Background Functional vocabulary selection is a key component of post-stroke language rehabilitation, yet limited evidence exists regarding which words are perceived as most meaningful by people with aphasia themselves. This study examined which vocabulary items are prioritised by individuals with aphasia or their relatives, as well as by chronic aphasia patients enrolled in the DULCINEA clinical trial.Methods and Procedures This cross-sectional observational study comprised two phases. In Phase 1, 15 individuals previously affected by aphasia and their relatives completed an online survey designed to identify everyday words and short phrases considered essential for functional communication. After refinement and categorisation, a base list of 183 items was generated. In Phase 2, 20 participants with chronic post-stroke aphasia selected, with support from relatives and speech and language therapists, the words they wished totrain during the DULCINEA intervention. A total of 891 trained words were analysed. The analyses were conducted at two levels and on an exploratory basis. At the word level, generalized linear mixed models (GLMMs) with a negative binomial distribution were used to examine differences across semantic categories and selected subgroups (sex, age, and depressive symptoms). At the participant level, individual proportional distributions were compared between subgroups using Mann - Whitney U tests with false discovery rate (FDR) correction.Results Conversation was the most frequently selected category in both the baseline list and the training items, followed by Series, Foods and Drinks, Emotional and Physical States, and Verbs. Descriptive variations were observed in certain categories according to sex and, to a lesser extent, age. No differences were observed according to the status of depressive symptoms. However, these subgroup differences were not statistically significant after correction for multiple comparisons and were associated with small effect sizes.Conclusions Individuals with aphasia prioritise highly functional vocabulary relevant to everyday communication, particularly conversational terms. While exploratory variations were observed across subgroups, these findings should be interpreted with caution given their lack of statistical significance, the small sample size, and the exploratory nature of the analyses. Larger studies are needed to confirm these preliminary observations and to further inform patient-centered vocabulary selection approaches in aphasia rehabilitation.
Background Reading is an important life skill that can be impaired in many persons with aphasia (PWA). However, compared to spoken language expression and comprehension, less is known about the nature and prevalence of specific reading difficulties that are experienced by PWA and current practices and resources available for clinical management.Aims This survey study examined the experiences and observations of PWA, caregivers, and speech-language pathologists (SLPs) to characterize the nature of reading difficulties and their impact. In addition, we explored how reading is addressed in clinical assessment and treatment.Methods A total of 130 respondents completed either a live videoconferencing survey (40 PWA) or a self-administered survey online (40 caregivers, 50 SLPs). Quantitative and qualitative analyses were conducted.Results All groups reported a high frequency of reading difficulties in PWA. The most frequently reported challenges by PWA and caregivers were in the areas of oral reading fluency and reading comprehension of sentences and connected text. SLPs more commonly reported observing letter and single-word level deficits in PWA. Importantly, despite prevalent reading difficulties, enjoyment in reading activities did not change post-stroke compared to pre-stroke. Qualitative analyses revealed that reading deficits impact PWA's identity, independence, emotional well-being, and social engagement. SLPs' reported challenges included limited session time, lack of evidence-based materials, and lack of training.Conclusion These findings suggest that reading difficulties in PWA impact life participation and well-being of PWA and caregivers. Perspectives from three stakeholder groups underscore the importance of extending clinical reading treatment tools beyond isolated word-level tasks to include sentence- and connected-text materials that better reflect the prioritized needs by PWA and caregivers.
Background Phonological anomia is one of the most persistent consequences of stroke-induced aphasia. Understanding how phonological treatment outcomes generalize within and across languages is essential for designing effective bilingual interventions. In bilingual aphasia, cross-linguistic transfer and cognate facilitation are often expected but inconsistently observed.Aims This single-case study tested, in a balanced Basque - Spanish bilingual with post-stroke phonological anomia, whether intensive phonological therapy (i) generalized to untreated items within the treated language, (ii) produced cross-linguistic transfer, (iii) was influenced by cognate status, and (iv) was maintained approximately 4.5 months later.Methods & Procedures A two-phase multiple-baseline design was implemented. Therapy was delivered monolingually in two consecutive 4-week blocks (Phase 1 = Basque, Phase 2 = Spanish) using an item-specific phonological programme aligned with Phonological Component Analysis principles. A list of 200 translation-equivalent items was created; within each language, items were assigned to treated and untreated sets, which differed across languages. After each phase and at follow-up, the participant completed a naming-by-definition task in both languages. Planned contrasts using generalized linear mixed-effects models evaluated within-language generalization, cross-linguistic transfer, cognate effects, and maintenance, with results expressed as model-based estimated probabilities and effect sizes.Outcomes & Results Therapy produced reliable improvement for trained items in the language of therapy. No generalization occurred to untreated items within language or to the untrained language, including for cognates. At follow-up, Spanish-treated items showed partial decline relative to end-of-treatment, whereas Basque performance remained stable. At the follow-up session itself, treated-versus-untreated differences were not statistically reliable in either language.Conclusions When impairment is primarily phonological and therapy targets phonological form, gains appear item-specific and language-specific, with limited evidence for cognate-driven or cross-language transfer. Clinically, improvements in both languages require direct intervention in each and systematic maintenance planning. These findings inform models of bilingual lexical access and guide evidence-based rehabilitation strategies for bilingual individuals with aphasia.
Background Multilingual individuals are increasingly represented in speech-language therapists' (SLTs) caseloads. Yet, clinicians report feeling underprepared to deliver linguistically and culturally responsive care, especially when clinical resources are mainly developed in English. This gap is particularly noticeable in French-speaking contexts, where access to tools tailored for multilingual aphasia care remains limited.Aim : To address this issue, we conducted a narrative review of the literature and developed a structured knowledge translation (KT) tool to support SLTs in providing person-centred, multilingual aphasia care.Method The narrative review combined evidence from over 60 sources (35 high-evidence-level studies and 33 case studies) from SpeechBite, ASHA Evidence Maps, Scopus and PubMed, focusing on studies from 2000 onwards related to aphasia, multilingualism, and clinical practice. Findings were sorted into assessment, intervention, and descriptive categories. After the review, the information was integrated into a Clinical KT tool for SLTs.Main contributions The resulting resource includes five asynchronous video modules and a companion PDF booklet aligned with the clinical care process: (1) Introduction - the multilingual person living with aphasia, (2) Elements to consider during the first meeting, (3) Adapted assessment, (4) Adapted speech-language therapy, and (5) Collaboration with an interpreter or translator. Each module provides evidence-based guidance and curated resource links. Throughout the tool, a clinical example helps clinicians envision how the presented content can be applied in practice. A custom GPT-4.0-powered chatbot, trained on the reviewed literature, is also included to provide real-time, evidence-informed support. The tool is based on the Knowledge-to-Action (KTA) framework and adult learning principles, with attention to visual accessibility.Conclusions This paper outlines the rationale, development process, and structure of the KT tool. By offering practical, context-sensitive guidance in clinicians' working languages, the tool aims to boost clinicians' confidence, narrow the gap between research and practice, and ultimately enhance care quality for multilingual individuals with aphasia. The initial version was developed for French-speaking SLTs, and the tool is currently being adapted to English with the aim of serving as a model for broader multilingual adaptations. The tools are freely accessible online.
Purpose: Aphasia is a common communication disorder following stroke and can substantially impair language abilities, social participation and overall quality of life. Although speech and language therapy is the primary intervention for aphasia rehabilitation, access to conventional face-to-face services may be limited due to geographic and logistical barriers. Telerehabilitation has emerged as an alternative model for delivering rehabilitation services remotely; however, evidence examining its combined effects on language performance and quality of life remains limited. This study aimed to investigate the association between telerehabilitation-based speech and language therapy and changes in language performance and health-related quality of life in individuals with post-stroke aphasia. Methods: This retrospective observational study analyzed prospectively collected clinical data from a state-supported telerehabilitation program. A total of 61 individuals diagnosed with post-stroke aphasia who completed a 30-session telerehabilitation-based speech therapy program were included. Language performance was assessed using the Aphasia Language Assessment Test (ADDT) and quality of life was evaluated using the Stroke-Specific Quality of Life Scale (SS-QOL). Pre- and post-intervention outcomes were compared using the Wilcoxon signed-rank test. Effect sizes were calculated to estimate the magnitude of change. Associations between language improvement and quality-of-life outcomes were examined using Spearman correlation analysis and multivariable linear regression was used to explore factors associated with quality-of-life improvement, with baseline language performance considered in the model. Results: Significant improvements were observed in both language performance (Z = -5.52, p < 0.001, r = 0.71) and overall quality of life (Z = -6.55, p < 0.001, r = 0.84) following the intervention. Changes in language performance were strongly associated with improvements in quality of life (rho = 0.62, p < 0.001) and were also significantly associated with quality-of-life improvement in regression analyses. Conclusions: Telerehabilitation-based speech and language therapy was associated with improvements in language outcomes and quality of life and showed promising pre - post improvements within this clinical cohort. These findings suggest that telerehabilitation may represent a feasible service delivery model within a real-world clinical context for individuals with post-stroke aphasia. However, given the observational single-group design and absence of a control group, the findings should be interpreted as real-world evidence of pre - post change rather than definitive evidence of causal treatment effects.
BackgroundAphasia disrupts sense of self and constrains the narrative capacity essential for identity reconstruction. While narrative co-construction approaches show promise for supporting identity development in people with aphasia, little is known about whether intervention effects persist beyond the immediate post-intervention period.AimsThis longitudinal qualitative study explored participants' lived experiences one year after completing the My Story Project, a collaborative storytelling intervention, with a focus on understanding the role their co-constructed stories played in their lives in the intervening year.Methods & ProceduresThree male participants with chronic aphasia (5-6 years post-stroke, ages 56-67) who had completed the My Story Project intervention participated in semi-structured follow-up interviews 12-13 months post-intervention. Interviews explored participants' experiences with the intervention and changes over the preceding year. Data were analyzed using reflexive thematic analysis grounded in an interpretive, constructivist paradigm. The Communication Confidence Rating Scale for Aphasia was administered to assess sustained changes in communication confidence.Outcomes & ResultsThree themes captured the longer-term impact: Becoming and Believing (ongoing identity development, agency, and hope); Envisioning and Achieving (translation of goals into concrete achievements including boat building and adaptive cycling); and Enduring (continued story relevance). Communication confidence gains were maintained or increased (converted score changes +3 to +9). Critically, behavioral achievements emerged six to twelve months post-intervention rather than immediately. Identity work remained active and complex, with both behavioral changes and ongoing self-doubt, suggesting identity reconstruction as a continuing process rather than fixed outcome.ConclusionsThe sustained transformation observed - participants building boats, riding bikes, and continuing to engage with their stories - demonstrates that narrative co-construction initiates processes that remain active long after intervention concludes. Behavioral changes emerged months after intervention rather than immediately, challenging conventional expectations for rapid outcomes and highlighting the need for extended follow-up timelines when evaluating narrative interventions. Findings position narrative intervention as addressing both internal identity work and concrete life participation outcomes essential to person-centered aphasia rehabilitation.
BackgroundAphasia following stroke can substantially disrupt communication and family dynamics, often placing considerable demands on family caregivers. Understanding the relationship between caregiver burden and the impact of aphasia on family life is important for improving support strategies and rehabilitation outcomes.AimThis study aimed to examine the relationship between caregiver burden and the impact of aphasia on family life in family members caring for people with aphasia following stroke.MethodsThis cross-sectional correlational study was conducted between February 2023 and February 2024 with 150 family caregivers of people with aphasia following stroke. Data were collected using the Burden Interview and the Family Aphasia Measure of Life Impact (FAMLI). Data were analyzed using Pearson correlation coefficients and linear regression analyses.ResultsA statistically significant negative correlation was found between caregiver burden and the impact of aphasia on family life, indicating that higher caregiver burden was associated with poorer family functioning. Caregiver burden was negatively associated with the Health and Daily Life and Communication and Emotions subscales of the FAMLI. However, no statistically significant relationship was found between caregiver burden and the Attitude and Personal Life subscale.ConclusionThe findings suggest that caregiver burden experienced by family members of people with aphasia following stroke is associated with several aspects of family life, particularly health, daily functioning, and emotional experiences.
BackgroundGiven the rising global prevalence of dementia from Alzheimer's disease, early detection at the stage of Mild Cognitive Impairment (MCI) has become increasingly critical. In countries like the United States (U.S.), speech-language pathologists (SLPs) play an essential role in early risk identification and cognitive management of MCI. However, knowledge, attitude, and practice (KAP) patterns among Indian SLPs remain underexplored in this context. It would also be of great interest to examine whether the KAP patterns of Indian SLPs regarding MCI differ from those of their U.S. counterparts, given the influence of cultural and healthcare diversities. Investigating such differences could provide valuable insights into cross-national practices, which in turn could inform the development of international guidelines for cognitive communicative services by SLPs delivering clinical care to older adults at-risk for dementia.AimThe study aimed to investigate the KAP of SLPs in India regarding MCI diagnosis and treatment and compared these findings with trends among SLPs in the U.S.Methods & ProceduresA cross-sectional study employing purposive sampling was conducted. The questionnaire, adapted from a U.S. based survey by Lanzi et al. (2022), assessed Indian SLPs' KAP related to MCI across three sections: demographics; knowledge and attitude; and clinical practice. Qualitative and quantitative analyses explored KAP patterns among Indian SLPs and then compared the results with the original American survey to examine potential culture-specific differences.Outcomes & ResultsResults from 94 SLPs revealed a discrepancy between knowledge and practices concerning MCI, specifically in subtypes, diagnostic criteria, and the tools used for assessment and treatment. Notable differences were observed between Indian and American SLPs, especially in assessing activities of daily living and using compensatory strategies for assessment, intervention, and goal setting.ConclusionsThe findings shed light on the current KAP patterns of Indian SLPs regarding MCI, identifying areas for improvement through targeted education and training. Furthermore, the cross-national comparison underscores the need for culturally sensitive, contextually relevant cognitive-communication interventions to improve the MCI management through collaboratively developed, evidence-based, culturally informed tools.
