From the introduction: "There are two variants of fronto-temporal dementia: a behavioral variant (behavioral FTD, bvFTD, Neary et al. (1998)), which causes changes in behavior and personality but leaves syntax, phonology and semantics relatively intact, and a variant that causes impairments in the language processing system (Primary Progessive Aphasia, PPA (Gorno-Tempini et al., 2004). PPA can be subdivided into subtypes fluent (fluent but empty speech, comprehension of word meaning is affected / `semantic dementia') and non-fluent (agrammatism, hesitant or labored speech, word finding problems). Some identify logopenic aphasia as a FTD-variant: fluent aphasia with anomia but intact object recognition and underlying word meaning."
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Patients with poststroke aphasia have higher mortality rates and worse functional outcome than patients without aphasia. Nurses are well aware of aphasia and the associated problems for patients with stroke because they have daily contact with them. The challenge is to provide evidence-based care directed at the aphasia. Although rehabilitation stroke guidelines are available, they do not address the caregiving of nurses to patients with aphasia. The aim of this study was to explore the evidence on rehabilitation of stroke patients with aphasia in relation to nursing care, focusing on the following themes: (1) the identification of aphasia, (2) the effectiveness of speech-language interventions.The findings of this study can be used to develop nursing rehabilitation guidelines for stroke patients with aphasia. Further research is necessary to explore the feasibility of using such guidelines in clinical nursing practice and to examine the experiences of patients with nursing interventions directed at aphasia.
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Background: Difficulty in communicating (due to aphasia) can have serious consequences for patients in health care settings. Communication Partner Training is effective for improving communication between people with aphasia and health care professionals. Aim and Objective: This study aims to evaluate the feasibility of developing and introducing a Communication Program which focuses on improving communication between nurses and persons with aphasia in a peripheral hospital setting. Methods & Procedures: A mixed-methods feasibility study was conducted with a pre-test post-test design in the quantitative part and two focus group discussions in the qualitative part. Nurses received training for communicating with persons with aphasia. In the pre-test and post-test, nurses filled in a questionnaire for barriers and facilitators and a feasibility questionnaire. Nurses’ attitudes towards the Communication Program were further explored in two focus group discussions. Outcomes & Results: Forty six nurses took part in the training sessions. Most nurses were satisfied about the Communication Program (24/30) and intended to continue using it (25/30). Almost all nurses saw positive effects for patients with aphasia (27/30), such as an increase in the ability to communicate. However, nurses reported that using the program was time consuming and that they still often experienced frustration when communicating with persons with aphasia. Conclusions: Improving communication with persons with aphasia via the Communication Program seems feasible and valuable according to nurses. Nurses probably need more support during implementation of the Communication Program, mainly due to time barriers and the complexity of communicating with persons with aphasia. Further research should focus on revising the program, training health care professionals with different educational backgrounds, and assessing the implementation of this communication partner training in health care settings.
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This thesis focuses on improving communication between people with aphasia and healthcare professionals (HCPs) working in hospitals or rehabilitation centers. After acquiring brain injury, people with aphasia generally go to healthcare facilities to receive acute- and multidisciplinary rehabilitation care. Unfortunately, communication access in healthcare facilities has not been fully available to people with aphasia. The general aim of this thesis was to improve the accessibility of communication in Dutch and Flemish healthcare centers for people with aphasia by developing and evaluating a Communication Partner Training (CPT) intervention for HCPs, named CommuniCare.
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Background There is an increasing amount of research that investigates the needs and wishes of people with aphasia and their relatives with regards to improving the accessibility of communication with healthcare professionals (HCP). An important way to improve this is by training HCP to use supportive conversation techniques and tools. Objectives This study aimed to inform the development of such a training, by adding to previous findings in the literature regarding the experiences, needs and wishes of people with aphasia and their relatives. We were interested in their experiences with the accessibility of communication and support from HCP and how they believed this can be improved. Methods An exploratory qualitative research design was chosen. Data was collected through qualitative semi-structured interviews with 20 people with aphasia and 12 relatives. The time post stroke ranged from 3 months to 41 years. Results Four themes described the data. According to people with aphasia and relatives (1) information transfer in healthcare settings and (2) the use of supported conversation techniques by HCP are inadequate, (3) there is a lack of shared decision-making in healthcare settings, and (4) support, guidance, counseling and education is mainly targeted at the person with aphasia. Conclusions People with aphasia and relatives reported a variety of positive and negative experiences in all themes. Even though guidelines and interventions have been developed to improve healthcare for people with aphasia and their relatives, we found that people still encounter substantial challenges in access to- and provision of information, shared decision-making, support and communication with HCP. The findings in this study provide some important recommendations for improvement, including the improvement of transfer of information, shared decision-making and individual support for the relatives.
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Purpose: Aphasia after stroke has been shown to lead to communication difficulties between healthcare professionals (HCP) and people with aphasia. Clinical guidelines emphasize the importance of teaching HCP to use supportive conversative techniques through communication partner training (CPT). The aim of this study is to explore and describe the experiences of HCP in communicating with people with aphasia and their needs and wishes for the content in CPT. Materials and methods: The data were collected through qualitative semi-structured interviews with 17 HCP. HCP were recruited from two geriatric rehabilitation centres in the Netherlands and one academic hospital in Belgium. The interviews drew upon the qualitative research methodologies ethnography and phenomenology and were thematically analysed using the six steps of Braun & Clarke. Results: Three themes were derived from the interviews. HCP experienced that communication difficulties impede healthcare activities (theme 1) and reported the need to improve communication through organizational changes (theme 2), changing the roles of SLTs (theme 3) and increasing knowledge and skills of HCP (theme 4). Conclusions: According to HCP, communication difficulties challenge the provision of healthcare activities and lead to negative feelings in HCP. HCP suggest that communication can be improved by providing more time in the healthcare pathway of people with aphasia, adapting healthcare information to the needs of people with aphasia, commitment of physicians and managers, changing the roles of SLTs and improving knowledge and skills of HCP. Implications for rehabilitation Communication between healthcare professionals (HCP) and people with aphasia can be improved by training HCP to use supportive conversation techniques and tools. An important condition for successful implementation of communication partner trainings in healthcare centres is to identify the experiences of HCP with communication with people with aphasia and their needs and wishes for training content. This study shows that communication problems between HCP and people with aphasia impede diagnosis and therapy with considerable implications for healthcare quality. The suggestions that HCP have concerning the content of communication partner trainings can be placed under "education" and "implementation and post-training support." HCP describe specific roles for speech-and language therapists to fulfil after the training and suggest two main changes that should be made at an organizational level.
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Spontaneous speech is an important source of information for aphasia research. It is essential to collect the right amount of data: enough for distinctions in the data to become meaningful, but not so much that the data collection becomes too expensive or places an undue burden on participants. The latter issue is an ethical consideration when working with participants that find speaking difficult, such as speakers with aphasia. So, how much speech data is enough to draw meaningful conclusions? How does the uncertainty around the estimation of model parameters in a predictive model vary as a function of the length of texts used for training?
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Aims: To detect differences in speech fluency in separate primaryprogressive aphasia syndromes (PPA) using automated analysistechniques. The resulting linguistic features are evaluated for theiruse in a predictive model to identify common patterns in speakerswith PPA. As fluency is observable in audio recordings, its quantifi-cation may provide a low-cost instrument that augments sponta-neous speech analyses in clinical practice.Methods and Procedures: Speech was recorded in 14 controls, 7nonfluent variant (nfvPPA) and 8 semantic variant (svPPA) speakers.The recordings were annotated for speech and non-speech withKaldi, a common toolkit for speech processing software. Variablesrelating to fluency (pause rate, number of pauses, length of pauses)were analyzed.Outcomes and Results: The best fitting distribution of pause dura-tion was a combination of two Gaussian distributions, correspond-ing with pause categories short vs. long.Group level differences were found in the rate of pauses andproportion of silence: nfvPPA speakers use more short pausesrelative to long pauses than control speakers, and the duration ofshort and long pauses is longer; svPPA speakers use more longerpauses relative to short pauses. Their short pauses are significantlyshorter than those from control speakers.Participants in both PPA groups pause more frequently. SvPPAspeakers are typically perceived as fluent. However, our analysisshows their fluency patterns to be distinct from control speakers, ifthe long-short distinction is observed.Conclusions: Automatic measurements of pause duration showmeaningful distinctions across the groups and might provide futureaid in clinical assessment.
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Objective The first objective was to assess the psychometric properties of the 92-item Dutch Naming Test (DNT-92), developed to assess word finding difficulties in people with aphasia, using Item Response Theory (IRT). The second objective was to select suitable items for a short version with a discriminative purpose. Method This study has a retrospective, psychometric research design, in which 510 DNT-92-forms of people with aphasia and 192 DNT-forms of healthy participants were used for analyses. An IRT analysis was performed and information on the item- and person parameters was obtained. Item selection for the short version was based on a combination of the discriminative ability of the items and their estimated theta or difficulty. Items with the highest information load, and a difficulty parameter in the range of overlap between the sample of people with aphasia and healthy participants were selected. Results A 2-PL IRT analysis showed best fit to the data. Assumptions of unidimensionality, local independence, and monotonicity were met. Items were removed incrementally, whilst checking sensitivity and specificity of the remaining short form. A selection of six items proved optimal in terms of sensitivity and specificity, with an area under the curve value of 0.85. Differences were found between participants younger than 70 and older. Conclusions The IRT assumptions for the DNT-92 were met, indicating that the test has good psychometric properties. A reduction of items to just six items proved possible, leading to a reliable six item short form with a discriminatory purpose.
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To identify and critically appraise the evidence for instruments assessing depression in stroke patients with aphasia.
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