Stroke imposes significant burdens on the health and quality of life terms of healthcare costs and lost productivity.
Aphasia adds to the cost of stroke related care. Many stroke survivors with aphasia receive therapy in inpatient
rehabilitation facilities. However, aphasia recovery is variable and there is limited evidence on the benefits of
inpatient rehabilitation on outcomes. The objective of the parent R01 is to describe the trajectories of linguistic,
cognitive-communicative, and health-related quality of life outcomes following stroke in persons with aphasia
during inpatient and outpatient rehabilitation to 18 months following stroke. A sample of 300 consecutively-
admitted stroke patients with aphasia recruited at three Midwestern rehabilitation hospitals will complete
measures of linguistic and cognitive-communicative performance, and the Quality of Life in Neurological
Disorders Measurement System instruments during rehabilitation and at 6-,12-, and 18- months post-stroke. We
will model outcomes as individual and group trajectories, allowing us to develop individual predictions which
could inform clinical planning and decision-making for new patients.
The Covid-19 pandemic has resulted in drastic changes in therapy access and utilization since we launched this
study. As a result, patients with aphasia may not receive any inpatient or outpatient speech and language therapy,
their lengths of stay or therapy schedules may be shortened, or therapies may be offered only through
telerehabilitation. Thus, the Specific Aims of this supplement are to:
1. Characterize the Covid-19 experience and telerehabilitation access, service delivery experiences, and
perceived effectiveness in a large national cohort of adults with aphasia.
2. Describe the nature and extent of disparities in telerehabilitation service delivery related to sex, race,
ethnicity, age, and insurance coverage.
3. Compare the cognitive-communicative and psychosocial health outcomes at 6, 12 and 18 months post-
stroke achieved by patients in our longitudinal cohort study (R01 DC017174) receiving telerehabilitation
vs. in-person vs. no services following discharge from inpatient rehabilitation.
We request a supplement for two years, given the longitudinal nature of the parent R01 grant. At the end of the
supplement, results for Aims 1 and 2 will be available. Descriptive results will be available for Aim 3 on a cohort
of about 50 participants followed to 18 months post-stroke, which will be sufficient to allow for a proof of concept
descriptive analysis, and eventual 300 by the end of the parent R01 for a complete analysis.
This supplement demonstrates innovation in that SLP telerehabilitation is relatively new. Outside of controlled
research studies, its benefits and limitations have not been assessed. An improved understanding of aphasia
recovery may assist with prognosis, allowing patients and caregivers to plan, helping clinicians choose
appropriate therapies, providing benchmarks against which to measure change, and allowing therapy
modifications when patients do not attain benchmarks.
