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Research Objectives To identify individual- and dyadic-level factors associated with caregiver burden in couples experiencing post-stroke swallowing difficulties (dysphagia). As burden negatively impacts survivor and caregiver well-being, it is important to understand the variables that contribute to post-stroke caregiver burden. Design Cross-sectional online survey. Setting General community. Participants A volunteer sample of 28 adult stroke survivors with dysphagia (mean age 60 years) and their spouses (mean age 57 years). Survivors were >3 months post-stroke (median 12.5 months) and living with their spouse who was providing some degree of caregiving. Interventions Not applicable. Main Outcome Measures Dependent variable: dysphagia-related caregiver burden. Independent variables: swallowing-specific quality of life; stroke impact (Stroke Impact Scale; SIS); dietary restrictiveness (based on consumption of texture modified food and drink); survivor, spouse, and dyadic congruence of appraisal of dysphagia's impact on the social aspect and logistics of mealtimes (e.g., socializing during meals; meal preparation). Results Increased burden was significantly associated with greater survivor- and spouse-perceived impact of dysphagia on the logistics of mealtimes (r=.547, p=.002 and r=.758, p Conclusions Factors related to dysphagia-related caregiver burden are multifactorial and include both survivor (dietary restrictiveness, swallowing-specific quality of life, perceived impact of dysphagia on mealtime logistics) and spousal (perceived impact of dysphagia on mealtime logistics) variables. These results support the interrelatedness of stroke survivor and caregiver health and well-being. There is a need for speech-language pathologists and other rehabilitation professionals to focus on the lived experience of both patients and their families in developing treatment plans. Further, incorporating increased dietary education and counseling into dysphagia management may facilitate reduced burden for stroke survivors and their families. Author(s) Disclosures Nothing to disclose.

Objective To evaluate language deficits after acute stroke and their association with post–acute care at a setting other than home. We hypothesized that deficits in language comprehension would be associated with discharge to a setting other than home after adjustment for physical/occupational therapy (PT/OT) needs. Design Secondary analysis of prospectively collected data. Discharge location, demographic characteristics (age, sex, race), and the presence of PT/OT recommendations were abstracted from the medical record. Setting Acute stroke unit at a tertiary medical center. Participants Left hemispheric stroke patients (N=152) within 24 hours of event. Interventions The following tasks were administered: (a–b) oral and written naming of pictured objects, (c) oral naming with tactile input (tactile naming), (d–f) oral reading, oral spelling, and repetition of words and pseudowords, (g) written spelling to dictation, (h) spoken word-picture verification (ie, auditory comprehension), and (i) written word-picture verification (ie, written word comprehension). Main Outcome Measure Discharge to a setting other than home. Results Of 152 cases, 88 were discharged home and 64 to another setting. Among stroke subjects discharged to a setting other than home, 63.6% had auditory comprehension deficits compared with 42.9% of those discharged home ( P =.03). Deficits in auditory and reading comprehension and oral spelling to dictation were significantly associated with increased odds of discharge to a setting other than home after adjustment for age and PT/OT recommendations. Conclusions Cases with deficits in auditory comprehension, reading comprehension, and oral spelling to dictation had increased odds of being discharged to settings other than home. Early evaluation of these language deficits and prompt treatment may allow patients who would otherwise be discharged to an institution to go home. Further research is needed to design and evaluate individualized treatment protocols and their effect on discharge recommendations.

Gonzalez-Fernandez M, Davis C, Molitoris JJ, Newhart M, Leigh R, Hillis AE. Formal education, socioeconomic status, and the severity of aphasia after stroke. Objective To determine the role of education and socioeconomic status on the severity of aphasia after stroke. Design Cross-sectional study. Setting Stroke units of 2 affiliated medical centers. Participants Stroke patients (n=173) within 24 hours of symptom development and hospitalized controls (n=62) matched for age, education, and socioeconomic status (SES) with normative brain magnetic resonance imaging. Interventions Not applicable. Main Outcome Measures Percent error on 9 language tasks (auditory and written comprehension, naming [oral, written, and tactile], oral reading, oral spelling, written spelling, and repetition). Education was recorded in years and dichotomized as less than 12 years or 12 years and above for data analysis. Demographic characteristics (age, sex, race) and stroke volume were recorded for adjustment. SES was obtained from census tract data as 2 variables: mean neighborhood household income and family income. Results The percentage of errors for participants with 12 or more years of education was significantly lower for auditory and written comprehension, written naming, oral reading, oral spelling, and written spelling of fifth grade vocabulary words, even after adjusting for age, sex, stroke volume, and SES. Conclusions These findings suggest that even once learned, access to written word forms may become less vulnerable to disruption by stroke with increasing years of education.