Background: Stroke frequently causes deficits that may impact a person’s ability to drive. Little has been reported about the frequency with which patients return to driving following a stroke or the use of driver evaluation services to determine a patient’s capacity to drive safely. Objective: To examine the frequency of return to driving post-stroke, self-imposed limitations in driving, and the utilization of evaluative services in the decision to return to driving. Methods: : The STEP-South Carolina Project surveyed 162 stroke survivors one year after their event, assessing clinical and functional outcomes and patient perceptions of the magnitude of the impact of stroke on their quality of life (“no effect”, “some effect”, or “great effect”). Multivariate analyses (adjusted for NIHSS) were performed to determine the relationship between driving status, the use of evaluative services, self-imposed limitations to driving and the patient’s perceived effect of stroke of the ability to perform valued life activities. Results: Multivariate analyses showed that 51.2% (83/162) of survey respondents returned to driving following their stroke, with 59% of these (49/83) returning within one month. Only 5.6% of all respondents (9/162) received any formal driving evaluation, though 11% (9/83) of those who had returned to driving had reported their stroke had a great effect on their ability to performed valued life activities. Among those who reported “no effect” on their ability to perform valued life activities and returned to driving, 45.8% (38/83) limited their driving, though it is unclear whether formal evaluation would have supported such a decision. Conclusion: The resumption of driving following stroke is usually a decision made without formal evaluation. Stroke survivors, including those who self-impose restrictions on their driving, may benefit from formal evaluation before returning to the driver’s seat.
Introduction Traditionally, the study of aphasia focused on brain trauma, clinical biomarkers, and cognitive processes, rarely considering the social determinants of health. This study evaluates the relationship between aphasia impairment and demographic, socioeconomic, and contextual determinants among people with aphasia (PWA). Methods PWA indexed within AphasiaBank—a database populated by multiple clinical aphasiology centers with standardized protocols characterizing language, neuropsychological functioning, and demographic information—were matched with respondents in the Medical Expenditure Panel Survey based on response year, age, sex, race, ethnicity, time post stroke, and mental health status. Generalized log-linear regression models with bootstrapped standard errors evaluated the association between scores on the Western Aphasia Battery-Revised Aphasia Quotient (WAB-R AQ) and demographic, economic, and contextual characteristics accounting for clustering of respondents and the stratification of data collection. Region, age, and income specific models tested the sensitivity of results. Results PWA over age 60 had 2.4% (SE = 0.020) lower WAB-R AQ scores compared with younger PWA. Compared to White PWA, Black and Hispanic PWA had 4.7% (SE = 0.03) and 0.81% (SE = 0.06) lower WAB-R AQ scores, respectively, as did those and living in the Southern US (-2.2%, SE = 0.03) even after controlling for age, family size, and aphasia type. Those living in larger families (β = 0.005, SE = 0.008), with income over $30,000 (β = 0.017, SE = 0.022), and a college degree (β = 0.030, SE = 0.035) had higher WAB-R AQ relative to their counterparts. Region-specific models showed that racial differences were only significant in the South and Midwest, while ethnic differences are only significant in the West. Sex differences only appeared in age-specific models. Racial and ethnic differences were not significant in the high-income group regression. Conclusion These findings support evidence that circumstances in which individuals live, work, and age are significantly associated with their health outcomes including aphasia impairment.
Abstract Purpose For individuals with cancer, palliative care improves quality of life, mood, and survival. Rural residents experience limited access to palliative care. In eastern North Carolina, a rural area, little is known about access to inpatient cancer‐related palliative care. This study describes access to inpatient palliative care and developed a predictive model of who was most likely to be admitted to an inpatient facility without a palliative care provider. Methods A descriptive, exploratory design was used to examine demographics, clinical variables, and inpatient admissions from 2017 and 2018, in a major regional teaching hospital system that included 8 hospitals (7 rural hospitals). Descriptive statistics and a binary logistic regression were used to analyze data. Findings The mean age was 62.2 years (N = 2,161, range: 18‐88, SD = 15.52): 49.4% were female, 54% lived in a rural county, and 44.4% were black. The outlying rural hospitals, with no palliative care providers on staff, had 388 admissions (18%). Only gender ( P = .0128), county ( P < .0001), and age ( P < .05) contributed to the logistic model. The predicted probability of being admitted to an inpatient facility with a palliative care provider is higher for younger males living in urban counties. That probability decreases with age regardless of the gender or type of county. Conclusions These findings highlight the limited availability of inpatient palliative care for those with cancer. Women, older adults, and rural residents are more likely to be admitted to 1 of the 7 rural hospitals with no palliative care provider on staff.
Stress is a common issue among students enrolled in graduate programs. Evidence suggests the specific factors driving and associated with stress may be unique to the characteristics of individual programs. The purpose of this study was to examine perceived stress among first- and second-year graduate students in a speech-language pathology (SLP) master's program.Fifty-one SLP students completed the Perceived Stress Scale (PSS) and three open-ended qualitative questions to elicit information about their stress. Non-parametric analyses were utilized to compare mean total PSS scores and four select PSS questions. General themes were identified for the open-ended questions.Second-year students experienced significantly higher stress (18.5/40.0) than first-year students (15.3/40.0) (U=217.5, p=0.048). Forty-eight percent of second-year students and 25% of first-year students reported moderate stress (PSS scores ≥20). Second-year students were more likely to report issues coping (p=0.013) and feeling overcome with difficulties (p=0.016) than first-year students.Graduate students enrolled in SLP programs experience high levels of stress throughout their clinical training programs. Although there are some overlapping facilitators, the pro¬gram design and increasing responsibilities appear to influence stress in unique ways. Adjusting to the demands of academic/clinical responsibilities are key facilitators of stress.
Introduction Roughly 30% of stroke survivors suffer from aphasia—a communication disorder that affects the ability to communicate effectively—but little is known about their healthcare expenditure or how it varies between aphasia subtypes. This study evaluates the relative differential in healthcare expenditure of anomic, Broca’s, Wernicke’s and Conduction aphasia and assesses expenditure between demographic cohortsMethods Individual level data from the 2010 Moss Aphasia Psycholinguistic Project Database was matched with the 2010 Medical Expenditure Panel Survey using a propensity score algorithm based on functional, health, and demographic characteristics. Multilevel, generalized, nonlinear regression models were applied to the resulting data set to assess the correlation between annual healthcare expenditure, time post onset (tpo), sex, race, family size, marital status, income, education, aphasia type, and region of residence. Results were used to predict expenditure by aphasia subtype, race, and sex. Multiple distributional specifications tested the sensitivity and ensured the robustness of estimates.Results Regression results indicate that individuals with Broca’s aphasia had statistically higher healthcare expenditures paying an average of $10,896.45 annually when compared to anomic ($7,927.60), Wernicke’s ($7,096.22), and Conduction ($9,447.19) aphasias. Additionally, healthcare expenditure increased with each year of age (β=0.004, SE=0.005), but decreased with each year after stroke (β=-0.002, SE=0.001). Females (β=0.358, SE=0.131) and Blacks (β=0.103, SE=0.200) paid significantly more annually compared to males and Whites, respectively. Neither region of residence, income, nor level of education were significantly correlated with healthcare expenditure.Conclusion This study showed that, while individuals with Broca’s aphasia had higher average healthcare expenditure than other subtypes, the differential was not statistically significant. Sex and race cohorts did, however, show statistically significant differences in healthcare expenditures. While causality is outside the scope of this analysis, additional work is needed to determine the best strategy to mitigate these disparities.
Background: Models of basal ganglia (BG) function suggest that expressive language deficits will likely and consistently present in BG disease.Disparities currently exist between the predictions of models of BG function in expressive language and data from studies of BG disease.Traditional expressive language assessment methodologies that emphasize measures of language form (word and sentence productivity) while not carefully considering how language is used, may only partially account for these disparities.Objective: To use measures of cohesion to examine the use of cohesive markers in narrative discourse.Methods: Twelve individuals with idiopathic Parkinson's disease (PD) were compared to 12 matched neurologically intact controls on measures of discourse performance.Three discourse samples (typical day, memorable vacation and family) were analyzed for measures of narrative productivity, number of cohesive ties and cohesive adequacy.Mixed model analyses were completed for group comparisons.Results: Group differences were not observed on measures of language form as measured by narrative productivity, communication units, and number of cohesive ties produced.In contrast, group differences were observed in cohesive adequacy as individuals with PD produced a higher percentage of incomplete and erroneous cohesive ties relative the control subjects across narratives.Conclusions: These results support the conclusion that the BG in PD may have an executive role in expressive language use that can be disrupted without impacting language form.
