Understanding Stroke Recovery in People with Aphasia

Understanding the factors that contribute to successful community reintegration of people with aphasia is the goal of the Stroke and Aphasia Recovery Laboratory. Lisa Tabor Connor, PhD, who heads the lab, is currently involved in several research projects to better understand barriers and facilitators to participation in people with aphasia, which is the loss of the ability to communicate after stroke. Connor and her colleagues in occupational therapy and neurology have been studying the risk factors for non-optimal participation after stroke for the past three years.

“In the participation study, we are examining how much people with aphasia resume their valued occupations in the community six months or more after stroke and what factors determine who will fully participate and who will not,” Connor says. “We are measuring factors such as stroke severity, social support, cognition, physical function, and communication.

By measuring these factors, our goal is to create a model to guide us to the most important risk factors so we can target them in future studies to optimize rehabilitation, and ultimately to enable people to participate fully in meaningful activities.”

Connor is also studying cognitive load – how much effort people are experiencing when they do tasks – through the use of an EEG-based system in people with aphasia who have difficulty with auditory comprehension. Study participants listen to complex and simple auditory passages and then must answer comprehension questions while wearing the EEG device.

“In the beginning phases of this study, we gave complex material to people with and without aphasia to see if we could use their brain signals to determine if they were in a high or low load state. The answer was yes, we could,” Connor says.

The next phase is to apply this information in rehabilitation. “Once we have determined their load under experimental conditions, we will then be able to use that information going forward to pinpoint which state they are in during rehabilitation tasks. If they are in a high load state, therapy intensity can then be adjusted to a lower level and increased more gradually.”

Connor’s newest project is in collaboration with Alexandre Carter, MD, PhD, assistant professor of neurology and occupational therapy at Washington University School of Medicine, and Jack Engsberg, PhD, professor in the Program in Occupational Therapy, utilizing virtual technology to examine spatial neglect after a right hemisphere stroke.

“Patients can see on the left side of space, but neglect the information there,” Connor says. “Traditionally, prism glasses have been used to expand the visual field through a procedure that has patients practice pointing at dots in front of them while wearing them. We know it works, but it can be very repetitive and dull. We want to take this concept into the virtual world.”

Through a feasibility grant with Carter as principal investigator, Connor is involved in a one year trial using the Kinect gaming system and a “virtual” hand. Participants are not able to see their actual arm; just an extension of their virtual hand on the screen that can be deviated into or away from the neglected space.

“The virtual hand translates the prism theory. We are establishing that when we deviate the virtual hand by ten degrees, we are getting the same effect we get with the glasses. In this first year, we are working on the programing and technological aspects of the project. Initial testing of the system has been promising,” Connor says. “Next steps are to take this into a gaming environment where the client will play a game using the deviated virtual hand for rehabilitation purposes.”

While research still is the primary focus of Connor’s work, improving the quality of everyday life in people with aphasia has become the driving force behind it.

“Since becoming part of the occupational therapy community, I think it is more important to look at things that really matter to people living with stroke and aphasia, like remembering to take medication, being able to drive again, and furthering their rehabilitation at home. The goal of all my research is to maximize participation in activities that matter to people with stroke and aphasia so they can live a full and meaningful life,” Connor says.