ABSTRACT Purpose To characterize the profile of the population of a Stroke Unit regarding the prevalence of aphasia and level of oral intake after the first ischemic stroke. Methods Quantitative, cross-sectional and retrospective study, collecting data from patients' electronic medical records, carried out in a Stroke Unit in a state hospital in Florianópolis, Santa Catarina State. Results The total population was 317 patients, of which 225 were included. The sample consisted predominantly of men and elderly individuals. Aphasia was present in 23.1% of patients at admission, with a reduction to 19.5% at discharge. Regarding the level of oral intake at admission and discharge from the Stroke Unit, it was observed that there was a significant reduction in the number of patients with Functional Oral Intake Scale (FOIS) 1 and a significant increase in FOIS 5. Conclusion A significant improvement in the severity of aphasia and in oral intake during hospitalization was observed, especially in patients undergoing speech-language pathology intervention.

Aphasia, a communication disability prevalent among stroke survivors, significantly impacts psychosocial well-being and quality of life. Intensive Comprehensive Aphasia Programs (ICAPs) provide intensive and comprehensive treatment, incorporating individual and group therapy, patient and family education, and technology utilization. Despite positive outcomes, global implementation of ICAPs remains limited. In Brazil, preliminary evidence supports the development of intensive and comprehensive aphasia programs, such as the Brazilian Aphasia House—a program inspired by the successful Aphasia House model in the United States. The Brazilian Aphasia House offers personalized and intensive therapy in a simulated domestic environment, encompassing individual and group therapy sessions, and patient and family education, with the goal of enhancing functional communication skills and overall quality of life. Operating as a teaching clinic within a public university, it also serves as a training ground for future therapists to expand ICAP availability in Brazil. Challenges in implementing ICAPs in Brazil include socioeconomic barriers, limited public aphasia awareness, a shortage of specialized professionals, transportation, and session costs. Sustainable implementation requires committed leadership and financial resourcing, with involvement from public institutions and universities. By increasing awareness and nationwide implementation of ICAPs, access to aphasia rehabilitation services can be improved, potentially leading to better outcomes for individuals with aphasia and their caregivers. The Brazilian Aphasia House serves as an exemplar of an ICAP, offering intensive and personalized therapy to enhance communication abilities and promote social participation for people with aphasia.

Purpose: to evaluate characteristics of aphasia rehabilitation, its barriers, and differences according to educational level (undergraduate level in speech-language pathology (SLP) or otherwise, professional qualification, Master's or Doctoral/Post-doctoral degree) and region of Brazil. Methods: A cross-sectional, quantitative, exploratory, analytical survey study was conducted. Speech therapists who work with people with aphasia (PwA) were invited to answer the online survey. Participants were recruited through the Brazilian Society of Speech-Language Pathology and Audiology and by snowball sampling. Results: Of the 103 participants, 55 (53%) were from the Southeast region, 55 (53.4%) held an SLP undergraduate or professional specialization degree only, 21 (20.4%) a Master's, and 27 (26.2%) a Doctoral or Post-doctoral degrees. Standardized instruments for assessing aphasia were used by 51 (49.5%) respondents. Functional therapy was used in 99% of cases. Professionals holding Doctoral or Post-doctoral degrees had a greater level of engagement in conferences (p=0.014) and in professional associations/societies than therapists qualified with lower education degrees (p<0.001). The high-educated group worked more with PWA during the year (p=0.002) and with more public health system users (p=0.002). These professionals also made greater use of telerehabilitation (p<0.001), group therapy approaches (p=0.015), and Transcranial Direct Current Stimulation (p=0.009). Additionally, they charged higher private consultation fees (p<0.001) and were predominantly from the Southeast region (p=0.047). Professionals from the South region delivered more outpatient care to PwA (p=0.007). All participants from the Southeast region used a multimodal therapy approach (p=0.021). For chronic PwA, professionals holding a Doctoral or Postdoctoral degree (p=0.035), and those from the Southeast region (p=0.049) provided therapy for longer. Conclusion: Results revealed differences in type of therapeutic approach, assessment instruments and duration of aphasia treatment, according to region and postgraduate level of education. Future studies should investigate the causes of these disparities, along with barriers or approach preferences that may stem from undergraduate training and impact aphasia treatment approaches in Brazil.

Introdução: A avaliação fonoaudiológica hospitalar tem um importante papel na prevenção e manejo de pacientes com risco de broncoaspiração. No entanto, nem sempre cabe ao fonoaudiólogo a primeira avaliação e definição da via alimentar nos pacientes hospitalares. Objetivo: Comparar as decisões fonoaudiológicas e médicas quanto à viabilidade da via alimentar em um hospital geral e identificar fatores associados com a melhora da deglutição. Métodos: Trata-se de um estudo retrospectivo de pacientes internados em hospital em Joinville durante março a agosto de 2018. A via alimentar foi considerada com base na Functional Oral Intake Scale (FOIS) sendo a primeira decisão comparada entre o fonoaudiólogo e o médico para o mesmo paciente. Resultados: Dos 171 pacientes, houve maior concordância entre as condutas médica e fonoaudiológica para alimentação por sonda nasoenteral (SNE) (88,7%) e alimentação oral livre (81,9%). No entanto, houve apenas 35% de concordância na definição de dieta adaptada, sendo a concordância geral moderada (Kappa 0,486). Houve evolução na alimentação por via oral em 62 pacientes (36%). Maior limitação da via alimentar, verificado pela necessidade de SNE (OR = 3,17; p = 0,025) e o maior número de atendimentos fonoaudiológicos intra-hospitalares (OR = 1,09; p = 0,020) foram associados com a melhora da disfagia. Conclusão: Encontrou-se concordância entre a avaliação dietética de casos para uso de SNE ou dieta livre entre o fonoaudiólogo e médico. Uso de SNE, como indicador de gravidade do paciente, e o maior número de sessões de fonoterapia foram associados com a melhora da disfagia durante a internação.

Conhecer as características dos usuários da Clínica-Escola de Fonoaudiologia torna possível traçar estratégias de promoção à saúde e intervenção que deem conta das necessidades desta população. O objetivo deste trabalho foi verificar o perfil dos pacientes atendidos na clínica-escola de fonoaudiologia no ambulatório de Motricidade Orofacial. Trata-se de uma metodologia que se vale de um estudo retrospectivo, observacional analítico, transversal, de caráter quantitativo, através de revisão de prontuários clínicos de pacientes atendidos no período de março de 2018 a julho de 2021. Esse projeto foi aprovado pelo Comitê de Ética da Associação Educacional Luterana Bom Jesus/IELUSC. Como resultados, verificou-se maior prevalência do gênero masculino (63%), com média de idade de 26 anos e mediana de 12 anos. Houve maior ocorrência de queixas relacionadas a alterações de fala (48,5%). Constatou-se que a hipótese diagnóstica com maior ocorrência foi de desvio fonético 15,2%, respirador oral (15,2%) e desvio fonológico (12,1%). Em relação às descobertas, essa pesquisa possibilitou compreender as características dos atendimentos no estágio em motricidade orofacial, pautados nas melhorias que podem ser feitas para o próprio funcionamento e para a comunidade que é beneficiada nesses atendimentos.

ABSTRACT Purpose To understand the meanings that the therapeutic bond assumes for clinical speech therapists. Methods The research was approved by the Ethics Committee, being of a transversal character, with a quantitative-qualitative approach in the Content Analysis. The research with the participation of 96 clinical speech therapists, registered in the Speech Therapy Council of the 3rd region (CRFa 3), which covers the States of Paraná and Santa Catarina. Results Of the 96 speech therapists included, a significant part of the participants defined the therapeutic bond as a relationship/interaction. Regarding the role of the bond for the speech therapy clinical work, most professionals declared theirs as a fundamental basis and another part of the bond is necessary for the evolution/development of the patient. Conclusion It is possible to understand that, according to the therapeutic patients, it is essential to sustain, maintain the clinical work for users, impacting the resignification of the complaint and the minimization of the users' suffering.

RESUMO Objetivo Compreender os sentidos que o vínculo terapêutico assume para fonoaudiólogos clínicos. Método A pesquisa foi aprovada por Comitê de ética, sendo de caráter transversal, de abordagem quanti-qualitativa, pautada na Análise do Conteúdo. A pesquisa contou com a participação de 96 profissionais fonoaudiólogos clínicos, inscritos no Conselho de Fonoaudiologia da 3ª região (CRFa 3), o qual abrange os Estados do Paraná e de Santa Catarina. Resultados Dos 96 fonoaudiólogos incluídos, parte significativa dos participantes definiram o vínculo terapêutico como sendo relação/interação. Referente ao papel do vínculo para o trabalho clínico fonoaudiológico, a maioria dos profissionais o descreveu como base fundamental e outra parte deles afirmou que tal vínculo é necessário para a evolução/desenvolvimento do paciente. Conclusão É possível compreender que, de acordo com os participantes, a relação terapêutica é essencial para a sustentação e manutenção do trabalho clínico fonoaudiológico, impactando na ressignificação da queixa e na minimização do sofrimento dos usuários.

Introdução: A compreensão da afasia é fundamental para os profissionais de saúde que prestam assistência a pacientes com AVC. No entanto, a informação disponível sobre a afasia ainda é limitada e insuficiente para uma abordagem eficaz. É de suma importância identificar o conhecimento dos profissionais de saúde a respeito da afasia, a fim de planejar o atendimento aos pacientes e suas famílias. Objetivo: Avaliar o nível de conhecimento dos profissionais de saúde de um hospital público em relação à afasia e analisar como eles lidam com pacientes com afasia durante o período de hospitalização. Método: Realizamos uma pesquisa com profissionais de saúde por meio de um questionário online para avaliar seu conhecimento sobre a afasia e suas estratégias de atendimento. Resultados: Os resultados indicam que profissionais de saúde com níveis de educação mais elevados tendem a possuir um entendimento mais sólido da afasia. No entanto, persistem lacunas de conhecimento em diversos aspectos da afasia. Embora a maioria dos profissionais se sinta adequadamente preparado para lidar com pacientes com afasia, eles reconhecem os desafios envolvidos e expressam o desejo de receber orientações para aprimorar suas habilidades de comunicação. Conclusão: Este estudo ressalta a necessidade de uma formação mais abrangente para os profissionais de saúde no que diz respeito à afasia e suas estratégias de comunicação. É fundamental o desenvolvimento de programas de treinamento e a elaboração de diretrizes específicas para os profissionais que atuam com esses pacientes, visando proporcionar um atendimento de alta qualidade.

Objetivo: Comparar o hábito e a frequência de leitura de pessoas com afasia submetidos a terapia fonoaudiológica grupal com pacientes que não realizaram terapia fonoaudiológica. Método: Participaram da pesquisa 27 pessoas com sequela de afasia em fase subaguda, após o primeiro episódio de acidente vascular cerebral isquêmico: 15 pacientes que não realizaram terapia fonoaudiológica em grupo e 12 que realizaram terapia fonoaudiológica grupal. Para avaliar a gravidade da afasia, foi aplicado o Teste de Boston para Diagnóstico das Afasias Reduzido (TBDA-R). Utilizou-se um questionário para avaliar o hábito de leitura dos participantes. Esta avaliação quanto a leitura foi realizada no momento da inclusão e após 3 meses para ambos os grupos. Resultados: Na comparação dos dois grupos, verificou-se um aumento no hábito de leitura regular no grupo que fez terapia fonoaudiológica, embora não significativo (42% para 75%). Já o grupo que não realizou terapia fonoaudiológica, embora não significativo, demonstrou diminuição do hábito de ler ao longo do período (53,3 para 40%), apesar de apresentar maior tempo de escolaridade. Conclusão: A terapia fonoaudiológica em grupo pode possibilitar o aumento da adesão e da frequência de leitura em pessoas com afasia.

Background: Collation of aphasia research data across settings, countries and study designs using big data principles will support analyses across different language modalities, levels of impairment, and therapy interventions in this heterogeneous population. Big data approaches in aphasia research may support vital analyses, which are unachievable within individual trial datasets. However, we lack insight into the requirements for a systematically created database, the feasibility and challenges and potential utility of the type of data collated. Aim: To report the development, preparation and establishment of an internationally agreed aphasia after stroke research database of individual participant data (IPD) to facilitate planned aphasia research analyses. Methods: Data were collated by systematically identifying existing, eligible studies in any language (>= 10 IPD, data on time since stroke, and language performance) and included sourcing from relevant aphasia research networks. We invited electronic contributions and also extracted IPD from the public domain. Data were assessed for completeness, validity of value-ranges within variables, and described according to pre-defined categories of demographic data, therapy descriptions, and language domain measurements. We cleaned, clarified, imputed and standardised relevant data in collaboration with the original study investigators. We presented participant, language, stroke, and therapy data characteristics of the final database using summary statistics. Results: From 5256 screened records, 698 datasets were potentially eligible for inclusion; 174 datasets (5928 IPD) from 28 countries were included, 47/174 RCT datasets (1778 IPD) and 91/174 (2834 IPD) included a speech and language therapy (SLT) intervention. Participants' median age was 63 years (interquartile range [53, 72]), 3407 (61.4%) were male and median recruitment time was 321 days (IQR 30, 1156) after stroke. IPD were available for aphasia severity or ability overall (n = 2699; 80 datasets), naming (n = 2886; 75 datasets), auditory comprehension (n = 2750; 71 datasets), functional communication (n = 1591; 29 datasets), reading (n = 770; 12 datasets) and writing (n = 724; 13 datasets). Information on SLT interventions were described by theoretical approach, therapy target, mode of delivery, setting and provider. Therapy regimen was described according to intensity (1882 IPD; 60 datasets), frequency (2057 IPD; 66 datasets), duration (1960 IPD; 64 datasets) and dosage (1978 IPD; 62 datasets). Discussion: Our international IPD archive demonstrates the application of big data principles in the context of aphasia research; our rigorous methodology for data acquisition and cleaning can serve as a template for the establishment of similar databases in other research areas.

Background: Stroke rehabilitation interventions are routinely personalized to address individuals’ needs, goals, and challenges based on evidence from aggregated randomized controlled trials (RCT) data and meta-syntheses. Individual participant data (IPD) meta-analyses may better inform the development of precision rehabilitation approaches, quantifying treatment responses while adjusting for confounders and reducing ecological bias. Aim: We explored associations between speech and language therapy (SLT) interventions frequency (days/week), intensity (h/week), and dosage (total SLT-hours) and language outcomes for different age, sex, aphasia severity, and chronicity subgroups by undertaking prespecified subgroup network meta-analyses of the RELEASE database. Methods: MEDLINE, EMBASE, and trial registrations were systematically searched (inception-Sept2015) for RCTs, including ⩾ 10 IPD on stroke-related aphasia. We extracted demographic, stroke, aphasia, SLT, and risk of bias data. Overall-language ability, auditory comprehension, and functional communication outcomes were standardized. A one-stage, random effects, network meta-analysis approach filtered IPD into a single optimal model, examining SLT regimen and language recovery from baseline to first post-intervention follow-up, adjusting for covariates identified a-priori. Data were dichotomized by age (⩽/> 65 years), aphasia severity (mild–moderate/ moderate–severe based on language outcomes’ median value), chronicity (⩽/> 3 months), and sex subgroups. We reported estimates of means and 95% confidence intervals. Where relative variance was high (> 50%), results were reported for completeness. Results: 959 IPD (25 RCTs) were analyzed. For working-age participants, greatest language gains from baseline occurred alongside moderate to high-intensity SLT (functional communication 3-to-4 h/week; overall-language and comprehension > 9 h/week); older participants’ greatest gains occurred alongside low-intensity SLT (⩽ 2 h/week) except for auditory comprehension (> 9 h/week). For both age-groups, SLT-frequency and dosage associated with best language gains were similar. Participants ⩽ 3 months post-onset demonstrated greatest overall-language gains for SLT at low intensity/moderate dosage (⩽ 2 SLT-h/week; 20-to-50 h); for those > 3 months, post-stroke greatest gains were associated with moderate-intensity/high-dosage SLT (3–4 SLT-h/week; ⩾ 50 hours). For moderate–severe participants, 4 SLT-days/week conferred the greatest language gains across outcomes, with auditory comprehension gains only observed for ⩾ 4 SLT-days/week; mild–moderate participants’ greatest functional communication gains were associated with similar frequency (⩾ 4 SLT-days/week) and greatest overall-language gains with higher frequency SLT (⩾ 6 days/weekly). Males’ greatest gains were associated with SLT of moderate (functional communication; 3-to-4 h/weekly) or high intensity (overall-language and auditory comprehension; (> 9 h/weekly) compared to females for whom the greatest gains were associated with lower-intensity SLT (< 2 SLT-h/weekly). Consistencies across subgroups were also evident; greatest overall-language gains were associated with 20-to-50 SLT-h in total; auditory comprehension gains were generally observed when SLT > 9 h over ⩾ 4 days/week. Conclusions: We observed a treatment response in most subgroups’ overall-language, auditory comprehension, and functional communication language gains. For some, the maximum treatment response varied in association with different SLT-frequency, intensity, and dosage. Where differences were observed, working-aged, chronic, mild–moderate, and male subgroups experienced their greatest language gains alongside high-frequency/intensity SLT. In contrast, older, moderate–severely impaired, and female subgroups within 3 months of aphasia onset made their greatest gains for lower-intensity SLT. The acceptability, clinical, and cost effectiveness of precision aphasia rehabilitation approaches based on age, sex, aphasia severity, and chronicity should be evaluated in future clinical RCTs.

Background: Group therapy has shown benefit in language recovery in patients with aphasia (PWA). However, many in the field question its role in improving quality of life for PWA, as well as whether socio-demographic factors are related to observed improvements. Aims: To explore socio-demographic characteristics potentially associated with improvement in quality of life following a multicomponent aphasia group therapy program in people with sub-acute and chronic stroke-related aphasia. Methods and procedures: This proof of concept Phase I pre- and post-test study investigated outcomes from 26 PWA more than 3 months after their first ischemic stroke following a multicomponent group therapy program. Each therapeutic group consisted of 5 to 6 participants, with a therapy intensity of 90 min twice a week for 12 weeks, and a total dose of 36 h. The primary outcome was the Stroke and Aphasia Quality of Life scale (SAQOL-39). The Boston Diagnostic Aphasia Examination Short Form (BDAE-SF) was used to evaluate potential changes in communication after therapy. Socio-demographic factors were analysed with respect to post-group SAQOL-39 scores. Outcomes and Results: A total of 26 patients participated in at least 80% of the therapy program, 65.4% male, mean age 59.2 years and a median post-stroke time of 8 months. Only the SAQOL-39 communication domain showed a significant increase after therapy (from 2.89 to 3.47; p = 0.016). There was a significant improvement in all aspects of the BDAE-SF after the group therapy. Being younger, having a caregiver, a larger number of people in the household, and being female were related to a greater gain in the SAQOL-39 communication domain. Younger PWA and milder aphasia severity were related to higher mean psychological domain scores after therapy.

RESUMO Objetivo o presente estudo comparou a qualidade de vida e percepções de cuidadores de sujeitos afásicos inseridos em um contexto de terapia grupal para afásicos. Métodos trata-se de um estudo transversal, observacional e quantitativo, realizado com 13 cuidadores de indivíduos afásicos que receberam atendimento grupal e 13 cuidadores de sujeitos afásicos que não receberam atendimento fonoaudiólogo grupal. Para coleta dos dados, foram realizadas entrevistas individuais com os cuidadores e utilizou-se o Questionário de Sobrecarga do Cuidador (Burden Interview – Zarit). Resultados constatou-se que 45,2% dos cuidadores referiram sobrecarga de moderada a severa. No entanto, a sobrecarga avaliada por meio do questionário foi de leve a moderada e sem diferença significativa entre o grupo com e sem terapia fonoaudiológica. Conclusão existe importante impacto na qualidade de vida de cuidadores de pacientes com afasia. Novos estudos são necessários para aprofundamento do papel da terapia fonoaudiológica em grupo na qualidade de vida de cuidadores.

Purpose:Speech and language pathology (SLP) for aphasia is a complex intervention delivered to a heterogeneous population within diverse settings. Simplistic descriptions of participants and interventions in research hinder replication, interpretation of results, guideline and research developments through secondary data analyses. This study aimed to describe the availability of participant and intervention descriptors in existing aphasia research datasets. Method:We systematically identified aphasia research datasets containing >= 10 participants with information on time since stroke and language ability. We extracted participant and SLP intervention descriptions and considered the availability of data compared to historical and current reporting standards. We developed an extension to the Template for Intervention Description and Replication checklist to support meaningful classification and synthesis of the SLP interventions to support secondary data analysis. Result:Of 11, 314 identified records we screened 1131 full texts and received 75 dataset contributions. We extracted data from 99 additional public domain datasets. Participant age (97.1%) and sex (90.8%) were commonly available. Prior stroke (25.8%), living context (12.1%) and socio-economic status (2.3%) were rarely available. Therapy impairment target, frequency and duration were most commonly available but predominately described at group level. Home practice (46.3%) and tailoring (functional relevance 46.3%) were inconsistently available. Conclusion :Gaps in the availability of participant and intervention details were significant, hampering clinical implementation of evidence into practice and development of our field of research. Improvements in the quality and consistency of participant and intervention data reported in aphasia research are required to maximise clinical implementation, replication in research and the generation of insights from secondary data analysis. Systematic review registration:PROSPERO CRD42018110947

Background: Aphasia negatively impacts quality of life. This is the first Brazilian study that investigates the prevalence of aphasia and its related factors, the results of which may underpin hospital and health service planning for this vulnerable population.Objective: To establish the prevalence of aphasia in patients after first-ever ischemic stroke (FEIS) and associated factors.Methods: This is a retrospective cohort study, based on a database held in Joinville, Brazil. All cases of FEIS admitted to one public hospital in Joinville in 2015 were selected. The diagnosis of aphasia was verified by neurologists through the language item of the National Institute of Health Stroke Scale (NIHSS).Results: Of the 350 patients with FEIS, 79 (22.6%) had aphasia. Patients with aphasia (PWA) were older, with a higher likelihood of dysarthria, more thrombolytic use, and greater stroke severity. PWA had higher mortality than patients without aphasia (24.1% versus 10.7%, p = .004) and longer hospitalization time (21.32 versus 17.46 days, p = .009). Higher NIHSS score was an independent predictor for the occurrence of aphasia on admission (OR 1.24, 95% CI 1.17-1.31, p < .001). Older age (OR 1.06, 95% CI 1.03-1.09, p < .001) and stroke severity by NIHSS (OR 1.19, 95% CI 1.12-1.25, p = <0.001) were independent predictors of death.Conclusions: PWA may need more health care during hospitalization, because of the severity of the stroke, and their frailty. Further studies are needed to assess the direct impact of aphasia on inpatients.

ABSTRACT Purpose: to understand the effects that dialogical practices can have on the social participation and autonomy of people over 60 years old, as well as the way they face their own aging. Methods: this qualitative study was based on the dialogical discourse analysis, which considers language as the practice that organizes and signifies human actions. Thus, after dialogical practices developed during weekly meetings of 90 minutes, focused on oral, reading and writing activities related to elderly people´s life stories, the aged participants responded to a semi-structured interview. Results: the results allowed verifying that dialogical activities had positive effects on elderly people´s social participation and autonomy, so, they could have: a) more confidence and freedom to use the language; b) strength and reassurance to make decisions; c) more possibility to cope with aging; d) enhancement of their self-esteem and self-worth. Conclusion: it can be concluded that activities based on dialogical practices can promote an active, participatory aging, with a better quality of life.