Abstract
This study examines the impact of cognition and communication on participation for people with aphasia (PWA). For participation in communication and cognitive-intensive activities among PWA, a modest amount of variance is accounted for by cognition and communication ability. Cognition is a significant independent predictor of participation in communication and cognitive-intensive activities for PWA. To facilitate community re-integration for PWA, OTs must consider internal and external factors.
Primary Author and Speaker: Madelyn Girardi
Additional Authors and Speakers: Lisa Tabor Connor
Contributing Authors: Marjorie Nicholas
This study examines the impact of cognition and communication, as both person factors and task demands, on participation for individuals with aphasia 6 months or greater post-stroke. Current literature shows that one-third of all strokes result in aphasia, impacting various modes of communication including speaking, writing, reading, gesturing, drawing, and listening (National Aphasia Association, n.d). Cognitive impairments are also reported in more than 50% of individuals post-stroke, frequently causing difficulty in areas of executive function, memory, attention, or apraxia (Gillen et al., 2015; Hochstenbach J, Prigatano G, & Mulder T, 2005). Furthermore, the specific demands of a task, or the skills required to successfully complete a given activity, may impact the extent to which an individual participates in a particular activity (Austin et al., 2013). Despite what is currently known about post-stroke function, PWA are often excluded from research as a result of communication impairments, and there is a lack of research regarding this topic. Without adequate evidence to demonstrate need, little is being done to address participation for this population of individuals post-stroke. It was hypothesized that cognition and communication, as both person factors and task demands, would have a significant impact on activity participation for PWA. A quasi-experimental, cross-sectional design was conducted to investigate this topic. Inclusion criteria: age 18 years or older, 6 months or greater post-stroke, mobile enough to come to testing site, and able to tolerate two sessions of three-hours each. Exclusion criteria: history of additional strokes, traumatic brain injury, pre-stroke disability, other existing neurological conditions, history of seizures, and history of mental health issues that are not well-controlled. Participants (n=45) completed the Activity Card Sort, The Delis Kaplan Executive Function System, and The Boston Diagnostic Aphasia Evaluation. These assessments measured percent retained participation in high cognition-demanding and high communication-demanding activities, degree of communication impairment, and degree of cognition impairment. Multiple regression 1 addressed how much of the variance in ACS cognitively demanding activities percent retained was accounted for by cognition and communication abilities, and multiple regression 2 addressed how much of the variance in ACS communication demanding activities percent retained was accounted for by cognition and communication abilities. Results show that for participation in communication and cognitive-intensive activities among PWA, a relatively modest amount of variance is accounted for by cognition and communication abilities. Approximately 22% of the variance in the ACS language-demanding activities and 20% of the variance in the ACS cognitively-demanding activities is explained by one’s communication and cognitive abilities. The findings of this study also revealed that for PWA, cognition is a significant independent predictor of participation in both cognitively-demanding and communication-demanding activities. This study highlights the possibility of including PWA in research through the use of modified assessments and supported communication techniques. In addition, the findings encourage OT practitioners to consider both internal and external factors to promote community re-integration for PWA post-stroke.
Austin, C., Connor, L.T., Mandoske, V., & Fox, K. (2013). Clarifying activity dimensions within the activity card sort to enhance measurement of participation (Unpublished manuscript submitted in partial fulfillment of the master’s degree in occupational therapy). Washington University School of Medicine: St. Louis, Missouri.
Hochstenbach J, Prigatano G, & Mulder T. (2005). Patients’ and relatives’ reports of disturbances 9 months after stroke: Subjective changes in physical functioning, cognition, emotion, and behavior. Archives of Physical Medicine and Rehabilitation, 86(8):1587–1593.
National Aphasia Association. (n.d.a). Aphasia fact sheet. Retrieved from https://www.aphasia.org/aphasia-resources/aphasia-factsheet
Gillen, G., Nilsen, D. M., Attridge, J., Banakos, E., Morgan, M., Winterbottom, L., & York, W. (2015). Effectiveness of interventions to improve occupational performance of people with cognitive impairments after stroke: An evidence-based review. American Journal of Occupational Therapy, (1), doi:10.5014/ajot.2015.012138