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April 3, 2003
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Topics in Geriatric Rehabilitation Vol. 19, No. 2, pp. 98–108 c 2003 Lippincott Williams & Wilkins, Inc.
Evaluation and Treatment of Aphasia Among the Elderly With Stroke
Richard D. Steele, PhD; Lefkos B. Aftonomos, MD; Marilyn W. Munk, MA, CCC-SLP
While aphasia is not per se a geriatric disorder, risk factors for aphasia increase with age, and effective treatments for older individuals must be sensitive to age-related needs and circumstances. This article first reviews evaluation tools, with their assessment domains and ways of using them, then moves to treatment approaches, with an eye in particular to describing experiences using advanced treatment programs with older aphasic patients, and concludes with discussions and examples of outcomes analyses that contribute to our understanding of improvements following treatment in older patients. Key words: advanced treatment programs, aphasia rehabilitation, computers, outcomes
HE DEFINITION of aphasia is a topic of discussion to this day.1 In a 1996 review article, Holland et al defined aphasia as “a language disorder that occurs in adults following focal brain damage, typically involving the language-dominant cerebral hemisphere.”2 They go on to say that while aphasia can occur in children, it is primarily a disorder of older persons—one that limits patients’ abilities to communicate with others through speech, sign, reading, and writing. They note its often devastating impact on the lives of persons who are—prior to onset—typically fully competent communicators. Theirs is a characterization of aphasia that will readily be recognized by clinicians who work with aphasic individuals, as it concisely captures the observable features
From the LingraphiCARE America, Inc., Oakland, Calif (Dr Steele); the Mills-Peninsula Health Services, San Mateo, Calif (Dr Aftonomos); and the Sister Kenny Institute, Minneapolis, Minn (Ms Munk). Corresponding author: Richard D. Steele, PhD, LingraphicCARE America, Inc., East 1325 20th Avenue, Spokane, WA 99203–3437 (e-mail: Steele@cdr.stanford. edu).
of the disorder. Traditional names identify the most common aphasic syndromes. Global aphasia, for instance, is the label applied to severe impairments in all modalities without exception—speaking, speech comprehension, reading, and writing. Broca’s aphasia is characterized by halting, effortful, and telegraphic utterances with relative preservation of verbal comprehension. Wernicke’s aphasia combines fluency of speech-like production with lack of communicative content—eg, via malapropisms, nonsense neologisms, syntactic incoherence, etc—and also with severe comprehension deficits. Conduction aphasia affects verbal expression foremost, in particular the ability to repeat spoken words or phrases. Persons with anomic aphasia contend most observably with a truncated active vocabulary, often searching unsuccessfully for a word or resorting to descriptive paraphrase. While aphasic disorders after stroke are not limited to older persons, the risks for such aphasias do increase with age. The primary cause of aphasia in the United States currently is stroke, and over one third of all stroke hospital admissions present with symptoms of aphasia.3 An aging US population, increasing
Up to one quarter of all geriatric patients with global aphasia have been reported as being demented. older as well as younger persons with aphasia appear well positioned to benefit from properly structured and executed therapeutic regimens that employ contemporary advanced technologies. for example. however. and complicates measures both of spontaneous recovery and improvement after treatment. Pashek and Holland8 found that patients under the age of 70 were twice as likely to show complete or partial recovery compared to patients over 70 one year postonset.10 In developing treatment strategies for geriatric persons with aphasia. but examples of similar lesions resulting in dissimilar aphasia types in older and younger patients have been reported. Older patients judged to be appropriate candidates for speech–language therapy by generally accepted criteria may be expected to perform as well as younger cohorts. the fluent aphasias are more likely to cooccur with anterior lesions in older patients compared to younger ones. may be associated with language deficits. Specific accommodations may be required to meet the special needs of geriatric patients. must be made between deleterious effects of age on spontaneous recovery on the one hand. language. and methods involved. and/or communication in ways similar to aphasic syndromes. Bearing all this in mind. as shown below and elsewhere. as well as with discussion of practical considerations associated with everyday service delivery. The development of advanced treatment technologies in recent years in general extends the range of therapy options available to speech–language therapists working with geriatric patients.9. providing an overview of issues and items of importance to the topic generally. Age may interact with lesion size and location after stroke to influence aphasia type. The presence of dementia will also have an impact on presentation and response to therapy in this group. Both ischemic and hemorrhagic events may produce aphasic syndromes. noninfarct related conditions that are also encountered among older individuals and that may affect speech. and cognitive powers.4–7 Nonfluent aphasias appear to be more prevalent than fluent aphasias generally among geriatric persons. For completeness. these neurodegenerative processes represent a spectrum where language disturbances play typically a less prominent role relative to the disruption of overall cognitive function and the associated behavioral disorders. In general. But absent specific contraindications. and treatment outcomes in response to therapy among geriatric patients on the other. sensory.11–16 This dual approach.AS144-02 April 3. treatment outcomes following appropriately prescribed therapy appear in fact to be independent of age. we conclude this introductory section with a brief overview of other. and greater life expectancies among those who survive stroke all combine to suggest that both the incidence and the prevalence of geriatric aphasias will rise in America’s future. provides readers both with useful overview of main clinical issues. we discuss each topic area from 2 complementary perspectives—first. 19. NO. 2/APRIL–JUNE 2003 99 . Under the major sections below. who as a rule will be in their declining years of physical. and when encountered. and second. subordinate to the cognitive impairments or as a principal feature. nonetheless. presenting concrete examples that draw on the authors’ first-hand experiences over the past several years providing adult outpatient aphasia therapy through a network of advanced community-based treatment programs known specifically as Language Care Center® (LCC) Treatment Programs. Alzheimer and non-Alzheimer dementias. below we offer the discussion of the evaluation and treatment of aphasia after stroke for those who work with older persons.8 Age may negatively influence the extent of spontaneous neurologic recovery in aphasic patients. Advanced age in itself is not a predictor of poor functional rehabilitation outcomes. materials. 2003 21:52 Char Count= 0 APHASIA rates of stroke survival. consideration must be given to the age-appropriateness and acceptability of the tools. and patients may vary consider- ably in preferences. VOL.8 A clear distinction. we believe.
22. the term Pick’s disease has been widely applied to similar progressive degenerative diseases with characteristic associated behavioral disturbances.21 EVALUATION OF APHASIA The clinical assessment of aphasia can involve complete or partial use of standardized instruments. Further information and order forms for WHO’s recently revised instrument. now called the International Classification of Functioning. Since then. and are secondary to the more severe and pervasive memory and behavioral deficits. Frontotemporal dementia (FTD) is the currently preferred term for describing focal frontal and temporal cortical atrophy. This is distinguished from the communicative disturbances of Alzheimer’s disease and frontal lobe dementia. and (iii) the activity limitation level. it identifies 3 distinct levels: (i) the impairment level. may be found at www3. and Health (ICF). Warrington has suggested that such progressive anomic deficits may reflect a fundamen- tal loss of semantic memory. The term Primary Progressive Aphasia (PPA) has been applied to a group of fluent and nonfluent dementia-related aphasias.cfm. with a typical onset in the 55–65-year age group. patients presenting with PPA perform well on tests of semantic memory. Alternatively. validity and reliability are uncertain.who. Levels of assessment Assessments of aphasia—either formal or informal—address various levels of performance and stratify patients by impairment and functional levels. is characterized primarily by a gradual decline in language function as the predominant characteristic with relative preservation of memory. 2003 21:52 Char Count= 0 STEELE et al In 1892. with this approach. paraphasia.23 Documented validity and reliability of such standardized tests make their use psychometrically attractive. in which word-finding difficulties and paucity of speech appear later in the course of the disease. or prosodic impairments. (ii) the participation restriction (or functional) level. impairment refers to loss or abnormality in organic function or structure. but also to malfunctions in nonlanguage systems. The typical presentation consists initially of wordfinding impairments that slowly progress to involve the syntactic and then the semantic components of language.24 Characterized briefly. participation restriction refers to impairmentinduced diminution in capacity to carry out tasks functionally. visuospatial functioning. and personality. stroke) on the lives of individuals is that originally introduced by the World Health Organization (WHO) in 1980 and recently revised. Given access to both necessary assessment instruments and requisite time.20 In contrast. from overgeneralized stereotypical speech patterns to more traditional aphasia symptoms such as dysnomia. Hodges18 describes a classification of the principal variants of FTD including frontal variant FTD. clinical assessments may employ ad hoc tasks or informal procedures devised by examining clinicians or others.int/icf/icftemplate.AS144-02 April 3.19 The PPA syndrome. Patients with semantic dementia may present with a fluent aphasia characterized by loss of memory for words. and progressive nonfluent aphasia. and activity limitation refers to the socially negative consequences of impairments or participation restrictions. A hybrid approach intersperses various ad hoc tasks with selected items extracted from existing instruments. The most widely-known scheme for describing the impact of sickness (eg. such as the Boston Diagnostic Assessment Examination (BDAE) or the Western Aphasia Battery (WAB). These non-Alzheimer dementias are associated with variable degrees and types of behavioral and language disturbances. Disability. Of relevance to treatment and outcome. 100 TOPICS IN GERIATRIC REHABILITATION . semantic dementia. the progressive language impairments in these syndromes may be related not only to linguistic deficits. Pick17 described a case of language disturbance associated with left posterior frontal and temporal atrophy.
where clinicians frequently have little or no access. PICA achieves exquisite sensitivity to change. severities. none focuses on participation restrictions that are occasioned by impairments or activity limitations that are specifically communicative in nature. (iii) Revised Edinburgh Functional Communication Profile31 . (2) supplementary tests for aphasic impairments. there are several other properties that are desirable in assessment instruments to be used in clinical settings. assessment instruments are assigned to 1 of 3 types: (i) psychosocial measure/ depression scales.3 instrument subtypes are identified: (1) general rehabilitation measures. At the level of functional communication (WHO “activity limitation”). given the relative thoroughness with which they assess patients’ performance at the impairment level: (i) Aphasia Diagnostic Profiles26 . (ii) BDAE22 . and (v) ASHA Functional Assessment of Communication Skills for Adults. this is uncommon. 2/APRIL–JUNE 2003 101 .23 The 4 instruments in this list are likely to be familiar. as they are relatively easily gathered by the therapist via testing in the clinic. (iii) Porch Index of Communicative Ability(PICA)27 . Rating scales for assess- ing functional communication include (i) the Functional Communication Profile29 . In practice. (ii) the Communicative Effectiveness Index(CETI)30 . Also. to most clinicians. impairment-level data are most widely used.35 At the WHO “participation restriction” level. the Boston Naming Test for assessing confrontational naming performance). Instead. (3) controlled probe tasks. (iv) the Communication Profile32 . Seven items in the latter 2 categories are worth naming here. at least generally.28 but that very narrowness makes them better suited to uses in more closely-targeted research studies than in community-based clinical treatment programs with their wider range of patient types.25 Instruments at the impairment level fall into 4 subtypes: (1) standardized aphasia test batteries. (2) measures of functional communication—rating scales.27 but administrators must go through a special training and certification course to become proficient in using its 16-level performance scoring scale. and (3) direct assessment of functional communication. which may compromise its practicality for daily clinical application (as opposed to research uses). These include sensitivity to change (responsiveness). there is an unmet need at the participation restriction level for an assessment instrument with a communicative focus.33 Direct assessment of functional communication characterizes (i) Communicative Abilities in Daily Living34 and (ii) the Amsterdam– Nijmegen Everyday Language Test. In contrast. capturing a multidimensional snapshot of patient status at each point of assessment.AS144-02 April 3. Assessment considerations In addition to validity and reliability. if outcomes are to be analyzed and reported. The first subtype—standardized aphasia test batteries—includes 4 items worth listing individually. depending on their authors’ goals during development. and (iv) WAB. While these instruments do probe aspects of handicap. (ii) health-related quality of life measures. NO. it can be comparatively difficult for therapists to validly and reliably assess activity limitation or participation restriction as patients go through the routines of their lives outside the clinic. and (4) discourse sampling. Indeed. then consistency and completeness in clinical data gathering are obligatory. It is VOL. and practicality of administration. Assessment instruments A recent book chapter surveys assessment instruments and assigns each to a subcategory below each WHO level. Instruments vary considerably along these parameters. Assessment instruments in the aforementioned categories (2)–(4) are useful in tracking narrower areas of performance (eg. and (iii) measures of wellbeing. and—without computer assistance—tedious to score. and treatment goals. 2003 21:52 Char Count= 0 APHASIA clinicians could in theory assess each patient at each of the 3 levels. 19. Sometimes the properties work at cross-purposes: for example. it can also be time-consuming to administer. relevance of assessed items to rehabilitation purposes.
TREATMENT OF APHASIA Conceptually. Outcome analyses. document changes after treatment under real-world clinical conditions (mixed etiologies. global aphasia. neurolinguistic approaches that focus on the treatment of underlying linguistic forms. There are. recommended times are at Start of Care (when the patient undergoes initial evaluation). levels of patient compliance. as a treatment of demonstrated efficacy may—or may not—lead to significantly improved outcomes in the real world. rehabilitation specialists including speech pathologists aim if possible for restoration of function through therapeutic interventions. Wernicke’s aphasia. and coherently interpretable results at the 2 levels may boost confidence in emergent findings. and to gather those data completely. to be sensitive to change. Reading. and other factors. there are neuropsychological approaches addressing cognitive impairments 102 TOPICS IN GERIATRIC REHABILITATION . Rather. possible intercurrent medical complications. When treating patients. they have focused primarily on treatment efficacy. etc). The 6 language subtests of WAB (Spontaneous Speech. so that change over the interval can be established. and at Discharge (when course of treatment has been completed). differing patient types. speech therapy for the rehabilitation of adults with aphasia draws on a similar range of approaches as its principal neighbors in rehabilitation medicine. 2003 21:52 Char Count= 0 STEELE et al useful to identify explicitly all portions of an assessment instrument to be administered. For assessment of functional communication. treating clinicians may draw on educative techniques and/or compensatory strategies to enhance functional performance. rigorously observed treatment frequencies and durations. Broca’s aphasia. inconsistent compliance). which may be roughly defined as changes after treatment under ideal conditions (delineated etiologies. From a conceptual perspective. For purposes of documenting treatment outcomes specifically. clear patient syndromes. aphasiology researchers have relatively infrequently investigated treatment outcomes per se. The only way to know for sure whether outcomes are significantly improved after clinical treatment is to track and analyze outcomes directly. to be quick and easy to complete. LCC Programs use CETI. Clinical use of assessment instruments: illustrative example For assessment at the impairment level. caseload mixes. In past decades.36 The distinction is important. Repetition. In constituting courses of treatment for patients. depending on the magnitude and robustness of treatment effects. clinicians in LCC Treatment Programs are encouraged to use the language subtests of WAB. It is also necessary to this end to gather data at 2 points in time. namely physical therapy and occupational therapy. high compliance levels). Naming. speech pathologists may organize therapy regimens in accordance with various alternative conceptual frameworks. which clearly distinguish between aphasic and nonaphasic language. and where restoration is beyond reach.30 CETI was designed to focus on functional tasks of particular importance to persons with aphasia. and administration can usually be accommodated within an initial 90-minute evaluation session. Writing) probe modalities individually. minimal medical complications.23 WAB contains an algorithm for calculating an overall metric of aphasia severity known as the Aphasia Quotient (AQ). This approach provides 2 independent yet related views on patient status. Auditory Verbal Comprehension. and it also assigns aphasic patients to 1 of 8 diagnostic categories (eg. varying treatment frequencies and durations. anomic aphasia.AS144-02 April 3. it is noteworthy that the functional ratings of the family member serve to complement the impairment-level test scores of the treating clinician. in contrast. and to be filled out by a family member or significant other who is able to observe the patient frequently as the latter engages in communicative activities of daily living in the community. for example.
speech pathologists will make best judgments on what practicable therapy approaches are likely to benefit a patient most.2. For example. living and family situations. NO. a patient’s goals. They also have to consider.it variously involved picture identification. treated in the first chapter under “Traditional Approaches” in Chapey’s anthology. being adapted and extended by clinicians using new tools and materials as they have become available. Schuell’s “stimulation approach” to rehabilitation. Neither the activities nor the various resulting modalities of language can be neatly isolated: in her view.39 Hers is an approach that has proved fruitful over time. it should be repeatable. and highly regarded studies. In view of all this. inclusion of other modalities). and reflects the heterogeneity in treatment approaches. Despite the variety and heterogeneity of different treatment approaches. duration. it is not surprising to read Damasio’s observation that “[t]here is no standard treatment of aphasia. intensive auditory stimulation should be used. and sentence completion.40–42 One of the earlier. predictability of timing. treatment duration authorization. personality. and reimbursement levels. it focused on performance in areas ranging from “auditory comprehension”to “writing”. given the range of constraints under which they and the patient will be operating. The resultant performance improvements reflect not so much the reteaching of language as the successful reintegration of the underlying components of competent language use. rehabilitation support. 2/APRIL–JUNE 2003 103 . Complicating matters.” Schuell’s observation that language performance appears to be more impaired than language competence in cases of aphasia led her to believe that important opportunities exist for the reintegration of performance components through appropriate stimulation of the patient. the 1986 VA Cooperative Study under the clinical leadership of Wertz. Her conceptual approach also led to clear and practical recommendations on how therapy should be conducted. it should be controllable. and activities should build upon one another in a coherent. and at the patient’s instance. while others are more eclectic and draw on this or that approach as adjudged to be of likely benefit to patients. Chapey’s anthology37 provides an excellent introduction to the available spectrum. Schuell and colleagues additionally developed a classification system of aphasia reflective of her understanding of the nature of the disorder and opportunities for patient improvement through the stimulation approach. documents both the efficacy. and there are more traditional therapy approaches relying on language stimulation to promote the functional reintegration of underlying cerebral mechanisms. as well as through literature reviews and meta-analyses. Some speech pathologists are strong adherents of one conceptual framework.”38 Rather. controlled studies. therapists must also take into account numerous additional factors beyond speech–language deficits when deciding how to proceed therapeutically. 2003 21:52 Char Count= 0 APHASIA in the comprehension and production of words. provides a good example. competent language performance is “of a piece. aphasia interventions are of demonstrated efficacy.40 Treatment for all patients was described as “individual” though usually of a “stimulus– response” variety.AS144-02 April 3. verbal repetition. integrative fashion. among others. for example. It is probably fair to say that each approach has proved capable of delivering measurable benefits to appropriate patients. stimuli should elicit a response. most rigorously designed. along various dimensions (volume. and none of them has consistently outperformed all others in magnitude of benefits across patients generally. psychological state. largest. 19. there should be systematic work from relatively simpler to relatively more challenging materials. inadequate responses may require not so much correction as repeated or enhanced stimulation. and at selected sites it adhered VOL. Schuell viewed language as the dynamic result of complexly choreographed interactions of activities occurring throughout the brain. Traditional therapy approaches are the most widely used. This has been shown in randomized. therapy setting.
Outcome studies have begun to address this issue.11. paper.AS144-02 April 3.49 Integrated programs with advanced tools: illustrative example As a concrete example. and CETI for patient assessment by family members at the functional communication level—and to submit the scores for entry into a centralized data registry. Such benefits come at a cost. what improvements following treatment are actually documented in clinical practice for patients using a particular approach. and improved performance following treatment. then either the patient must acquire the system or the clinician must provide it. pencil. for example. or treatment software for generalpurpose computers. LCC Treatment Programs incorporate 4 key components that have been designed to work in concert to constitute effective courses of therapy. and yet others relate to the analysis and reporting of clinical outcomes. and associated methods. materials.13 Below we discuss some of the issues faced by clinicians trying to understand and cope with such recent developments. Costs should not thereby increase. For all these reasons. it is not adequate simply to get better results. etc. sometimes with associated print materials. hardware and software require upgrading periodically. require that the clinician purchase or lease a computer system. and (d) specialized Training for treating clinicians in the use of these various LCC tools. word lists.mankato. Clinicians who provide therapy in this way are encouraged to gather data before and after courses of treatment—using WAB for patient assessment at the impairment level. the penetration of high technology into the realms of clinical speech therapy has generally been slow and uneven. In the current context of fis- cal restraints and ever increasing emphases on clinician productivity.45–48 Benefits cited variously include more consistent stimuli. pictures. Software packages. A practical problem here is that one crucial piece of information has typically been lacking. There are time commitments required to learn to operate systems and programs. Many examples may be found at the website www. and further attention will likely be required to individualize treatment for each patient. 2003 21:52 Char Count= 0 STEELE et al to the treatment guidelines of formally specified programs such as Melodic Intonation Therapy. (b) a Data Registry for recording demographic. there are both direct and indirect costs to be borne. these improvements are associated with the incorporation of additional technologies into the treatment process. Recent years have witnessed additional striking improvements in outcomes following treatment of aphasia. diagnostic.msus. (c) a proprietary treatment technology known as the Lingraphica® (LG) System. 104 TOPICS IN GERIATRIC REHABILITATION . a prosthetic version of the LG System is also available. automatic results reporting. treating clinicians in this study drew on the traditional varieties. and assessment data of patients treated. Usually. edu/dept/comdis/kuster2/ For 2 decades.43 or PACE.51 . which is used both during treatment sessions in the clinic and also at home between treatment sessions for patient practice of prescribed clinical exercises50. and data are now available on many hundreds of patients. and if a patient is to practice at home. which provides detailed treatment guidelines for each of the diagnostic categories of aphasia and related disorders. High-technology treatment tools These are usually computer-like clinical devices. Furthermore. As a rule. self-paced practice. researchers have been reporting benefits to patients from the use of such tools. namely. These 4 components are (a) a Patient Care Algorithm. Data aggregation has been underway for several years. While some of these are of the high-technology variety. These are not inconsequential considerations. however. Such tools clearly may confer benefits. treatment. ie. or—even better—they should decrease.44 As to technology. There is the further matter of costeffectiveness. greater clinician productivity. others are organizational/operational in nature. For aphasic patients in need of a Speech Generating Device following discharge from treatment.
2003 21:52 Char Count= 0 APHASIA Outcome analyses using these data establish that persons with aphasia improve significantly.AS144-02 April 3. in every measure tracked following participation in such courses of treatment.2 49.05) for every group in which n ≥ 6.0001 <.7 Post-treatment mean 68.2 VOL.5 points (+10. AQ.5 70.3 48. by age at start of care (n = 282) Age at start of care 20 ≤ Age < 30 30 ≤ Age < 40 40 ≤ Age < 50 50 ≤ Age < 60 60 ≤ Age < 70 70 ≤ Age < 80 80 ≤ Age < 90 90 ≤ Age < 100 ∗ p < . naming.5%). Results documentation: qualitative In addition to quantitatively calculating mean score improvements using assessment instrument scores (as illustrated above). This latter issue appears deserving of further study.3 39. The results document that—while patients in all age ranges may be candidates for significant improvements at the impairment level after treatment in LCC programs—the magnitudes of these improvements may possibly decline slightly with increasing age. Results documentation: quantitative Performance changes after treatment The most straightforward thing to do with outcomes data is to calculate whether.2* +11.2%).2 points (+18.3 58. spontaneous speech. with a mean CETI overall improvement of +18. Visual inspection of the improvement data suggests an overall general pattern of diminution in the improvement scores with increasing age.6 55. A recent analysis of data from 50 participants in 2 LCC Treatment Programs showed these persons with aphasia improved significantly after treatment—in the mean—in every language modality assessed at the impairment level by WAB (ie.3* +10.2 58. one can also examine outcome data to identify important patterns of qualitative change. reading.5 Difference of means +13. as well as on all 16 functional communication items included on CETI. Targeted examples follow below.07) in improvement magnitudes by age ranges. Here.5 59.9 39. auditory verbal comprehension. and that those improvements are significant (p < .0001 <. Quantitative outcome examples—WAB AQ improvements following LCC treatment.5 61.001 >.4 54. a sample of 282 LCC patients of all ages is divided into age ranges by decades.5 66. Table 1 illustrates how outcome analyses can help better understand the relationship of age to improvements after treatment.14 Mean AQ improvement for the sample was found to be +10.1 50. repetition.3 52. writing) and on WAB’s overall metric of severity. n 4 6 14 46 81 85 43 3 Pre-treatment mean 55. in the mean. NO. and 42 who had been discharged from more traditional speech therapy previously.3 +16. the performance of a sample of patients has improved significantly after treatment on some assessed item.1* +7.0001 <. in the mean. Analysis shows that the mean AQ score improves in every age range. and a one-way analysis of variance reveals a trend toward significance (p = . with WAB AQ means before and after treatment calculated and compared by groups. 19. 2/APRIL–JUNE 2003 105 . Previous analyses have documented a significant pattern of evolution to less severe aphasia Table 1.0001 <.8 p >.1* +8.2* +13. This sample included 34 patients who were more than 6 months postonset at start of LCC care.4* +9.05.01 <.1 .
Medicare began covering the provision of such SGDs to appropriate patients with aphasia and related disorders.0 points following treatment. some older (as well as younger) adults with aphasia benefit from having a speech generating device (SGD) to help meet their communication needs in everyday life following discharge from speech therapy. with brief device descriptions and effectiveness discussions. while 3 patients (4%) were reassigned to a more severe diagnostic category. Qualitative outcome examples—changes in aphasia diagnostic categories following LCC treatment. while 0 of 46 (0%) evolved to more severe diagnostic categories. 2003 21:52 Char Count= 0 STEELE et al Table 2. and documenting outcomes that are well conceived and executed for persons with aphasia in general appear to hold their worth in dealing with aphasia among geriatric 106 TOPICS IN GERIATRIC REHABILITATION . Table 2 compares patients’ WAB assignments to aphasia diagnostic categories before and after LCC treatment specifically for patients whose WAB AQ score changed— up or down—by at least 5. Speech generating devices in aphasia rehabilitation Finally. Results show that—among these 79 chronically aphasic older patients—19 (24%) were reassigned to a less severe aphasia diagnostic category following LCC treatment. in chronically aphasic patients 75 years and older (n = 79) Within Transcortical normal Global Broca’s Wernicke’s motor Conduction Anomic limits Pre-Tx Dx Global (7) Broca’s (25) Wernicke’s (7) Transcortical motor (2) Conduction (10) Anomic (28) 5 2 1 17 1 2 4 Post-Tx Dx 1 5 1 2 8 1 23 1 4 1 Categories are ordered by ascending midpoints of AQ-ranges. diagnostic categories in chronic aphasia following participation in LCC Treatment Programs. ways of evaluating aphasia. numbers in the table indicate patient counts by diagnostic categories. and beginning in 2001. In the previous report.” Katz52 gives a more complete list of available options. italics indicate same-type aphasia diagnostic categories before and after LCC treatment.12 Table 2 presents the findings of such an analysis using data specifically from a sample of older patients.0 points. In a recent chapter entitled “Computer applications in aphasia treatment. This general comparability suggests that whatever mechanisms underlie these particular changes may be available to many older patients as well as to younger ones. the overall pattern was rather similar: 17 of 46 subjects (37%) evolved to less severe diagnostic categories. Such prosthetic aids properly represent yet another element in the arsenal of tools available for aphasia rehabilitation.AS144-02 April 3. all of whom were more than 6 months postonset at start of LCC care and hence were in the presumed chronic stage of aphasia. treating patients. In this instance. which included both younger and older aphasic patients. boldface indicates different type of aphasia diagnostic categories accompanied by an AQ change—up or down—of at least 5. the patient sample comprises 79 individuals over 75 years of age. CONCLUSIONS The conclusions that follow appear warranted on the basis of available evidence: First.
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