From Participants to Participationin Aphasia Research

Leora Cherney, Jackie Hinckley, Lisa Stewart

WHATEXACTLYIS“LPAA”RESEARCHLEORAR.CHERNEY,PHD,CCC-SLP,BC-ANCDS

COLEMANFOUNDATIONCHAIRSCIENTIFICCHAIR:THINKANDSPEAKLAB

SHIRLEYRYANABILITYLABPROFESSOR,PHYSICALMEDICINE&REHABILITATION,

PROFESSOR,COMMUNICATIONSCIENCES&DISORDERSNORTHWESTERNUNIVERSITY

ISTHISLPAARESEARCH?

• Recoveryoflanguagefunctionandbrainmetabolisminapatientwithcrossedaphasia:2yearfollow-upofbrainFDGPETimages

• Gavelclubforpeoplewithaphasia:communicationconfidenceandqualityofcommunicationlife

• Useofco-verbalgesturesduringword-findingdifficultyamongCantonesespeakerswithfluentaphasiaandunimpairedcontrols

• Publicawarenessofaphasia– resultsofaSwedishsample• Playingateamgameimproveswordproductioninpost-strokeaphasia

• Erroranalysisoforalparagraphreadinginindividualswithaphasia

ISTHISLPAARESEARCH?

• Effectsofphonomotor treatmentondiscourseproduction?

• Deliveringwordretrievaltherapiesforpeoplewithaphasiainavirtualenvironment

• Abehavioralstudyofthenatureofverb-noundissociationinthenonfluent variantofprimaryprogressiveaphasia

• Motorevokedpotentialofupperlimbsispredictiveofaphasiarecovery

• Aninvestigationofhospitalityindustrystudents’awarenessandknowledgeofaphasia

• Speakalongwithoutthesong:Whatpromotesfluencyinpeoplewithaphasia?

Mission: Growing a network of healthcare, business, and community leaders to advance lifelong communication access for people with aphasia.

http://www.aphasiaaccess.org

LIFEPARTICIPATIONAPPROACHTOAPHASIA(LPAA)

• Generalphilosophyandmodelofservice-delivery• Focusesonre-engagementinlifebystrengtheningdailyparticipationinactivitiesofchoice

• http://www.asha.org/public/speech/disorders/LPAA.htm

LIFEPARTICIPATIONAPPROACHTOAPHASIA(LPAA)

• LPAAplacesthelifeconcernsofthoseaffectedbyaphasiaatthecenterofalldecisionmaking.

• Itempowerstheconsumertoselectandparticipateintherecoveryprocessandtocollaborateonthedesignofinterventionsthataimforamorerapidreturntoactivelife.

• TheLPAAProjectGroup(RobertaChapey,JudithF.Duchan,RobertaJ.Elman,LindaJ.Garcia,AuraKagan,JonLyon,andNinaSimmonsMackie)oftheAmericanSpeech-LanguageHearingAssociation

• http://www.asha.org/public/speech/disorders/LPAA.htm

COREVALUESOFLPAA

• Explicitgoalisenhancementoflifeparticipation• Allthoseaffectedbyaphasiaareentitledtoservice

• Measuresofsuccessincludedocumentedlifeenhancementchanges

• Bothpersonalandenvironmentalfactorsaretargetsofintervention

• Emphasisisonavailabilityofservicesasneededatallstagesofaphasia

ARETHESETHECOREVALUESOFLPAARESEARCH?

• Explicitgoalisenhancementoflifeparticipation• Allthoseaffectedbyaphasiaareentitledtoservice

• Measuresofsuccessincludedocumentedlifeenhancementchanges

• Bothpersonalandenvironmentalfactorsaretargetsofintervention

• Emphasisisonavailabilityofservicesasneededatallstagesofaphasia

PICOPROCESS

• ThePICOprocess isatechniqueusedinevidencebasedpractice toframeandansweraclinicalorhealthcarerelatedquestion.

• ThePICOacronymstandsfor• P – Populations/People/Patient/Problem• I – Intervention• C – Comparison,ControlorComparator(optional)• O – Outcome

P– POPULATIONS/PEOPLE/PATIENT/PROBLEM

• Allthoseaffectedbyaphasiaareentitledtoservice

• Personwithaphasia• Otherswhoareincontactwiththepersonwithaphasia

• Familymembers• Professionals/students• Communitymembers

• Emphasisisonavailabilityofservicesasneededatallstagesofaphasia

• Acute,Subacute,Chronic

I– INTERVENTION(S)

• Explicitgoalisenhancementoflifeparticipation• Bothpersonalandenvironmentalfactorsaretargetsofintervention

I– INTERVENTION(S)

• Explicitgoalisenhancementoflifeparticipation• Bothpersonalandenvironmentalfactorsaretargetsofintervention

I– INTERVENTION(S)

• Howexplicitmustthegoalofenhancinglifeparticipationbe?

I– INTERVENTION(S)

• LPAAempowerstheconsumertoselectandparticipateintherecoveryprocessandtocollaborateonthedesignofinterventionsthataimforamorerapidreturntoactivelife.

C– COMPARISON,CONTROLORCOMPARATOR(OPTIONAL)

• Comparinginterventions• Comparingparticipants(controlgroup)• Personwithaphasiamayserveashis/herowncontrol

• Single-subjectdesign• Delayedtreatment/wait-listcontrol

O– OUTCOME

• Measuresofsuccessincludedocumentedlifeenhancementchanges

LIVINGWITHAPHASIA:FRAMEWORKFOROUTCOMEMEASUREMENT(A-FROM)

LIVINGWITHAPHASIA:FRAMEWORKFOROUTCOMEMEASUREMENT(A-FROM)

HOWMANYELEMENTSOFPICOMUSTBELPAARELATED?

Playingateamgameimproveswordproductioninpost-strokeaphasia

P- participantswithaphasiaI- teamgame;picturenaming;groupmay“reducefeelingsofisolationandlackofconfidence”C– pre/postassessmentO– picturenaming;discourse(descriptionof

picturedscene)

FOCUSOFTHEQUESTION

• Assessment• Diagnosis• Prognosis• Treatment• Cost-Effectiveness• Prevention

STUDYDESIGN

• QuantitativevsQualitative• RetrospectivevsProspective• SystematicReview• Single-subjectdesign(singlecaseexperimentaldesign)

• RCT(Phase1,2or3)

ISTHISLPAARESEARCH?

• Recoveryoflanguagefunctionandbrainmetabolisminapatientwithcrossedaphasia:2yearfollow-upofbrainFDGPETimages

• Gavelclubforpeoplewithaphasia:communicationconfidenceandqualityofcommunicationlife

• Useofco-verbalgesturesduringword-findingdifficultyamongCantonesespeakerswithfluentaphasiaandunimpairedcontrols

• Publicawarenessofaphasia– resultsofaSwedishsample• Playingateamgameimproveswordproductioninpost-strokeaphasia

• Erroranalysisoforalparagraphreadinginindividualswithaphasia

ISTHISLPAARESEARCH?

• Effectsofphonomotor treatmentondiscourseproduction?

• Deliveringwordretrievaltherapiesforpeoplewithaphasiainavirtualenvironment

• Abehavioralstudyofthenatureofverb-noundissociationinthenonfluent variantofprimaryprogressiveaphasia

• Motorevokedpotentialofupperlimbsispredictiveofaphasiarecovery

• Aninvestigationofhospitalityindustrystudents’awarenessandknowledgeofaphasia

• Speakalongwithoutthesong:Whatpromotesfluencyinpeoplewithaphasia?

InternationalClassificationofFunctioning,DisabilityandHealth