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Background: Primary Progressive Aphasia describes a languageled dementia and its variants. There is little research exploring the experiences of living with this disease. Metaphor, words that represent something else, have been studied extensively in healthrelated narratives to gain a more intimate insight into health experiences. Aims: This study explored the metaphors used spontaneously by people with PPA, their care partners (family), and speech and language therapists/pathologists (SLT/Ps) providing support along the continuum of care. Methods & Procedures: This study examined two previously collected data sets comprising naturalistic talk where metaphors were not the specific focus, the first from focus groups conducted with people with PPA and their families and the second from focus groups conducted with SLT/Ps working with people with PPA. Transcribed data were analysed for metaphor use through an iterative narrative approach. Outcomes & Results: In all, 237 examples of metaphorical language were identified in the data, with 14 metaphors from people with PPA, 116 from the families and 106 from SLT/Ps. Different metaphors were used by participants to describe their experiences depending on which variant of PPA they were living with, and people also described their disease differently over time. SLT/Ps also used metaphors, however, their language reflected the structured, professional perspective of delivering speech and language therapy services. Conclusions & Implications: SLT/Ps should listen for and recognise the metaphorical language used by people with PPA and their families to ensure therapeutic alignment, see beyond the PPA to recognise the individual’s needs, and provide person-centred and empathic support. [ABSTRACT FROM AUTHOR]

Background: Very early aphasia rehabilitation studies have shown mixed results. Differences in therapy intensity and therapy type contribute significantly to the equivocal results. Aims: To compare a standardized, prescribed very early aphasia therapy regimen with a historical usual care control group at therapy completion (4-5 weeks post-stroke) and again at follow-up (6 months). Methods & Procedures: This study compared two cohorts from successive studies conducted in four Australian acute/sub-acute hospitals. The studies had near identical recruitment, blinded assessment and data-collection protocols. The Very Early Rehabilitation (VER) cohort (N = 20) had mild-severe aphasia and received up to 20 1-h sessions of impairment-based aphasia therapy, up to 5 weeks. The control cohort (n = 27) also had mild-severe aphasia and received usual care (UC) therapy for up to 4 weeks post-stroke. The primary outcome measure was the Aphasia Quotient (AQ) and a measure of communicative efficiency (DA) at therapy completion. Outcomes were measured at baseline, therapy completion and 6 months post-stroke and were compared using Generalised Estimating Equations (GEE) models. Outcomes & Results: After controlling for initial aphasia and stroke disability, the GEE models demonstrated that at the primary end-point participants receiving VER achieved 18% greater recovery on the AQ and 1.5% higher DA scores than those in the control cohort. At 6 months, the VER participants maintained a 16% advantage in recovery on the AQ and 0.6% more on DA scores over the control cohort participants. Conclusions & Implications: A prescribed, impairment-based aphasia therapy regimen, provided daily in very early post-stroke recovery, resulted in significantly greater communication gains in people with mild-severe aphasia at completion of therapy and at 6 months, when compared with a historical control cohort. Further research is required to demonstrate large-scale and long-term efficacy.

The article emphasizes the importance of understanding the factors influencing the quality of life for residents living with dementia and the need for innovative approaches. It highlights the Montessori method as a possible solution, demonstrating the positive outcomes it can achieve. It also provides a blueprint for implementing the Montessori model of care, emphasizing the need for a clear vision, specific goals, training, prepared environments.

Objective: Research involving people with dementia is vital to appropriately inform policy and practice decisions affecting this population. As dementia‐care researchers, we frequently advocate to Human Research Ethics Committees for the right of people with dementia to choose whether to participate in research. This brief report provides some considerations for researchers and ethics committees. Method: Descriptive summary of principles that argue for inclusion of people with dementia in research studies. Results: Specifically excluding people living with dementia from research because of perceived cognitive impairment is inappropriate in light of human rights principles and the right to contribute to evidence‐based care. Conclusions: There is a difference between capacity to provide informed consent and ability to provide perspectives that are valid for each individual. Providing the opportunity for a person with dementia to participate in research and offering support to do this is a matter of human rights. [ABSTRACT FROM AUTHOR]

Background: Despite a growing literature characterising connected speech and discourse impairments associated with primary progressive aphasia (PPA), intervention in PPA has focused predominantly on lexical retrieval and picture-naming treatments, with limited generalisation of therapy gains reported. Recent developments in the post-stroke aphasia literature with discourse-level approaches have provided highly promising findings for the generalisation of language gains to everyday communication, and an opportunity to investigate whether the same benefits may be found in the PPA population. Aims: This study evaluated the effectiveness of a discourse intervention in two individuals with PPA to determine whether significant improvements were seen in word retrieval and discourse organisation in everyday discourse. Methods & Procedures: KW, a 54-year-old man, who presented with semantic variant PPA, and AS, a 59-year-old woman, presenting with logopenic variant PPA, completed the NARNIA intervention programme (Whitworth, Leitão et al., 2015) in 20 sessions over a 10-week period. Discourse performance was sampled prior to intervention across 10 tasks involving four different genres, at one time point, and compared to performance immediately and four weeks post intervention. The multilevel intervention protocol aimed to increase awareness of word retrieval, sentence structure, and macrostructure of a range of discourse genre. Outcomes & Results: Both participants made significant gains in discourse production immediately after intervention and when reassessed four weeks later, in the absence of change on naming tasks and in the context of stable overall cognitive performance. Significant gains were seen in the amount of overall output, noun and verb usage, and the number of body elements in macrostructure in everyday discourse in topics that were not trained in treatment. Further to the findings of the original NARNIA study in post-stroke aphasia, significant gains were also seen in narrative discourse across lexical categories for both participants. Informativeness and efficiency of communication also improved significantly for KW across all genres. Both participants reported significant gains in measures of social communication and participation. Conclusions: The study suggests that improvements in everyday discourse may be possible when the discourse level is directly targeted, that lexical access can improve in the absence of targeting lexical items, and that discourse-level interventions have the potential to impact real-life communication in individuals with PPA. As the first known study to trial a multilevel intervention in the context of PPA, the findings may be of clinical and theoretical significance, and warrant further investigation. [ABSTRACT FROM AUTHOR]

Background: Communication outcomes following stroke are improved when treatments for aphasia are administered early, within the first 3 months after stroke, and provided for more than 2 hours per week. However, uncertainty remains about the optimal type of aphasia therapy. Aims: We compared constraint-induced aphasia therapy (CIAT) with individual, impairment-based intervention, both administered early and daily after acute stroke. Methods&Procedures: This prospective, single-blinded, randomised, controlled trial recruited participants with mild to severe aphasia within 10 days of an acute stroke from acute/subacute Perth metropolitan hospitals (n = 20). Participants were allocated by computer-generated block randomisation method to either the CIAT (n = 12) or individual, impairment-based intervention group (n = 8) delivered at the same intensity (45–60 min, 5 days a week) for 20 sessions over 5 weeks (15–20 hours total). The primary outcome, measured after completing the intervention, was the Aphasia Quotient (AQ) from the Western Aphasia Battery. Secondary outcomes were the AQ at 12 and 26 weeks post stroke, a Discourse Analysis (DA) score and the Stroke and Aphasia Quality of Life Scale (SAQoL), measured at therapy completion, 12 and 26 weeks post stroke. There was a 10% (n = 2) dropout at the primary end point, both participants were in the CIAT group. The estimates for each treatment group were compared using repeated measures ANOVAs. Data from the 26-week follow-up assessment are presented, however, were not included in the between-group comparisons due to the low number of data points in each group. Outcomes & Results: Within groups analyses comparing performance at baseline, therapy completion, and 12 weeks post stroke revealed a statistically significant treatment effect for the AQ (p < .001), DA (p = .002), and SAQoL (p < .001). Between groups analysis found there was no significant difference between the CIAT and individual therapy groups on any outcome measure. Conclusions: CIAT and individual therapy produced comparable amounts of change in the very early phase of recovery suggesting a standard, intensive daily dose of therapy within this period of recovery is feasible and beneficial. There were no significant differences between the two groups demonstrating that CIAT, which is provided in a group format, may be a viable option in the very early phase of aphasia recovery. The study highlights the need for further research into the impact of therapy type in very early aphasia therapy. [ABSTRACT FROM PUBLISHER]