controlling for age, education, aphasia severity and lesion volume. The interaction is significant, showing that a history of high blood pressure and severe deep white matter hyperintensities together are associated with poorer Matrix Reasoning scores. The overall model explains 41.85% of the overall variation in Matrix Reasoning score in this group of participants. These findings underscore the importance of considering cardiovascular risk factors in aphasia treatment, specifically hypertension and its relationship to brain health in post-stroke cognitive function.

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“…Behavioral and imaging data from participants (N = 70) with chronic language impairment (aphasia) after left-hemisphere stroke were retrospectively analyzed. All participants were part of the Predicting Outcomes of Language Rehabilitation (POLAR; NCT03416738) study at the Center for the Study of Aphasia Recovery (C-STAR) at the University of South Carolina and the Medical University of South Carolina (Kristinsson et al, 2021(Kristinsson et al, , 2023. ASHAcertified speech-language pathologists with experience working with individuals with aphasia administered all assessments.…”

Section: Methodsmentioning

confidence: 99%

Dissociating reading and auditory comprehension in persons with aphasia

Harrington¹,

Kristinsson²,

Wilmskoetter³

et al. 2023

Preprint

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Rationale: Language comprehension is often affected in individuals with post-stroke aphasia. However, deficits in auditory comprehension are not fully correlated with deficits in reading comprehension and the mechanisms underlying this dissociation remain unclear. This distinction is important for understanding language mechanisms, predicting long-term impairments, and future development of treatment interventions. Using comprehensive auditory and reading measures from a large cohort of individuals with aphasia, we evaluated the relationship between aphasia type and reading comprehension impairments, the relationship between auditory vs. reading comprehension deficits and the crucial neuroanatomy supporting the dissociation between reading and auditory deficits.Methods: Scores from the Western Aphasia Battery Revised (WAB-R) from 70 participants with aphasia after a left-hemisphere stroke were utilized to evaluate both reading and auditory comprehension of linguistically equivalent stimuli. Univariate ANOVAs were used to assess the relationship between auditory comprehension and aphasia types and linear models were employed to test the relationship between reading and auditory comprehension deficits. Lesion symptom mapping (LSM) was used to determine the dissociation of crucial brain structures supporting reading comprehension deficits controlling for auditory deficits and vice-versa. Results: Participants with Broca's or global aphasia had the worst performance on reading comprehension. Auditory comprehension explained 26% of the variance in reading comprehension for sentence completion and 44% for following sequential commands. Controlling for auditory comprehension, worse reading comprehension performance was independently associated with damage to the inferior temporal gyrus, fusiform gyrus, posterior inferior temporal gyrus, inferior occipital gyrus, lingual gyrus, and posterior thalamic radiation.Conclusion: Auditory and reading comprehension are only partly correlated in aphasia. Reading is an integral part of daily life and directly associated with quality of life and functional outcomes. This study demonstrated that reading performance is directly related to lesioned areas in the boundaries between visual association regions and ventral stream language areas. This behavioral and neuroanatomical dissociation provides information about the neurobiology of language and mechanisms for potential future treatment interventions.

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Predicting Outcomes of Language Rehabilitation: Prognostic Factors for Immediate and Long-Term Outcomes After Aphasia Therapy

Cited by 10 publications

References 109 publications

Success rates of intensive aphasia therapy: real-world data from 448 patients between 2003 and 2020

Success rates of intensive aphasia therapy: real-world data from 448 patients between 2003 and 2020

Under pressure: the interplay of hypertension and white matter hyperintensities with cognition in chronic stroke aphasia

Dissociating reading and auditory comprehension in persons with aphasia

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