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Cited by 75Neurobiology of Language and BilingualismAssistive Technology in Communication and MobilityDementia and Cognitive Impairment Research

Improving outcomes for persons with aphasia in advanced community-based treatment programs

Aftonomos, Lefkos B., Appelbaum, James S., Steele, Richard D.·1999·Stroke
DOI 10.1161/01.str.30.7.1370
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Abstract

Background and Purpose —Studies have yet to document that community-based aphasia treatment programs routinely produce results comparable or superior to published research protocols. We explore this issue here in an outcome study of individuals with aphasia enrolled in 2 community-based, comparably managed and equipped therapy programs, which use a specially designed computer-based tool that is employed therapeutically in adherence to an extensive, detailed, and formally trained patient care algorithm. Methods —Patients (n=60) were assessed before and after treatment with standardized instruments at both the impairment and the disability levels. Pretreatment and posttreatment means were calculated and compared, with statistical significance of differences established with the use of 1-tailed matched t tests. One-way ANOVAs were used to analyze the comparability of patient performance changes among various subgroups, eg, patients in acute versus chronic stages of aphasia, patients by aphasia diagnostic type at start of care, patients by severity level at start of care, and patients by treatment location. Results —Analysis shows that patients spanned a wide range of aphasia diagnostic types, impairment severity levels at start of care, and times after onset. Patients’ mean performance scores improved significantly in response to treatment in all measures assessed at both the impairment level and the functional communication level. Mean overall improvements ranged from 6.6% to 19.8%, with statistical significance ranging from P =0.0006 to P <0.0001. ANOVAs revealed no significant differences between improvements in patients in the acute versus chronic stages of aphasia, between those at different impairment severity levels at start of care, between those treated at different locations, or, at the functional level, between those with different diagnostic types of aphasia at start of care. Conclusions —–Measures of both language impairment and functional communication can be broadly, positively, and significantly influenced by therapy services that are delivered to persons with aphasia in these community-based programs. The significant improvements are shown to be available to individuals with chronic as well as acute aphasia and independent of diagnostic type of aphasia, impairment severity at start of care, or geographic program location.

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Crossref · 10.1161/01.str.30.7.1370

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  • The WAB-AQ summary effect sizes (within-group 5.03; between-group 5.05) matched its SEM of 5, a value previously described as clinically meaningful improvement.

    “WAB-AQ summary ESs (Within group: 5.03; Between group: 5.05), were equivalent to its SEM of 5, which has been framed as a metric of clinically meaningful improvement.40–42”

    From Benchmarks of Significant Change After Aphasia Rehabilitation (2019) · cites this paper as [42]

  • Hula et al. (2010) found that the WAB-AQ's SEM was about 2 for AQs from 28 to 68, but rose to as high as 12 outside that interval.

    “However, the seminal work of Hula, Donovan, Kendall & Gonzalez-Rothi, 2010,42 demonstrating that the WAB-AQ’s SEM was actually closer to 2 for AQs between 28-68, but much higher (i.e., up to 12) for scores outside that range (i.e., AQs of 0-27, 69-100) serves to clearly distinguish the summary ES established in this study from measurement error.”

    From Benchmarks of Significant Change After Aphasia Rehabilitation (2019) · cites this paper as [42]

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Research works printed but not linked: 9

  1. Steele RD, Weinrich M, Kleczewska MK, Carlson GS, Wertz RT. Eval- uating performance of severely aphasic patients on a computer-aided visual communication system. In: Brookshire RH, ed. Clinical Apha- siology. Vol 17. Minneapolis, Minn: BRK Publishers; 1987:46 -53.
  2. Appelbaum JS, Steele RD, Aftonomos LB, Harris VM. Improving outcomes for aphasic patients in advanced, Center-based treatment programs. Paper presented at: 1998 Clinical Aphasiology Conference; June 14 -17, 1998; Asheville, NC.
  3. Appelbaum JS, Harris VM, Chadwell AL. Maximizing functional outcomes in communication for persons with aphasia. Paper presented at: Tenth Annual Stroke Rehabilitation Conference; October 15-16, 1998; Boston, Mass.
  4. Steele RD, Aftonomos LB, Appelbaum JS, Harris VM. Language Care Center SM Treatment Programs for promoting recovery in aphasia: tools, materials, methods, and outcomes. Aphasiology. In press.
  5. Wertz RT, Deal JL, Holland AL, Kurtzke JF, Weiss DG. Comments on an uncontrolled aphasia no treatment trial. ASHA. 1986;38:31. Letter.
  6. Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Assessment: melodic intonation therapy. Neurology. 1994;44:566 -568.
  7. Damasio AR. Aphasia: review article, medical progress. N Engl J Med. 1992;326:531-539.
  8. Ellwood PM. Outcome management: a technology of patient experience. N Engl J Med. 1988;318:1549 -1556.
  9. Darley FL. Aphasia. Philadelphia, Pa: Saunders; 1982.

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Authors
Aftonomos, L. B., Appelbaum, J. S., & Steele, R. D.
Affiliations
From LingraphiCARE America, Inc, Language Care Center, Palo Alto, Calif (L.B.A., R.D.S.); Department of Rehabilitation Medicine, Mills-Peninsula Hospital, San Mateo, Calif (L.B.A.); Language Care Center of Kansas City (Kan) (J.S.A.); and Kanza Group, Kansas City, Mo (J.S.A.).
Venue
Stroke
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
1999-07
Volume
30
Issue
7
Pages
1370-1379
ISSN
  • 0039-2499 (ISSN-L)
  • 1524-4628
DOI
10.1161/01.str.30.7.1370
OpenAlex
W2125458147
Cited by
75
References
37
Citations by year
2026: 2 · 2024: 1 · 2023: 1 · 2022: 1 · 2021: 2 · 2019: 2 · 2018: 3 · 2017: 5 · 2016: 2 · 2015: 4 · 2014: 3 · 2013: 4
FWCI
1.66
Type
journal article
Language
en
Open access
closed
Locations
  • Stroke (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Life Sciences › Neuroscience › Cognitive Neuroscience › Neurobiology of Language and Bilingualism
  • Health Sciences › Health Professions › Occupational Therapy › Assistive Technology in Communication and Mobility
  • Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
Keywords
aphasia, computer-assisted therapy, language impairment, functional communication, chronic aphasia, acute aphasia, aphasia severity, stroke rehabilitation
MeSH terms
Adult, Aged, Aged, 80 and over, Analysis of Variance, Aphasia, California, Community Health Services, Female, Humans, Kansas, Male, Middle Aged, Speech Therapy, Treatment Outcome

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