Esther Sung Kim

Bilingual aphasia is an acquired language disorder, most commonly caused by stroke, that affects both languages of a bilingual speaker. Similarly, multilingual aphasia may impact all languages used...

The Canadian Stroke Best Practice Recommendations 7 ^th edition update of the Rehabilitation, Recovery and Community Participation module is presented in three parts. This publication, Part One of the series, reflects the growing and changing body of research evidence available to guide planning, ongoing screening and assessment, management, education, and support of individuals with stroke, their families, and caregivers. This module provides guidance for the planning and delivery of coordinated and seamless systems of care from acute stroke onset to return to community settings by an interdisciplinary team of healthcare providers with expertise in stroke. These recommendations were developed with active involvement of people with lived experience of stroke at all phases. These recommendations are intended to support the progress achieved during the initial recovery stages and enable individuals with stroke to resume life roles and leisure activities as best as possible, to achieve optimal recovery goals. Evidence for effective rehabilitation therapies and support for individuals with stroke and their families continues to emerge and gaps in knowledge should drive future research.

The 7th edition update of the Rehabilitation, Recovery and Community Participation module is presented in three parts. Part Three of the series reflects the current research evidence focused on person-centered care, optimizing an individual’s return to their community and engaging in active and meaningful participation. Emphasis is placed on regular healthcare follow-up, maximizing secondary prevention strategies, assessment, diagnosis, and management of mood disorders and cognitive status, sleep health, and post-stroke fatigue. Personal issues that are important and meaningful to individuals with stroke are addressed, including returning to driving, vocational roles, relationships, sexuality, life roles, leisure, social participation, advance care planning, and palliative care. This module highlights the need for coordinated and seamless systems of care that extend beyond the first few months after stroke, building on progress achieved during the initial recovery, to support seamless longer-term recovery. The main goal of these recommendations is to help individuals with stroke achieve as much independence as possible in meaningful life roles and leisure activities. Successful planning across transitions requires integrated and coordinated people-centered efforts by all stroke team members and the broader community. Active engagement of the individual and family at all stages of planning and goal setting is essential.

Background: People with aphasia present with language and communication deficits, most notably in lexical retrieval (naming). Although positive outcomes in naming have been observed following speech-language treatment, many individuals with aphasia continue to face impairments after the acute phase of rehabilitation. Mobile app–based therapies are increasingly being used by speech-language pathologists in the rehabilitation of people with aphasia as an adjunct to or in lieu of traditional in-person therapy approaches. These apps can increase the intensity of treatment and have been shown to result in meaningful outcomes across several domains. Objective: VoiceAdapt is a mobile therapy app addressing naming impairments, designed within a user-centered design framework. The VoiceAdapt app uses two evidence-based lexical retrieval treatments to engage people with aphasia to improve their naming abilities through interaction with the app. The purpose of this study was to conduct a randomized controlled trial to examine the preliminary clinical efficacy of training with VoiceAdapt on the language and communication outcomes of people with aphasia. Methods: A two-arm, waitlist-controlled, crossover group randomized controlled trial was conducted at two sites within Canada. During the intervention phase, participants completed 5 weeks of independent training with the app, which involved naming practice using Semantic Features Analysis and Phonological Components Analysis. The primary outcome measure was naming performance (Boston Naming Test); secondary outcomes included measures of overall language and naming (Western Aphasia Battery-Revised), communication (Communication Effectiveness Index), and quality of life (Stroke and Aphasia Quality of Life Scale-39). Results: A total of 37 people with aphasia in the chronic stages (average 4.6 y postonset of aphasia) participated in this study. Participants used the app for an average of 20 hours over the 5-week intervention phase. Training with VoiceAdapt resulted in an increase of 1.6 points on the Boston Naming Test (Cohen d=0.3). Evidence for improved naming was also observed on trained items, as well as subtests of naming or word-finding on the WAB-R. Training with the app also resulted in a significant increase in participants’ perceptions of their communication quality of life (increase of 0.1 points; Cohen d=0.3), but no other measures (WAB-R Aphasia Quotient, Communicative Effectiveness Index) were significant. Conclusions: Individuals with aphasia who used the VoiceAdapt app for 5 weeks to target naming skills demonstrated measurable gains in naming and communication-based quality of life. Notably, these changes were observed in a remotely delivered program, in participants who were in the chronic stages of aphasia. These findings inform the profession on the use of app-based home therapy programs as an accessible, cost-effective option for individuals in the chronic stages of recovery who often have limited options for rehabilitation.

Primary progressive aphasia (PPA) and primary progressive apraxia of speech (PPAOS) are neurodegenerative syndromes characterized by progressive decline in language or speech. There is a growing number of studies investigating speech-language interventions for PPA/PPAOS. An updated systematic evaluation of the treatment evidence is warranted to inform best clinical practice and guide future treatment research. We systematically reviewed the evidence for behavioral treatment for speech and language in this population. Reviewed articles were published in peer-reviewed journals through 31 May 2021. We evaluated level of evidence, reporting quality, and risk of bias using a modified version of the American Speech-Language Hearing Association (ASHA) Levels of Evidence, an appraisal point system, additional reporting quality and internal/external validity items, and, as appropriate, the Single Case Experimental DesignScale or the Physiotherapy Evidence Database – PsycBITERating Scale for Randomized and Non-Randomized Controlled Trials. Results were synthesized using quantitative summaries and narrative review. A total of 103 studies reported treatment outcomes for 626 individuals with PPA; no studies used the diagnostic label PPAOS. Most studies evaluated interventions for word retrieval. The highest-quality evidence was provided by 45 experimental and quasi-experimental studies (16 controlled group studies, 29 single-subject designs). All (k = 45/45) reported improvement on a primary outcome measure; most reported generalization (k = 34/43), maintenance (k = 34/39), or social validity (k = 17/19) of treatment for at least one participant. The available evidence supports speech-language intervention for persons with PPA; however, treatment for PPAOS awaits systematic investigation. Implications and limitations of the evidence and the review are discussed.

This study aims to describe the experiences and needs of Canadian speech-language pathologists (SLPs) who conducted communication assessments via telepractice across the lifespan during the first year (2020) of the COVID-19 pandemic. The present study consisted of an online survey that aimed to capture both quantitative aspects of telepractice-based communication assessment and the qualitative experience of shifting to telepractice. One hundred sixty-eight practicing SLPs across Canada participated in the survey, between September 2020 and January 2021. Quantitative results were analysed using descriptive statistics while open-ended responses were analysed using thematic analysis. SLPs identified challenges and opportunities relating to client and family engagement, access to and knowledge of technology, and the reliability of assessment tools. SLPs also identified a future need for online assessment materials and training, such as materials adapted for different communication needs (e.g. augmentative and alternative communication). The present study contributes to a growing understanding worldwide of potential benefits and challenges related to telepractice, fuelled by the necessary shift in practices in our field during the COVID-19 pandemic. The results provide direction for continuing to build a valid and inclusive approach to telepractice in the future.

Background: Indigenous populations across Canada, the United States (US), Australia, and New Zealand (NZ) are disproportionately affected by traumatic brain injury (TBI) and traumatic spinal cord injury (TSCI), both of which can lead to a lifetime of ongoing treatment as well as physiological and psychological impacts. Despite this, a paucity of data exists related to the healthcare experiences within the pathways of care specific to Indigenous populations with TBI/TSCI. This scoping review aims to identify the types of research conducted for, with, and about Indigenous populations, while comparing existing knowledge gaps concerning TBI/TSCI among Indigenous populations across Canada, US, Australia, and NZ. Methods: This review was guided by a five-stage scoping review methodology. It was conducted by a collaborative team of Indigenous and non-Indigenous researchers and a Traditional Knowledge Keeper. We searched 9 databases for peer-reviewed articles related to TBI and/or TSCI and Indigenous populations across all four countries, published between 2000-2021. The initial search resulted in 2,110 sources, and two independent reviewers (EK & LR) screened all citations for inclusion. Overall, 75 articles were selected for the final review. Results: A total of 75 articles were included in the final review. 68 studies were focused exclusively on TBI, and 7 studies focused on TSCI. 23 of the included studies were from Australia, 24 from US, 15 from Canada, and 12 from NZ, and one paper was a commentary led by researchers in more than one country. The studies were focused across 5 main subject areas: epidemiology (n=33), rehabilitation (n=25), physician perspectives (n=5), patient knowledge (n=5), and full pathway of care (n=7). Across these themes, three sub-themes also emerged: patient experience (n=11), development of culturally appropriate tool/program (n=10), and cultural understandings of neurotrauma (n=3). Moreover, only 20 of the 75 studies included some form of Indigenous community engagement. Implications & Conclusion: Overall, this scoping review highlighted the types of research being done about TBI/TSCI within Indigenous populations, the current knowledge gaps, and how communities are involved within the research process. Global healthcare systems operate differently, and consequently, result in varying health outcomes. The results highlight that there is a lack of Indigenous-driven projects, and a gap within Indigenous-specific data collection strategies. This calls for future research to be driven by community-specific priorities and prioritize Indigenous data governance strategies.

Pupil dilation functions as a proxy for cognitive effort and can be measured through automated pupillometry. The aim of this scoping review is to examine how individuals with cognitive impairment differ in task-evoked pupillary responses relative to cognitively healthy individuals. A systematic literature search across six databases was conducted to identify studies examining changes in pupillary responses evoked by cognitive tasks comparing patients with dementia to healthy controls. Eight articles met inclusion criteria and were included for review. Differences in task-evoked pupillary response between cognitively impaired and cognitively healthy participants were observed across studies. Pupil dilation is decreased in patients with Alzheimer’s Disease compared to controls, with no difference observed in patients with mild cognitive impairment. A mild, non-significant trend towards reduced pupil dilation in patients with either Parkinson’s Disease or Dementia with Lewy Bodies suggests a similar but less pronounced effect than in AD patients. Further research is required to examine the utility of task-evoked pupillary responses as a potential biomarker indexing cognitive decline in individuals transitioning to mild cognitive impairment and/or dementia.

Purpose: Communication access is a human right, but many individuals with communication impairments face challenges accessing their environments. As part of a larger study investigating barriers and facilitators to communication access in the retail/service industry, the purpose of the present study was to investigate the experiences of people with aphasia (PWA) accessing goods and services in their communities. Methods: Nine PWA were interviewed about their experiences accessing retail businesses and services. Interviews were coded and thematically analyzed to identify key themes related to barriers and facilitators to communication during business interactions. Stakeholders on the research team included two PWA, who provided input throughout the research process. Results: Three main themes were found: supporting communication, aphasia awareness and education, and respect for PWA. Codes within each theme comprised facilitators that led to positive experiences and barriers that led to negative business interactions. Discussion/Conclusions: People with aphasia identified tangible ways that retail businesses can be made more communicatively accessible. Stakeholders with aphasia made meaningful contributions to the research process. Future work will investigate how these findings, integrated with business perspectives, can be used to support businesses in applying strategies to become more communicatively accessible.

Background: Script training is an aphasia treatment approach that has been demonstrated to have a positive effect on communication of individuals with aphasia; however, it is time intensive as a therapeutic modality. To augment therapy-induced neuroplasticity, transcranial direct current stimulation (tDCS) may be implemented. tDCS has been paired with other speech-language treatments, however, has not been investigated with script training.Aims: The purpose of this study was to determine if tDCS improves communication proficiency when paired with script training, compared to script training alone.Methods and Procedures: A single-subject experimental design was implemented with a participant with non-fluent aphasia, using two scripts across treatment conditions: script training with sham-tDCS, and script training with anodal-tDCS. Treatment sessions were 75 min long, administered three times weekly. Anodal tDCS was implemented for 20 min with a current of 1.5 mA over the right inferior frontal gyrus.Results: Large effect sizes were obtained on script mastery for both stimulation conditions (anodal d₂ = 9.94; sham d₂ = 11.93). tDCS did not improve script accuracy, however, there was a significant improvement in the rate of change of script pace relative to baseline (3.99 seconds/day, p < 0.001) in the anodal tDCS condition.Conclusion: Despite a null tDCS result on accuracy, the script training protocol increased script performance to a near-fluent level of communication. There is preliminary evidence to suggest that tDCS may alter the rate of script acquisition, however, further research to corroborate this finding is required. Implications for future studies are discussed.