Defining Trajectories of Linguistic, Cognitive-Communicative and Quality of Life Outcomes in Aphasia

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 inpatientrehabilitation facilities. However, aphasia recovery is variable and there is limited evidence on the benefits ofinpatient 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 aphasiaduring 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 completemeasures of linguistic and cognitive-communicative performance, and the Quality of Life in NeurologicalDisorders Measurement System instruments during rehabilitation and at 6-,12-, and 18- months post-stroke. Wewill model outcomes as individual and group trajectories, allowing us to develop individual predictions whichcould 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 thisstudy. 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 throughtelerehabilitation. 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 thesupplement, results for Aims 1 and 2 will be available. Descriptive results will be available for Aim 3 on a cohortof about 50 participants followed to 18 months post-stroke, which will be sufficient to allow for a proof of conceptdescriptive 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 controlledresearch studies, its benefits and limitations have not been assessed. An improved understanding of aphasiarecovery may assist with prognosis, allowing patients and caregivers to plan, helping clinicians chooseappropriate therapies, providing benchmarks against which to measure change, and allowing therapymodifications when patients do not attain benchmarks.