Big CACTUS- A study to assess the clinical and cost effectiveness of aphasia computer treatment versus usual stimulation or attention control long term post stroke

This pragmatic randomised controlled trial was funded by NIHR and supported by the Tavistock Trust for Aphasia. Aphasia is a communication disorder often caused by stroke. It affects the ability to understand, talk, read and write. People with aphasia rarely receive treatment from NHS speech and language therapists for more than 3 months. The Big CACTUS study compared outcomes for people with persistent aphasia using computerised speech and language therapy at home (supported by a volunteer speech therapist) with those having usual care (standard speech and language therapy provision or general daily communication activity), or attention control (daily completion of puzzle book activities).

278 participants with aphasia and 177 carers across UK took part (Norfolk Community Health and Care NHS Trust was one of the 21 recruiting sites). The study found that people with aphasia improved their word finding ability with the addition of a low cost computer therapy and these improvements lasted at least 6 months after the therapy. The full report is available on NIHR Journals Library here and a paper published in the Lancet Neurology. A lay summary leaflet (on the left), a published Booklet and a Video which can be viewed on the Big CACTUS webpage are summarising the findings.


Colours and Symbols (CAS) A new low-tech supported communication tool for people with aphasia

Colours and Symbols (CAS) was developed by the researcher in 2014 and has been used with people with communication difficulties at NHS West Suffolk Foundation Trust since 2016. This pilot study aimed to gauge opinion of people with aphasia by trialling conventional supported communication over six 30 minute sessions, which is routinely used as therapy, then comparing it to supported communication using CAS over six 30 minute sessions, by completing an aphasia friendly questionnaire. The clinicians were also asked their opinion of the tool using a questionnaire. The Norfolk Community Health and Care Trust Speech and Language Therapist Team was one of six to participate in the trial.

Results indicate that CAS gives greater control of conversation to people with aphasia and they initiate conversation more; there is increased diversity of topics using CAS and greater complexity and depth of conversations can occur when people with aphasia are using CAS.

Functional Strength Training and Movement Performance Therapy for Upper Limb Recovery Early Poststroke—Efficacy, Neural Correlates, Predictive Markers, and Cost-Effectiveness: FAST-INdiCATE Trial.

This multicentre study, coordinated by UEA researchers, investigated whether functional strength training (FST) improves upper limb recovery early post stroke more than movement performance therapy (MPT), and explored neural correlates of clinical improvement in response to both therapies. There was no significant difference in upper limb improvement between FST and MPT and the study found no clinically important association between clinical improvement and change in the neural measures in response to either trial interventions. A substantial variation around the mean change from baseline for both interventions suggests inter-individual differences among stroke survivors in recovery and how they may respond to different physical therapies. Paper is published in Frontiers in Neurology.

Supported Communication to Improve Participation in Rehabilitation (SCIP-R)

SCIP-R, led by Dr Simon Horton at University of East Anglia, in collaboration with Norfolk Community Health & Care NHS Trust, Addenbrookes Hospital and Norfolk Conversation Partners, and sponsored by South Norfolk CCG, aimed to assess the feasibility and acceptability of training stroke service staff to provide supported communication for people with moderate-severe aphasia in an in-patient rehabilitation setting and to collect data for economic evaluation.

The study demonstrated the feasibility of staff recruitment to the intervention and of delivering the supported communication (SC) training to a multidisciplinary stroke team. It also designed simple methods for ongoing staff support such as reflective learning logs, nudges in a pocket guide form or pens as a reminder to use SC. The study provided the opportunity of tailoring an intervention to service users with moderate severe-aphasia.

The researchers have produced a YouTube video which can be viewed on the study website (click on picture), to disseminate the outcomes. The results are published in BMJ Open.