Occupational Therapy Within an Intensive Comprehensive Aphasia Program: Outcomes for People Living With Chronic Stroke

PURPOSE: Medicare patients are discharged from rehabilitation services when they no longer make gains in activities of daily living (Dobkin, 2005). However, studies of individuals with chronic stroke, characterized as greater than 6 mo poststroke, have highlighted the idea of occupational gaps. These gaps are defined as activities individuals want to do that they are not doing that persist after the completion of traditional rehabilitation services (Eriksson, Aasnes, Tistad, Guidetti, & von Koch, 2012). People with aphasia poststroke report that while physical functioning and health goals are addressed during their rehabilitation, goals regarding social participation, leisure, and work and volunteering are not addressed (Worrall et al., 2011).

There are a few studies that demonstrate that people with chronic stroke can increase activity level and satisfaction with leisure and other valued activities (Hartman-Maeir et al., 2007), as well as satisfaction with community integration (Mayo et al., 2015). The primary purpose of this study was to determine if individuals with chronic stroke with aphasia experience an increase in satisfaction and improved performance of personally valued occupations as a result of participation in a community-based intensive comprehensive aphasia program (ICAP) that includes occupational therapy (OT). This research clearly fits the American Occupational Therapy Foundation research priority that focuses on health behaviors to prevent and manage chronic conditions.

DESIGN: A within-subject research design was used to investigate the effectiveness of an intensive, interprofessional, community-based program for individuals living with chronic stroke and aphasia. Participants were recruited by speech–language pathologists through the university’s aphasia resource center and local networking. Inclusion criteria included those who experienced a stroke >6 mo prior to the study, lived in the community, presented with aphasia secondary to a single stroke, were able to manage elevator and bathroom needs independently, and could understand and follow simple directions. The program ran for 4 wk each summer with six or seven different participants each summer. This poster describes the occupational therapy intervention and outcomes data from 3 yr of this program.

METHOD: The Canadian Occupational Performance Measure (COPM), goal attainment scaling (GAS), and the Stroke Impact Scale (SIS) were used to measure outcomes. Data were collected 4 wk prior to the start of the program, 1 wk prior to the start of the program, and 1 wk and 3 mo after completion of the program. Collaborative goal setting, both group and individual OT sessions, and interprofessional activities were key aspects of the program. The Wilcoxon signed-rank test, a nonparametric method of data analysis, was used to analyze the data.

RESULTS: Nineteen people with chronic aphasia poststroke participated in the 4-wk interdisciplinary program over three summers (2013–2015). A significant positive change was found in performance and satisfaction scores on the COPM pretest to posttest and on the GAS. No significant results were noted in overall SIS scores; however, positive changes were noted in two domains.

CONCLUSION: Findings from this study support inclusion of OT in an ICAP to increase the performance of and satisfaction with valued occupations focusing on instrumental activities of daily living, leisure, work, and social participation for people with chronic stroke and aphasia.

IMPACT STATEMENT: This study furthers the literature related to individuals’ ability to make positive, clinically and statistically significant gains in participation in the chronic stages of stroke, therefore highlighting the importance of providing occupational therapy services to individuals well after stroke.

References

Dobkin, B. H. (2005). Rehabilitation after stroke. New England Journal of Medicine, 352, 1677–1684. https://doi.org/10.1056/NEJMcp043511

Eriksson, G., Aasnes, M., Tistad, M., Guidetti, S., & von Koch, L. (2012). Occupational gaps in everyday life one year after stroke and the association with life satisfaction and impact of stroke. Topics in Stroke Rehabilitation, 19, 244–255. https://doi.org/10.1310/tsr1903-244

Hartman-Maeir, A., Eliad, Y., Kizoni, R., Nahaloni, I., Kelberman, H., & Katz, N. (2007). Evaluation of a long-term community based rehabilitation program for adult stroke survivors. NeuroRehabilitation, 22, 295–301.

Mayo, N. E., Anderson, S., Barclay, R., Cameron, J. I., Desrosiers, J., Eng, J. J., . . . Bayley, M. (2015). Getting on with the rest of your life following stroke: A randomized trial of a complex intervention aimed at enhancing life participation post stroke. Clinical Rehabilitation, 29, 1198–1211. https://doi.org/10.1177/0269215514565396

Worrall, L., Sherratt, S., Rogers, P., Howe, T., Hersh, D., Ferguson, A., & Davidson, B. (2011). What people with aphasia want: Their goals according to the ICF. Aphasiology, 25, 309–322. https://doi.org/10.1080/02687038.2010.508530