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

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Stroke imposes significant burdens on the health and quality of life of survivors and their caregivers, and presents a major public health issue in 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 this study is to describe the trajectories of linguistic, cognitive-communicative, and health-related quality of life (QoL) outcomes following stroke in persons with aphasia during inpatient and outpatient rehabilita- tion to 18 months following stroke. A sampleof 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 (Neuro-QoL) 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-mak- ing for new patients. The Specific Aims are to: Aim 1: Establish a prospective cohort of stroke patients with aphasia, and define their typical trajectory of lin- guistic, cognitive-communicative, and health-related QoL recovery at admission to and discharge from the IRF, and at 6, 12, and 18 months post onset. Aim 2: Identify factors that are associated with linguistic, cognitive-communicative, and health-related QoL out- comes from among the following: patient factors including demographic and clinical characteristics related to stroke and aphasia; treatment variables including inpatient and outpatient aphasia therapy characteristics and informal aphasia services; and biomarkers, including genetic and neuroimaging biomarkers. Aim 3: Evaluate the stability of the models of linguistic, cognitive-communicative, and health-related QoL out- comes recovery that are developed from Aims 1 and 2. This study is innovative in its use of (1) standardized assessments that measure not only linguistic outcomes but also communication and QoL outcomes; (2) patient-centered, self-report instruments such as Neuro-QoL to de- tect clinically important change through 18 months post-stroke; (3) individual growth curve analysis to describe recovery trajectories and examine associations between demographic, lesion, aphasia, genetic, and speech and language therapy characteristics; (4) biomarkers that have been implicated in promoting neuroplasticity; (5) rest- ing state functional magnetic resonance imaging to evaluate the association between network pathology and recovery from aphasia; (6) information on type, amount, and duration of aphasia treatment provided in clinical settings; and (7) information on informal aphasia services following discharge from formal therapy.