Melanie Cole, MS (Host): welcome to Better Edge, a Northwestern Medicine podcast for physicians. I'm Melanie Cole. And we have a panel for you today highlighting aphasia. Joining me is Michelle Armour, she's a speech and language pathologist, Program Lead Clinician, and Founder of the Northwestern Medicine Aphasia Center at Marianjoy Rehabilitation Hospital; and Dr. Sonia Sheth, she's the Medical Director of the Stroke Rehabilitation Program at Northwestern Medicine Marianjoy Rehabilitation Hospital. Thank you both for joining us today. And Dr. Sheth, I'd like to start with you. Can you please tell us a little bit about aphasia? Give us a little bit of an overview.

Dr Sonia Sheth: So, aphasia is a disorder that results from damage to portions of the brain responsible for language. It usually occurs on the left side of the brain. It can occur suddenly in a patient who has had a stroke or a traumatic brain injury, or it can develop more slowly in a patient who has a progressive neurologic disorder or a brain tumor.

Melanie Cole, MS: Thank you so much, Dr. Sheth and Michelle. What is an Intensive Comprehensive Aphasia Program, as you're the founder? Tell us a little bit about it and how it's different from Marianjoy's Community-Based Program.

Michelle Armour, RN: Sure. So, an intensive program is designed to maximize on the principles of neuroplasticity, specifically by providing services at a really intense level with higher frequency of treatment sessions. So to be considered an ICAP in general, therapy needs to be provided a minimum of three hours a day for at least two weeks, and it needs to address just a wide range of goals by incorporating different approaches to treatment. So, different approaches meaning various evidence-based therapies, but across individual sessions, group sessions, and even dyad sessions, so where there's one therapist and two patients.

Some programs also offer other recreational options, such as OT or music therapy. Our ICAP specifically meets all of that criteria, which makes it much different than our current community-based program, which is the program you mentioned, the Northwestern Medicine Aphasia Center at Marianjoy. That program is all group-based, and it really just targets increased quality of life as our main outcome measure. It's not intensive, it meets once per week for three hours, and really targets just general goals for socialization, quality of life and functional communication. The ICAP, however, is much more targeted on more tangible improvements on the person's language abilities. And we look for those changes through standardized testing, which is also very different from the community program, where we don't do testing at all, it's more laid back.

Melanie Cole, MS: This is so interesting. Michelle, sticking with you for a minute, I'd like you to speak about the objective of the program and ICAP, and it sounds to me like a very multidisciplinary program. So, tell us about it and also tell us about the curriculum involved.

Michelle Armour, RN: So, the objective of the program is to help individuals with aphasia make as much progress as possible in this relatively short amount of time. And we do that by maximizing on those principles of neuroplasticity. So as providers, we know to achieve neuroplasticity, we need a high frequency of practice. We need repetition and we need intensive services, and that's exactly what ICAPs are designed to do.

So, the NM, Northwestern Medicine ICAP at Marianjoy, offers a couple different registration options so that the patients have some choices. So, our curriculum is you can choose to do it part-time or full-time. The part-time option provides therapy four hours a day, four days a week, for four weeks; or the full-time option, which provides therapy six hours a day, four days a week, for four weeks. So, throughout all of that time, we provide individual, group, and dyad treatments across many different evidence-based practice therapies that we provide.

And we also give the patients an option. So whether they're part-time or full-time, they get an option of one hour of every day that they're enrolled in the ICAP to either take an interdisciplinary route and do some upper extremity work with robotics with an occupational therapist. Or if they don't have upper extremity motor needs, then they have the option of additional speech and language practice through computer-led sessions. We have access to a lot of different apps and software that can lead them through more speech and language type of skilled practice.

We also are sure to incorporate their care partners. So, we have care partner trainings where their family is welcome to join. And we train them on supportive communication and provide them with a lot of education, training, and resources to really make sure that we involve the family into the care.

And then, one thing that sets our ICAP apart from others is that the whole program is strictly led by licensed speech-language pathologists. A lot of programs might use students to help provide some of this intensive treatment, but ours is all by licensed speech-language pathologists, and we keep our enrollment numbers small in order to maintain tight patient and therapist ratios.

Melanie Cole, MS: This is so comprehensive, Michelle. Is this a relatively new service delivery model for stroke rehab? How was the concept born?

Michelle Armour, RN: Yes, ICAPs are relatively new. The knowledge of increased amount of therapy yielding better outcomes has always been present, we know that. But actual programs with structured offerings to provide more intensive treatment is relatively new. They were first described in literature about 10 years ago, but in recent years have really grown in popularity with new programs beginning to appear across the globe.

The concept itself was really just born from passionate aphasiologists who know their patients can improve by increased therapy dosage. So, unique programs started to pop up and they all included this increased dosage as a common factor. And as those unique programs started to grow and there started to be more available, standards started to kind of develop around them to really coin the term of an ICAP.

Melanie Cole, MS: So, Dr. Sheth, who are ICAPs best suited for?

Dr Sonia Sheth: ICAPs are best suited for any patient who has true aphasia and a patient who has had a stroke or brain injury. The one thing is, is the patient must be extremely motivated and have adequate endurance. The type and severity of aphasia doesn't matter as much. It's more about their ability to participate in a very intensive program with our speech therapists.

Melanie Cole, MS: So Dr. Sheth, I'd like some final thoughts from you. Are ICAP programs fairly unique? Is it unusual to have an ICAP in a hospital setting?

Dr Sonia Sheth: Yes, ICAPs are definitely rare to have in a hospital setting. They're more common in university settings. The research has really supported how effective the approach can be. Though they are more common in university settings, there are some within hospital systems, but it's just a handful within the US.

Melanie Cole, MS: Michelle, last word to you. Tell us about your program, your team, all the people that are involved and why you want other providers to know about this very unique program at Northwestern Medicine's Marianjoy Rehabilitation Hospital.

Michelle Armour, RN: Sure. So Marianjoy, it's structured really nicely to follow a patient across the continuum of care. So, we obviously offer inpatient and outpatient services, but we also have an amazing set of specialty clinics that can be accessed at any point in someone's recovery. One of our specialty clinics being the NM Aphasia Center at Marianjoy.

So having the ICAP as an additional option for our clients can be really helpful because it can be accessed at any point. It doesn't matter how long it's been since the stroke or brain injury, if someone is that motivated to improve and they want access to that intensive opportunity, then they can come to Marianjoy and receive that. I think it's also helpful because it's just offering another opportunity for this where they might not have to travel. So if the people are local, great! We're right here, we're in the suburbs, there are so many communities right around us. But if people do want to travel, there is a lot happening here in Wheaton, Illinois. And if people want to come out of state for the ICAP, they can do so. That is very common with ICAPs, people travel just to seek that opportunity. And we're just so excited to have this excellent team of speech-language pathologists, occupational therapists and support staff to really be able to host this ICAP and just add to the wonderful programs that are already out there.

Melanie Cole, MS: What an amazing program. And thank you both so much for joining us and telling us about the Aphasia Program at Northwestern Medicine's Marianjoy Rehabilitation Hospital. Thank you again. And to refer your patient or for more information, you can head over to our website at breakthroughsforphysicians.nm.org to get connected with one of our providers. That concludes this episode of Better Edge, a Northwestern Medicine podcast for physicians. I'm Melanie Cole. Thanks so much for joining us today.