Transcription:
Aphasia

Melanie Cole (Host):    Welcome to Better Edge, a Northwestern Medicine Podcast for Physicians. I'm Melanie Cole and I invite you to listen as we discuss Northwestern Medicine Aphasia Center at Marianjoy Rehabilitation Hospital. Joining me in this panel are Dr. Mahesh Ramachandran. He's the Chief Medical Officer of Northwestern Medicine's Marianjoy Rehabilitation Hospital, and Michelle Armour. She's the Program Lead Clinician at Northwestern Medicine Aphasia Center at Marianjoy Rehabilitation Hospital. Thank you both for joining us today. Dr. Ramachandran, I'd like to start with you, if you could tell us a little bit about aphasia and what you're seeing in the trends.

Mahesh Ramachadran, MD (Guest): So, aphasia as a, scientific definition is basically an impairment of language and typically, this happens after a stroke that affects the dominant hemisphere, on the left side. It is a very prominent disabling factor of a stroke, and there are many different types of aphasia. And depending on the location of the stroke, is the manifestation of the deficits that happen, within the aphasia.

A hallmark of speech therapies post-stroke is treatment of aphasia because of aphasias can be quite disabling and really affect a patient's functional outcome and quality of life, after they've suffered a stroke. So, speech therapist treatment with regards to aphasia is not only as an inpatient, but also will occur as an outpatient as well.

There are many different techniques and, and specific treatments depending on the type of aphasia. And I think Michelle is going to be talking to us a little bit more about that. But, impairment of language, verbal expression, reading, comprehension of language, or all large impairments that happen, following a stroke in the dominant hemisphere. And, without that treatment, patients can have significant impairments and in effect their quality of life, without those specific treatments.

Host: So, then Michelle how has Marianjoy unique in delivering aphasia treatment for patients? Tell us a little bit about what you do.

So, Marianjoy Michelle Armour MS, CCC-SLP (Guest): is unique because we have developed the Northwestern Medicine Aphasia Center. And the Aphasia Center concept has been around for many years now, but there are not many of them across the world and an Aphasia Center uses a different approach to therapy. So, it's really made for anyone that's experiencing, aphasia at any point in their recovery. The service delivery model we use, across most Aphasia Centers and specifically at our Aphasia Center here at Marianjoy is the life participation approach to aphasia, which really puts the patient at the center of the care. The life participation approach and that service delivery model is based around these five core values.

And in summary, the values state that the ultimate goal for treatment should really be enhanced life participation of our patients with aphasia and their success in treatment should be measured in that way, by those life enhancement changes. It also goes on to state that every person with aphasia is entitled to service, no matter what stage they are in their recovery, the severity of their aphasia and that therapy should really focus on personal and environmental factors that should be incorporated into treatment.

And that's what we do at our Aphasia Center. We take that approach to our delivery. And the fact that we are a Rehabilitation Hospital means we're offering this service to really bridge the gaps. We provide our, aphasia treatment at the inpatient level, the outpatient level, and then we have this community program that's also accessible to any of our patients with aphasia, no matter what level of recovery they might be, in.

Host: Well, then Michelle, tell other providers why you feel this is so effective. Tell us a little bit about what you've seen and how it works.

Michelle: Absolutely. So the value of LPAA is that it's completely patient-centered right. So, it puts the enhancement of life at the core of the care that we provide. So, by delivering services in that fashion, the therapist can help the patient achieve not only improved language and communication, but hopefully quality of life as well, and psychosocial considerations that affect their quality of life.

So, I think it's effective, what we're doing, because it ensures that the patient with aphasia feels heard in a world where often they are not. You know, communication's really at the heart of all of our relationships, whether that be personal, work, community. So, life with aphasia can leave someone feeling isolated and alone, but this delivery model ensures that as a therapy team, we can help prevent that from happening.

In terms of our outcomes, what we've learned? We did a study that was actually published in 2019 that outlined, our outcomes within our first year of opening. We wanted to see, you know, and learn ourselves is this, method that we’re using, is it effective? And we evaluated quality of life pre and post multiple enrollments in our program all the way up to one year. We measured that through the Stroke and Aphasia Quality of Life Scale. And we found that we had statistically significant improvements in our patient reported quality of life scores, following every enrollment, as well as at that one year mark. So, that was, very positive for us to see. And it showed us that what we were doing was working for our patients and that we can continue to grow upon that.

Host: Dr. Ramachandran, tell us some of the key factors you feel are important in increasing that treatment success. And while you're doing that, tell us a little bit of how technology has impacted this treatment.

Dr. Ramachadran: Well, I think that, with regards to aphasia treatment, as a whole, participation, in such a program, would be very important in success of that program. A lot of, stroke patients as a whole, and certainly those with aphasia get quite frustrated, anxious, and depressed. And even after an inpatient program, compliance with treatment protocols and so on do fall, because of this type of, frustration and mood disorders that follow. So, for patients to see continued success and improvements in their language and in their deficits would be very important. And I think, that support group atmosphere, that the aphasia group has, really improves the participation and quality, of treatments, really help the patients understanding how they're getting better and also discussion with other members also helps them from a psychosocial aspect as well. I think Michelle has some ideas with regards to the technical advancements in aphasia.

Host: Well, yes. And Michelle, I would like you to go into more of that, if you would, about how Marianjoy is using that technology that Dr. Ramachandran was discussing?

Michelle: So, I'd like to tag onto what he mentioned too, with the key factors. You know, when we think about key factors in treatment success for aphasia; standard factors of treatment are always going to be related. So, those principles of neuro-plasticity related to intensity and frequency and the saliency of the stimuli, but that patient centered care aspect, as he mentioned, is also extremely important.

So, even with the technology we use, we want to keep all those key factors in mind, in terms of, technology then to act, to increase their intensity and frequency, to practice technology for individuals with aphasia has continued to change their lives. They've gone through, you know, different providers have invented this technology that has increased practice opportunities with different language applications, for the iPad, for tablets that make continued practice for those in the chronic phase or the acute phase, just more accessible.

So, now they're not just getting speech therapy a couple of times a week. They're able to access these, ongoing opportunities for continued, practice and therapeutic opportunities on a more regular basis. In addition to that, at our Aphasia Center, we have a technology unit where we practice training individuals on the technologies that are available for that purpose for continued practice.

However, there's also a lot of Aphasia software that's been developed. Some of those include using an avatar on the screen to actually lead through a speech therapy exercise, which again, just increases their accessibility to continued practice. Some that we do specifically in training in our technology unit is with different software that's available to help individuals compensate for any reading or writing challenges that couple with their aphasia. As Dr. Ramachandran had mentioned, reading and writing are so, deficits related to the aphasia language impairments. So, by training them on this, we're helping them learn the software, but also then practice in functional use with their phone, with tablets, with computers, sending texts, sending emails, to really build upon that life enhancement that we target with the life participation approach to aphasia.

I should also mention technology for our lower level patients, technology advances have also allowed for the use of different speech generating devices, which we also incorporate in our individual and group sessions as much as possible to increase communication access for those individuals.

Host: What a great program that you have set up, and Dr. Ramachandran, what does the future hold for aphasia treatment? Are there any interesting research to watch, anything you'd like to share for other providers?

Dr. Ramachadran: Well, I, think that, aphasia treatments, are continuing to evolve, here at Marianjoy, from our inpatient unit, we discharge, probably more stroke patients than any other facility in the state of Illinois, certainly from a Medicare standpoint, we have, that number of patients. And so, our, speech pathologists see a wide variety of, aphasic patients and so subtle changes or subtle aphasics that typically are not seen, our speech therapists are seeing and working on how to solve problems, for these particular patients. In addition, we have dedicated speech pathologists that, work only with stroke patients and aphasic patients and with that clinical experience, it really helps improve the techniques and the treatments, for these stroke patients. I think Michelle alluded to, studies that we've done in our Aphasia Center with regards to the improvements that we're looking at and the technological advances, with iPads and so on to help, enhance aphasia recovery.

Michelle: Just to add on to what he just mentioned related to, the future for aphasia treatment, generally speaking, there's a lot of research happening right now in the, speech pathology world related to aphasia, looking at biomarkers in aphasia, the relationship between cognition and aphasia and then just development of new technologies that are out there to make, aphasia treatment more accessible.

Specific to Marianjoy too,, we have two studies that are being published at this time. One targeting a program that we developed, on a specific training program to train nursing staff members on supportive communication with their patients with aphasia to really help improve our patient satisfaction and our ability to communicate effectively with all of our patients across the inpatient hospital.

We also have another study that'll be coming out in the next, four to six weeks, hopefully that investigated the use of a treatment within the acute aphasia population on our inpatient stroke unit. You know, most literature and research utilize the chronic aphasia population to investigate effectiveness of treatments. So, we really wanted to investigate how to use these specific treatments. But are they always effective with acute aphasia in that inpatient rehab environment? So, definitely be sure to watch out for both of those coming shortly.

Host: As we wrap up Michelle, I'd like to give the last word to you. What would you like other providers to know about Marianjoy's Aphasia Program and when you feel it's important they refer?

Michelle: So, I think the thing to really remember about our program is that we are open to anyone that's seeking additional opportunities. It is a community-based program. Meaning they would call, they would inquire with us. We would ask them questions, make sure it's an appropriate fit and they can refer just about anyone. We do a screening process to make sure that we can provide the services appropriate for them. We're also offering right now, Telemedicine groups and individual sessions, as well as in-person groups and individual sessions. So, we are trying to accommodate as many people as possible. And our patient satisfaction rates have been wonderful since we opened as well, which really shows us that our patients are benefiting according to the data we're collecting, but they're also just enjoying this experience and it's giving them an opportunity that is hard to find in a lot of locations. So, I think it's also important to know that we did this as a team, as a labor of love. We wanted to make this available for our patients, and I think other places can do the same within a larger healthcare system, across different states to really make something like this happen for patients all across the globe.

Host: Thank you both so much for joining us today and telling us about the Northwestern Medicine Aphasia Center at Marianjoy Rehabilitation Hospital. To refer your patient or for more information, please visit our website@marianjoy.org. Or you can also visit nm.org to get connected with one of our providers. That concludes this episode of Better Edge, a Northwestern Medicine Podcast for Physicians. Please remember to subscribe, rate and review this podcast and all the other Northwestern Medicine podcasts. Melanie Cole.