Description of an Intensive Residential Aphasia Treatment Program: Rationale, Clinical Processes, and Outcomes

Winans-Mitrik, Ronda and Schumacher, James and Hula, William and Dickey, Michael and Doyle, Patrick (2013) Description of an Intensive Residential Aphasia Treatment Program: Rationale, Clinical Processes, and Outcomes. [Clinical Aphasiology Paper]

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Abstract

The influence of treatment intensity on treatment response in persons with aphasia (PWA) has received considerable attention in the aphasia treatment literature over the past 15 years. A meta-analysis of 55 aphasia treatment studies conducted by Robey (1998) revealed that treatment gains were greatest when therapy was provided more than two hours per week. In a subsequent review of 10 aphasia treatment studies, Bhogal, Teasell, & Speechley (2003) reported a positive relationship between treatment intensity and treatment outcomes. More recently, systematic evidenced-based reviews that included 4 RCTs (Kelly, Brady, & Enderby 2010), and 11 other studies (Cherney, Patterson, Raymer 2011) directly comparing more vs. less intensive treatment schedules reported only modest or equivocal evidence in favor of intensive treatment. During this same period, changes in reimbursement models have resulted in decreasing lengths of stay for inpatient rehabilitation and an increasing shift to outpatient settings (Ottenbacher et al, 2004). The change to outpatient service delivery has limited access to care for many PWAs who live outside of urban centers or who lack adequate transportation services. For example, despite the exemption of Veterans Healthcare Administration (VHA) enrollees from private pay therapy caps, a search of VHA’s Corporate Data Warehouse revealed that of the 10,371 enrollees carrying a diagnosis of aphasia in FY12, only 30% (3198) received speech-language rehabilitation services, with an average treatment dose of 12 hours. Within this context, several non-hospital-based intensive aphasia rehabilitation programs have emerged in recent years in an attempt to improve access to services and to maximize patient outcomes (Cherney et al., 2011). In this poster we provide a brief overview and describe the treatment philosophy, clinical processes and clinical outcomes of an intensive, residentially-based aphasia treatment program operated by the Veterans Healthcare Administration.

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