assessment and management of aphasia post stroke
TRANSCRIPT
Assessment and management of Aphasia post
stroke
A/Prof Erin GodeckeSenior Research Fellow Speech PathologySchool of Medical and Health SciencesEmail: [email protected]
@ErinGodecke
Screening toolshttp://www.aphasiapathway.com.au/?name=aphasia-screening-tools
Treatment provided
• Commenced on average before Day 10 post stroke
• Treatment period 28-32 days
• UC = 9.5h HI = 21.7h
Baseline communication characteristicsUC
n=81UC-Plus
n=81VERSEn=83
WAB - AQ Mean(SD) 42∙4(28∙9) 41(27∙8) 40∙1(28)
Mild (93∙6–62∙6) n(%) 25(31) 23(28) 24(29)
Moderate (62∙5–31∙3) n(%) 24(30) 24(30) 25(30)
Severe (0–31∙2) n(%) 32(40) 34(42) 34(41)
Clock Drawing/Cog Test Median(IQR) 1(3∙5) 1(3) 2(4)
Dysarthria n(%) 31(38) 40(49) 44(53)
Apraxia of Speech n(%) 43(53) 39(48) 46(55)
Well balanced
–Week 12 outcomesUC
(n=70)UC+
(n=75)VERSE(n=72)
Unadjusted p-value
WAB - AQ, Mean (SD) 70 (28.8) 65.1 (30.9) 69.4 (28.8) p=0.55§
Boston Naming Test, Mean (SD)
31∙3 (18∙8) 27∙6 (21∙5) 33∙2 (19∙9) p=0∙27§
Stroke and Aphasia Quality of Life Scale, Mean (SD)
3∙6 (0∙8) 3∙3 (0∙9) 3∙3 (0∙8) p=0∙92§
Aphasia Depression Rating Scale, Mean (SD)
5∙0 (3∙8) 5∙3 (3∙5) 5∙8 (4∙2) p=0∙43§
SAEs n 68 63 58 p=0.09†
†Chi-Square Test; §One-way ANOVA
Week 26 outcomesUC
(n=70)UC+
(n=75)VERSE(n=72)
Unadjusted p-value
WAB - AQ, Mean (SD) 75∙7 (25∙3) 70∙8 (29∙2) 72∙7 (28∙9) p=0∙51§
% Maximal Potential Recovery (SD) 61∙7 (25∙8) 54.7 (34∙2) 54∙9 (35∙3) p=0∙37§
Boston Naming Test, Mean (SD) 37∙5 (18.0) 32∙9 (20∙5) 36∙4 (19∙6) p=0∙40§
Stroke and Aphasia Quality of Life Scale, Mean (SD)
Aphasia Depression Rating Scale, Mean (SD)
3∙65 (0∙76)
4.76 (3.8)
3∙48 (0∙86)
3.95 (3.37)
3∙53 (0∙80)
4.44 (3.34)
p=0∙50§
p=0.92ǂ
§One-way ANOVA; ǂKruskal-Wallis
Conclusions
• Early intensive therapy is feasible • Early intensive therapy is not harmful• First 40 days: ‘More intensive is not better’
Usual Care aphasia therapy: Started < day 102-3 times per week30-40 minutes per sessionTherapy type to be confirmed
The Results
After controlling for baseline aphasia severity, NIHSS, hospitalsite and total therapy amount:
1.Average Session Length had a significant effect on recovery(p=0.024)
2.On average, increasing the session length by 1 minuteresulted in a 0.33 point higher AQ score at 12 weeks post-stroke
The Results: Interpretation
If 2 participants have the same baseline AQ score and NIHSS scoreand each participant receives a total of 1350 minutes (22.5 hours) oftherapy in the first 12 weeks post-stroke, but
• Participant A receives 30 sessions of 45 minutes eachand
• Participant B receives 45 sessions of 30 minutes each
ThenParticipant A can be expected to achieve 5 points* more on AQ at 12
weeks than Participant B
Usual Care +
n = 25 videos
Total number of
tasks
96
Total number of
different tasks
51
Average no.
tasks per
session
3.8