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Purpose: This article characterizes graduate student clinicians' (GSCs') understanding of their roles as stakeholders in clinical implementation and research before participating in an intensive comprehensive aphasia program (ICAP). Method: Seven GSCs participated in a pre-ICAP intervention focus group to characterize their perceived roles in stakeholder-engaged research. Following an extensive ICAP training orientation and clarification of key definitions, the focus group prompt asked GSCs to describe what they view as important issues for developing future research protocols that investigate student clinician outcomes in the context of an ICAP. Qualitative content analysis using an inductive coding approach was applied to the focus group transcript. Results: The GSCs preparing to participate in ICAPs report that they are highly invested in the clinical implementation and research of the ICAP service delivery model. Discussion/Conclusions: The GSCs are crucial stakeholders in the development of GSC-run ICAPs across clinical implementation and all phases of research.

Patient-centered care is extending the sphere of health care beyond the patient, focusing attention upon the family caregiver(s). In this context, patient-family relationships are at the center of consistent, well-developed interprofessional interventions that encompass caregiver education, training, and wellness. Cohort models of intervention include groups of patients who start and stop a program or intervention simultaneously. One such cohort-based service delivery model is an intensive comprehensive aphasia program (ICAP), which provides an ideal context in which to address holistic care for the person with aphasia and his or her family caregivers. The interprofessional family caregiver intervention program of the ICAP at the University of Montana is twofold: (1) speech-language pathologists and graduate student clinicians in speech-language pathology provide family caregiver education and resources, communication training, and psychosocial support and (2) a licensed professional counselor and counselor-in-training provide group counseling for family caregivers focusing on personal wellness, caregiving strategies, emotional health, and adaptation to significant life changes. The fusion of equitable interprofessional collaboration, along with the cohort model of the ICAP, allows for acquisition of knowledge, communication strategies, and coping skills along with the development of close, meaningful relationships with other caregivers and persons with aphasia.

Stroke survivors with aphasia who participate in intensive post-acute aphasia rehabilitation programs make a variety of significant investments. As the number of Intensive Comprehensive Aphasia Programs (ICAPs) increase across healthcare settings worldwide, patient perspectives of this innovative service delivery become increasingly important. Stakeholder perspectives can provide meaningful contributions to intervention implementation, growth, and sustainability. The purpose of this pilot study was to qualitatively explore patient perspectives about the experience of participating in a university-based ICAP implemented by graduate student clinicians. Researchers used an interpretive phenomenological approach to analyze nine structured interviews from five stroke survivors with aphasia who described their lived experiences during an ICAP. Thematic analysis involved an iterative and collaborative coding process. Transcripts were coded and themes were developed from the patients' shared perspectives. Trustworthiness was maximized through acknowledgement of the researchers' positionality and bias, variation in the sample, member checks, and sustained relationships between stakeholders. Three primary themes emerged from patient interviews: (1) the ICAP is hard work; (2) the impact of the ICAP on communication is noticeable, and (3) relationships "make" the ICAP. Themes support emerging evidence that ICAPs implemented by graduate student clinicians may be a worthwhile investment for many stroke survivors with aphasia, thereby contributing to the cost-benefit utility and implementation feasibility of this service delivery model. Stroke survivors with aphasia reported mixed levels of acceptability pertaining to the perceptible impact on communication improvement, and the challenging, rewarding, frequent, and varied opportunities to interact with others. [ABSTRACT FROM AUTHOR]

Aphasia negatively impacts functional daily communicative participation, participation in life's domestic, educational, vocational and recreational roles, psychosocial well-being and social relationships, and overall quality of life, thereby increasing the need for holistic, comprehensive care. Interprofessional collaboration has the potential to increase comprehensive patient care while also improving education and training for student clinical providers. The Intensive Comprehensive Aphasia Program (ICAP) is a growing service delivery model that infuses comprehensive care and principles of neuroplasticity, making it an ideal context for interprofessional collaboration. The purpose of this pilot project was to explore the perspectives of stroke survivors living with aphasia and interprofessional graduate student clinical providers who participated in a telehealth interprofessional psychoeducation and wellness group that was developed by healthcare providers from speech–language pathology and counseling to support aphasia recovery and living well with aphasia. A qualitative phenomenological research design was applied to explore the experiences of five stroke survivors living with aphasia, one graduate student clinical provider from speech-language pathology, and one graduate student clinical provider from counseling who participated in an Interprofessional Aphasia Community Group, that took place during the Summer 2020 University of Montana Telehealth ICAP. Content analysis procedures were applied to verbatim transcripts obtained during weekly focus groups with the stroke survivors living with aphasia and student clinical provider reflections. Themes that emerged from weekly focus group transcripts suggest that stroke survivors with aphasia wanted less information during each group session, further simplification of information presented during the group sessions, and increased opportunities for discussion, communication practice, and time to connect with one another. Themes that emerged from graduate student reflections suggest that graduate student clinical providers were positively impacted by the interprofessional collaboration, improving skills, knowledge, and attitudes of their own and each other's disciplines. These themes also identified methods for improving future interprofessional collaboration in the context of an ICAP. This project documents what is believed to be the first telehealth delivered Interprofessional Aphasia Community Group in the context of an ICAP. Qualitative exploration of this interprofessional collaboration highlights the perspectives, voices, and experiences of stroke survivors with aphasia and graduate student clinical providers. These experiences offer insight into how collaborative care can increasingly improve participant experiences in the context of an ICAP. [ABSTRACT FROM AUTHOR]

Intensive Comprehensive Aphasia Programs (ICAPs) were first described in 2013 with an international survey documenting 12 unique programs. ICAPs involve high dose intervention delivered in both group and individual settings, targeting communication across impairment, functioning, participation, and contextual domains. In this study, we aimed to investigate international growth in ICAPs. We developed a 43-item questionnaire expanding on the original 2013 version to investigate program modifications, activities, protocolised therapies, software and apps, and family involvement. The survey was disseminated to aphasia clinicians and researchers internationally (November 2019–February 2020). Thirty-nine unique respondents completed the survey from nine countries. Twenty-one met the criteria for an ICAP or modified ICAP (mICAP): 14 ICAPs; 7 mICAPs, and 13 of these were new programs. ICAPs differed from mICAPs with greater emphasis on group sessions, use of technology, total communication, advocacy, and art activities. A large range of protocolised therapies were used across programs. An increased focus on mood and psychosocial well-being was observed compared to the 2013 survey. The number and comprehensiveness of ICAPs has grown since 2013 with development of modified versions. Future research should focus on comparative efficacy of ICAPs/mICAPs and other forms of aphasia interventions and factors underpinning growth and sustainability. Clinicians who coordinate or are considering commencing an ICAP in future can use these results to consider the design of their program. Coordinators should carefully consider the components of their ICAPs and advise consumers whether they meet the definition of an ICAP or a mICAP. With the increasing number of ICAPs across the globe, clinicians commencing an ICAP may wish to contact existing ICAPs within their country for advice. Program sustainability may be challenging and these results provide an indication of some of the key challenges coordinators may face. [ABSTRACT FROM AUTHOR]

Intensive Comprehensive Aphasia Programs (ICAPs) implement evidence-based, holistic therapies in a short-duration cohort model. ICAPs are growing in popularity, yet there are still relatively few programs, partially due to the high cost of running an ICAP. ICAPs implemented by graduate student clinicians can reduce the overall cost of an ICAP, but Phase I efficacy data for cognitive-linguistic outcomes for an ICAP carried out by graduate students has yet to be reported. To investigate the impact of a graduate student-run ICAP on measures of cognitive-linguistic change, and to identify relationships between individual and treatment variables and cognitive-linguistic function across pre- and post-ICAP administration. Fifty-three stroke survivors with chronic aphasia (33 males, 20 females; 32 first-time participants and 21 repeat participants; mean age = 65 years; mean time post-onset = 34 months) participated in an ICAP implemented by graduate students across eight cohorts. Cognitive-linguistic outcome measures included: Western Aphasia Battery, Revised (WAB-R); Boston Naming Test, Second Edition (BNT-2); and Raven's Coloured Progressive Matrices (RCPM). Paired samples t-tests were used to compare pre- and post-ICAP performance for each measure, and Pearson's r correlation coefficients were used to evaluate relationships between measures, as well as individual and treatment variables. Statistically significant change was observed on all three measures post-treatment, with small to no effect size. Participants who had completed a previous ICAP showed greater change on the WAB-R and RCPM, but no other individual or treatment variables significantly predicted change on outcome measures. Results provide Phase I, proof-of-concept evidence of positive cognitive-linguistic change in stroke survivors with aphasia following ICAP participation. An ICAP implemented by graduate student clinicians produced significant improvements for persons with chronic aphasia. [ABSTRACT FROM AUTHOR]

Stroke survivors with aphasia often experience reduced psychosocial well-being. Intensive comprehensive aphasia programs (ICAPs) are an ideal model in which to treat persons with aphasia (PWAs) to improve both cognitive-linguistic impairments and psychosocial well-being. To investigate the impact of a university-based ICAP on psychosocial well-being using measures of depression, aphasia-related quality of life, and communicative participation. Thirty-seven PWAs (13 females, 24 males; mean age of 65 years; mean time post onset of 60 months) participated in a university-based ICAP across six ICAP sessions. Psychosocial outcome measures were administered before and after participating in an ICAP including: Geriatric Depression Scale (GDS), Assessment of Living with Aphasia (ALA), and Communicative Effectiveness Index (CETI). Paired samples t-tests were used to compare pre- and post-ICAP performance on each measure, and Pearson's r correlation coefficients were used to evaluate potential relations between measures, as well as relations between measures and demographic and treatment variables. Depression, as measured by the GDS, significantly decreased pre- to post-ICAP. Pre-treatment scores for the GDS and ALA were significantly correlated. Change scores for the GDS were predictive of change scores for the ALA and CETI. PWAs who had the lowest educational attainment showed the greatest change on the GDS and ALA. Results suggest that the ICAP service delivery model has the potential to improve psychosocial well-being by reducing depression and improving quality of life. Findings provide preliminary evidence that the ICAP model can be efficacious when implemented in a university setting. [ABSTRACT FROM AUTHOR]

Background: The term "communicative participation" refers to participation in the communication aspects of life roles at home, at work and in social and leisure situations. Participation in life roles is a key element in biopsychosocial frameworks of health, such as the World Health Organization's International Classification of Functioning, Disability and Health (ICF) and the Aphasia Framework for Outcomes Measurement. The Communicative Participation Item Bank (CPIB) was developed as a patient-reported measure of communicative participation for adults. Initial validation focused on adults with motor speech or voice disorders. No prior studies have conducted quantitative validation analyses for the CPIB for people with aphasia (PWA). Aims: The primary purpose of this study was to begin validation of the CPIB for PWA by conducting an analysis of differential item functioning (DIF). A DIF analysis was used to identify whether item parameters of the CPIB differed between PWA and the populations used in prior CPIB calibration. Secondary analyses evaluated the level of assistance needed by PWA to complete the CPIB, relationships between the CPIB and a gold-standard patient-reported instrument for PWA—American Speech-Language-Hearing Association Quality of Communication Life Scale (ASHA-QCL) and relationships between PWA and family proxy report on the CPIB. Methods & Procedures: This study included 110 PWA and 90 proxy raters. PWA completed a battery of patient-reported questionnaires in one face-to-face session. Speech-language pathologists provided communication support. Data on aphasia severity from the Western Aphasia Battery—Revised (WAB-R) and demographic data either existed from prior research or were collected during the session. Proxy raters completed a similar battery of self-report questionnaires. Outcomes & Results: Results of the DIF analysis suggested statistically significant DIF on two of the 46 items in the CPIB, but the DIF had essentially no impact on CPIB scores. PWA with WAB-R Aphasia Quotient scores above 80 appeared comfortable reading the CPIB items, although required occasional assistance. Most participants who were unable to complete the CPIB had WAB-R Aphasia Quotient scores lower than 50. Correlation between the CPIB and ASHA-QCL was moderate; and correlation between PWA and proxy scores was low. Conclusions: Most PWA were able to respond to CPIB items, although most required or requested support. Although these results are preliminary due to a small sample size, the data support that the CPIB may be valid for PWA. Caution is warranted regarding proxy report because of low correlation between PWA and proxy ratings. [ABSTRACT FROM AUTHOR]

Background: Although aphasia rehabilitation has been shown to be efficacious, many questions remain regarding how best to deliver treatment to maximise functional gains for persons with aphasia. Treatment-delivery variables, such as intensity and dosage, are likely to influence both behavioural and structural changes during anomia treatment. While numerous protocols have concluded that treatment intensity positively impacts functional outcomes, few studies to date have examined the role that dose plays in patient outcomes for anomia treatment. Aims: This study sought to investigate how manipulating dose of repeated confrontation naming within sessions influences naming in persons with aphasia. Repeated practice of confrontation naming, without feedback, was hypothesised to improve trained but not untrained words, to be persistent after withdrawal, and to be sensitive to the number of trials (i.e., dose) within sessions. Methods and Procedures: A single-subject ABA design, with replication across seven participants with aphasia, was used to investigate the influence of repeated confrontation naming attempts on the acquisition and maintenance of trained pictures relative to untrained pictures. Training involved repeated attempts to name pictures, along with repeated exposure to pictures of objects (nouns) and their names, without feedback. The primary independent variable was within session dose; the dependent variable was naming accuracy. Outcomes and Results: Naming accuracy improved for all participants for trained pictures across both acquisition and maintenance phases per visual inspection; such positive effects were not observed for untrained pictures. Effect-size calculations indicate that three of seven participants demonstrated considerable change for trained items, while one of seven participants demonstrated meaningful change for untrained items. The high-dose condition elicited small effect sizes for one participant, and large effect sizes for two of seven participants, while the low-dose condition elicited small and medium effect sizes for two of seven participants. Conclusions: Participants across a variety of aphasia severity levels responded positively to two doses of repeated confrontation naming practice, without feedback, across phases of this naming protocol. Results are in line with principles of neuroplasticity and demonstrate that repeated practice, without feedback, can produce significant and persistent changes in naming ability for some persons with aphasia. [ABSTRACT FROM AUTHOR]

An introduction is presented in which the editor discusses articles in the issue on topics including family caregivers of individuals with aphasia; caregiving and other acquired neurogenic communication disorders; and pertinent to family caregivers of individuals with neurological disorders.

BackgroundAimsMethods & ProceduresOutcomes & ResultsConclusionsIntensive Comprehensive Aphasia Programs (ICAPs) provide high doses of treatment over short periods. Treatment intensity in post-stroke aphasia rehabilitation and research is not well understood and is typically underspecified, including within ICAPs and modified Intensive Comprehensive Aphasia Programs (mICAPs), in which intensity is a fundamental design component. One recently developed model of treatment conceptualisation, the Multidimensional Dose Articulation Framework (MDAF), may offer a systematic, comprehensive, and granular method of characterising treatment intensity, though this framework has not yet been used to capture elements of intensity and dose during an ICAP or mICAP.The purpose of this paper is to examine and describe increasingly specific details of treatment intensity for both an ICAP and mICAP delivered at the University of Montana (UMT).Fourteen participants with aphasia attended an 84-hour ICAP (n = 8) or a 24-hour mICAP (n = 6) delivered by graduate student clinicians at UMT. Ethics approval was obtained from the UMT IRB (#13-23). We examined intensity and dose using components of the MDAF including broad temporal parameters, and episode-specific length and intensity. Descriptive statistics were used to report group-level, participant-level, and treatment-level parameters.In this descriptive manuscript, we use a series of vignettes to report temporal parameters from the MDAF including treatment duration, days, sessions, and session density, and episode-level characteristics including episode length and episode intensity. Vignette one examines ICAP and mICAP planned versus actual temporal parameters. Vignette two describes episode-level detail across two evidence-based treatments administered during the ICAP. Vignette three details differences in delivery of a single treatment approach between two participants. In each vignette, we discuss the benefits and challenges of tracking treatment intensity with fine detail.Comprehensive specification of dose and intensity parameters is essential to compare efficacious treatment programs and to understand variability in treatment response across individuals with aphasia. The MDAF is a promising tool, though detailed treatment intensity remains a challenging construct to measure, particularly at the level of the episode. Clinical researchers interested in dose and intensity and authors of evidence-based therapy approaches must continue to work to define and describe active ingredients within therapy approaches. [ABSTRACT FROM AUTHOR]