Poster The Joint Annual Meeting of the Stroke Society of Australasia (SSA) and Smartstrokes 2023

Maintaining Language and Quality of Life Gains with Low-dose, Technology-delivered Aphasia Therapy: Preliminary Results of the CHAT-Maintain Program (#154)

Jessica Campbell (†) 1 2 , Jade Dignam 1 2 , Natalie Hickey 1 2 , Jaycie Bohan 1 2 , Deborah Hersh 3 4 , Annie Hill 1 2 , Phill Jamieson 1 2 , John Pierce 5 , Emma Power 6 , Miranda Rose 5 , Kirstine Shrubsole 1 , David Copland 1 2
  1. Queensland Aphasia Research Centre, The University of Queensland, Brisbane, QLD, Australia
  2. Surgical Treatment and Rehabilitation Service (STARS) Education and Research Alliance, The University of Queensland and Metro North Health, Brisbane, QLD, Australia
  3. Chairperson, Australian Aphasia Association, Perth, WA, Australia
  4. Curtin School of Allied Health, Curtin University, Perth, WA, Australia
  5. Centre of Research Excellence in Aphasia Rehabilitation and Recovery, La Trobe University, Melbourne, VIC, Australia
  6. Graduate School of Health Disciplines, Speech Pathology, University of Technology, Sydney, NSW, Australia

Background: 

Evidence suggests that while communication improves post intensive aphasia therapy1, for many participants these gains do not persist long term2. Efficacious, feasible and cost-effective methods of maintaining gains post intensive therapy are required.

Aims: 

This study evaluated the feasibility and preliminary efficacy of CHAT-Maintain, an individualised, low-dose, technology supported home therapy program, delivered post-intensive therapy for people with aphasia.

Methods: 

A prospective, non-randomised, feasibility design was employed.

Eighteen adults (11M, 7F; mean age =65.4years; mean time post onset =24.7months) with post-stroke aphasia, were recruited from the Comprehensive High-dose Aphasia Therapy (CHAT) and TeleCHAT (CHAT via telerehabilitation) programs.

Participants completed an individualised, technology-delivered home program for a minimum of one hour per week for 6months. Home practice utilised evidence-based aphasia therapy software and was supplemented with support calls from a speech pathologist. 

Outcome measures included the Comprehensive Aphasia Test (CAT)3, Communication Effectiveness Index (CETI)4, Communication Confidence Rating Scale for Aphasia (CCRSA)5 and the Stroke and Aphasia Quality of Life Scale-39 (SaQOL-39)6 and were administered post-treatment, at 3-months and 6-months follow-up. Data were analysed using paired-samples t-tests.  

Results: 

Fourteen participants completed CHAT-Maintain. Two participants withdrew due to medical reasons and two participants were lost to follow up.

Participants completed a mean of 44hours of self-directed therapy (range: 10–115hours) and received a mean of seven support calls (range: 4-11) over 6months.

Significant treatment gains were maintained for the CAT (p<.001), CETI (p=.037) and SaQOL-39 (p=.023) at 3-months follow-up and for the CAT (p<.001) and CETI (p=.009) at 6-months follow-up. While significant improvements on the CCRSA were not observed post-treatment, significant gains were found at 3-months (p=.004) and 6-months (p=.006) follow-up.

Conclusion: 

CHAT-maintain is a feasible, low-dose, technology-supported model of care which has the potential to support the long-term maintenance of language, communication and quality of life gains post-intensive therapy. Data collection is ongoing with planned comparisons to usual care post-intensive therapy.   

  1. Brady, M. C., Kelly, H., Godwin, J., Enderby, P., Campbell, P., & Brady, M. C. (2016). Speech and language therapy for aphasia following stroke. Cochrane library, 2016(6). doi:10.1002/14651858.CD000425.pub4
  2. Menahemi-Falkov, M., Breitenstein, C., Pierce, J. E., Hill, A. J., O'Halloran, R., & Rose, M. L. (2021). A systematic review of maintenance following intensive therapy programs in chronic post-stroke aphasia: importance of individual response analysis. Disability and Rehabilitation, 1-16. doi:10.1080/09638288.2021.1955303
  3. Swinburn, K., Porter, G., & Howard, D. (2004). Comprehensive Aphasia Test. Hove, East Sussex: Psychology Press.
  4. Lomas, J., Pickard, L., Bester, S., Elbard, H., Finlayson, A., & Zoghaib, C. (1989). The Communicative Effectiveness Index (CETI): Development and psychometric evaluation of a functional communication measure for adult aphasia. Journal of Speech and Hearing Disorders, 54(1), 113-124. doi:10.1044/jshd.5401.113
  5. Babbitt, E. M., Heinemann, A. W., Semik, P., & Cherney, L. R. (2011). Psychometric properties of the Communication Confidence Rating Scale for Aphasia (CCRSA): Phase 2. Aphasiology, 25(6-7), 727-735. doi:10.1080/02687038.2010.537347
  6. Hilari, K., Byng, S., Lamping, D. L., & Smith, S. C. (2003). Stroke and aphasia quality of life scale-39 (SAQOL-39) - Evaluation of acceptability, reliability, and validity. Stroke, 34(8), 1944-1950. doi:10.1161/01.str.0000081987.46660.ed