Aphasia LIFT: Effects of increased treatment duration on measures of

impairment, activity/participation, QOL, and satisfaction

Amy Rodriguez 1,2,3,4 Brooke Grohn1,2 Eril McKinnon1 Charlene Pearson1,2

Kyla Brown1,2 Sophia Van Hees1,3 David Copland1,3 Linda Worrall1,2

1 Centre for Clinical Research Excellence in Aphasia Rehabilitation 2 School of Health and Rehabilitation Science, The University of Queensland, Brisbane, QLD

3 Communication Disability Centre, The University of Queensland, Brisbane, QLD 4 Centre for Clinical Research, The University of Queensland, Brisbane, QLD

Background

Intensive: minimum 3 hrs/day, 5 days/wk, 2 wks

Comprehensive: targets impairment and

activity/participation levels of language functioning

individual and group therapy

patient/family education

technology

Goal : “Maximize communication potential and enhance

life participation”

Cherney et al., 2011

Intensive comprehensive aphasia programs (ICAPs)

Background

Family and

friends

Goal setting

Daily

feedback

Positive

approach

Aphasia

friendly

Neuro-

plasticity

Challenge

tasks

Education

Background

First trial demonstrated positive results across all outcome measures

Variability of improvement and participant feedback resulted in

increasing program duration

To determine if increased treatment duration would yield improved

outcomes in:

language impairment

functional communication

communication-related QOL

participant satisfaction

Participants

LIFT 1 LIFT 2

Gender 3M, 2F 6M, 2F

Age 18-68 years

(~52 yrs)

40-79 years

(~65 yrs)

MPO

8-49 months (~26.4 mos)

12-56 months (~21.4 mos)

Aphasia mild to

moderate severe

moderate to severe

AOS

mod-severe (n=1) moderate (n=2)

mod-severe (n=1)

Treatment Delivery

Impairment

Functional

Group

Challenge

0 30 60

mins mins mins

1 wks 2 wks 3 wks 4 wks

Intervention

duration

1 day 3 days 5 days

Session

frequency

Computer

LIFT 1

LIFT 2

Session

duration

Impairment

• skill-based

• word retrieval

• sentence

production

• AOS

**clinician led

Treatment Approaches

Functional

• context-based

• role-playing

• supported

communication

**clinician led

Computer

• REACT

• Aphasia

Tutor

• Speech

Sounds on

Cue

**student led

Group

• aphasia

education,

support

• successfully

living with

aphasia

• conversation

**student and

clinician led

Challenge Task

• communication-

based task

• preparation of

presentation for

final day

**student led

Language

Impairment

• Comprehensive

Aphasia Test (CAT) –

Naming Subtest

• Boston Naming

Test (BNT)

Outcome Measures

Functional

Communication

• Communicative

Effectiveness Index

(CETI)

• Discourse

(CIU & CIU/min)

Participant

Satisfaction

• Self-rated scale

• Semi-structured

interview

Quality of

Life

• ASHA Quality of

Communication Life

Scale (QCL)

• Assessment for

Living with Aphasia

(ALA)

LIFT Group Results

Mean (SD) Range p-value ES Corrected ES

CAT

Naming

22.2 (22.4)

25.6 (23.8)

0- 51

0- 58

.012

.12

.10

BNT

19.3 (18.2)

22.2 (20.4)

0- 43

0- 47

.021

.17

.14

CETI

4.16 (1.5)

5.81 (1.8)

1.69- 7.0

2.61- 8.19

.008

.64

.51

Discourse

34.1 (14.4)

41.3 (14.0)

14.7- 52.5

24.1- 63.1

.017

.52

.37

ALA

101.9 (17.6)

113.2 (19.6)

78.5- 129.50

83.0- 142.0

.017

.61

.48

QCL

3.64 (.76)

4.09 (.64)

2.50- 4.82

2.88- 4.88

.038

.89

.69

Individual Snapshot

CAT BNT CETI Discourse ALA QCL

L1P1 √ √ √ √ √ √ √ -- √

L1P2 √ √ √ √ √ √ √ √ √

L1P3 √ √ √ -- √ √ -- √

L1P4 √ √ -- √ √ -- √ -- √ --

L2P1 √ √ √ √ √ √ √ -- √ √ √ --

L2P2 -- -- -- -- √ √ -- -- -- -- √ √

L2P3 -- -- -- -- √ √ -- -- √ √ √ √

L2P4 √ √ -- -- √ √ √ -- -- √ -- √

L2P5 -- √ √ √ √ √ √ √ -- -- √ --

L2P6 -- -- -- -- √ √ -- -- √ -- -- --

L2P7 -- -- -- -- √ √ √ -- √ √ √ √

LIFT 1 LIFT 2

CAT Naming

Pre-Post= 25%

Pre- F/U= 14%

Pre-Post= 9%

Pre- F/U= 16%

BNT

LIFT 1 LIFT 2

Pre-Post= 13%

Pre- F/U= 15%

Pre-Post= 22%

Pre- F/U= 16%

CETI

LIFT 1 LIFT 2

Pre-Post= 23%

Pre- F/U= 20%

Pre-Post= 34%

Pre- F/U= 48%

%CIU

Pre-Post= 10%

Post-F/U= 14%

Pre-Post= 5%

Post-F/U= -13%

LIFT 1 LIFT 2

CIU/min

Pre-Post= 26%

Post-F/U= 21%

Pre-Post= 32%

Post-F/U= 18%

LIFT 1 LIFT 2

ALA

LIFT 1 LIFT 2

Pre-Post= ---%

Pre- F/U= 10%

Pre-Post= 9%

Pre- F/U= 12%

QCL

LIFT 1 LIFT 2

Pre-Post= 2%

Pre- F/U= 8%

Pre-Post= 22%

Pre- F/U= 17%

Satisfaction

LIFT 1 LIFT 2

0

0.5

1

1.5

2

2.5

3

3.5

4

4.5

5 LIFT 1 LIFT 2

Has your communication

improved?

4.75 4.71

Were you satisfied with

your progress in therapy?

5.00 4.71

Were your goals met?

4.50 4.36

Satisfaction

CG: I think Joe was extremely tired

through those four weeks and he felt that

perhaps if they had two weeks and then a

break and then another two weeks.

CG: I think in Roger’s case, I think four weeks was far

too long… I don’t know…

PWA: ...That was it. It was everything. It was beautiful. It

was really nice. Bit much (pointing to page) to do every night

the same thing, the same thing....

Interviewer: So you’ve got here Monday, Tuesday,

Wednesday, just do three days a week.

PWA: Yeah.

PWA: I don’t know, just more

(laughing).

Interviewer: Intensity

CG: Yeah, he enjoyed that

PWA: Yeah, I mean I wanted to

work, yeah.... And if you’re, like

I’m younger (unclear), so I’m forty

years....

Satisfaction

CG: At first I was excited that he got into the program, but I realised that Roger’s disability is there for a long haul and my expectation in the beginning may have been too high....

PWA: Da-da-da good. (holds up two fingers)

But da-da-da (shaking head) talk.

Interviewer: Talk

CG: learn how to talk. It was good, but she

didn’t learn how to talk.

Interviewer: It was good but you didn’t

learn how to talk?

PWA: Yeah. PWA: still want to be able to talk…

Conclusion

Increasing the duration of Aphasia LIFT yielded variable but

positive outcomes

Improvements in naming/word retrieval

only those with some residual naming ability improved

Greatest improvement on proxy-rated functional communication

increase for all participants regardless of severity

Improvement in some participants on performance-based

functional communication measures

Conclusion

Improvements in self-rated communication-related QOL

regardless of aphasia severity

Treatment gains were enduring in most cases

Self-rated satisfaction was high for communication improvement,

progress in therapy and achievement of goals, but some issues

highlighted during feedback

increased intensity difficult for older and more severe participants

increased intensity= increased expectations

Future Directions

Next LIFT trial in November

3 week duration, 50 hours

cognitive testing

treated/untreated items

caregiver outcomes/satisfaction

Investigation of non-intensive LIFT (aka NiCAP)

8 week duration, 50 hours

Acknowledgments

Aphasia LIFT Team

This project is supported by the NHMRC CCRE in Aphasia Rehabilitation.

Linda Worrall

David Copland

Anthony Angwin

Kyla Brown

Elizabeth Cardell

Petrea Cornwell

Bronwyn Davidson

Brooke Grohn

Shiree Heath

Lucy Lyons

Eril McKinnon

Anna Macdonald

Charlene Pearson

Rachelle Pitt

Alexia Rohde

Tracy Roxbury

Sophia Van Hees

Tara Brown

Caitlyn Brandenburg

Melissa Cook

Jessie Cutler

Melody Dobrinin

Rebecca Dodds

Tasha Haran

Keegan Hewitt

Vanessa Hoare

Caitlyn O’Connor

Katrina Quirke

Victoria Sandham

Shelly Tregea

Alana Vickers

Acknowledgments

We extend our sincerest thanks to the participants involved in Aphasia LIFT