Project Overview
Stroke imposes significant burdens on the health and quality of life terms of healthcare costs and lost productivity. Aphasia adds to the cost of stroke related care. Many stroke survivors with aphasia receive therapy in inpatient rehabilitation facilities. However, aphasia recovery is variable and there is limited evidence on the benefits of inpatient rehabilitation on outcomes.
The objective of the parent R01 is to describe the trajectories of linguistic, cognitive-communicative, and health-related quality of life outcomes following stroke in persons with aphasia during inpatient and outpatient rehabilitation to 18 months following stroke. A sample of 300 consecutively- admitted stroke patients with aphasia recruited at three Midwestern rehabilitation hospitals will complete measures of linguistic and cognitive-communicative performance, and the Quality of Life in Neurological Disorders Measurement System instruments during rehabilitation and at 6-,12-, and 18- months post-stroke. We will model outcomes as individual and group trajectories, allowing us to develop individual predictions which could inform clinical planning and decision-making for new patients.
The Covid-19 pandemic has resulted in drastic changes in therapy access and utilization since we launched this study. As a result, patients with aphasia may not receive any inpatient or outpatient speech and language therapy, their lengths of stay or therapy schedules may be shortened, or therapies may be offered only through telerehabilitation.
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Principal Investigator(s)
Research Aims
The specific aims of this supplement are to:
1. Characterize the Covid-19 experience and telerehabilitation access, service delivery experiences, and perceived effectiveness in a large national cohort of adults with aphasia.
2. Describe the nature and extent of disparities in telerehabilitation service delivery related to sex, race, ethnicity, age, and insurance coverage.
3. Compare the cognitive-communicative and psychosocial health outcomes at 6, 12 and 18 months post- stroke achieved by patients in our longitudinal cohort study (R01 DC017174) receiving telerehabilitation vs. in-person vs. no services following discharge from inpatient rehabilitation.
This supplement will last for two years, given the longitudinal nature of the parent R01 grant. At the end of the supplement, results for Aims 1 and 2 will be available. Descriptive results will be available for Aim 3 on a cohort of about 50 participants followed to 18 months post-stroke, which will be sufficient to allow for a proof of concept descriptive analysis, and eventual 300 by the end of the parent R01 for a complete analysis.
This supplement demonstrates innovation in that SLP telerehabilitation is relatively new. Outside of controlled research studies, its benefits and limitations have not been assessed. An improved understanding of aphasia recovery may assist with prognosis, allowing patients and caregivers to plan, helping clinicians choose appropriate therapies, providing benchmarks against which to measure change, and allowing therapy modifications when patients do not attain benchmarks.