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From Participants to Participationin Aphasia Research
Leora Cherney, Jackie Hinckley, Lisa Stewart
WHATEXACTLYIS“LPAA”RESEARCHLEORAR.CHERNEY,PHD,CCC-SLP,BC-ANCDS
COLEMANFOUNDATIONCHAIRSCIENTIFICCHAIR:THINKANDSPEAKLAB
SHIRLEYRYANABILITYLABPROFESSOR,PHYSICALMEDICINE&REHABILITATION,
PROFESSOR,COMMUNICATIONSCIENCES&DISORDERSNORTHWESTERNUNIVERSITY
ISTHISLPAARESEARCH?
• Recoveryoflanguagefunctionandbrainmetabolisminapatientwithcrossedaphasia:2yearfollow-upofbrainFDGPETimages
• Gavelclubforpeoplewithaphasia:communicationconfidenceandqualityofcommunicationlife
• Useofco-verbalgesturesduringword-findingdifficultyamongCantonesespeakerswithfluentaphasiaandunimpairedcontrols
• Publicawarenessofaphasia– resultsofaSwedishsample• Playingateamgameimproveswordproductioninpost-strokeaphasia
• Erroranalysisoforalparagraphreadinginindividualswithaphasia
ISTHISLPAARESEARCH?
• Effectsofphonomotor treatmentondiscourseproduction?
• Deliveringwordretrievaltherapiesforpeoplewithaphasiainavirtualenvironment
• Abehavioralstudyofthenatureofverb-noundissociationinthenonfluent variantofprimaryprogressiveaphasia
• Motorevokedpotentialofupperlimbsispredictiveofaphasiarecovery
• Aninvestigationofhospitalityindustrystudents’awarenessandknowledgeofaphasia
• Speakalongwithoutthesong:Whatpromotesfluencyinpeoplewithaphasia?
Mission: Growing a network of healthcare, business, and community leaders to advance lifelong communication access for people with aphasia.
http://www.aphasiaaccess.org
LIFEPARTICIPATIONAPPROACHTOAPHASIA(LPAA)
• Generalphilosophyandmodelofservice-delivery• Focusesonre-engagementinlifebystrengtheningdailyparticipationinactivitiesofchoice
• http://www.asha.org/public/speech/disorders/LPAA.htm
LIFEPARTICIPATIONAPPROACHTOAPHASIA(LPAA)
• LPAAplacesthelifeconcernsofthoseaffectedbyaphasiaatthecenterofalldecisionmaking.
• Itempowerstheconsumertoselectandparticipateintherecoveryprocessandtocollaborateonthedesignofinterventionsthataimforamorerapidreturntoactivelife.
• TheLPAAProjectGroup(RobertaChapey,JudithF.Duchan,RobertaJ.Elman,LindaJ.Garcia,AuraKagan,JonLyon,andNinaSimmonsMackie)oftheAmericanSpeech-LanguageHearingAssociation
• http://www.asha.org/public/speech/disorders/LPAA.htm
COREVALUESOFLPAA
• Explicitgoalisenhancementoflifeparticipation• Allthoseaffectedbyaphasiaareentitledtoservice
• Measuresofsuccessincludedocumentedlifeenhancementchanges
• Bothpersonalandenvironmentalfactorsaretargetsofintervention
• Emphasisisonavailabilityofservicesasneededatallstagesofaphasia
ARETHESETHECOREVALUESOFLPAARESEARCH?
• Explicitgoalisenhancementoflifeparticipation• Allthoseaffectedbyaphasiaareentitledtoservice
• Measuresofsuccessincludedocumentedlifeenhancementchanges
• Bothpersonalandenvironmentalfactorsaretargetsofintervention
• Emphasisisonavailabilityofservicesasneededatallstagesofaphasia
PICOPROCESS
• ThePICOprocess isatechniqueusedinevidencebasedpractice toframeandansweraclinicalorhealthcarerelatedquestion.
• ThePICOacronymstandsfor• P – Populations/People/Patient/Problem• I – Intervention• C – Comparison,ControlorComparator(optional)• O – Outcome
P– POPULATIONS/PEOPLE/PATIENT/PROBLEM
• Allthoseaffectedbyaphasiaareentitledtoservice
• Personwithaphasia• Otherswhoareincontactwiththepersonwithaphasia
• Familymembers• Professionals/students• Communitymembers
• Emphasisisonavailabilityofservicesasneededatallstagesofaphasia
• Acute,Subacute,Chronic
I– INTERVENTION(S)
• Explicitgoalisenhancementoflifeparticipation• Bothpersonalandenvironmentalfactorsaretargetsofintervention
I– INTERVENTION(S)
• Explicitgoalisenhancementoflifeparticipation• Bothpersonalandenvironmentalfactorsaretargetsofintervention
I– INTERVENTION(S)
• Howexplicitmustthegoalofenhancinglifeparticipationbe?
I– INTERVENTION(S)
• LPAAempowerstheconsumertoselectandparticipateintherecoveryprocessandtocollaborateonthedesignofinterventionsthataimforamorerapidreturntoactivelife.
C– COMPARISON,CONTROLORCOMPARATOR(OPTIONAL)
• Comparinginterventions• Comparingparticipants(controlgroup)• Personwithaphasiamayserveashis/herowncontrol
• Single-subjectdesign• Delayedtreatment/wait-listcontrol
O– OUTCOME
• Measuresofsuccessincludedocumentedlifeenhancementchanges
LIVINGWITHAPHASIA:FRAMEWORKFOROUTCOMEMEASUREMENT(A-FROM)
LIVINGWITHAPHASIA:FRAMEWORKFOROUTCOMEMEASUREMENT(A-FROM)
HOWMANYELEMENTSOFPICOMUSTBELPAARELATED?
Playingateamgameimproveswordproductioninpost-strokeaphasia
P- participantswithaphasiaI- teamgame;picturenaming;groupmay“reducefeelingsofisolationandlackofconfidence”C– pre/postassessmentO– picturenaming;discourse(descriptionof
picturedscene)
FOCUSOFTHEQUESTION
• Assessment• Diagnosis• Prognosis• Treatment• Cost-Effectiveness• Prevention
STUDYDESIGN
• QuantitativevsQualitative• RetrospectivevsProspective• SystematicReview• Single-subjectdesign(singlecaseexperimentaldesign)
• RCT(Phase1,2or3)
ISTHISLPAARESEARCH?
• Recoveryoflanguagefunctionandbrainmetabolisminapatientwithcrossedaphasia:2yearfollow-upofbrainFDGPETimages
• Gavelclubforpeoplewithaphasia:communicationconfidenceandqualityofcommunicationlife
• Useofco-verbalgesturesduringword-findingdifficultyamongCantonesespeakerswithfluentaphasiaandunimpairedcontrols
• Publicawarenessofaphasia– resultsofaSwedishsample• Playingateamgameimproveswordproductioninpost-strokeaphasia
• Erroranalysisoforalparagraphreadinginindividualswithaphasia
ISTHISLPAARESEARCH?
• Effectsofphonomotor treatmentondiscourseproduction?
• Deliveringwordretrievaltherapiesforpeoplewithaphasiainavirtualenvironment
• Abehavioralstudyofthenatureofverb-noundissociationinthenonfluent variantofprimaryprogressiveaphasia
• Motorevokedpotentialofupperlimbsispredictiveofaphasiarecovery
• Aninvestigationofhospitalityindustrystudents’awarenessandknowledgeofaphasia
• Speakalongwithoutthesong:Whatpromotesfluencyinpeoplewithaphasia?
InternationalClassificationofFunctioning,DisabilityandHealth