AS144-02 April 3, 2003 21:52 Ch ar Count= 0

STEELE et al

Table 2. Qualitative outcome exampleschanges in aphasia diagnostic categories followingLCC treatment, in

chronically aphasic patients 75 years and older (

n

= 79)
Post-Tx Dx Within T r a n s c ortical n o r m a l Global Brocas Wernickes

motor Conduction Anomic limits Pre-Tx DxGlobal (7)

5

11 Brocas (25)
17

215 Wernickes (7) 2

4

1 Transcortical 2 motor (2)Conduction (10)

8

11 Anomic (28) 1
23

Categories are ordered by ascending midpoints of AQ-ranges; numbers in the table indicate patient counts by diag-nostic categories; italics indicate same-type aphasia diagnostic categories before and after LCC treatment; boldfaceindicates different type of aphasia diagnostic categories

accompanied by an AQ changeup or downof at least5.0 points.

diagnostic categories in chronic aphasiafollowing participation in LCC TreatmentPrograms.

12

Table 2 presents the findings of such an analysis using data specifically from asample of older patients. In this instance, thepatient sample comprises 79 individuals over 75 years of age, all of

whom were more than6 months postonset at start of LCC care andhence were in the presumed chronic stageof aphasia. Table 2 compares patients WABassignments to

aphasia diagnostic categoriesbefore and after LCC treatment specifically for patients whose WAB AQ score changed up or downby at least 5.0 points followingtreatment. Results show that

among these79 chronically aphasic older patients 19(24%) were reassigned to a less severe aphasiadiagnostic category following LCC treatment, while 3

patients (4%) were reassigned to amore severe diagnostic category. In the previ-ous report, which included both younger andolderaphasicpati ents,theoverallpatter nwasrathersimilar:1

7of46subjects(37% )evolvedtolesssever ediagnosticcategori es,while0of 46(0%) evolvedtomoreseve rediagnosticcategories. This general comparability suggeststhatwhateve rmechanismsunderli

etheseparticularchangesmayb eavailabletomanyol der patients as well as to younger ones. Speech generating devices in aphasia rehabilitation

Finally, some older (as well as younger)adults with aphasia benefit from having aspeech generating device (SGD) to help meettheir communication needs in everyday

lifefollowing discharge from speech therapy.Such prosthetic aids properly represent yet another element in the arsenal of toolsavailable for

aphasia rehabilitation, and be-ginning in 2001, Medicare began coveringthe provision of such SGDs to appropriatepatients with aphasia and related disorders.In a

recent chapter entitled Computer appli-cations in aphasia treatment, Katz

52

gives amore complete list of available options, withbrief device

descriptions and effectivenessdiscussi ons. CONCLUSIONS The conclusions that follow appear warranted on the basis of available evidence:First, ways of evaluating

aphasia, treating patients, and documenting outcomes that are well conceived and executed for persons with aphasia in general appear to hold their worthindealin

gwithaphasiaamong geriatric
106 TOPICS IN GERIATRIC REHABILITATION

AS144-02 April 3, 2003 21:52 Ch ar Count= 0

APHASIA

patients as well. There appears, in particu-lar, to be no blanket

contraindication to theuse of appropriately designed advanced treat-ment technologies or programs per se witholder persons. There further appear to be nointrinsic

obstacles to the introduction of advanced treatment programs into various set-tings. Significantly improved outcomes appeartobeavailableto appropriatelyidentif

iedcandidates at all age levels. Outcome analysesof data presented here suggest the possibility ofagradua landslightdiminutio noftreatmenteffect sizes, absolutely, with increasing

age.Qualitatively, however, older patients appear to move to less severe diagnostic categoriesin numbers and following patterns similar tothose documented for

younger persons withaphasia also, at least following LCC treatment.Finally, SGDs may play an important role for ongoingcommun icationsupportofold erper-sons with aphasia. In general,

then, the treat-ment of geriatric aphasia is shown to befirst and foremost the treatment of
aphasia

,thoughleavenedwit haheightenedawaren essof, and

responsiveness to, age-related issues. ACKNOWLEDGM ENTS We thank the following individuals for their assistance and support during the writing of this

article: Ralph Gomory, GeorgeBeitzel, Veronica Harris, Robert Gonsalves,Holly Vafi, Jill Gregori, and Jane Horn. We alsoacknowledge all the LCC clients,

families,and therapists whose insights, feedback, andsuggestions have provided both guidance andinspiration over the years. REFERENCES

1. McNeil MR, Pratt SR. Defining aphasia: some theoret-ical and clinical implications of operating from a for-mal definition.
Aphasiology

. 2001;15(10/11):901 911.2. Holland AL, Fromm DS, DeRuyter F, Stein M. Treat-ment efficacy: aphasia.
J Speech Lang Hear Res

.1996;39:S27S36.3. Pedersen PM, Jrgensen HS, Nakayama H, RaaschouHO, Olsen TS. Aphasia in acute stroke: incidence, determinants,andrecovery.
AnnNeurol.

1995;38:659666.4. Basso A, Bracchi M, Capitani E. Age and evolution of language area functions:

a study on adult stroke patients.

Cortex

. 1987;23:475483.5. Eslinger PJ, Damasio AR. Age and type of aphasia inpatientswithstroke.
JNeurolNeurosurgPsychia try

.1981;44:377381.6. Habib MA, Poncet M, Salaman G. Age-related

changesin aphasia type and stroke.

Brain Lang

. 1987;31:245251.7. Obler LK, Albert ML, Goodglass H, Benson DF. Apha-sia type and aging.
Brain Lang

. 1978;6:318322.8. Pashek GV, Holland AL. Evolution of aphasia in thefirst year post-onset.
Cortex

. 1988;24:411423.9. Tesio L, Franchignoni FP, Perucca L, Porta GL. Theinfluence of age on length of stay, functional inde-pendence and discharge destination of rehabilitationinpatients in Italy.
Disabil Rehab

. 1996;18:502508.10. Kong KH, Chua KS, Tow AP. Clinical characeris-

tics and functional outcome of stroke patients75 years old and older.
Arch Phys Med Rehabil

.1998;79:15351539.11. AftonomosLB,SteeleRD, WertzRT.Promotingrecov -ery in chronic aphasia with an interactive technol-ogy.

Arch Phys Med Rehabil.

1997;78:841846.12. Aftonomos LB, Appelbaum JS, Steele RD. Im-proving outcomes for persons with aphasia inadvanced community-based treatment programs.
Stroke.

1999;30:13701379.13. Steele RD, Aftonomos LB. Advances in the clinical re-habilitation of aphasia

and related disorders. In: Mo-han RB, ed.

Research Advances in Biomedical Engi- neering, II

. Kerala, India: Global Research Network;2001.14. Aftonomos LB, Steele RD, Appelbaum JS, Harris VM.Relationshipsbetween impairmentlevelassessmentsand

functional-level assessments in aphasia: find-ings from LCC treatment programmes.

Aphasiology

.2001;15:951964.15. Harris VM, Shireman CW, Steele RD. Innovative programming for adults with aphasia.
Adv Speech-Lang Pathol Audiol

. 1997;7(23): 9,15.16. Harris VM, Aftonomos LB, Steele RD. LanguageCare Center

treatment programs and the rehabil-itation of aphasia and related disorders.

ASHA Spe- cial Interest Division-2 (Neurophysiology and Neurogenic Speech and

Language Disorders) Newslet- ter

. Rockville, MD: ASHA; April 2000.17. Pick A.Uber die Beziehungen der senilenHirnatrophie zur Aphasie.
Prager Med Wochen- schr

. 1892;17:165167.18. Hodges JR. Frontotemporal dementia

(Picks dis-ease): clinical features and assessment.

Neurology

.2001;56(suppl. 4):S6-S10.

VOL. 19, NO. 2/APRILJUNE 2003 107

AS144-02 April 3, 2003 21:52 Ch ar Count= 0

STEELE et al 19. MesulamMM.Primarypro gressiveaphasia.

AnnNeu- rol

. 2001;49:425432.20. Warrington EK. Selective impairment of semanticmemory.

Q J Exp Psychol

. 1975;27:635657.21. Hodges JR, Patterson K. Nonfluent progressive apha-sia and semantic dementia: a comparative neu-ropsychological study.
J Int Neuropsychol Soc

.1996;2:511524.22. Goodglass H, Kaplan E.

The Assessment of Aphasiaand Related Disorders

. 2nd ed. Philadelphia, Pa: Lea& Febiger; 1983.23. Kertesz A.

Western Aphasia Battery

. New York, NY:Harcourt Brace Jovanovich; 1982.24. WorldHealthOrganization .

InternationalClassifica- tion of Impairments, Disabilities, and Handicaps

.Geneva, Switzerland: WHO; 1980.25. Holland AL, Thompson CK. Outcomes measurementin aphasia. In: Frattali CM, ed.
Measuring Out- comes in Speech-Language Pathology

. New York,NY: Thieme; 1998.26. HelmEstabrooks N.

Aphasia Diagnostic Profiles

.Chicago, IL: Riverside; 1992.27. Porch B.

Porch Index of Communicative Abil- ity

. Palo Alto, Calif: Consulting Psychologists Press;1971.28. KaplanE,GoodglassH,W eintraubS.

BostonNaming Test

. Philadelphia, Pa: Lea and Febiger; 1983.29. Sarno M

. The Functional Communication Profile: ManualofDirection s

.NewYork,NY:Instituteo fRe-habilitation Medicine; 1969.30. Lomas J, Pickard L, Bester S, Elbard H, Finlayson A,Zoghaib C. The Communicative Effectiveness Index:development and

psychometric evaluation of a func-tional communication measure for adult aphasia.

J Speech Hear Dis

. 1989;54:113124.31. Wirz S, Skinner C, Dean E.

Revised Edinburgh Functional Communication Profile

. Tucson, Ariz: Communication Skill Builders; 1990.32. Payne J.

Communication Profile: A Functional SkillsSurvey

.SanAntonio,Tex:Commu nicationSkillBuilders; 1994.33. Frattali CM, Thompson CK, Holland AL, Wohl C,Ferketic M.
American SpeechLanguageHearing Association

Functional Assessment of Commu- nication Skills for Adults

. Rockville, Md: ASHA;1995.34. Holland AL.

Communicative Abilities in Daily Living-2

. Austin, Tex: Pro-Ed; 2000.35. Blomert L, Kean ML, Koster C, Schokker J. AmsterdamNijmegen Everyday

Language Test: construction, reliability, and validity.

Aphasiology

. 1994;8:381407.36. Frattali CM. Outcomes measurement: definitions, di-mensions, and perspectives. In: Frattali CM, ed.
Mea- suring Outcomes in Speech-Language Pathology

.New York, NY: Thieme; 1998.37. Chapey R, ed.

Language Intervention Strategiesin Aphasia and Related Neurogenic Communica- tion Disorders

. 4th ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 2001:919 pp.38. Damasio AR. Medical progress: aphasia (review arti-cle).
New Eng J Med

. 1992;326:531539.39. Duffy JR, Coelho CA. Schuells stimulation approachto rehabilitation. In: Chapey R, ed.
Language Inter- vention Strategies in Aphasia and Related Neuro- genic Communication Disorders

. 4th ed. Philadel-phia, Pa: Lippincott Williams & Wilkins; 2001:341 382.40. Wertz RT, Weiss

DG, Aten JL, et al. Comparison of clinic, home, and deferred language treatment for aphasia: a veterans administration cooperative study.
Arch Neurol

. 1986;43:653658.41. Robey RR. The efficacy of treatment for aphasic persons: a meta-analysis.
Brain Lang

. 1994;47:582608.42. Robey RR. A metaanalysis of clinical outcomes inthe treatment of aphasia.

J Speech Lang Hear Res

.1998;41:172187.43. Sparks RW. Melodic intonation therapy. In: Chapey R, ed.

Language Intervention Strategies in Adult Aphasia

. Baltimore, Md: Williams & Wilkins; 1981.44. Davis GA, Wilcox MJ. Incorporating parametersof natural conversation in aphasia treatment. In:Chapey R, ed.
Language Intervention Strategies in Adult Aphasia.

Baltimore, Md: Williams & Wilkins;1981.45. Colby K, Christinaz D, Parkison

R, Graham S, Karpf C.Awordfindingcomputerprogram withadynamiclexicalsemantic memory for patients with anomiausing an intelligent speech prosthesis.
Brain Lang

.1981;14:272281.46. Loverso F, Prescott T, Selinger M, Wheeler K, SmithR. The application

of microcomputers for the treat-ment of aphasic adults. In: Brookshire RH, ed.
ClinicalAphasiologyConferenc eProceedings

.Minneapo-lis, Minn: BRK Publishers; 1985.47. Katz RC. Efficacy of aphasia treatment using mi-crocomputers: clinical forum.

Aphasiology

. 1987;1:141175.48. Weinrich M, McCall D, Weber C, Thomas K, Thorn-burn L. Training on an iconic communication systemfor severe aphasia can improve natural language pro-duction.
Aphasiology

. 1995;9;343364.49. Ellwood PM. Outcome

management: a technology of patient experience.

N Engl J Med

. 1988;318:15491556.50. SteeleRD.Lingraphicmeth odsininterfacedesign.In:H erathS,ed.

ProceedingsoftheInternati onalWork- shop on Human Interface Technology

. Aizu, Japan:University of Aizu; 1995.51.

Lingraphica

System

Clinical Manual

. Oakland,Calif: LingraphiCARE America Inc.; 2001.52. Katz RC. Computer applications in aphasia treat-ment. In: Chapey R, ed.
Language InterventionStrategies in Aphasia and Related

Neurologenic Communicati onDisorders

.4thed.Philadelphia,Pa:L ippincott Williams & Wilkins; 2001:718741.

108 TOPICS IN GERIATRIC REHABILITATION