Behind the therapy door: what is “usual care” aphasia therapy in acute stroke management?

Figures & data

Table 1. Participant demographic and stroke characteristics

	n = 19
Age Mean (SD)	68.0 (14.7)
Female (%)	7 (37)
Oxford Stroke Classification
Hemorrhagic (%)	1 (5)
PACs (%)	16 (84)
PoCs (%)	1 (5)
TACs (%)	1 (5)
Baseline WABR-AQ Mean (SD)	43.1 (24.3)
Baseline WABR-AQ Severity Classification (%)
Mild	7 (37)
Moderate	6 (32)
Severe	6 (32)
Modified Rankin Scale Score
2 – Slight	1 (5)
3 – Moderate	10 (53)
4 – Moderate Severe	4 (21)
5 – Severe	4 (21)
National Institutes of Health Scale Score
Mean (SD)	8.7 (6.5)

Note. PACs = Partial Anterior Circulation syndrome; PoCs = Posterior Circulation syndrome; TACs = Total Anterior Circulation syndrome.

Table 2. TIDieR checklist as applied in this study (Hoffmann et al., 2014)

Item Number	Item	Detail
1	Brief Name	Sourced from the main trial documentation
2	Why	Sourced from the main trial documentation
3	What – Materials	The therapy materials were noted as they appeared in the video recording.
4	What – Procedures	A description of the treatment task/activity (e.g., picture naming) along with the desired output level (i.e. single word, sentence or conversation level) was generated.
5	Who Provided	Sourced from the main trial database.
6	How	As per main trial documentation.
7	Where	Sourced from the main trial database.
8	When and How much	Description of the number of times the intervention was delivered and over what period of time. Within this study this also includes the dosage conceptualised as therapeutic inputs such as verbal output measures provided in the session.
9	Tailoring	Description of how the intervention was personalised or adapted. This was conceptualised as clinical decision making by the therapist that would personalise the treatment given. Included in this section is task explanations and therapy rationales. Key therapeutic inputs were also cueing and feedback and are reported in this section.

Table 3. Measures of therapeutic inputs calculated by SALT software – TIDieR Item 8

Measure	Definition
Total Utterances	Total number of utterances produced by the therapist calculated by SALT software.
MLU (words)	Mean Length of Utterance (MLU) in words calculated by SALT software.
MLU (morphemes)	Mean Length of Utterance (MLU) in morphemes calculated by SALT software.
Total words	Total number of words said by the therapist calculated by SALT software.
Utterances Per Minute (UPM)	Utterances per minute calculated by SALT software.
Words Per Minute (WPM)	Words per minute calculated by SALT software.
Mean turn length (words)	Mean turn length calculated by SALT software.

Table 4. Measures of therapeutic inputs – TIDieR Item 9

Measure	Definition
Task explanation	Presence of an introduction and/or explanation of task from the therapist.
Rationale Discussion	Presence of discussion from the therapist about why the task was chosen.
Total number of cues used	Total number of cues used by the therapist.
Cue Type	Where a cue was used it was coded according to the type (phonological, semantic, orthographic, visual, forced alternative, sentence completion, articulatory placement, direct model).
Cues used with success	The number of times a cue was used by the therapist and the participant responded correctly.
% cues that were successful	Percentage of the total number of cues used by the therapist that were successful.
Feedback	Type of feedback given. Two types were coded. Supportive feedback aimed to facilitate word retrieval without providing specific word information cues and included subtypes of elaboration, clarification and requests for more information. Problem solving feedback represented a way of externalising the word finding process and explaining the errors and consisted of two sub-types, correct/incorrect and an explanation of error (Byng, 1995).

Table 5. Summary of the number of tasks completed across the therapy sessions

Task	n = 25
Total number	96
Total number of different tasks	51
Average no. per session	3.8
Output level (excludes iPad tasks)
Single word level	53/96 (55%)
Sentence level	27/96 (28%)
Conversation/paragraph level	10/96 (10%)
Modality
Verbal output	65/96 (68%)
Written output	11/96 (11%)
Receptive output	14/96 (15%)
iPad tasks	6/96 (6%)

Table 6. Tasks completed in treatment sessions

Type of Task, in order of most to least frequent (n = 51)	Quantity (n = 96)
Expressive Language – Verbal
Single Word Level
Picture Naming	12
Semantic association naming	5
Automatic Speech	4
Odd one out (semantic)	3
Naming minimal Pairs	2
Object naming	2
Question and Answer task	2
Selecting prepositions	2
Generating synonyms	2
Generating antonyms	1
Convergent naming	1
Repetition of non-words	1
Phonemic Generative Naming	1
Semantic Category identification	1
Single word repetition	1
Sentence Level
Picture description (not personal photo)	5
Constraint Induced Aphasia Therapy (CIAT) style barrier game	3
Reading aloud	3
Verbal reasoning (idioms and problem solving)	2
Articulate game (verbal explanation)	1
Personal photo description	1
Procedural discourse (e.g., making a cup of tea)	1
Reading semantic feature analysis prompts for to generate words	1
Script training	1
Solitaire card game (verbal requests)	1
Taboo (verbal explanation)	1
Conversation Level
Conversation	4
Situational Language (e.g., ordering a coffee)	1
Expressive Language – Written
Single Word Level
List writing (self-generated words)	2
Single word writing (from dictation)	2
Crosswords	1
Functional writing (name, address etc.)	1
Hangman game (letter and word generation)	1
Sentence Level
Written work sheet for sentence composition	2
Writing answers to reading comprehension	1
Written picture description	1
Receptive- Reading Comprehension
Paragraph Comprehension (answering questions)	2
Receptive – Auditory Comprehension
Single Word Level
Object to picture matching	2
Picture matching (same picture to same picture)	1
Semantic association receptive task (match associated pictures)	1
Semantic association (which one can you eat?)	1
Single word auditory comprehension	1
Sentence Level
Semantic description comprehension task	2
Following a receptive command to place a picture in a grid	1
Paragraph level
Newspaper article with multiple choice questions	1
Paragraph comprehension (listening for the main idea)	1
Yes/No Questions after listening to a paragraph	1
Other- iPad Tasks
iPad written single word to picture matching	2
iPad articulation app	1
iPad choosing the missing letter	1
iPad sorting jumbled letters	1
iPad verbal single word to picture matching	1

Table 7. Summary of verbal output from therapists per session

Measure	Mean (SD)
Total Therapist utterances	679.6 (226.0)
Therapist MLU (words)	4.4 (0.9)
Therapist MLU (morphemes)	4.9 (0.9)
Therapist Total words	2848.6 (857.9)
Therapist UPM	14.5 (7.6)
Therapist WMP	55.8 (14.0)
Mean turn length (therapist)	9.7 (2.8)

Note. MLU refers to Mean Length of Utterance, UPM refers to Utterances Per Minute, WMP refers to Words Per Minute

Figure 1. Average number of cues used by cue category per session

Figure 2. Average number of times a cue was used with success in a session by cue category

Table 8. Summary of types of feedback used by therapists per session

Measure	Mean (SD)
Problem solving accuracy feedback	51.8 (34.7)
Supportive clarification feedback	10.9 (11.3)
Supportive elaboration feedback	8.9 (11.7)
Problem solving explains error feedback	8.3 (8.8)
Supportive requests feedback	7.5 (17.9)

Hoffmann, T. C., Glasziou, P. P., Boutron, I., Milne, R., Perera, R., Moher, D., Altman, D. G., Barbour, V., Macdonald, H., Johnston, M., Lamb, S. E., Dixon-Woods, M., McCulloch, P., Wyatt, J. C., Chan, A.-W., & Michie, S. (2014). Better reporting of interventions: Template for intervention description and replication (TIDieR) checklist and guide. British Medical Journal, 348: g1687. https://doi.org/10.1136/bmj.g1687

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