scholarly journals Clinical Effectiveness of the Queen Square Intensive Comprehensive Aphasia Service for Patients With Poststroke Aphasia

Stroke ◽  
2021 ◽  
Author(s):  
Alexander P. Leff ◽  
Sarah Nightingale ◽  
Beth Gooding ◽  
Jean Rutter ◽  
Nicola Craven ◽  
...  
Keyword(s):  
Repeated Measures ◽  
Clinical Effectiveness ◽  
Functional Communication ◽  
Auditory Comprehension ◽  
Language Therapy ◽  
Time Interaction ◽  
Short Period ◽  
High Doses ◽  
Effectiveness Index ◽  
Communicative Effectiveness

Background and Purpose: Poststroke aphasia has a major impact on peoples’ quality of life. Speech and language therapy interventions work, especially in high doses, but these doses are rarely achieved outside of research studies. Intensive Comprehensive Aphasia Programs (ICAPs) are an option to deliver high doses of therapy to people with aphasia over a short period of time. Methods: Forty-six people with aphasia in the chronic stage poststroke completed the ICAP over a 3-week period, attending for 15 days and averaging 6 hours of therapy per day. Outcome measures included the Comprehensive Aphasia Test, an impairment-based test of the 4 main domains of language (speaking, writing, auditory comprehension, and reading) which was measured at 3 time points (baseline, immediately posttreatment at 3 weeks and follow-up at 12-week post-ICAP); and, the Communicative Effectiveness Index, a carer-reported measure of functional communication skills collected at baseline and 12 weeks. Results: A 2-way repeated measures multivariate ANOVA was conducted. We found a significant domain-by-time interaction, F =12.7, P <0.0005, indicating that the ICAP improved people with aphasia’s language scores across all 4 domains, with the largest gains in speaking (Cohen’s d =1.3). All gains were maintained or significantly improved further at 12-week post-ICAP. Importantly, patients’ functional communication, as indexed by changes on the Communicative Effectiveness Index, also significantly improved at 12-week post-ICAP, t =5.4, P <0.0005, also with a large effect size (Cohen’s d =0.9). Conclusions: People with aphasia who participated in the Queen Square ICAP made large and clinically meaningful gains on both impairment-based and functional measures of language. Gains were sustained and in some cases improved further over the subsequent 12 weeks.

scholarly journals Clinical Effectiveness of The Queen Square Intensive Comprehensive Aphasia Service for Patients With Post-Stroke Aphasia

2021 ◽  
Author(s):  
Alex Leff ◽  
Jenny Crinion
Keyword(s):  
Language Production ◽  
Clinical Effectiveness ◽  
Functional Communication ◽  
Auditory Comprehension ◽  
Language Therapy ◽  
Post Stroke ◽  
Time Interaction ◽  
Short Period ◽  
High Doses ◽  
Uk National Health Service

BACKGROUND AND PURPOSE: Post-stroke aphasia has a major impact on peoples’ quality of life. Speech and language therapy interventions work, especially in high doses, but these doses are rarely achieved outside of research studies. Intensive Comprehensive Aphasia Programmes (ICAPs) are an option to deliver high doses of therapy to people with aphasia (PWA) over a short period of time. Here we report the clinical effectiveness of the Queen Square ICAP, a clinical-academic service set up in partnership between charities and the UK national health service (NHS).METHODS: Forty-six PWA in the chronic stage post-stroke completed the ICAP over a 3- week period. Outcome measures included the Comprehensive Aphasia Test, an impairment- based test of the four main domains of language (speaking, writing, auditory comprehension and reading) which was measured at three time points (Baseline, immediately post- treatment at 3-Weeks and follow-up at 3-Months); and, the Communicative Effectiveness Index (CETI), a carer-reported measure of functional communication skills collected at Baseline and 3-Months.RESULTS: We found a significant domain-by-time interaction indicating that the ICAP improved PWA’s language scores across all four domains, with the largest gains in speaking. All gains were maintained or significantly improved further by 3-Months post ICAP. Importantly patients’ functional communication, as indexed by changes on the CETI, also significantly improved at 3-Months. Effect sizes were large for changes in language production and the CETI, and medium for changes in language perception.CONCLUSIONS: PWA who participated in the Queen Square ICAP made large and clinically meaningful gains on both impairment-based and functional measures of language. Gains were sustained and in some cases improved further over the subsequent 3 months.Key words: Aphasia, ICAP, impairment, function, languageAbbreviations: CAT (comprehensive aphasia test), CETI (communicative effectivenessindex), ICAP (intensive comprehensive aphasia programme), PWA (people with aphasia).

The Communicative Effectiveness Index

1989 ◽  
Vol 54 (1) ◽  
pp. 113-124 ◽  
Author(s):  
Jonathan Lomas ◽  
Laura Pickard ◽  
Stella Bester ◽  
Heather Elbard ◽  
Alan Finlayson ◽  
...  
Keyword(s):  
Psychometric Properties ◽  
Interrater Reliability ◽  
Significant Others ◽  
Functional Communication ◽  
Performance Change ◽  
Communication Situations ◽  
Global Ratings ◽  
Communication Ability ◽  
Effectiveness Index ◽  
Communicative Effectiveness

Groups of aphasic patients and their spouses generated a series of communication situations that they felt were important in their day-to-day life. Using criteria to ensure that the situations were generalizable across people, times, and places, we reduced the number of situations to 36 and constructed an index that allowed the significant others of 11 recovering and 11 stable aphasic individuals to rate their partners' performance in the situations on two occasions 6 weeks apart. These data were then used to evaluate the psychometric properties of the Communicative Effectiveness Index (CETI) as a measure of change in functional communication ability. Further application of a generalization criterion reduced the final index to 16 situations. Results showed the CETI to be internally consistent and to have acceptable test-retest and interrater reliability. It was valid as a measure of functional communication according to the pattern of correlations found with other measures (Western Aphasia Battery, Speech Questionnaire, and global ratings). Finally, it was responsive to functionally important performance change between testings. Further research with the CETI and its usefulness for clinicians and researchers are discussed.

scholarly journals The effect of augmented speech-language therapy delivered by telerehabilitation on poststroke aphasia—a pilot randomized controlled trial

2020 ◽  
Vol 34 (3) ◽  
pp. 369-381 ◽  
Author(s):  
Hege Prag Øra ◽  
Melanie Kirmess ◽  
Marian C Brady ◽  
Iselin Partee ◽  
Randi Bjor Hognestad ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Usual Care ◽  
Controlled Trial ◽  
Test Sentence ◽  
Sentence Production ◽  
Control Group ◽  
Auditory Comprehension ◽  
Randomized Controlled ◽  
Effectiveness Index ◽  
Communicative Effectiveness

Objective: Pilot a definitive randomized controlled trial of speech-language telerehabilitation in poststroke aphasia in addition to usual care with regard to recruitment, drop-outs, and language effects. Design: Pilot single-blinded randomized controlled trial. Setting: Telerehabilitation delivered from tertiary rehabilitation center to participants at their home or admitted to secondary rehabilitation centers. Subjects: People with naming impairment due to aphasia following stroke. Intervention: Sixty-two participants randomly allocated to 5 hours of speech and language telerehabilitation by videoconference per week over four consecutive weeks together with usual care or usual care alone. The telerehabilitation targeted functional, expressive language. Main measures: Norwegian Basic Aphasia Assessment: naming (primary outcome), repetition, and auditory comprehension subtests; Verb and Sentence Test sentence production subtest and the Communicative Effectiveness Index at baseline, four weeks, and four months postrandomization. Data were analyzed by intention to treat. Results: No significant between-group differences were seen in naming or auditory comprehension in the Norwegian Basic Aphasia Assessment at four weeks and four months post randomization. The telerehabilitation group ( n = 29) achieved a Norwegian Basic Aphasia Assessment repetition score of 8.9 points higher ( P = 0.026) and a Verb and Sentence Test score 3 points higher ( P = 0.002) than the control group ( n = 27) four months postrandomization. Communicative Effectiveness Index was not significantly different between groups, but increased significantly within both groups. No adverse events were reported. Conclusion: Augmented telerehabilitation via videoconference may be a viable rehabilitation model for aphasia affecting language outcomes poststroke. A definitive trial with 230 participants is needed to confirm results.

scholarly journals The Communicative Effectiveness Index: Its use with South African stroke patients

1992 ◽  
Vol 39 (1) ◽  
Author(s):  
Claire Penn ◽  
Kelly Milner ◽  
Peter Fridjhon
Keyword(s):  
South African ◽  
Left Hemisphere ◽  
Right Hemisphere ◽  
Assessment Tool ◽  
Communication Disorders ◽  
Functional Communication ◽  
Stroke Patients ◽  
Language Groups ◽  
Effectiveness Index ◽  
Communicative Effectiveness

The functional communication of a group of 28 South African stroke patients was examined using the Communicative Effectiveness Index (CETI). It was translated into Afrikaans, Sotho and Zulu and administered to the significant others of 22 aphasic patients with left hemisphere damage and 6 patients with right hemisphere damage. Results were related to the results of standardised language testing and to case history factors such as cultural factors and time since onset. The CETI was readministered in the case of eight of the aphasic subjects after a mean period of six months in order to assess its sensitivity to recovery. Results showed that the CETI seems applicable across different language groups, that it is sensitive to change across time as well as sensitive to the communication disorders resulting from both right and left hemisphere damage. Further it appears to correlate well with overall level of severity. It does not appear differentiate patients in terms of time since onset. Its potential use as a relatively culture free assessment tool in the South African context is discussed.

Validating Four Standard Scales in Spiritually Practicing and Nonpracticing Samples Using Propensity Score Matching

2008 ◽  
Vol 24 (3) ◽  
pp. 165-173 ◽  
Author(s):  
Niko Kohls ◽  
Harald Walach
Keyword(s):  
Propensity Score ◽  
Propensity Score Matching ◽  
Repeated Measures ◽  
Propensity Scores ◽  
Total Sample ◽  
Experimental Manipulation ◽  
Brief Symptom Inventory ◽  
Time Interaction ◽  
Social Support Scale ◽  
Lower Test

Validation studies of standard scales in the particular sample that one is studying are essential for accurate conclusions. We investigated the differences in answering patterns of the Brief-Symptom-Inventory (BSI), Transpersonal Trust Scale (TPV), Sense of Coherence Questionnaire (SOC), and a Social Support Scale (F-SoZu) for a matched sample of spiritually practicing (SP) and nonpracticing (NSP) individuals at two measurement points (t1, t2). Applying a sample matching procedure based on propensity scores, we selected two sociodemographically balanced subsamples of N = 120 out of a total sample of N = 431. Employing repeated measures ANOVAs, we found an intersample difference in means only for TPV and an intrasample difference for F-SoZu. Additionally, a group × time interaction effect was found for TPV. While Cronbach’s α was acceptable and comparable for both samples, a significantly lower test-rest-reliability for the BSI was found in the SP sample (rSP = .62; rNSP = .78). Thus, when researching the effects of spiritual practice, one should not only look at differences in means but also consider time stability. We recommend propensity score matching as an alternative for randomization in variables that defy experimental manipulation such as spirituality.

scholarly journals Statistical analysis of two arm randomized pre-post designs with one post-treatment measurement

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Fei Wan
Keyword(s):  
Treatment Effect ◽  
Repeated Measures ◽  
Informed Choice ◽  
Clinical Effectiveness ◽  
Change Score ◽  
Post Treatment ◽  
Analysis Of Covariance ◽  
Alternative Methods ◽  
Main Effect ◽  
Comparable Performance

Abstract Background Randomized pre-post designs, with outcomes measured at baseline and after treatment, have been commonly used to compare the clinical effectiveness of two competing treatments. There are vast, but often conflicting, amount of information in current literature about the best analytic methods for pre-post designs. It is challenging for applied researchers to make an informed choice. Methods We discuss six methods commonly used in literature: one way analysis of variance (“ANOVA”), analysis of covariance main effect and interaction models on the post-treatment score (“ANCOVAI” and “ANCOVAII”), ANOVA on the change score between the baseline and post-treatment scores (“ANOVA-Change”), repeated measures (“RM”) and constrained repeated measures (“cRM”) models on the baseline and post-treatment scores as joint outcomes. We review a number of study endpoints in randomized pre-post designs and identify the mean difference in the post-treatment score as the common treatment effect that all six methods target. We delineate the underlying differences and connections between these competing methods in homogeneous and heterogeneous study populations. Results ANCOVA and cRM outperform other alternative methods because their treatment effect estimators have the smallest variances. cRM has comparable performance to ANCOVAI in the homogeneous scenario and to ANCOVAII in the heterogeneous scenario. In spite of that, ANCOVA has several advantages over cRM: i) the baseline score is adjusted as covariate because it is not an outcome by definition; ii) it is very convenient to incorporate other baseline variables and easy to handle complex heteroscedasticity patterns in a linear regression framework. Conclusions ANCOVA is a simple and the most efficient approach for analyzing pre-post randomized designs.

Social isolation of goats: significance of visual contact with conspecifics on behavioral and physiological responses

2021 ◽  
Author(s):  
Govind Kannan ◽  
Zaira M Estrada-Reyes ◽  
Phaneendra Batchu ◽  
Brou Kouakou ◽  
Thomas H Terrill ◽  
...  
Keyword(s):  
Social Isolation ◽  
Stress Responses ◽  
Repeated Measures ◽  
Physiological Stress ◽  
Physiological Responses ◽  
Average Weight ◽  
Median Frequency ◽  
Visual Contact ◽  
Time Interaction ◽  
Rank Score

Abstract Social isolation can increase distress in goats, particularly when they cannot maintain visual contact with conspecifics. This experiment was conducted to determine the behavioral and physiological responses in goats during isolation with or without visual contact with conspecifics. Male Spanish goats (uncastrated, 8-mo old, average weight 29.4 ± 0.59 kg) were randomly assigned to a control (CO) group with no isolation or to one of four isolation treatment (TRT) pens (1.5 × 1.5 m) with: (1) open grill panels but with no visual contact with conspecifics (IO), (2) covered grill to prevent visual contact (IC), (3) open grill with visual contact (IV), or (3) covered grill with a 30 × 30 cm window to allow visual contact (IW) for 90 min of social isolation (n = 12 goats/TRT). Blood samples were collected at 0, 30, 60, and 90 min (Time) from isolated and control goats. The experiment was repeated one week later using the same animals, with each goat being subjected to the same isolation treatment the second time to study the effect of prior exposure to isolation. Friedman’s Two-Way ANOVA by Ranks Test in SAS showed that the median frequency of vocalization (rank score) in goats was high in IO group, low in IV and IW groups, and intermediate in IC group (P &lt; 0.01). Vocalization rank score was also higher (P &lt; 0.01) during the first 30 min of isolation in goats. Median frequency of visual contact was higher in the IW group than in the IV group (P &lt; 0.01). Frequency of climbing behavior was high in IC and IO groups, low in IV group, and intermediate in IW group (P &lt; 0.01). Repeated Measures Analysis using GLM procedures in SAS revealed that plasma cortisol and glucose concentrations tended (P &lt; 0.1) to be the highest in IO group than in CO, IC, IV, and IW groups. Cortisol levels were also higher (Time; P &lt; 0.05) at 0 and 90 min compared to 30 and 60 min. Norepinephrine concentrations decreased (P &lt; 0.05) with Time, and plasma non-esterified fatty acid (NEFA) levels were affected by TRT × Time interaction (P &lt; 0.01). Overall, epinephrine, norepinephrine, glucose, and NEFA concentrations were lower (P &lt; 0.01) and cortisol concentrations and lymphocyte counts higher (P &lt; 0.01) when goats were exposed to isolation the second time. The results showed that goats with no visual contact with conspecifics during social isolation had greater physiological stress responses and spent more time vocalizing or trying to escape the pen, which may indicate distress.

246 Examining Melatonin-induced Changes in Uterine Blood Flow and Vaginal Temperatures in Nutrient Restricted Pregnant Heifers

2021 ◽  
Vol 99 (Supplement_3) ◽  
pp. 132-132
Author(s):  
Zully E Contreras-Correa ◽  
Riley D Messman ◽  
Hector Sanchez-Rodriguez ◽  
Caleb O Lemley
Keyword(s):  
Blood Flow ◽  
Repeated Measures ◽  
Farm Animals ◽  
Nutrient Restriction ◽  
Dependent Manner ◽  
Uterine Blood Flow ◽  
Time Interaction ◽  
Main Effect ◽  
Treatment Interaction ◽  
Induced Changes

Abstract The objectives were to examine melatonin mediated changes in temporal uterine blood flow (UBF) and vaginal temperatures (VT) in 54 Brangus heifers (Fall, n = 29; Summer, n = 25) during compromised pregnancy. At d160 of gestation, heifers were assigned to 1 of 4 groups consisting of adequately fed (ADQ-CON; 100% NRC; n=13), global nutrient restricted (RES-CON; 60% NRC; n = 13), and ADQ or RES supplemented with 20 mg of melatonin (ADQ-MEL, n = 13; RES-MEL, n = 15). In the morning (0500h) and afternoon (1300h) of d220 of gestation, temperature dataloggers (Onset Computer Corporation) attached to progesterone-free CIDRs were used to record VT, while UBF was determined via Doppler ultrasonography. Data were analyzed using repeated measures of ANOVA (SAS). Significant differences were found in UBF and VT between Fall and Summer groups (P&lt; 0.05), therefore seasons were individually analyzed. In Fall, a nutrition by treatment interaction was significant, where the RES-CON heifers exhibited reduced total UBF compared to ADQ-CON (5.67±0.68 vs. 7.97±0.54 L/min; P = 0.012). In Summer, there was not a main effect of nutrition (P = 0.390); nevertheless, the MEL heifers exhibited increased total UBF compared to the CON counterparts (8.16±0.73 vs. 6.00±0.70 L/min; P = 0.048). Moreover, there was a nutrition by treatment by time interaction in VT for Fall and Summer heifers (P &lt; 0.0001). In Fall, all groups had decreased VT in the morning compared to the afternoon (P &lt; 0.0001). Whereas, in Summer, VT increased for ADQ-CON, RES-CON, and ADQ-MEL from morning to afternoon (P &lt; 0.0001), while the RES-MEL remained constant throughout the day (P = 0.649). Furthermore, during the afternoon RES-MEL heifers exhibited decreased VT compared to ADQ-CON (38.91±0.09 vs. 39.26±0.09°C, respectively; P=0.039). In summary, nutrient restriction and melatonin supplementation altered UBF in a season dependent manner. Additionally, with the VT differences observed in Summer, future studies should evaluate the potential of melatonin supplementation for mitigating heat stress in farm animals.

Outcome Study Findings of an Intensive Outpatient Program for Missionaries and Clergy

2016 ◽  
Vol 44 (4) ◽  
pp. 281-289 ◽  
Author(s):  
Jeanne L. Jensma
Keyword(s):  
Repeated Measures ◽  
Outcome Study ◽  
Psychological Healing ◽  
Education Group ◽  
Outpatient Program ◽  
Short Period ◽  
Intensive Outpatient Program ◽  
Significant Clinical Improvement ◽  
Intensive Outpatient ◽  
Christian Leaders

This article reports the findings of an outcome study done at ALONGSIDE, a counseling-focused retreat center that offers three-week intensive outpatient programs for Christian leaders, the majority of whom are missionaries. Repeated measures research utilized the Outcome Questionnaire - 45.2 (OQ-45.2) to explore whether or not clients participating in the three-week intensive outpatient program realized significant clinical progress and whether or not therapeutic gains were retained after the conclusion of the program. Missionaries and other Christian leaders took the inventory online a month before coming to ALONGSIDE, upon arrival, at the end of the three-week program, and three months after the program concluded. The results indicated that a month of time before arrival did not bring about a significant reduction in symptomatology among the 191 subjects, but three weeks of ALONGSIDE's intensive outpatient program resulted in significant clinical improvement which remained when the inventory was taken again three months post-program. This suggests that in a fairly short period of time, an intensive outpatient program consisting of psycho-education, group psychotherapy, and individual and/or marital counseling within a milieu of intentional Christian community can be a highly effective model for promoting enduring psychological healing.

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