A Study of Effect of Aphasia Severity and Post Stroke Aphasia Syndromes on Quality of Life of Patients with Aphasia in Central India

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International Journal of Medical Science and Current Research (IJMSCR)

Available online at: www.ijmscr.com

Volume2, Issue 4,Page No: 429-434

July-August 2019

429

Medicine ID-101739732

IJMSCR

A Study of Effect of Aphasia Severity and Post Stroke Aphasia Syndromes on Quality of

Life of Patients with Aphasia in Central India

Dr. Archana Verma1, Dr. Umesh Kumar Chandra2*, Dr. Lalan Pratap Singh3, Dr. Rajendra Uikey4 1

DNB Neurology, MD Medicine, Associate Professor, 2,4MD Medicine, Senior Resident,

3

MD Medicine, Former Resident,

Department of Medicine, MGM Medical College, Indore, MP, India.

*Corresponding Author:

Dr. Umesh Kumar Chandra

MD, Senior Resident, Department of Medicine, MGM Medical College, Indore, MP, India

Type of Publication: Original Research Paper Conflicts of Interest: Nil

ABSTRACT

Introduction

Quality of life is defined as individual’s perceptions of their position in life in the context of culture and of value systems where they live and in relation to their goals, expectations, standards, and concerns. The quality of life of patients with post stroke aphasia is a developing concept that is highly significant for research made in the field of their rehabilitation. Assessment of quality of life is a very complex and sensitive process. Quality of life is, by its nature, dynamic and versatile and it depends on several factors.

Materials and Methods

This study was conducted in 33 consecutive patients after taking valid written consent, who attended OPD of Department of Medicine, MGM Medical College and MY Hospital, Indore, during one year period. Continuous variables were analysed with correlation coefficient(r) value and discontinuous variables were analysed by using Kruskal Wallace Test.

Results

Communication domain of quality of life had statistically significantly correlated with aphasia type (p-0.002, Chi Square 18.632). Total quality of life had not statistically significantly correlated with type of aphasia (p-0.091, Chi Square 9.503). Average quality of life of non-fluent group and fluent group was 133.75 and 148.63 respectively. Physical and communication domain of quality of life had statistically significantly (p-0.007 and p-0.000) correlated with severity of aphasia.

Conclusions

Quality of life after the post stroke aphasia had reduced in the physical, communicative, psychosocial and energy domain. Type of aphasia influenced the communicative domain but not physical, psychosocial and energy domain. Degree of severity of stroke influenced the quality of life in all domains.

Keywords: Aphasia, Communication domain, Quality of Life

INTRODUCTION

Quality of life (QOL) is defined as individual’s perceptions of their position in life in the context of culture and of value systems where they live and in relation to their goals, expectations, standards and concerns [1]. The quality of life of patients with post stroke aphasia is a developing concept that is highly significant for research made in the field of their rehabilitation. Assessment of quality of life is a very complex and sensitive process. QOL is, by its nature,

dynamic and versatile and it depends on several factors.

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other disabilities and the quality of life can clearly be seen in assessments of the quality of life; assessments of QOL can be used for assessing success and clinicians are increasingly requested to show the positive effects of their interventions on everyday life of people with aphasia[2].

Quality of life assessment goes beyond language impairments and is an integral part of planning intervention for clients based on their personal experiences. However, current QOL measures are limited for use with people with aphasia (PWA). The Strokes and Aphasia Quality of Life Scale-39[3] is one of the few valid and reliable measures used to assess QOL in people with mild to moderate aphasia. However, the validity and reliability of the SAQOL-39 has not been established for individuals with severe aphasia who are unable to read and comprehend the written item [3, 4] often, proxy reports for people with severe aphasia are not reliable and can contribute to misunderstanding of people with severe aphasia and their QOL[4].

MATERIALS AND METHODS

This study was conducted in 33 consecutive patients of aphasia that was caused by a stroke, at least one year after onset and after taking valid written consent, who were attending OPD of Department of Medicine, MGM Medical College and MY Hospital, Indore, during one year period.

Study design

Hospital based group study to examine correlation between quality of life of person with post stroke aphasia and various demographic and clinical parameters.

Following assessment were done

a. General medical history

b. General and systemic examination

c. NIH Stroke Scale

d. HASIT(Hindi Aphasia Screening Indore Test)

for presence and absence of aphasia

e. Boston Diagnostic Aphasia Examination for Aphasia Syndrome

f. Aphasia profile, Aphasia Severity

g. Quality of life questionnaire by patient and care giver

h. Aphasia awareness questionnaire by patient and care giver both.

Inclusion criteria

a. A person with stroke of the at least one month duration as determined by NIHSS and neuroimaging,

b. A person with post stroke aphasia as

determined by HASIT, Hindi version of French aphasia screening test,

c. Male and female sex both, between 18-80 years old were included,

d. Consent given by both patient and care taker were included,

e. Patient and care giver both are capable of responding to various testing method,

f. Literate patients,

g. A person has Hindi as primary language.

Exclusion criteria

a. Patient with severe illness and disabled, so as to become incapable to participate in study, b. Patient with severe dementia,

c. Patient with severe vision loss, d. Patient with severe hearing loss, e. Psychotic like illness,

f. Prisoners.

Statistics

a. The correlation between continuous variables were analysed with correlation coefficient(r) value.

b. Kruskal Wallace Test was used to assess

significance of association between

discontinuous variable.

RESULTS

As shown in table 1, Patients with post stroke aphasia generally reduced mean of all domains of quality of life. The average value of Physical domain is 64.30 points out of the maximum 85, Psychosocial domain is 35.48 points out of maximum 45, Communication domain is 22.54 points out of maximum 34, Energy domain was 16.12 points out of maximum 20.

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As shown in table 3, there was statistically significant correlation between severity of stroke and physical domain of QOL in BARTHEL score (p value 0.000), NIHSS (p value 0.000), MRS (p value 0.000) and HASIT (p value 0.000). Psychosocial domain of QOL statistically significantly correlated with severity of stroke in BARTHEL score (p value 0.000). There was statistically significant correlation between severity of stroke and communication domain of QOL in BARTHEL score (p value 0.001), NIHSS (p value 0.000), MRS (p value 0.000) and HASIT (p value 0.000). There was statistically insignificant correlation between severity of stroke and energy domain of QOL in BARTHEL score, NIHSS, MRS, and HASIT.

As shown in table 4, there was statistically significant correlation of physical domain (p value 0.007) and communication domain (p value 0.000) with severity of aphasia.

As shown in table 5, severity of grade 1, 2, 3, 4, and 5 was present in 9(27%), 1(3%), 12(37%), 1(3%) and 10(30%) patients respectively.

DISCUSSION

We have included 33 consecutive patients with aphasia (31 male and 2 female) having mean age 49.69 years. Most of the patients were the males with gross under representation of female could not be avoided due to social reasons. Our patients were younger as compared to patients in studies from Western countries (69years-79years). Mean time from stroke period was 2.16 years, comparable with other Western studies. Most of the patients were married, received speech therapy, and belonged to middle class. The average BARTHEL score, MR score, and NIHS score were 85.69, 2.24, and 4.18 respectively. The most common aphasia syndrome were Anomic (9/33, 27.7%), Broca’s (8/33, 24.4%), Global (8/33, 24.4%) and Mixed (6/33, 18.1%). The least common were transcortical (1/33, 3.03%) and Wernick’s (1/33, 3.03%).

We observed that patients with post stroke aphasia generally have reduced total quality, mean value was 138.4. The average value of physical domain was 64.3 points out of the maximum 85, psychosocial domain was 35.54 points out of the maximum 45, communication domain was 22.54 points of maximum 34, and energy domain was 16.12 points

out of the maximum 20. Our results are mostly comparable to other studies searched from literature.

Osman Sinanovic et al [5] found that the patient with aphasia had reduced quality of life at physical, psychosocial, communication and energy domains.

Ross and Wertz [6] compared the quality of life between 18 subjects with chronic aphasia and 18 subjects without brain damage (as a control group) in their research. The results showed that subjects with aphasia had significantly lower quality of life than subjects from the control group.

Engell et al [7] studied the correlation between quality of life and language performances. Total, physical, and psychosocial scores were significantly correlated with communicative and systemic failures in spontaneous language, but not with articulation disorders.

In our study, the severity of aphasia was significantly correlated with physical domain, communication domain but not psychosocial domain and energy domain. Impairment of language was evaluated by using HASIT and Boston Diagnostic Aphasia Examination (BDAE). HASIT score BDAE score were significantly correlated with physical domain and communication domain. The patients with mild post stroke aphasia had higher quality of life and patients with more severe post stroke aphasia had lower quality of life. In our study, the severity of aphasia was not significantly correlated with psychosocial and energy domain. It might be due to

limited means of communication. Emotional

problems can often be underestimated in patients with aphasia. The mild and chronic aphasia patients had a better QOL than severe and acute ones, underlining the fact that passing of time helps patients with language disorders to adopt themselves to the new condition. Our results are similar to the many study but with some differences.

Depression, social isolation, decrease in productive activity and change in family role are frequently reported in chronic aphasia patients after stroke. Social isolation is a serious issue for stroke patients [8]

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previous study showed that socialization outside the home was decreased to 50.4% after stroke and that 38% of the patients showed decreased in hobby activities and other interests [11].

Bahia et al [12] reported that the non-fluent aphasic group presents an average score lower than the value found for the fluent aphasic group, indicating lower QOL, there was no significant statistic difference between the groups. They also demonstrated that the domains most affected by stroke were language, social roles and thinking in non-fluent aphasic group and personality, social roles and thinking in the fluent aphasic group.

A limitation of this study was the small sample size and fact that subjects were recruited from a single hospital. Participants included in this study had been followed up via OPD. Patients with more severe aphasia might have been included. BARTHEL score, MRS, NIHS score, HASIT and SAQOL-39 questionnaire were used without re-evaluating other post stroke troubles related to cognitive function at the time of interview, is also a limitation of this study. We did not evaluated community integration, depression and anxiety levels.

CONCLUSIONS

Quality of life after the post stroke aphasia is reduced in the physical, communicative, psychosocial and energy domain. Type of aphasia, influenced the

communicative domain but not physical,

psychosocial and energy domain. Degree of severity of stroke influenced the quality of life in all domains.

REFERENCES

1. ANONYMOUS 1996, what is quality of life?

World Health Forum 17: 354-354.

2. WORRALL L, E, HOLLAND 2003 Editorial:

Quality of life in aphasia. Hilari, K. (2003).

The stroke and aphasia quality of life scale 39-item version. A physiology 17(4): 329-332 3. Hilari, K., Byng, S., Lamping, D.L., and Smith, S.C. (2003). Stroke and aphasia

quality of life scale-39(SAQOL-39):

Evaluation of acceptability, reliability, and validity. Stroke, 34, 1944-1950.

4. Hilari, K., & Byng, S. (2009). Health-related quality of life in people with severe aphasia,

International journal of language and

communication disorders, 44(2), 193-205. 5. Osman Sinanovic, Period boil, 2012, Vol.

114, No. 3.

6. Ross K. B., Wertz RT 2002, Relationship between language-based disability and quality of life in chronically aphasic adults. A physiology 16 (8): 791-800.

7. Engell B, Hunter B O, Willmes K, Huber W,

Quality of life: Validation of a pictorial self- rating procedure, A physiology 17(2003), (4): 383-396.

8. Hinckley JJ, Packard ME. Family education seminars and social functioning of adults with chronic aphasia. J Commun Disord 2001; 34:241-254.

9. Dalemans R, de Witte LP, Lemmens J, van den Heuvel WJ. Social participation through the eyes of people with aphasia: a systemic review. ClinRehabil 2008; 22:542-55.

10. Dalemans R, de Witte LP, Wade D, van den Heuvel W. Social participation through the eyes of people with aphasia. Int J Lang Commun Disord 2010; 45:537-50.

11. Labi ML, Phillips TF, Greshman GE. Psychosocial disability in physically restored long term stroke survivors. Arch Phys Med Rehabil 1980; 61:561-65.

12. Audiol Commun Res. 2014;19(4):352

Table 1: Descriptive statistics of various domains of Quality of Life

Domain N Mean Median SD Minimum Maximum

Physical 33 64.30 64 16.26 35 85

Psychological 33 35.48 35 5.28 26 45

Communication 33 22.54 22 4.43 16 34

Energy 33 16.12 16 1.20 13 20

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Table 2: Correlation between type of aphasia and various domains of quality of life

Domain Aphasia Type N Mean±SD P value

Physical Broca’s

Global

Anomic

Mixed Wernick’s

Transcortical

8

9

6

1

67.75±15.97

53.87±14.93

70.88±15.21

60.83±17.47

82.00

64.00

0.230

Total 33

Psychosocial Broca’s

Global

Anomic

Mixed Wernick’s

Transcortical

8

9

6

1

64.30±16.26

39.75±5.45

33.75±4.47

34.11±5.10

39

36

0.181

Total 33

Communication Broca’s

Global

Anomic

Mixed Wernick’s

Transcortical

8

9

6

1

22.12±4.05

18.00±1.60

26.77±3.52

21.83±2.92

27

24

0.002

Total 33

Energy Broca’s

Global

Anomic

Mixed Wernick’s

Transcortical

8

9

6

1

16.62±1.40

16.12±1.72

16.11±1.33

15.50±1.22

16

0.745

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Table 3: Correlation between severity of stroke and various domains of quality of life

Physical Domain

Psychosocial Domain

Communication

Domain

Energy Domain

BARTHEL Score

Spearman’s Coefficient

0.823 0.443 0.533 0.148

P value 0.000 0.010 0.001 0.411

N 33 33 33 33

NIHSS Spearman’s

Coefficient

-0.828 -0.335 -0.609 -0.155

P value 0.000 0.057 0.000 0.390

N 33 33 33 33

MRS Spearman’s

Coefficient

-0.593 -0.322 -0.619 -0.092

P value 0.000 0.068 0.000 0.612

N 33 33 33 33

HASIT Spearman’s

Coefficient

0.548 0.181 0.806 0.704

P value 0.000 0.313 0.000 0.682

N 33 33 33 33

Table 4: Correlation between domains of quality of life and severity of aphasia

Physical Domain

Psychosocial Domain

Communication Domain

Energy Domain

Spearman’s Cofficient

0.463 0.111 0.802 0.092

P value 0.007 0.537 0.000 0.610

N 33 33 33 33

Table 5: Distribution of patients according to severity of aphasia

Aphasia Severity Grade Number %

1 9 27

2 1 3

3 12 37

4 1 3

5 10 30