Active Projects
From Impairment to Participation: A Systems Approach to Understanding the Complexity of Aphasia
Aphasia is a language disorder, but its ramifications extend beyond language to cognition, participation, and psychosocial factors. Indeed, quality of life for persons with aphasia (PWA) is lower than for those with Alzheimer’s disease and cancer. Our field has historically conceptualized aphasia in two ways: impairment-focused or life participation (or consequences focused). Although the field now recognizes that these two conceptualizations are intertwined and co-exist within the lives of PWAs, the rehabilitation of aphasia is still based on these discrete conceptualizations (see Fridriksson & Hillis, 2017). Treating these as discrete approaches can lead to missed recognition of and interventions targeting the interconnectedness between impairment and life participation. While these relationships between impairment and participation domains are verbally noted in the literature, there remains no comprehensive, formalized model to guide rehabilitation planning. Thus, the first, necessary step in formalizing a model, is to understand the complexity of variable interactions across impairment and life participation approaches. Our aim is to formalize an innovative complexity model of aphasia that informs a holistic, precision medicine approach to rehabilitation of aphasia and ultimately improve PWAs’ quality of life. We will 1) formalize a complexity model of aphasia to identify critical variables (A) and emergent causal relationships (B) across impairment and life participation approaches, and 2) explore the prognostic value of the pre-treatment complexity model by testing whether the most critical and causal variables predict post-treatment outcomes (C). We will use an intensive comprehensive aphasia program (ICAP) dataset that is uniquely suited to address a challenge in formalizing a complexity model of aphasia, namely a dataset with variables typically measured within both impairment and life participation approaches. Dataset includes participants starting from 2016 and has information pre- and post- ICAP measurements capturing impairment in language and cognitive abilities (i.e., spontaneous speech, auditory verbal comprehension, repetition, naming, written expression, and cognition) and life participation with personal and social impact variables (i.e., physical and mental health, communicative confidence, communicative efficacy, and social roles and activities).
MPI: Dr. Nichol Castro
Collaborators: Dr. Leora Cherney, Dr. Edie Babbitt
Funding: R21DC022357
Validating Non-linguistic Biomarkers of Depression in Persons with Aphasia
Persons with aphasia (PWAs) are thought to be at higher risk for depression, a psychiatric condition characterized by chronically low mood, than other stroke survivors. Depression in PWAs is thought to be associated with increased cognitive and linguistic impairment, risk of stroke recurrence, and mortality. However, identifying depression in PWAs is challenging as their language disturbances make it difficult to assess symptoms using traditional methods, i.e., questionnaires and psychiatric interviews. This approach seeks to assess depression in persons with aphasia using laboratory-assessed biomarkers that require minimal language abilities and are strongly indicative of depression. A goal of this study is thus to assess the ability of three laboratory-assessed biomarkers to detect depression in PWAs: (a) heart-rate variability (HRV) at rest, (b) pupil dilation, and (c) gaze duration (a measure of biased attention) to negatively (i.e., sad faces) and positively (i.e., happy faces) valenced images. Aim 1 of the study will adopt a novel convergent validity approach and use as its validator a composite reference standard based on multiple proxies or indicators of depression. Composite reference standards are routinely employed to validate new biomarkers when imperfect diagnostic tests exist, but its application to depression assessment in PWA has not been done. Aim 2 will Investigate the association between PWA’s laboratory-assessed biomarkers and daily-life affective experiences and social interactions, as assessed by caregivers’ daily experience sampling method (ESM) assessments. ESM requires brief, frequent (multiple per day), at-home assessments (in this case, from caregivers), thus minimizing recall bias and increasing ecological validity. Aim 3 will Investigate the test-retest reliability of laboratory-assessed biomarkers in predicting depression and ESM ratings of affect and social interactions. We will investigate the test-retest reliability of the laboratory-assessed biomarkers by re-administering them to PWAs 7 days later.
Collaborators: Dr. Stewart Shankman, Dr. Leora Cherney
Funding: NICHD R03 HD111008
Creating a Daily Life Measure of Depression for Persons with Aphasia and Examining its Relation with Communicative Confidence
Aphasia is a multi-modality disturbance of language that is often acquired after a left hemisphere stroke. Post-stroke depression is associated with worse language and cognitive performance and overall decreased quality of life. However, persons with aphasia are typically excluded from studies of post-stroke depression due to a lack of valid assessment tools. More importantly, studies of depression in persons with aphasia only assess depression using weekly retrospective measures, thus ignoring the day-to-day variability in mood. An innovative approach to assessing the dynamic nature of depression is ecological momentary assessment (EMA). EMAs involve repeated sampling of data over time in the real-time in real-world environments. EMAs are ecologically valid but have not been used in persons with aphasia due to their language disturbances. A goal of this study is to use user-centered design to create and validate an aphasia-friendly EMA of depression and investigate its association with communicative confidence (N = 95). Aim 1 of the study will adapt a user-centered design by involving persons with aphasia, their caregivers, and speech-language pathologists to design and construct brief (~less than 60s) EMA measure of depression. Validity of the EMA measure will be established using an established depression scale for persons with aphasia. Aim 2 will establish the validity of the EMA assessment of depression using a smartphone-based measure of physical activity (i.e., step count). Reduced physical activity is a robust correlate of depression in both neurologically healthy individuals and those with stroke. Aim 3 will investigate the relationship between depression and communicative confidence and test the incremental validity of the EMA measure over the retrospective weekly measure of depression. Usability and feasibility of the EMA will also be established.
Collaborators: Dr. Stewart Shankman, Dr. James Griffith, Dr. Madhu Reddy
Funding: NIDCD K23 DC020757, Shirley Ryan AbilityLab C-STAR P2C HD101899+
Emotion Recognition in Persons with Stroke: A Longitudinal Eye-Tracking Study
The purpose of this study is to investigate the emotional recognition of faces and words in person with acute right hemisphere stroke. Participants will be measured in their ability to recognize facial emotions, emotional words in sentences while their eyes are being tracked. We are also analyzing participants' facial expressions as they recognize different emotions.
Role: Principal Investigator
Funding: Shirley Ryan AbilityLab Catalyst Foundation Grant
A Systems Approach to Understanding the Complexity of Aphasia
The long-term goal of this project is to develop a complexity science model of aphasia that transforms the conceptualization and rehabilitation of aphasia and maximally improves both the aphasia (impairment) and its impact (participation) in a parsimonious and efficient way.
Role: Co-Principal Investigator with Nichol Castro, PhD.
Funding: Investigator-initiated
Network analysis
We have multiple on-going projects that utilize the method of network analysis in person(s) with spinal cord injury, aphasia, stroke, and traumatic brain injury. See more on the “Past Projects” page.
Effects of communication functioning, depression, and interpersonal relationship on social participation in persons with traumatic brain injury longitudinally
Collaborator(s) : Nichol Castro, Ph.D.
This study is investigating how does communication functioning, depression, and interpersonal relationships affect social participation at 1, 2, and 5 year(s) longitudinally post traumatic brain injury (TBI) using network analysis. We will be using data from Traumatic Brain Injury Model Systems (TBIMS). Cross-lagged panel network (CLPN) will be used to analyze a temporal, post-TBI social participation network.
Other Projects in the Lab
Cortical Activity During Swallowing in Post-Stroke Individuals
We are conducting a research study to investigate brain responses during swallowing in post-stroke individuals with and without swallowing disorders (dysphagia). We are using functional near-infrared spectroscopy (fNIRS), a noninvasive imaging modality, to assess brain activity while participants swallow varied liquid consistencies (e.g., juice and thickened juice). Other measures in this study include a clinical swallowing assessment (e.g., Functional Oral Intake Scale, Eating Assessment Tool, and Mann Assessment of Swallowing Ability), instrumental assessment of swallowing (Modified Barium Impairment Profile – MBSImP), and respiratory-swallowing coordination.
Role: Mentor
PI: Mariana Mendes Bahia, Ph.D., CCC-SLP
Funding: Shirley Ryan AbilityLab
The Development of fNIRS Capability at the Shirley Ryan AbilityLab: A Post-Stroke Aphasia Study
Collaborator(s): Leora Cherney, Ph.D., CCC-SLP, BC-ANCDS
The Shirley Ryan AbilityLab is conducting a research study that will help us understand how brain activity is impacted by language treatments. We are recruiting participants with post-stroke aphasia and neurologically healthy individuals who have never had a stroke. Both groups will engage with a computer-based language treatment called Oral Reading for Language in Aphasia (ORLA) while undergoing recording with a neuroimaging technology called functional near-infrared spectroscopy (fNIRS). ORLA involves repeatedly reading sentences under different conditions, like reading silently to oneself, reading aloud independently, or reading aloud along with a computer-generated voice. fNIRS involves wearing a cap that shines light onto the scalp in order to measure blood flow in the brain.
This study is currently recruiting persons with aphasia and healthy controls. Click here to learn more.
Role: Mentor
PI: Evan Houldin, Ph.D.
Funding: Shirley Ryan AbilityLab
