Poster E15, Thursday, August 22, 2019, 3:45 – 5:30 pm, Restaurant Hall
Clinical Implementation of Transcranial Direct Current Stimulation (tDCS): Speech-Language Pathologist’ Opinions Regarding the Translation of tDCS into Clinical Practice
Lynsey Keator1, Alexandra Basilakos1, Christopher Rorden2,3, Jordan Elm4, Leonardo Bonilha3, Julius Fridriksson1,2;1Department of Communication Sciences and Disorders, University of South Carolina, 2McClausland Center for Brain Imaging, University of South Carolina, 3Department of Psychology, University of South Carolina, 4Department of Public Health Services, Medical University of South Carolina, 5Department of Neurology, Medical University of South Carolina
Introduction: Following a stroke, 20-30% of survivors suffer from aphasia (Engelter et al., 2018; Laska et al., 2001) and for 15% aphasia continues into the chronic stages of recovery (Wade et al., 1994). Many studies have investigated tDCS in aphasia rehabilitation and results support A-tDCS may be a promising adjuvant treatment for behavioral aphasia therapy (Baker et al., 2010, Fridriksson et al., 2011; Cherney et al., 2010; Meinzer, 2016; Marangolo et al. 2011; 2013; 2014). To consider implementation of tDCS into clinical practice, practicing SLPs working directly with patients with aphasia (PWA) across a variety of work settings were surveyed about their familiarity with tDCS, concerns about its use, and the amount of tDCS-related improvement (or “tDCS boost”) that would convince them to use tDCS. Methods: Two hundred and twenty-one SLPs returned a survey, with 155 valid responses retained for analysis. The survey polled SLPs about their familiarity with tDCS, concerns about adopting tDCS, and importantly, the “tDCS boost” in aphasia therapy outcome (measured as increase in Western Aphasia Battery-Revised Aphasia Quotient, WAB-R-AQ; Kertesz, 2007) needed to incorporate tDCS into clinical practice. Surveys were distributed online via email and social networking platforms using REDCap (Harris et al., 2009). Results: 71% reported being familiar with tDCS prior to completing the survey and importantly, 94.2% reported concerns related to at least one of five broad categories: training/continuing education (68.4%), administrative approval (60%), cost (47.1%), safety (45.8%) and insurance reimbursement (41.9%); 30.3% reported at least three concerns. With respect to the degree of “tDCS boost,” respondents reported a mean 22.9% desired boost (SD=20.1, range=0-100) in treatment related increase in AQ in order to consider adopting tDCS into practice. The 90th percentile corresponded to a 50% “tDCS boost”. There was a significant main effect of years of experience for the “tDCS boost” question, ((X2(3)=9.3, p=0.025), and a negative correlation between “tDCS boost” and percent of PWA caseload (rs = -0.17, p = 0.043). Conclusions: This is the first study to identify clinician familiarity with tDCS and quantify a behavioral change necessary to adopt tDCS as a part of post-stroke aphasia treatment in the rehabilitation setting. SLPs reported an average “tDCS boost” of 22.9% (equivalent to a 2 point increase in WAB-AQ; 90th percentile = 50% “tDCS boost and a 5-point increase) in treatment outcome would be necessary for consideration of clinical implementation. To illustrate, if a patient who improves by 10 WAB AQ points following conventional, behavioral aphasia therapy, SLPs would be likely to adopt tDCS if the patient improved an additional 2-5 points (total of 12-15 points). Data trends suggest clinicians in academic setting, with more experience, or with a greater number of PWA on caseload report a lower “tDCS boost” threshold. SLPs’ concerns related to the clinical adoption of tDCS can and should be used to guide translational research studies aimed to meet clinical needs. Furthermore, such reports will be crucial in informing policy decisions that can facilitate the adoption of tDCS into practice.
Themes: Disorders: Acquired, Language Therapy
Method: Neurostimulation