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1. A feasibility randomised waitlist-controlled trial of a personalised multi-level language treatment for people with aphasia: The remote LUNA study.

Author

Dipper, Lucy, Devane, Niamh, Barnard, Rachel, Botting, Nicola, Boyle, Mary, Cockayne, Lin, Hersh, Deborah, Magdalani, Carla, Marshall, Jane, Swinburn, Kate, and Cruice, Madeline

Subjects
*CLINICAL trial registries, *TREATMENT effectiveness, *APHASIA, *SPEECH therapists, *CLINICAL trials
Abstract

Background: Stroke survivors with aphasia want to improve their everyday talking (discourse). In current UK practice, 90% of speech and language therapists believe discourse assessment and treatment is part of their role but are hampered by barriers in resources, time and expertise. There is a clinical need for well-articulated discourse assessment and treatments. LUNA is a multi-level treatment targeting words, sentences and discourse macrostructure in personal stories that addresses this clinical need. Objectives: This study aimed to assess the feasibility and acceptability of LUNA trial procedures in a randomised waitlist-controlled trial; and to evaluate preliminary efficacy. Methods: This paper reports a phase II, waitlist-controlled, proof-of-concept feasibility trial. Participants with chronic aphasia (n = 28) were recruited from the community and randomised to an Immediate (n = 14) or Delayed (n = 14) group. LUNA treatment was delivered twice weekly for 10 weeks via the videoconferencing technology, Zoom. Feasibility was assessed in terms of participant recruitment and retention, adherence, missing data, and treatment fidelity. Preliminary treatment efficacy was assessed in terms of between group differences in outcome measures relating to discourse, language, and psychosocial state. Results: The remote LUNA trial was feasible: 85% of those eligible consented to the trial; trial retention was 86%; 87% of treatment sessions were delivered as scheduled, and 79% of participants completed 80%+ of the treatment programme; data was missing only for participants who withdrew; treatment fidelity was high at 92% adherence; and only one clinical outcome measure demonstrated ceiling effects. ANCOVA analysis of the clinical outcome measures revealed group differences with medium and large effect sizes, indicating, improvements in the production of words, sentences, discourse macrostructure, overall language functioning (WAB-R), and psychosocial state (VAMS) following LUNA treatment. For most outcomes measured, similar treatment benefits were suggested in a secondary, non-parametric analysis. Conclusions: Large-scale evaluation of the clinical efficacy and cost-effectiveness of LUNA is warranted and supported by these findings. Trial registration: Clinical trials registration: NCT05847023 (clinical trials.gov). [ABSTRACT FROM AUTHOR]

Published
2024
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2. Event processing for language : an investigation of the relationship between events, sentences, and verbs : using data from 6 people with non-fluent aphasia

Author

Dipper, Lucy Tamsin

Subjects
302.2
Abstract

This thesis focuses on conceptualisation for language, or event processing, and identifies some of its key aspects. Five tasks were created in order to isolate various layers of conceptual processing; two video tasks requiring no language output; a further video task requiring verbs to be selected from a choice of three; an odd- one-out task with photographs of events; and a sentence judgement task. These tasks were performed by six people with non-fluent aphasia. A major finding was that there are some aspects of processing common to both language and non-language tasks. It is claimed that the linguistic system contains certain organising principles that enable information to be structured so that it is expressible in language. These organising principles can be seen to exert a strong influence on the conceptual system, even in non-language tasks. The results from the tasks also indicated five separable layers of conceptual processing: distinguishing events from non-events; identifying event type; identifying the relationship encoded by the event; identifying the roles played by participant entities; and identifying perspective. These aspects of processing may be selectively impaired in aphasia and methods for their independent assessment are discussed. The implications for the characterisation of conceptual processing and the relationship between conceptualisation and language are considered. In conclusion, the clinical implications of this finding are examined; in terms of stimulus materials for assessment and therapeutic intervention and in relation to functional communication.

Published
1999

3. Creating a theoretical framework to underpin discourse assessment and intervention in aphasia

Author

Dipper, Lucy, Marshall, Jane, Boyle, Mary, Hersh, Deborah, Botting, Nicola, Cruice, Madeline, Dipper, Lucy, Marshall, Jane, Boyle, Mary, Hersh, Deborah, Botting, Nicola, and Cruice, Madeline

Abstract

Discourse (a unit of language longer than a single sentence) is fundamental to everyday communication. People with aphasia (a language impairment occurring most frequently after stroke, or other brain damage) have communication difficulties which lead to less complete, less coherent, and less complex discourse. Although there are multiple reviews of discourse assessment and an emerging evidence base for discourse intervention, there is no unified theoretical framework to underpin this research. Instead, disparate theories are recruited to explain different aspects of discourse impairment, or symptoms are reported without a hypothesis about the cause. What is needed is a theoretical framework that would clarify the specific linguistic skills that create completeness, coherence, and complexity (i.e., richness) in discourse, and illuminate both the processes involved in discourse production and the reasons for breakdown. This paper reports a review and synthesis of the theoretical literature relevant to spoken discourse in aphasia discourse, and we propose a novel theoretical framework which unites these disparate sources. This framework is currently being tested as the foundation for Linguistic Underpinnings of Narrative in Aphasia (LUNA) treatment research. In this paper, we outline the novel framework and exemplify how it might be used to guide clinical practice and research. Future collaborative research is needed to develop this framework into a processing model for spoken discourse.

Published
2021

6. Creating a theoretical framework to underpin discourse assessment and intervention in aphasia

Author

<p>Stroke Association</p>, Dipper, Lucy, Marshall, Jane, Boyle, Mary, Hersh, Deborah, Botting, Nicola, Cruice, Madeline, <p>Stroke Association</p>, Dipper, Lucy, Marshall, Jane, Boyle, Mary, Hersh, Deborah, Botting, Nicola, and Cruice, Madeline

Abstract

Dipper, L., Marshall, J., Boyle, M., Hersh, D., Botting, N., & Cruice, M. (2021). Creating a theoretical framework to underpin discourse assessment and intervention in aphasia. Brain Sciences, 11(2), article 183. https://doi.org/10.3390/brainsci11020183

7. UK speech and language therapists' views and reported practices of discourse analysis in aphasia rehabilitation

Author

Cruice, Madeline, Botting, Nicola, Marshall, Jane, Boyle, Mary, Hersh, Deborah, Pritchard, Madeleine, Dipper, Lucy, Cruice, Madeline, Botting, Nicola, Marshall, Jane, Boyle, Mary, Hersh, Deborah, Pritchard, Madeleine, and Dipper, Lucy

Abstract

Cruice, M., Botting, N., Marshall, J., Boyle, M., Hersh, D., Pritchard, M., & Dipper, L. (2020). UK speech and language therapists’ views and reported practices of discourse analysis in aphasia rehabilitation. International Journal of Language & Communication Disorders, 55(3), 417-442. https://doi.org/10.1111/1460-6984.12528

8. Treatment for improving discourse in aphasia: A systematic review and synthesis of the evidence base

Author

Dipper, Lucy, Marshall, Jane, Boyle, Mary, Botting, Nicola, Hersh, Deborah, Pritchard, Madeleine, Cruice, Madeline, Dipper, Lucy, Marshall, Jane, Boyle, Mary, Botting, Nicola, Hersh, Deborah, Pritchard, Madeleine, and Cruice, Madeline

Abstract

Dipper, L., Marshall, J., Boyle, M., Botting, N., Hersh, D., Pritchard, M., & Cruice, M. (2020). Treatment for improving discourse in aphasia: a systematic review and synthesis of the evidence base. Aphasiology, 35(9), 1125-1167. https://doi.org/10.1080/02687038.2020.1765305

9. Measuring communication as a core outcome in aphasia trials: Results of the ROMA-2 international core outcome set development meeting

Author

Wallace, Sarah J., Worrall, Linda, Rose, Tanya A., Alyahya, Reem S. W., Babbitt, Edna, Beeke, Suzanne, de Beer, Carola, Bose, Arpita, Bowen, Audrey, Brady, Marian C., Breitenstein, Caterina, Bruehl, Stefanie, Bryant, Lucy, Cheng, Bonnie B. Y., Cherney, Leora R., Conroy, Paul, Copland, David A., Croteau, Clare, Cruice, Madeline, Dipper, Lucy, Hilari, Katerina, Howe, Tami, Kelly, Helen, Kiran, Swathi, Laska, Ann-Charlotte, Marshall, Jane, Murray, Laura L., Patterson, Janet, Pearl, Gill, Quinting, Jana, Rochon, Elizabeth, Rose, Miranda L., Rubi-Fessen, Ilona, Sage, Karen, Simmons-Mackie, Nina, Visch-Brink, Evy, Volkmer, Anna, Webster, Janet, Whitworth, Anne, Dorze, Guylaine Le, Wallace, Sarah J., Worrall, Linda, Rose, Tanya A., Alyahya, Reem S. W., Babbitt, Edna, Beeke, Suzanne, de Beer, Carola, Bose, Arpita, Bowen, Audrey, Brady, Marian C., Breitenstein, Caterina, Bruehl, Stefanie, Bryant, Lucy, Cheng, Bonnie B. Y., Cherney, Leora R., Conroy, Paul, Copland, David A., Croteau, Clare, Cruice, Madeline, Dipper, Lucy, Hilari, Katerina, Howe, Tami, Kelly, Helen, Kiran, Swathi, Laska, Ann-Charlotte, Marshall, Jane, Murray, Laura L., Patterson, Janet, Pearl, Gill, Quinting, Jana, Rochon, Elizabeth, Rose, Miranda L., Rubi-Fessen, Ilona, Sage, Karen, Simmons-Mackie, Nina, Visch-Brink, Evy, Volkmer, Anna, Webster, Janet, Whitworth, Anne, and Dorze, Guylaine Le

Abstract

BackgroundEvidence-based recommendations for a core outcome set (COS; minimum set of outcomes) for aphasia treatment research have been developed (the Research Outcome Measurement in Aphasia-ROMA, COS). Five recommended core outcome constructs: communication, language, quality of life, emotional well-being and patient-reported satisfaction/impact of treatment, were identified through three international consensus studies. Constructs were paired with outcome measurement instruments (OMIs) during an international consensus meeting (ROMA-1). Before the current study (ROMA-2), agreement had not been reached on OMIs for the constructs of communication or patient-reported satisfaction/impact of treatment. AimTo establish consensus on a communication OMI for inclusion in the ROMA COS. Methods & ProceduresResearch methods were based on recommendations from the Core Outcome Measures in Effectiveness Trials (COMET) Initiative. Participants with expertise in design and conduct of aphasia trials, measurement instrument development/testing and/or communication outcome measurement were recruited through an open call. Before the consensus meeting, participants agreed on a definition of communication, identified appropriate OMIs, extracted their measurement properties and established criteria for their quality assessment. During the consensus meeting they short-listed OMIs and participants without conflicts of interest voted on the two most highly ranked instruments. Consensus was defined a priori as agreement by >= 70% of participants. Outcomes & ResultsIn total, 40 researchers from nine countries participated in ROMA-2 (including four facilitators and three-panel members who participated in pre-meeting activities only). A total of 20 OMIs were identified and evaluated. Eight short-listed communication measures were further evaluated for their measurement properties and ranked. Participants in the consensus meeting (n = 33) who did not have conflicts of interest (n = 29) voted on

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