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Effects of social engagement and individual motivation on aphasia outcomes
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Poster C53 in Poster Session C, Wednesday, October 25, 10:15 am - 12:00 pm CEST, Espace Vieux-Port
Lily Walljasper1, Sarah M. Schneck1, Jillian L. Entrup1, Marianne Casilio1, Anna Kasdan1, Caitlin F. Onuscheck1, Deborah F. Levy1, Michael de Riesthal1, Stephen M. Wilson1,2; 1Vanderbilt University Medical Center, 2University of Queensland
Individuals with post-stroke aphasia often cite social interaction with their families and communities, and individual motivation to improve their speech and language, as important factors in their recovery process [1–2]. However, these constructs are difficult to measure, and it remains unclear whether they contribute to aphasia recovery above and beyond the key predictors of lesion location and extent [3]. In this study, we investigated whether social engagement and/or individual motivation are predictive of aphasia outcomes. The present analysis is based on 93 individuals who presented with acute aphasia after dominant hemisphere stroke (age 61.6±13.7, range 23–90; 52/41 male/female) and for whom language evaluations (Quick Aphasia Battery [QAB] [4]) and interviews probing social and motivational factors were acquired between 3 months to 1 year post-stroke. Acute QAB overall scores were 4.6±3.1 and final scores were 7.8±2.1 on a 10-point scale. To measure social engagement and motivation, speech-language pathologists carried out a thorough interview with each patient, along with their caregiver where appropriate. We used a standardized bank of questions (e.g., Who do you spend time talking to? What kinds of things do you do to stay busy each week? Do you belong to any groups? etc.). Then, we rated social engagement and motivation, each on a 5-point scale (none, minimal, fair, good, excellent). These ratings were included as predictors in a linear model of aphasia outcome (QAB overall score). Other predictors included time post onset, age, sex, handedness, education, stroke type, damage to frontal, fronto-parietal, and temporal ROIs, and total lesion volume. The model explained 74.4% of the variance in aphasia outcome, with lesion factors accounting for much of the variance, as described previously [3]. We found that social engagement had a highly significant effect on aphasia outcome (β=0.73±0.20 QAB points per social scale point, 95% CI=[0.34, 1.12], t=3.71, p=.0004), with a medium effect size (f2=0.181, Δr2=4.6%). Social engagement also had a significant effect in an ancillary analysis of change in QAB overall score from the acute to the final observation (p=.0020). In contrast, individual motivation did not have an effect on aphasia outcome (β=–0.14±0.13, CI=[–0.39, 0.12], t=–1.07, p=.29). Our findings provide strong support for the importance of social engagement after stroke, suggesting that an enriched social environment with frequent opportunities to communicate with multiple consistent communication partners facilitates recovery from aphasia. This implies that support for social reintegration should be prioritized in the clinical management of individuals with aphasia. Future work will focus on psychometric validation of our rating approach, detailed temporal analyses of the bidirectional relationships between aphasia and social engagement, and investigation of other environmental and individual factors that may influence aphasia outcomes. [1] Le Dorze et al. Aphasiology 2014;28:421-439. [2] Woodman et al. Disabil Rehabil 2014;36:2031-43. [3] Wilson et al. Brain 2023;146:1021-39. [4] Wilson et al. PLoS One 2018;13:e0192773.
Topic Areas: Disorders: Acquired,