Aphasia LIFT: Effects of increased treatment duration on measures of
impairment, activity/participation, QOL, and satisfaction
Amy Rodriguez 1,2,3,4 Brooke Grohn1,2 Eril McKinnon1 Charlene Pearson1,2
Kyla Brown1,2 Sophia Van Hees1,3 David Copland1,3 Linda Worrall1,2
1 Centre for Clinical Research Excellence in Aphasia Rehabilitation 2 School of Health and Rehabilitation Science, The University of Queensland, Brisbane, QLD
3 Communication Disability Centre, The University of Queensland, Brisbane, QLD 4 Centre for Clinical Research, The University of Queensland, Brisbane, QLD
Background
Intensive: minimum 3 hrs/day, 5 days/wk, 2 wks
Comprehensive: targets impairment and
activity/participation levels of language functioning
individual and group therapy
patient/family education
technology
Goal : “Maximize communication potential and enhance
life participation”
Cherney et al., 2011
Intensive comprehensive aphasia programs (ICAPs)
Background
Family and
friends
Goal setting
Daily
feedback
Positive
approach
Aphasia
friendly
Neuro-
plasticity
Challenge
tasks
Education
Background
First trial demonstrated positive results across all outcome measures
Variability of improvement and participant feedback resulted in
increasing program duration
To determine if increased treatment duration would yield improved
outcomes in:
language impairment
functional communication
communication-related QOL
participant satisfaction
Participants
LIFT 1 LIFT 2
Gender 3M, 2F 6M, 2F
Age 18-68 years
(~52 yrs)
40-79 years
(~65 yrs)
MPO
8-49 months (~26.4 mos)
12-56 months (~21.4 mos)
Aphasia mild to
moderate severe
moderate to severe
AOS
mod-severe (n=1) moderate (n=2)
mod-severe (n=1)
Treatment Delivery
Impairment
Functional
Group
Challenge
0 30 60
mins mins mins
1 wks 2 wks 3 wks 4 wks
Intervention
duration
1 day 3 days 5 days
Session
frequency
Computer
LIFT 1
LIFT 2
Session
duration
Impairment
• skill-based
• word retrieval
• sentence
production
• AOS
**clinician led
Treatment Approaches
Functional
• context-based
• role-playing
• supported
communication
**clinician led
Computer
• REACT
• Aphasia
Tutor
• Speech
Sounds on
Cue
**student led
Group
• aphasia
education,
support
• successfully
living with
aphasia
• conversation
**student and
clinician led
Challenge Task
• communication-
based task
• preparation of
presentation for
final day
**student led
Language
Impairment
• Comprehensive
Aphasia Test (CAT) –
Naming Subtest
• Boston Naming
Test (BNT)
Outcome Measures
Functional
Communication
• Communicative
Effectiveness Index
(CETI)
• Discourse
(CIU & CIU/min)
Participant
Satisfaction
• Self-rated scale
• Semi-structured
interview
Quality of
Life
• ASHA Quality of
Communication Life
Scale (QCL)
• Assessment for
Living with Aphasia
(ALA)
LIFT Group Results
Mean (SD) Range p-value ES Corrected ES
CAT
Naming
22.2 (22.4)
25.6 (23.8)
0- 51
0- 58
.012
.12
.10
BNT
19.3 (18.2)
22.2 (20.4)
0- 43
0- 47
.021
.17
.14
CETI
4.16 (1.5)
5.81 (1.8)
1.69- 7.0
2.61- 8.19
.008
.64
.51
Discourse
34.1 (14.4)
41.3 (14.0)
14.7- 52.5
24.1- 63.1
.017
.52
.37
ALA
101.9 (17.6)
113.2 (19.6)
78.5- 129.50
83.0- 142.0
.017
.61
.48
QCL
3.64 (.76)
4.09 (.64)
2.50- 4.82
2.88- 4.88
.038
.89
.69
Individual Snapshot
CAT BNT CETI Discourse ALA QCL
L1P1 √ √ √ √ √ √ √ -- √
L1P2 √ √ √ √ √ √ √ √ √
L1P3 √ √ √ -- √ √ -- √
L1P4 √ √ -- √ √ -- √ -- √ --
L2P1 √ √ √ √ √ √ √ -- √ √ √ --
L2P2 -- -- -- -- √ √ -- -- -- -- √ √
L2P3 -- -- -- -- √ √ -- -- √ √ √ √
L2P4 √ √ -- -- √ √ √ -- -- √ -- √
L2P5 -- √ √ √ √ √ √ √ -- -- √ --
L2P6 -- -- -- -- √ √ -- -- √ -- -- --
L2P7 -- -- -- -- √ √ √ -- √ √ √ √
Satisfaction
LIFT 1 LIFT 2
0
0.5
1
1.5
2
2.5
3
3.5
4
4.5
5 LIFT 1 LIFT 2
Has your communication
improved?
4.75 4.71
Were you satisfied with
your progress in therapy?
5.00 4.71
Were your goals met?
4.50 4.36
Satisfaction
CG: I think Joe was extremely tired
through those four weeks and he felt that
perhaps if they had two weeks and then a
break and then another two weeks.
CG: I think in Roger’s case, I think four weeks was far
too long… I don’t know…
PWA: ...That was it. It was everything. It was beautiful. It
was really nice. Bit much (pointing to page) to do every night
the same thing, the same thing....
Interviewer: So you’ve got here Monday, Tuesday,
Wednesday, just do three days a week.
PWA: Yeah.
PWA: I don’t know, just more
(laughing).
Interviewer: Intensity
CG: Yeah, he enjoyed that
PWA: Yeah, I mean I wanted to
work, yeah.... And if you’re, like
I’m younger (unclear), so I’m forty
years....
Satisfaction
CG: At first I was excited that he got into the program, but I realised that Roger’s disability is there for a long haul and my expectation in the beginning may have been too high....
PWA: Da-da-da good. (holds up two fingers)
But da-da-da (shaking head) talk.
Interviewer: Talk
CG: learn how to talk. It was good, but she
didn’t learn how to talk.
Interviewer: It was good but you didn’t
learn how to talk?
PWA: Yeah. PWA: still want to be able to talk…
Conclusion
Increasing the duration of Aphasia LIFT yielded variable but
positive outcomes
Improvements in naming/word retrieval
only those with some residual naming ability improved
Greatest improvement on proxy-rated functional communication
increase for all participants regardless of severity
Improvement in some participants on performance-based
functional communication measures
Conclusion
Improvements in self-rated communication-related QOL
regardless of aphasia severity
Treatment gains were enduring in most cases
Self-rated satisfaction was high for communication improvement,
progress in therapy and achievement of goals, but some issues
highlighted during feedback
increased intensity difficult for older and more severe participants
increased intensity= increased expectations
Future Directions
Next LIFT trial in November
3 week duration, 50 hours
cognitive testing
treated/untreated items
caregiver outcomes/satisfaction
Investigation of non-intensive LIFT (aka NiCAP)
8 week duration, 50 hours
Acknowledgments
Aphasia LIFT Team
This project is supported by the NHMRC CCRE in Aphasia Rehabilitation.
Linda Worrall
David Copland
Anthony Angwin
Kyla Brown
Elizabeth Cardell
Petrea Cornwell
Bronwyn Davidson
Brooke Grohn
Shiree Heath
Lucy Lyons
Eril McKinnon
Anna Macdonald
Charlene Pearson
Rachelle Pitt
Alexia Rohde
Tracy Roxbury
Sophia Van Hees
Tara Brown
Caitlyn Brandenburg
Melissa Cook
Jessie Cutler
Melody Dobrinin
Rebecca Dodds
Tasha Haran
Keegan Hewitt
Vanessa Hoare
Caitlyn O’Connor
Katrina Quirke
Victoria Sandham
Shelly Tregea
Alana Vickers