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Purpose: A critical review was completed to evaluate replication of aphasia treatments that have been vetted and accepted on the American Speech-Language-Hearing Association Practice Portal. Method: The electronic databases Academic Search Premier, ProQuest Central, CINAHL Complete, and ERIC were searched for relevant articles using treatment names as keywords. Coders compared stimuli, material, design, and statistical analysis to pilot treatment approaches. Each study was coded as direct, conceptual, failed, or no replication. Results: Eighteen treatment approaches were selected for this review. A total of 188 articles met the inclusion criteria. Results revealed that 14 out of 18 treatment approaches were somehow replicated. Direct replications as the most valuable replication type for affirming previously found results were represented in only 1.5% of all studies (3/188). Failed direct replication were at 2% overall (4/188). Conceptual replications were more common across treatment approaches, but also represented at a low level with 22.8% (43/188). The majority of studies were coded as no replication attempt with 73.4%. Discussion: A critical factor in developing an evidence-based practice is the existence of replicated results for treatment. Replication evaluates the reproducibility of an author's or authors' research methodology and resulting outcomes and helps to ensure that observed treatment effects are reproducible. For an evidence-based treatment to be implemented or used in any clinical setting, it must be one that can be replicated. Direct and conceptual replications of aphasia treatment approaches were found to be alarmingly low considering the importance of replication in our field. It is recommended that replication should become more valued and mainstreamed in aphasia research. A replication database that compiles and maintains treatment manuals for replication purposes can increase the accessibility and acceptability of replications for researchers.

Background: People with aphasia present with different of demographic, language, stroke, and impairment profiles. A Cochrane review found that two-thirds of included trials had comparison data on p...

Serious psychological consequences and limited social access are significant effects of chronic aphasia due to stroke. There appears to be a need for ongoing family education and counseling throughout the chronic stage in order to address the psychosocial needs of these individuals and their families. We describe an alternative approach to family education for chronically aphasic individuals. Six-month follow-up results suggest that this educational program has a positive impact on social behaviors, understanding of aphasia, and family communication patterns. The importance of developing and providing educational programs to the chronically impaired beyond the point of formal rehabilitation is discussed.

The purpose of this article is to envision how the clinical practice of aphasia management might be done 10 years in the future. The vision of how an individual clinician's daily tasks are changed is built on current trends, including the aging of the population, the life participation approach to aphasia, development and use of evidence-based practices, person-centered care, and technology. To be prepared for the future of these trends, we will need to develop clinical capacity, not only in the number of speech-language pathologists but also most importantly in their competence for using evidence-based practices and training others to support effective communication, including other health care providers. Research needs that will support the future are also described.

Objective On the path to picture naming, words that relate semantically to the pictured object become activated in the mental lexicon. We used a neuroscientific approach to investigate this semantic activation spreading process in adults who stutter (AWS). Methods Fourteen AWS and 14 adults who do not stutter (AWNS) completed a picture–word priming task. On each trial, a picture was named at a delay. On some trials, an unattended auditory probe word was presented after the picture, before naming commenced. Event-related potentials recorded to probe words Semantically-Related to the picture labels, and to probe words Semantically- and Phonologically-Unrelated to the picture labels, were compared using spatial–temporal principal component analysis. Results Posterior N400 amplitude was attenuated for Semantically-Related versus Unrelated probes in AWNS, while in AWS posterior N400 amplitude was enhanced for Semantically-Related versus Unrelated probes. Marginal albeit potentially relevant group differences in the morphology of other ERP components were also observed. Conclusions The posterior N400 results point to a strategic, inhibitory influence on semantic activation spreading in AWS on the path to naming. Group differences in the amplitude of other ERP components tentatively suggest that AWS allocated attentional resources differently than the AWNS during the task. Preliminary ERP evidence of intact conceptual (as opposed to lexical-semantic) priming in the AWS is also discussed. Significance This study contributes to a growing body of research describing linguistic performance in AWS.

Despite great strides in the life-participation approach to aphasia therapy and the arduous work of several therapists to include patients in the decision-making and goal-setting process of therapy, the patient's direct perspective on the experience of treatment is seldom portrayed in academic journals. In the current article, the voices and different agendas of a stroke survivor with aphasia, her speech-language therapists, and an aspiring qualitative researcher are discussed by means of intertwined narratives, dialogues, and discourses. During an in-depth interview process, the researcher hears the effects of a discharge report on the perceptions and life course of a person living with aphasia. The researcher explores her own reactions and thoughts about the discharge process and report writing. The narratives in this article illustrate the potentially serious impact of seemingly routine clinical procedures, such as a discharge report.

Purpose The purpose of this supplement article is to provide a resource of pertinent information concerning implementation science for immediate research application in communication sciences and disorders. Method Key terminology related to implementation science is reviewed. Practical suggestions for the application of implementation science theories and methodologies are provided, including an overview of hybrid research designs that simultaneously investigate clinical effectiveness and implementation as well as an introduction to approaches for engaging stakeholders in the research process. A detailed example from education is shared to show how implementation science was utilized to move an intervention program for autism into routine practice in the public school system. In particular, the example highlights the value of strong partnership among researchers, policy makers, and frontline practitioners in implementing and sustaining new evidence-based practices. Conclusions Implementation science is not just a buzzword. This is a new field of study that can make a substantive contribution in communication sciences and disorders by informing research agendas, reducing health and education disparities, improving accountability and quality control, increasing clinician satisfaction and competence, and improving client outcomes.

Background : Intensive rates of treatment have been shown to have positive outcomes but have rarely been directly compared with non-intensive treatment. Certain types of treatment may be more effective at intensive rates than others. Aims : The purpose of this study was to compare intensive and non-intensive rates of one particular, highly specified type of treatment termed “context-based treatment”. Methods & Procedures : Thirteen adults with moderately severe aphasia were assigned to either intensive or non-intensive treatment. A battery of assessments was designed to measure the effectiveness of the treatment and the transfer of the treatment to more and less similar contexts. Outcomes & Results : There was no advantage of intensive treatment for achieving mastery of the trained context, or in transferring those skills to similar environments, or challenging environments. Conclusions : If replicated, the results could suggest that context-based treatment may be a treatment type of choice when treatment...

This study sought preliminary relationships between discourse deficits and cognitive abilities in persons with right hemisphere disorder (RHD). Seven participants with RHD were matched with a non-neurologically impaired control group. One narrative and two procedural samples were elicited: the story of Cinderella and two procedural discourse samples based on familiar tasks. Macrostructural and microstructural measures of the discourse samples were correlated to cognitive domain scores achieved on a cognitive assessment, the Cognitive Linguistic Quick Test ( CLQT [Helm-Estabrooks, N. (2001). Cognitive Linguistic Quick Test . San Antonio, TX: The Psychological Corporation]). Two-tailed t -tests indicated that there were no statistically significant differences in cognitive scores between the RHD and control groups, nor were there differences in discourse measures between the two groups on either procedural task. The narrative production task yielded significant group differences on four measurements—CIU, CIU/minute, total main concept points, and number of absent main concepts. Within the RHD group, there were correlations between the attention, clock drawing, and visuospatial domains of the cognitive measure and narrative measures. The results of this study indicated that although there were no significant differences between the two groups on the cognitive measure, the RHD group produced insufficient narratives. Narrative discourse appears to be a sensitive context in which to pursue the exploration of cognitive–discourse relationships in RHD.

Vocational and social outcomes of rehabilitation, such as employment, Social Integration, and life satisfaction, are critical determinants of the usefulness of rehabilitation. The purpose of this study was to describe the employment status, Social Integration, and perceived life satisfaction of adults with chronic aphasia 2 years after discharge from an intensive treatment program. Among the 20 survey respondents, 62% of those who had been working prior to aphasia onset were also working at the time of follow-up. Those who were working before but not after onset had higher Home Integration scores. There was a relatively large perceived change in communication from clinic discharge to the 2-year follow-up. Eighty-five percent of the respondents indicated a positive life satisfaction rating. There was a significant positive relationship between Home Integration and life satisfaction ratings. The results are discussed in relation to other reports of employment and social outcomes for stroke and aphasia. Learning outcomes As a result of this activity, the participant will be able to: (1) identify factors that may contribute to the successful return to work for adults with chronic aphasia; (2) describe the vocational and social outcomes of a select group of adults with chronic aphasia after participation in an intensive treatment program; and (3) discuss future need areas in understanding vocational and social participation for adults with chronic aphasia after intervention.

Aphasia affects functional activities and participation in social roles years after onset. Some group and individual programs have reported success in improving social activities and perceived wellness. These programs typically last several weeks or months. A short, 2-day seminar style program designed for adults with chronic aphasia and their families is described in this report. Six-month follow-up data from participant pairs demonstrates a significant improvement in functional activity level, improved knowledge of aphasia, and improved family relationships. Nonparticipant pairs did not demonstrate any changes over the same period. These findings replicate and extend those of a previous study on the same 2-day seminar [Top. Stroke Rehabil. 2 (1995) 53.]. The results of this study demonstrate the important outcomes of even a very brief program designed to address the long-term psychosocial needs of adults living with aphasia and their families. Educational objectives: As a result of this activity, the participant will be able to: (1) describe a brief family education seminar for adults with chronic aphasia; (2) discuss outcomes in family adjustment, community reintegration, and activities of daily living associated with participation in a family education seminar; and (3) evaluate areas of programming and outcomes that should be addressed in future research.

Context- and skill-based treatment approaches, as embodied by functional and cognitive neuropsychological interventions, predict different patterns of acquisition and transfer of skill based on their theoretical foundations. This project was designed to compare the relative outcomes of these two treatment approaches on a comprehensive set of functional and psycholinguistic measures among aphasic adults. Twelve subjects with chronic, nonfluent aphasia were randomly assigned to each of the two treatments, and their performance compared to that of a baseline group consisting of five nonfluent aphasic subjects. Context-based training focused on role-plays of a functional task, and skill-based training focused on a naming intervention divorced from a functional context. Preliminary findings suggested that patterns of improvement and transfer at post-treatment testing were generally consistent with predictions. The results are a preliminary step towards making empirically based clinical decisions about what tre...

There is a lack of empirical evidence on which clinicians can base their daily decisions about aphasia treatment rate and duration. The purpose of this series of studies was to review the outcomes of various rates of speech/language therapy on the naming performances of adults with aphasia. A retrospective pre/post design was employed with a total of 40 subjects across studies. Results revealed the significant positive effects of intensive speech/language therapy on the naming skills of adults with aphasia, and that these improvements were greater than those obtained during non-intensive treatment, Although there are limitations of the treatment-based, retrospective research design, this line of research contributes to the ability of rehabilitation professionals to make appropriate treatment recommendations regarding treatment rate.

Perceptions of lifestyle satisfaction are an important component of quality of life and handicap measurements. Thirty- one adults with aphasia completed a questionnaire in which they rated their Lifestyle satisfaction and reported other demographic, health, communication, social contact and Vocational information. Forty-six per cent of the respondents reported general lifestyle satisfaction. Logistic regressions were estimated to differentiate the effects of the predictor variables on the likelihood of a positive lifestyle- satisfaction rating. A negative effect of time post-onset was demonstrated. The results are discussed in the context of previous reports of lifestyle satisfaction in the general stroke population.

Purpose This study explored whether perceptions of evidence or organizational context were associated with the use of external memory aids with residents with dementia in skilled nursing facilities (SNFs). Method A survey design, supplemented by a small sample of exploratory interviews, was completed within the Promoting Action on Research Implementation in Health Services framework. Ninety-six speech-language pathologists (SLPs) and 68 facility rehabilitation directors (FRDs) completed the Organizational Readiness to Change Assessment (Helfrich, Li, Sharp, & Sales, 2009) in relationship to the use of external memory aids. Five SLPs completed an interview exploring perceptions of evidence and context in relationship to memory aid use. Results SLPs and FRDs had favorable perceptions of evidence supporting memory aids. FRDs perceived the organizational context of the SNF more favorably than SLPs. SLP participants used external memory aids in the past 6 months in 45.89% of cases of residents with dementia. For SLP participants, a 26% ( p < .05) increase of external memory aid use was associated with every 1-unit change in favor of the evidence. Interview data revealed barriers to external memory aid implementation. Conclusions Part of evidence-based practice implementation may be influenced by clinician perceptions. Efforts to increase implementation of external memory aids in SNFs should address these clinician perceptions.

Person-centeredness in clinical practice incorporates the values of clients into a shared decision-making approach. The values of person-centeredness can be extended into the realm of research when the views of consumers towards relevant and important research topics are sought. Work in other health domains has shown the importance of gathering consumer views on health care research, which ultimately extends into health care policy and practice. The purpose of this paper is to report methods used successfully to gather the views of individuals living with aphasia on research topics they view as important.The project is founded on principles of community-based participatory research. Using a modified nominal group technique, members of an aphasia support group generated a list of research topics.The Aphasia Support Group identified twenty-two potential research questions. Although a majority (59%) of the research questions generated by persons with aphasia could be addressed with accumulated scientific evidence, the remainder of the generated questions has not been addressed in the research literature.This project demonstrates that consumers with aphasia can participate as stakeholders in the discussion of research needs in aphasia. Additional work is needed to fully develop a consumer-informed research agenda for aphasia.The perspectives of individuals with post-stroke aphasia on research needs can be successfully collected using nominal group techniques. Consumer input to research agendas and priorities can help to address potential research biases. Clinicians and researchers can use these techniques and other communication supports to foster collaborative, patient-centered care in their practice and work.

Purpose The purpose of this article was to illustrate the importance of the implementation of cognitive-communication screenings in acute stroke and to discuss the need for further research on whether and how these screenings are implemented. Cognitive-communication screenings after stroke are the subject of existing practice guidelines and are supported by accumulated evidence. Method The author uses an autoethnographic narrative —a tool founded in phenomenology—to provide an in-depth description of the experiences of a family in which one member experienced right-hemispheric stroke. She uses systematic introspection to produce a narrative using literary techniques. Results The narrative illustrates the experiences of one family when one of their members has a right-hemisphere stroke, and cognitive-communication impairments are never formally identified by professionals involved in the patient's care. Conclusions The narrative is linked to the published literature and the importance of identifying and managing cognitive-communication impairments after stroke. A model of implementation science is presented as one way to consider the challenges clinicians face when attempting to implement evidence-based practices. The model and examples from other fields show avenues for further research.

Purpose Obtaining health information and resources can influence an individual's (a) access to services, (b) interactions with health care providers, and (c) ability to manage one's own health needs. The purpose of this study was to gather the perceptions of consumers living with aphasia about resource availability and information needs. Method An online survey of consumers in the United States was conducted about the availability of aphasia resources. Analysis of survey responses and comments formed the basis for focus group questions. Four focus groups consisting of persons with aphasia and their caregivers were conducted to explore the survey response themes more deeply. Results Survey respondents ( N = 302) rated aphasia resources as “somewhat difficult to find.” Topics ranked as most important by these respondents were (a) how to keep improving, (b) communication strategies, (c) aphasia treatment techniques, (d) coping strategies, and (e) strategies for caregivers. Survey comments and focus group themes suggested that accessing information is difficult, health care providers are not perceived to know about aphasia resources, and there is a lack of public awareness of aphasia that is a barrier to finding information and resources. Conclusion Understanding how people living with aphasia seek information may allow us to better tailor access to resources in the future.

Purpose Treatment fidelity is a measure of the reliability of the administration of an intervention in a treatment study. It is an important aspect of the validity of a research study, and it has implications for the ultimate implementation of evidence-supported interventions in typical clinical settings. Method Aphasia treatment studies published in the last 10 years in 3 journals were reviewed using coding techniques that were adapted from Gresham, Gansle, Noell, Cohen, and Rosenblum (1993). The following items were noted: identifying information, study design, description of both the dependent and independent variables, and whether a measure of treatment fidelity was explicitly included. Results Of the aphasia treatment studies published in the last 10 years, 14% explicitly reported treatment fidelity. Most studies reporting treatment fidelity used checking of videotaped sessions by independent raters. Of the reviewed studies, 45% provided sufficient treatment description to support replication. Conclusion Treatment fidelity is widely acknowledged as being critical to research validity and is a foundation for the implementation of evidence-based practices, but only a small percentage of aphasia treatment studies published in the last 10 years explicitly reported treatment fidelity. Recommendations for research practices include increased attention to matters of treatment fidelity in the peer review process and explicit incorporation of 3 levels of treatment fidelity in treatment research. Supplemental Material https://doi.org/10.23641/asha.14963517

This study quantifies connected speech samples of post-acute adults with mild, moderate and severe levels of aphasia. Yorkston and Beukelman (1980) established utterance production values for 50 adults with mild and moderate aphasic impairments. The present study reports mean and standard deviation syllable and utterance content values for severe impairments as well, based on the performance profiles of 103 adults with aphasia.

In this introduction to the issue, it is asserted that a positive therapeutic relationship may be equally important to good rehabilitation outcomes as the administration of an effective, evidence-based treatment. The author illustrates this assertion with two variations of a clinical story in which aspects of the therapeutic relationship are manipulated. The narrative methodologies used in the articles in this issue, including ethnography, autoethnography, and personal narrative, are defined. Because details of the therapeutic relationship can best be explored through narrative methodologies, there will always be a role for narratives in the understanding of best clinical practice.

The purpose of this study was to compare responses to comments of adults with aphasia and those with normal language in two elicitation contexts, picture-stimulus and spontaneous conversation. The results indicate that picture-stimulus elicitation is a valid method for assessing responses to comments among adults with aphasia. The potential uses of the picture-stimulus method at specific points in the intervention process are discussed.

The question "What does it take to live successfully with stroke and aphasia?" was posed and answers were sought within already published accounts written by people living with aphasia. Published accounts that were identified as eligible and included in the study had to meet the following criteria: they had to be a published book or journal article that would be nationally available; they had to be authored or co-authored by a person with chronic aphasia due to stroke; and they had to be a personal narrative of some type. 28 publications meeting these criteria were identified through a search of bibliographic databases and websites, and 20 were available for analysis. 4 themes emerged. First, social support was identified as a critical factor in living successfully. Second, successful living appears to require an adaptation of one's perception of self. Third, most of the writers of the accounts looked to the future and set new goals. Finally, all of the published accounts noted the importance of taking charge of one's own continued communication improvement. Characteristics of the writers are discussed. The 4 themes are linked to the professional literature, and implications for future clinical work are explored. The potential bias of the interpreter is acknowledged.

We applied the Verbal Response Mode coding system to 80 medical interviews to characterize role dimensions of patient and physician and to assess the relation between physicians' role dimensions and patients' satisfaction. Role dimensions conformed closely to prior work Physicians' acquiescence was positively correlated with satisfaction. This study suggests that the role dimensions generated by the Verbal Response Mode taxonomy are a useful measure of patients' and physicians' relationships.