Frank Becker

• Behn, Nicholas; Harrison, Madeleine; Brady, Marian C; Breitenstein, Caterina; Carragher, Marcella; Fridriksson, Julius et al (2022). Developing, monitoring, and reporting of fidelity in aphasia trials: core recommendations from the collaboration of aphasia trialists (CATs) trials for aphasia panel. Aphasiology
• Brady, Marian C.; Ali, Myzoon; Vandenberg, Kathryn; Williams, Linda J.; Williams, Louise R., Abo, Masahiro et al (2022). Dosage, Intensity, and Frequency of Language Therapy for Aphasia: A Systematic Review–Based, Individual Participant Data Network Meta-Analysis. Stroke 53 (3), 956–967
• The RELEASE Collaboration (2021): Predictors of Poststroke Aphasia Recovery - A Systematic Review-Informed Individual Participant Data Meta-Analysis” Stroke 52 (5), 1778–1787
• Øra HP. Kirmess M, Brady MC, Partee IAC, Hognestad RB, Johannessen BCB, Thommessen B, Becker F (2020): “The effect of augmented speech-language therapy delivered by telerehabilitation on post stroke aphasia – a pilot randomized controlled trial” Clinical Rehabilitation (e-pub ahead of print: https://doi.org/10.1177/0269215519896616)
• Gjellesvik TI, Becker F, Tjønna AE, Indredavik B, Nilsen H, Brurok B, Tørhaug T, Busuladzic M, Lydersen S, Askim T (2020): “Effects of High-Intensity Interval Training after Stroke (The HIIT-Stroke study) - A Multicenter Randomized Controlled Trial” Archives of Physical Medicine and Rehabilitation, 101 (6), 939 – 947
• Brunner I, Skouen JS, Hofstad H, Assmus J, Becker F, Sanders AM, Pallesen H, Kristensen LQ, Michielsen M, Thijs L, Verheyden G (2017): “Virtual Reality Training for Upper Extremity in Subacute Stroke (VIRTUES)” Neurology, 12(89): 2413 – 2421
• Becker F, Reinvang I (2007): “Mismatch negativity elicited by tones and speech sounds: Changed topographical distribution in aphasia” Brain and Language, 100 , 69 – 78

• Vege, Kristine Marie Mamen; Månum, Grethe; Sunnerhagen, Katharina Stibrant & Becker, Frank (2026). MEDICAL COMPLICATIONS IN CHILDREN WITH CENTRAL NERVOUS SYSTEM INJURIES DURING INPATIENT REHABILITATION. Journal of Rehabilitation Medicine. ISSN 1650-1977. 58. doi: 10.2340/jrm.v58.44907. Full text in Research Archive Show summary

  Objective: To investigate the occurrence and consequences of medical complications during inpatient rehabilitation of children with central nervous system (CNS) injury. Design: A prospective observational study conducted at a tertiary rehabilitation centre. Subjects: Participants aged 2 to 17 years with acquired CNS injury requiring multidisciplinary inpatient rehabilitation. Methods: Data were collected from medical charts and questionnaires on admission and discharge, assessing predefined complications and associated impacts on the rehabilitation process. Results: Of the 64 participants, 59 experienced a total of 183 instances of medical complications, comprising 19 distinct complication types. Most common were sleep disturbances, pain, -constipation, anaemia, infections, spasticity, and malnutrition. No significant correlation was observed between the occurrence of complications and age, gender, or diagnosis group. In total, 74% of the complications were found to have no impact on the rehabilitation process; however, malnutrition, infections, and spasticity could notably lead to interrupted or prolonged stays, altered rehabilitation goals, and worsened functional prognoses. Conclusion: Medical complications frequently occur during inpatient rehabilitation. While many have no significant consequences, malnutrition, infections, and spasticity in particular warrant further attention clinically and in future research.

• Johansen, Truls Sveløkken; Matre, Martin Engen; Løvstad, Marianne; Olsen, Alexander; Lund, Anne & Martinsen, Anne Catrine Trægde [Show all 10 contributors for this article] (2026). Predictors of improved attentional control after Virtual Reality-based cognitive rehabilitation in chronic traumatic brain injury. Disability and Rehabilitation. ISSN 0963-8288. doi: 10.1080/09638288.2026.2663968. Full text in Research Archive
• Matre, Martin Engen; Johansen, Truls Sveløkken; Olsen, Alexander; Tornås, Sveinung; Martinsen, Anne Catrine & Lund, Anne [Show all 13 contributors for this article] (2026). Ecological validity of a Norwegian version of the Awareness of Social Inference Test. Applied neuropsychology: Adult. ISSN 2327-9095. doi: 10.1080/23279095.2026.2631123. Full text in Research Archive
• Kraby, Maria Ryssdal; Toropchyna, Mariia; Holtan, Anders & Becker, Frank (2025). Ukrainian war trauma patients abroad: the rehabilitation process in light of language barriers, cultural differences, war, and infection isolation. Journal of Rehabilitation Medicine. ISSN 1650-1977. 57, p. 42929–42929. doi: 10.2340/jrm.v57.42929. Full text in Research Archive Show summary

  Objective: To study the rehabilitation of Ukrainian war trauma patients abroad, focusing on 5 areas of particular interest: communication, cultural differences, infection isolation, psychosocial load, and the rehabilitation process. Design: Observational study. Subjects: (i) 14 Ukrainian patients who underwent rehabilitation at Sunnaas Rehabilitation Hospital, Norway; (ii) 15 members of multidisciplinary teams providing war trauma rehabilitation. Methods: Combined methods. Patients: medical file review, Client Satisfaction Questionnaire 8, custom questionnaire on the 5 focal areas. Hospital staff: focus-group interviews. Results: Patients preferred professional interpreters, while multilingual staff served an additional role in providing psychological support and cultural mediation. All patients experienced infection isolation, and health professionals worried about the added psychological strain this entailed. Patients reported high trust in the therapists and high satisfaction with rehabilitation. Although war and infection isolation were negative influences, patients reported overall good mood. Health professionals reported becoming more skilled at facilitating rehabilitation under these conditions. Conclusion: Despite challenges within the 5 areas assessed, providing rehabilitation to patients evacuated from a country at war is feasible and valuable for patients and health professionals. Both patients and health professionals showed willingness to adapt to foreign concepts, perhaps aided by multilingual health professionals acting as cultural mediators.

• Matre, Martin Engen; Johansen, Truls Sveløkken; Tornås, Sveinung; Martinsen, Anne Catrine Trægde; Olsen, Alexander & Lund, Anne [Show all 13 contributors for this article] (2025). Reliability and validity of a Norwegian version of the awareness of social inference test. Neuropsychological Rehabilitation. ISSN 0960-2011. doi: 10.1080/09602011.2025.2558872. Full text in Research Archive Show summary

  To establish reliability and construct validity of a Norwegian version of the social cognition test, the Awareness of Social Inference Test (N-TASIT). Participants with traumatic brain injury (TBI; n = 101) and 50 matched healthy controls performed either a virtual reality (VR) or 2D version of N-TASIT at baseline and 16 weeks later. Reliability measures were test-retest reliability and internal consistency. Intraclass correlation (ICC) and Cronbach’s alpha (α) were calculated for the overall sample and both groups separately. Construct validity was tested with known groups validity, convergent and discriminant validity. Known groups analysis was conducted for both versions separately and combined. Convergent and discriminant validity were determined by associations between N-TASIT and established measures of social cognition and with measures of cognition, emotional distress and fatigue. ICC for the total sample was 0.63 (95% CI 0.49–0.73), and α was 0.88, when presentation modes (VR and 2D) were combined. The healthy control group outperformed the TBI group in both presentation modes. Medium-to-large associations were found between N-TASIT performance and social cognitive measures, and mostly weak or no significant correlations with non-social domains. N-TASIT appears psychometrically sound and comparable to the original. The influence of presentation mode on performance remains unclear.

• Johansen, Truls Sveløkken; Matre, Martin Engen; Løvstad, Marianne; Olsen, Alexander; Lund, Anne & Martinsen, Anne Catrine Trægde [Show all 13 contributors for this article] (2025). Virtual Reality in Training of Sustained Attention, Processing Speed, and Working Memory After Traumatic Brain Injury: A Randomized Controlled Trial. Archives of Physical Medicine and Rehabilitation. ISSN 0003-9993. 107(1), p. 31–31. doi: 10.1016/j.apmr.2025.07.005. Full text in Research Archive
• Vege, Kristine Marie Mamen; Månum, Grethe; Sunnerhagen, Katharina Stibrant & Becker, Frank (2025). Paediatric Moderate to Severe Injury to the Central Nervous System: Patients' and Caregivers' Experiences of Medical Complications and Related Healthcare Needs. Child: Care, Health and Development. ISSN 0305-1862. 51(4). doi: 10.1111/cch.70137. Full text in Research Archive Show summary

  ABSTRACT Purpose Few studies describe medical complications after central nervous injury in children and adolescents as a whole, with a focus on their consequences for patients and their caregivers. This study explores the frequency and effects of medical complications on such children and youth, as well as their caregivers, after discharge from a tertiary rehabilitation centre. Materials and Methods This questionnaire‐based study included 151 patients aged 2–18 years admitted to a tertiary rehabilitation centre due to acquired injury to the central nervous system in the years 2016–2021. Results Seventy answers were retrieved between 11 and 85 months post‐injury. The majority of the patients (67%) had experienced medical complications following their central nervous system injury. The most frequent complications were sleep difficulties (39%), pain (26%), spasticity (26%), constipation (22%) and overweight (17%). There were no substantial differences related to gender, age, or diagnosis group. Frequency of complications and length of rehabilitation stay were associated with an increase of 4% for each additional day of admission. Those reporting medical complications more frequently used medication for the same complications during subacute rehabilitation. They also tended to have more serious injuries. Just above a quarter of those reporting medical complications needed hospital admission and/or surgery, while the majority could be treated at a lower healthcare level. The majority answered that the complications were time consuming and had consequences for the ability to perform everyday tasks and the capacity to participate in leisure activities. The complications' psychological impact was also highlighted. Conclusion Medical complications occur frequently in children/youth who have sustained an injury to the central nervous system that requires inpatient rehabilitation. They have consequences for multiple aspects of the patient's life, even years after discharge from the rehabilitation institution.

• Vege, Kristine Marie Mamen; Månum, Grethe; Sunnerhagen, Kathrina Stibrant & Becker, Frank (2025). Medical complications after acquired pediatric injury to the Central nervous system: a scoping review. Disability and Rehabilitation. ISSN 0963-8288. doi: 10.1080/09638288.2025.2526704. Full text in Research Archive Show summary

  Purpose This scoping review aims to give an overview of the literature describing medical complications in children from 2 to 17 years, arising in the subacute and chronic phases after pediatric CNS injury, and to identify knowledge gaps on the subject. Methods Our scoping review of publications in databases Embase and Medline follows the guidelines of Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). Results We identified 11,497 articles published from 2000 to 2024. Initial screening reduced these to 1,220, which were reviewed in full-text, resulting in inclusion of 373 publications. Acquired brain injury was the most common CNS injury, with neoplastic etiology as the dominating subgroup. The majority of the articles were retrospective studies and case studies. Most publications reported one complication, and comprehensive approaches were scarce. Epilepsy and endocrine disturbances were the most frequently reported complications in brain injury patients, and scoliosis and pressure ulcers predominated in the spinal cord injury group. Conclusion Despite a broad literature on the current topic, more longitudinal studies are needed, especially studies with a comprehensive approach to the medical complications that can occur after the acute phase in children with CNS injury.

• Brady, Marian C; Mills, Claire; Øra, Hege Prag; Novaes, Natalia; Becker, Frank & Constantinidou, Fofi [Show all 18 contributors for this article] (2025). European Stroke Organisation (ESO) guideline on aphasia rehabilitation. European Stroke Journal. ISSN 2396-9873. 10(4), p. 1189–1220. doi: 10.1177/23969873241311025. Full text in Research Archive Show summary

  Evidence of effective aphasia rehabilitation is emerging, yet intervention and delivery varies widely. This European Stroke Organisation guideline adhered to the guideline development standard procedures and Grading of Recommendations, Assessment, Development and Evaluation (GRADE) methodology. The resulting multi-disciplinary, evidence-based recommendations support the delivery of high-quality stroke-related aphasia rehabilitation. The working group identified 10 clinically relevant aphasia rehabilitation questions and rated outcomes’ relevance and importance. Following systematic searching, independent reviewers screened title-abstracts and full-texts for randomised controlled trials of speech-language therapy (SLT) for stroke-related aphasia. Results were profiled using PRISMA. Risk-of-bias was evaluated using the Cochrane Risk-of-Bias 1 tool. We prioritised final-value data. Where possible we conducted meta-analyses (RevMan) using random effects and mean, standardised mean differences (functional communication, quality of life, aphasia severity, auditory comprehension and spoken language outcomes) or odds ratios (adverse events). Using GRADE, we judged quality of the evidence (high-to-very low) and ESO recommendation strength (very strong-to-very weak). Where evidence was insufficient to support recommendations, expert opinions were described. Based on low-quality evidence we recommend the provision of higher total SLT dose (⩾20 h) and suggest higher SLT intensity and frequency to improve outcomes in aphasia rehabilitation. Similarly, we suggest the provision of individually-tailored SLT and digital and group therapy delivery models. Very low-level evidence for transcranial direct current stimulation (tDCS) with SLT informed the expert consensus that such interventions should only be provided in the context of high-quality trials. Evidence-based clinical-research priorities to inform SLT aphasia rehabilitation intervention choice and delivery are highlighted.

• Moksnes, Håkon Øgreid; Andelic, Nada; Schäfer, Christoph; Anke, Audny Gabriele Wagner; Søberg, Helene L. & Røe, Cecilie [Show all 17 contributors for this article] (2024). Unmet rehabilitation needs in the first 6 months post-injury in a trauma centre population with moderate-to-severe traumatic injuries. Journal of Rehabilitation Medicine. ISSN 1650-1977. 56, p. 1–10. doi: 10.2340/jrm.v56.40078. Full text in Research Archive Show summary

  Objective: To describe the needs for subacute inpatient rehabilitation and community-based healthcare services, rehabilitation, and social support in patients with moderate-to-severe traumatic injury in the first 6 months post-injury. Further, to explore associations between sociodemographic and clinical characteristics and unmet needs.<p> <p>Design: Multicentre prospective cohort study. <p>Subjects: Of 601 persons (75% males), mean (standard deviation) age 47 (21) years, admitted to trauma centres in 2020 with moderate-to-severe injury, 501 patients responded at the 6-month follow-up and thus were included in the analyses. <p>Methods: Sociodemographic and injury-related characteristics were recorded at inclusion. Estimation of needs was assessed with the Rehabilitation Complexity Scale Extended–Trauma and the Needs and Provision Complexity Scale on hospital discharge. Provision of services was recorded 6 months post-injury. Multivariable logistic regressions explored associations between baseline variables and unmet inpatient rehabilitation and community-based service needs. <p>Results: In total, 20% exhibited unmet needs for subacute inpatient rehabilitation, compared with 60% for community-based services. Predictors for unmet community-based service needs included residing in less central areas, profound injury severity, severe head injury, and rehabilitation referral before returning home. <p>Conclusion: Inadequate provision of healthcare and rehabilitation services, particularly in the municipalities, resulted in substantial unmet needs in the first 6 months following injury.

• Nilsen, Helle Walseth; Martinsen, Anne Catrine Trægde; Johansen, Inger; Kirkevold, Marit; Sunnerhagen, Katharina Stibrant & Becker, Frank (2023). Demographic, Medical, and Clinical Characteristics of a Population-Based Sample of Patients With Long-lasting Locked-In Syndrome. Neurology. ISSN 0028-3878. 101(10). doi: 10.1212/WNL.0000000000207577. Full text in Research Archive
• Garratt, Andrew; Engen, Kathrine; Kjeldberg, Ingvild; Nordvik, Jan Egil; Ringheim, Inge & Westskogen, Lise [Show all 7 contributors for this article] (2023). Use of EQ-5D-5L for Assessing Patient-Reported Outcomes in a National Register for Specialized Rehabilitation. Archives of Physical Medicine and Rehabilitation. ISSN 0003-9993. 105(1), p. 40–48. doi: 10.1016/j.apmr.2023.04.026. Full text in Research Archive Show summary

  Objective: To compare problems reported on EQ-5D-5L dimensions, index, and EQ visual analog scale (VAS) scores in patients receiving spe- cialized rehabilitation in Norway with general population norms. Design: Multicenter observational study. Setting: Five specialist rehabilitation facilities participating in a national rehabilitation register between March 11, 2020, and April 20, 2022. Participants: 1167 inpatients admitted (N=1167), with a mean age of 56.1 (range, 18-91) years; 43% were female. Interventions: Not applicable. Main Outcome Measures: EQ-5D-5L dimension, index, and EQ VAS scores. Results: At admission, mean§SD EQ-5D-5L index scores were 0.48 (0.31) compared to 0.82 (0.19) for general population norms. EQ VAS scores were 51.29 (20.74) compared to 79.46 (17.53) for population norms. Together with those for the 5 dimensions, these differences were all statisti- cally significant (P<.01). Compared to population norms, patients undergoing rehabilitation had more health states as assessed by the 5 dimen- sions (550 vs 156) and EQ VAS (98 vs 49). As hypothesized, EQ-5D-5L scores were associated with number of diagnoses, admission to/from secondary care, and help with completion. At discharge there were statistically significant improvements in all EQ-5D-5L scores that compare favorably with available estimates for minimal important differences. Conclusions: The large deviations in scores at admission and score changes at discharge lend support to EQ-5D-5L application in national quality measurement. Evidence for construct validity was found through associations with number of secondary diagnoses and help with completion.

• Brady, Marian C.; Ali, Myzoon; Berg, Kathryn Vanden; Williams, Linda J.; Williams, Louise R. & Abo, Masahiro [Show all 68 contributors for this article] (2022). Complex speech-language therapy interventions for stroke-related aphasia: The RELEASE study incorporating a systematic review and individual participant data network meta-analysis. Health and social care delivery research. ISSN 2755-0060. 10(28). doi: 10.3310/RTLH7522. Full text in Research Archive
• Behn, Nicholas; Harrison, Madeleine; Brady, Marian C; Breitenstein, Caterina; Carragher, Marcella & Fridriksson, Julius [Show all 16 contributors for this article] (2022). Developing, monitoring, and reporting of fidelity in aphasia trials: core recommendations from the collaboration of aphasia trialists (CATs) trials for aphasia panel. Aphasiology. ISSN 0268-7038. doi: 10.1080/02687038.2022.2037502. Full text in Research Archive Show summary

  Background Developing, monitoring, and reporting of fidelity are essential and integral components to the design of randomised controlled trials (RCTs) in stroke and aphasia. Treatment fidelity refers to the degree to which an intervention is delivered as intended and is directly related to the quality of the evidence generated by RCTs. Clear documentation of treatment fidelity in trials assists in the evaluation of the clinical implications of potential benefits attributed to the intervention. Consideration of the implementation requirements of a research-based intervention as intended in a clinical context is necessary to achieve similar outcomes for a clinical population. Despite this, treatment fidelity is rarely reported in RCTs of aphasia intervention. Aim To describe fidelity strategies and develop core recommendations for developing, monitoring, and reporting of fidelity in aphasia intervention RCTs. Scope Relevant conceptual frameworks were considered. The Behaviour Change Consortium comprehensive framework of fidelity was adopted. It includes five areas: study design, training providers, delivery of treatment, treatment receipt, and treatment enactment. We explored fidelity in RCTs with a range of complex aphasia interventions (e.g., ASK, Big CACTUS, COMPARE, FCET2EC, POLAR, SUPERB, and VERSE) and described how different trial design factors (e.g., phase of trial, explanatory vs. pragmatic, number and location of sites, and number and type of treatment providers) influenced the fidelity strategies chosen. Strategies were mapped onto the five areas of the fidelity framework with a detailed exploration of how fidelity criteria were developed, measured, and monitored throughout each trial. This information was synthesised into a set of core recommendations to guide aphasia researchers towards the adequate measurement, capture, and reporting of fidelity within future aphasia intervention studies. Conclusions/Recommendations Treatment fidelity should be a core consideration in planning an intervention trial, a concept that goes beyond treatment adherence alone. A range of strategies should be selected depending on the phase and design of the trial being undertaken and appropriate investment of time and costs should be considered.

• Brady, Marian C.; Ali, Myzoon; Vandenberg, Kathryn; Williams, Linda J.; Williams, Louise R. & Abo, Masahiro [Show all 55 contributors for this article] (2022). Precision rehabilitation for aphasia by patient age, sex, aphasia severity, and time since stroke? A prespecified, systematic review-based, individual participant data, network, subgroup meta-analysis. International Journal of Stroke. ISSN 1747-4930. 17(10), p. 1067–1077. doi: 10.1177/17474930221097477. Full text in Research Archive Show summary

  Background: Stroke rehabilitation interventions are routinely personalized to address individuals’ needs, goals, and challenges based on evidence from aggregated randomized controlled trials (RCT) data and meta-syntheses. Individual participant data (IPD) meta-analyses may better inform the development of precision rehabilitation approaches, quantifying treatment responses while adjusting for confounders and reducing ecological bias. Aim: We explored associations between speech and language therapy (SLT) interventions frequency (days/week), intensity (h/week), and dosage (total SLT-hours) and language outcomes for different age, sex, aphasia severity, and chronicity subgroups by undertaking prespecified subgroup network meta-analyses of the RELEASE database. Methods: MEDLINE, EMBASE, and trial registrations were systematically searched (inception-Sept2015) for RCTs, including ⩾ 10 IPD on stroke-related aphasia. We extracted demographic, stroke, aphasia, SLT, and risk of bias data. Overall-language ability, auditory comprehension, and functional communication outcomes were standardized. A one-stage, random effects, network meta-analysis approach filtered IPD into a single optimal model, examining SLT regimen and language recovery from baseline to first post-intervention follow-up, adjusting for covariates identified a-priori. Data were dichotomized by age (⩽/&gt; 65 years), aphasia severity (mild–moderate/ moderate–severe based on language outcomes’ median value), chronicity (⩽/&gt; 3 months), and sex subgroups. We reported estimates of means and 95% confidence intervals. Where relative variance was high (&gt; 50%), results were reported for completeness. Results: 959 IPD (25 RCTs) were analyzed. For working-age participants, greatest language gains from baseline occurred alongside moderate to high-intensity SLT (functional communication 3-to-4 h/week; overall-language and comprehension &gt; 9 h/week); older participants’ greatest gains occurred alongside low-intensity SLT (⩽ 2 h/week) except for auditory comprehension (&gt; 9 h/week). For both age-groups, SLT-frequency and dosage associated with best language gains were similar. Participants ⩽ 3 months post-onset demonstrated greatest overall-language gains for SLT at low intensity/moderate dosage (⩽ 2 SLT-h/week; 20-to-50 h); for those &gt; 3 months, post-stroke greatest gains were associated with moderate-intensity/high-dosage SLT (3–4 SLT-h/week; ⩾ 50 hours). For moderate–severe participants, 4 SLT-days/week conferred the greatest language gains across outcomes, with auditory comprehension gains only observed for ⩾ 4 SLT-days/week; mild–moderate participants’ greatest functional communication gains were associated with similar frequency (⩾ 4 SLT-days/week) and greatest overall-language gains with higher frequency SLT (⩾ 6 days/weekly). Males’ greatest gains were associated with SLT of moderate (functional communication; 3-to-4 h/weekly) or high intensity (overall-language and auditory comprehension; (&gt; 9 h/weekly) compared to females for whom the greatest gains were associated with lower-intensity SLT (&lt; 2 SLT-h/weekly). Consistencies across subgroups were also evident; greatest overall-language gains were associated with 20-to-50 SLT-h in total; auditory comprehension gains were generally observed when SLT &gt; 9 h over ⩾ 4 days/week. Conclusions: We observed a treatment response in most subgroups’ overall-language, auditory comprehension, and functional communication language gains. For some, the maximum treatment response varied in association with different SLT-frequency, intensity, and dosage. Where differences were observed, working-aged, chronic, mild–moderate, and male subgroups experienced their greatest language gains alongside high-frequency/intensity SLT. In contrast, older, moderate–severely impaired, and female subgroups within 3 months of aphasia onset made their greatest gains for lower-intensity SLT. The acceptability, clinical, and cost effectiveness of precision aphasia rehabilitation approaches based on age, sex, aphasia severity, and chronicity should be evaluated in future clinical RCTs.

• Gjellesvik, Tor Ivar; Becker, Frank; Tjønna, Arnt Erik; Indredavik, Bent; Lundgaard, Eivind & Solbakken, Hedvig Rystad [Show all 10 contributors for this article] (2021). Effects of High-Intensity Interval Training After Stroke (The HIIT Stroke Study) on Physical and Cognitive Function: A Multicenter Randomized Controlled Trial. Archives of Physical Medicine and Rehabilitation. ISSN 0003-9993. 102(9), p. 1683–1691. doi: 10.1016/j.apmr.2021.05.008. Full text in Research Archive Show summary

  Objective: To assess the effects of high-intensity interval training (HIIT) on physical, mental, and cognitive functioning after stroke. Design: The HIIT Stroke Study was a single-blind, multicenter, parallel-group randomized controlled trial. Setting: Specialized rehabilitation units at 3 Norwegian hospitals. Participants: Adult stroke survivors (N=70) 3 months to 5 years after a first-ever stroke. Mean age was 57.6§9.2 years and 58.7§9.2 years in the intervention and control groups, respectively. Interventions: Participants were randomized to standard care in combination with 4£4 minutes of treadmill HIIT at 85%-95% of peak heart rate or standard care only. Outcomes: Outcomes were measured using physical, mental, and cognitive tests and the FIM and Stroke Impact Scale. Linear mixed models were used to analyze differences between groups at posttest and 12-month follow-up. Results: The intervention group showed a significant treatment effect (95% confidence interval [CI]) from baseline to posttest on a 6-minute walk test of 28.3 (CI, 2.80-53.77) meters (P=.030); Berg Balance Scale 1.27 (CI, 0.17-2.28) points (P=.025); and Trail Making Test Part B (TMT-B; 24.16 [CI, 46.35 to 1.98] s, P=.033). The intervention group showed significantly greater improvement on TMT-B at the 12-month followup (25.44 [CI, 49.01 to 1.87] s, P=.035). The control group showed significantly greater improvement in total Functional Independence Measure score with a treatment effect of 2.37 (CI, 4.30 to 0.44) points (P=.016) at 12-month follow-up. No significant differences were identified between groups on other outcomes at any time point. Conclusions: HIIT combined with standard care improved walking distance, balance, and executive function immediately after the intervention compared with standard care only. However, only TMT-B remained significant at the 12-month follow-up.

• Brady, Marian C.; Ali, Myzoon; Vandenberg, Kathryn; Williams, Linda J.; Williams, Louise R. & Abo, Masahiro [Show all 50 contributors for this article] (2021). Dosage, Intensity, and Frequency of Language Therapy for Aphasia: A Systematic Review–Based, Individual Participant Data Network Meta-Analysis. Stroke. ISSN 0039-2499. 53(2), p. 956–967. doi: 10.1161/STROKEAHA.121.035216. Full text in Research Archive Show summary

  Background and Purpose: Optimizing speech and language therapy (SLT) regimens for maximal aphasia recovery is a clinical research priority. We examined associations between SLT intensity (hours/week), dosage (total hours), frequency (days/week), duration (weeks), delivery (face to face, computer supported, individual tailoring, and home practice), content, and language outcomes for people with aphasia. Methods: Databases including MEDLINE and Embase were searched (inception to September 2015). Published, unpublished, and emerging trials including SLT and ≥10 individual participant data on aphasia, language outcomes, and time post-onset were selected. Patient-level data on stroke, language, SLT, and trial risk of bias were independently extracted. Outcome measurement scores were standardized. A statistical inferencing, one-stage, random effects, network meta-analysis approach filtered individual participant data into an optimal model examining SLT regimen for overall language, auditory comprehension, naming, and functional communication pre-post intervention gains, adjusting for a priori–defined covariates (age, sex, time poststroke, and baseline aphasia severity), reporting estimates of mean change scores (95% CI). Results: Data from 959 individual participant data (25 trials) were included. Greatest gains in overall language and comprehension were associated with >20 to 50 hours SLT dosage (18.37 [10.58–26.16] Western Aphasia Battery–Aphasia Quotient; 5.23 [1.51–8.95] Aachen Aphasia Test–Token Test). Greatest clinical overall language, functional communication, and comprehension gains were associated with 2 to 4 and 9+ SLT hours/week. Greatest clinical gains were associated with frequent SLT for overall language, functional communication (3–5+ days/week), and comprehension (4–5 days/week). Evidence of comprehension gains was absent for SLT ≤20 hours, <3 hours/week, and ≤3 days/week. Mixed receptive-expressive therapy, functionally tailored, with prescribed home practice was associated with the greatest overall gains. Relative variance was <30%. Risk of trial bias was low to moderate; low for meta-biases. Conclusions: Greatest language recovery was associated with frequent, functionally tailored, receptive-expressive SLT, with prescribed home practice at a greater intensity and duration than reports of usual clinical services internationally. These exploratory findings suggest critical therapeutic ranges, informing hypothesis-testing trials and tailoring of clinical services.

• Ali, Myzoon; Vandenberg, Kathryn; Williams, Linda J.; Williams, Louise R.; Abo, Masahiro & Becker, Frank [Show all 50 contributors for this article] (2021). Predictors of Poststroke Aphasia Recovery. A Systematic Review-Informed Individual Participant Data Meta-Analysis. Stroke. ISSN 0039-2499. 52(5), p. 1778–1787. doi: 10.1161/STROKEAHA.120.031162. Full text in Research Archive Show summary

  Background and Purpose: The factors associated with recovery of language domains after stroke remain uncertain. We described recovery of overall-language-ability, auditory comprehension, naming, and functional-communication across participants’ age, sex, and aphasia chronicity in a large, multilingual, international aphasia dataset. Methods: Individual participant data meta-analysis of systematically sourced aphasia datasets described overall-language ability using the Western Aphasia Battery Aphasia-Quotient; auditory comprehension by Aachen Aphasia Test (AAT) Token Test; naming by Boston Naming Test and functional-communication by AAT Spontaneous-Speech Communication subscale. Multivariable analyses regressed absolute score-changes from baseline across language domains onto covariates identified a priori in randomized controlled trials and all study types. Change-from-baseline scores were presented as estimates of means and 95% CIs. Heterogeneity was described using relative variance. Risk of bias was considered at dataset and meta-analysis level. Results: Assessments at baseline (median=43.6 weeks poststroke; interquartile range [4–165.1]) and first-follow-up (median=10 weeks from baseline; interquartile range [3–26]) were available for n=943 on overall-language ability, n=1056 on auditory comprehension, n=791 on naming and n=974 on functional-communication. Younger age (<55 years, +15.4 Western Aphasia Battery Aphasia-Quotient points [CI, 10.0–20.9], +6.1 correct on AAT Token Test [CI, 3.2–8.9]; +9.3 Boston Naming Test points [CI, 4.7–13.9]; +0.8 AAT Spontaneous-Speech Communication subscale points [CI, 0.5–1.0]) and enrollment <1 month post-onset (+19.1 Western Aphasia Battery Aphasia-Quotient points [CI, 13.9–24.4]; +5.3 correct on AAT Token Test [CI, 1.7–8.8]; +11.1 Boston Naming Test points [CI, 5.7–16.5]; and +1.1 AAT Spontaneous-Speech Communication subscale point [CI, 0.7–1.4]) conferred the greatest absolute change-from-baseline across each language domain. Improvements in language scores from baseline diminished with increasing age and aphasia chronicity. Data exhibited no significant statistical heterogeneity. Risk-of-bias was low to moderate-low. Conclusions: Earlier intervention for poststroke aphasia was crucial to maximize language recovery across a range of language domains, although recovery continued to be observed to a lesser extent beyond 6 months poststroke.

• Williams, Louise R; Ali, Myzoon; Vandenberg, Kathryn; Williams, Linda J.; Abo, Masahiro & Becker, Frank [Show all 50 contributors for this article] (2021). Utilising a systematic review-based approach to create a database of individual participant data for meta- and network meta-analyses: the RELEASE database of aphasia after stroke. Aphasiology. ISSN 0268-7038. doi: 10.1080/02687038.2021.1897081. Full text in Research Archive Show summary

  Background: Collation of aphasia research data across settings, countries and study designs using big data principles will support analyses across different language modalities, levels of impairment, and therapy interventions in this heterogeneous population. Big data approaches in aphasia research may support vital analyses, which are unachievable within individual trial datasets. However, we lack insight into the requirements for a systematically created database, the feasibility and challenges and potential utility of the type of data collated. Aim: To report the development, preparation and establishment of an internationally agreed aphasia after stroke research database of individual participant data (IPD) to facilitate planned aphasia research analyses. Methods: Data were collated by systematically identifying existing, eligible studies in any language (≥10 IPD, data on time since stroke, and language performance) and included sourcing from relevant aphasia research networks. We invited electronic contributions and also extracted IPD from the public domain. Data were assessed for completeness, validity of value-ranges within variables, and described according to pre-defined categories of demographic data, therapy descriptions, and language domain measurements. We cleaned, clarified, imputed and standardised relevant data in collaboration with the original study investigators. We presented participant, language, stroke, and therapy data characteristics of the final database using summary statistics. Results: From 5256 screened records, 698 datasets were potentially eligible for inclusion; 174 datasets (5928 IPD) from 28 countries were included, 47/174 RCT datasets (1778 IPD) and 91/174 (2834 IPD) included a speech and language therapy (SLT) intervention. Participants’ median age was 63 years (interquartile range [53, 72]), 3407 (61.4%) were male and median recruitment time was 321 days (IQR 30, 1156) after stroke. IPD were available for aphasia severity or ability overall (n = 2699; 80 datasets), naming (n = 2886; 75 datasets), auditory comprehension (n = 2750; 71 datasets), functional communication (n = 1591; 29 datasets), reading (n = 770; 12 datasets) and writing (n = 724; 13 datasets). Information on SLT interventions were described by theoretical approach, therapy target, mode of delivery, setting and provider. Therapy regimen was described according to intensity (1882 IPD; 60 datasets), frequency (2057 IPD; 66 datasets), duration (1960 IPD; 64 datasets) and dosage (1978 IPD; 62 datasets). Discussion: Our international IPD archive demonstrates the application of big data principles in the context of aphasia research; our rigorous methodology for data acquisition and cleaning can serve as a template for the establishment of similar databases in other research areas.

• Søberg, Helene Lundgaard; Moksnes, Håkon Øgreid; Anke, Audny; Røise, Olav; Røe, Ellen-Cecilie Treu & Aas, Eline [Show all 20 contributors for this article] (2021). Rehabilitation Needs, Service Provision, and Costs in the First Year Following Traumatic Injuries: Protocol for a Prospective Cohort Study. JMIR Research Protocols. 10(4), p. 1–10. doi: 10.2196/25980. Full text in Research Archive Show summary

  Background: Traumatic injuries, defined as physical injuries with sudden onset, are a major public health problem worldwide. There is a paucity of knowledge regarding rehabilitation needs and service provision for patients with moderate and major trauma, even if rehabilitation research on a spectrum of specific injuries is available.<p> <p>Objective: This study aims to describe the prevalence of rehabilitation needs, the provided services, and functional outcomes across all age groups, levels of injury severity, and geographical regions in the first year after trauma. Direct and indirect costs of rehabilitation provision will also be assessed. The overarching aim is to better understand where to target future efforts.<p> <p>Methods: This is a population-based prospective follow-up study. It encompasses patients of all ages with moderate and severe acute traumatic injury (New Injury Severity Score >9) admitted to the regional trauma centers in southeastern and northern Norway over a 1-year period (2020). Sociodemographic and injury data will be collected. Upon hospital discharge, rehabilitation physicians estimate rehabilitation needs. Rehabilitation needs are assessed by the Rehabilitation Complexity Scale Extended–Trauma (RCS E–Trauma; specialized inpatient rehabilitation), Needs and Provision Complexity Scale (NPCS; community-based rehabilitation and health care service delivery), and Family Needs Questionnaire–Pediatric Version (FNQ-P). Patients, family caregivers, or both will complete questionnaires at 6- and 12-month follow-ups, which are supplemented by telephone interviews. Data on functioning and disability, mental health, health-related quality of life measured by the EuroQol Questionnaire (EQ-5D), and needs and provision of rehabilitation and health care services are collected by validated outcome measures. Unmet needs are represented by the discrepancies between the estimates of the RCS E–Trauma and NPCS at the time of a patient’s discharge and the rehabilitation services the patient has actually received. Formal service provision (including admission to inpatient- or outpatient-based rehabilitation), informal care, and associated costs will be collected.<p> <p>Results: The project was funded in December 2018 and approved by the Regional Committee for Medical and Health Research Ethics in October 2019. Inclusion of patients began at Oslo University Hospital on January 1, 2020, and at the University Hospital of North Norway on February 1, 2020. As of February 2021, we have enrolled 612 patients, and for 286 patients the 6-month follow-up has been completed. Papers will be drafted for publication throughout 2021 and 2022.<p> <p>Conclusions: This study will improve our understanding of existing service provision, the gaps between needs and services, and the associated costs for treating patients with moderate and major trauma. This may guide the improvement of rehabilitation and health care resource planning and allocation.

• Brady, Marian C.; Ali, Myzoon; Williams, Louise R; Williams, Linda J.; Abo, Masahiro & Becker, Frank [Show all 67 contributors for this article] (2020). Communicating simply, but not too simply: Reporting of participants and speech and language interventions for aphasia after stroke. International Journal of Speech-Language Pathology. ISSN 1754-9507. 22(3), p. 302–312. doi: 10.1080/17549507.2020.1762000. Full text in Research Archive Show summary

  Purpose: Speech and language pathology (SLP) for aphasia is a complex intervention delivered to a heterogeneous population within diverse settings. Simplistic descriptions of participants and interventions in research hinder replication, interpretation of results, guideline and research developments through secondary data analyses. This study aimed to describe the availability of participant and intervention descriptors in existing aphasia research datasets. Method: We systematically identified aphasia research datasets containing ≥10 participants with information on time since stroke and language ability. We extracted participant and SLP intervention descriptions and considered the availability of data compared to historical and current reporting standards. We developed an extension to the Template for Intervention Description and Replication checklist to support meaningful classification and synthesis of the SLP interventions to support secondary data analysis. Result: Of 11, 314 identified records we screened 1131 full texts and received 75 dataset contributions. We extracted data from 99 additional public domain datasets. Participant age (97.1%) and sex (90.8%) were commonly available. Prior stroke (25.8%), living context (12.1%) and socio-economic status (2.3%) were rarely available. Therapy impairment target, frequency and duration were most commonly available but predominately described at group level. Home practice (46.3%) and tailoring (functional relevance 46.3%) were inconsistently available. Conclusion : Gaps in the availability of participant and intervention details were significant, hampering clinical implementation of evidence into practice and development of our field of research. Improvements in the quality and consistency of participant and intervention data reported in aphasia research are required to maximise clinical implementation, replication in research and the generation of insights from secondary data analysis. Systematic review registration: PROSPERO CRD42018110947

• Wouda, Matthijs Ferdinand; Lundgaard, Eivind; Becker, Frank & Strøm, Vegard (2020). Changes in cardiorespiratory fitness and activity levels over the first year after discharge in ambulatory persons with recent incomplete spinal cord injury. Spinal Cord. ISSN 1362-4393. doi: 10.1038/s41393-020-0514-7. Full text in Research Archive Show summary

  Abstract Study design Secondary analysis of a clinical trial. Objectives To investigate changes in cardiorespiratory fitness (CRF) and activity level in ambulatory persons with SCI during the first year after discharge from inpatient rehabilitation. Setting Sunnaas Rehabilitation Hospital, Nesoddtangen, Norway. Methods Thirty persons with incomplete SCI, all community walkers (25 males and 5 females, 18–69 years old) were recruited to a clinical trial of a 12 weeks home-based aerobic exercise program of either high or moderate intensity. During the last week of inpatient rehabilitation (baseline), participants performed a maximal exercise test on a treadmill (peak oxygen uptake; peak VO 2 ) and a 6-min walking test (6MWT). Also, total daily energy expenditure (TDEE) and daily amount of steps were measured continuously during 7 days in the participants’ homes. All tests were repeated after 3 and 12 months (post tests). Results Twenty of the 30 clinical trial participants performed baseline and both posttests and are included in this secondary analysis. We found no statistically significant between-group differences in the time course over the first year of either peak VO 2 , 6MWT, or physical activity outcomes. Therefore, data from both exercise groups and the control group were merged for secondary analyses, revealing statistically significant increase over time in peak VO 2 , 6MWT, and TDEE. The increase over time in the average daily steps did not reach statistical significance. Conclusions Ambulatory persons with SCI were able to increase their CRF levels over the first year after discharge from inpatient rehabilitation, despite a minimal increase in activity levels.

• Brady, Marian C.; Ali, Myzoon; Vandenberg, Kathryn; Williams, Linda J.; Abo, Masahiro & Becker, Frank [Show all 50 contributors for this article] (2020). RELEASE: a protocol for a systematic review based, individual participant data, meta- and network meta-analysis, of complex speech-language therapy interventions for stroke-related aphasia. Aphasiology. ISSN 0268-7038. 34(2), p. 137–157. doi: 10.1080/02687038.2019.1643003. Full text in Research Archive Show summary

  Background: Speech and language therapy (SLT) benefits people with aphasia following stroke. Group level summary statistics from randomised controlled trials hinder exploration of highly complex SLT interventions and a clinically relevant heterogeneous population. Creating a database of individual participant data (IPD) for people with aphasia aims to allow exploration of individual and therapy-related predictors of recovery and prognosis. Aim: To explore the contribution that individual participant characteristics (including stroke and aphasia profiles) and SLT intervention components make to language recovery following stroke. Methods and procedures: We will identify eligible IPD datasets (including randomised controlled trials, non-randomised comparison studies, observational studies and registries) and invite their contribution to the database. Where possible, we will use meta- and network meta-analysis to explore language performance after stroke and predictors of recovery as it relates to participants who had no SLT, historical SLT or SLT in the primary research study. We will also examine the components of effective SLT interventions. Outcomes and results: Outcomes include changes in measures of functional communication, overall severity of language impairment, auditory comprehension, spoken language (including naming), reading and writing from baseline. Data captured on assessment tools will be collated and transformed to a standardised measure for each of the outcome domains. Conclusion: Our planned systematic-review-based IPD meta- and network meta-analysis is a large scale, international, multidisciplinary and methodologically complex endeavour. It will enable hypotheses to be generated and tested to optimise and inform development of interventions for people with aphasia after stroke. Systematic review registration: The protocol has been registered at the International Prospective Register of Systematic Reviews (PROSPERO; registration number: CRD42018110947)

• Øra, Hege Prag; Kirmess, Melanie; Brady, Marian C.; Partee, Iselin Anne Cecilia; Hognestad, Randi Bjor & Johannessen, Beate Bertheau [Show all 8 contributors for this article] (2020). The effect of augmented speech-language therapy delivered by telerehabilitation on post stroke aphasia – a pilot randomized controlled trial. Clinical Rehabilitation. ISSN 0269-2155. 34(3), p. 369–381. doi: 10.1177/0269215519896616. Full text in Research Archive Show summary

  Pilot a definitive randomized controlled trial of speech-language telerehabilitation in poststroke aphasia in addition to usual care with regard to recruitment, drop-outs, and language effects. Pilot single-blinded randomized controlled trial. Telerehabilitation delivered from tertiary rehabilitation center to participants at their home or admitted to secondary rehabilitation centers. People with naming impairment due to aphasia following stroke. Sixty-two participants randomly allocated to 5 hours of speech and language telerehabilitation by videoconference per week over four consecutive weeks together with usual care or usual care alone. The telerehabilitation targeted functional, expressive language. Main measures: Norwegian Basic Aphasia Assessment: naming (primary outcome), repetition, and auditory comprehension subtests; Verb and Sentence Test sentence production subtest and the Communicative Effectiveness Index at baseline, four weeks, and four months postrandomization. Data were analyzed by intention to treat. No significant between-group differences were seen in naming or auditory comprehension in the Norwegian Basic Aphasia Assessment at four weeks and four months post randomization. The telerehabilitation group ( n = 29) achieved a Norwegian Basic Aphasia Assessment repetition score of 8.9 points higher ( P = 0.026) and a Verb and Sentence Test score 3 points higher ( P = 0.002) than the control group ( n = 27) four months postrandomization. Communicative Effectiveness Index was not significantly different between groups, but increased significantly within both groups. No adverse events were reported. Augmented telerehabilitation via videoconference may be a viable rehabilitation model for aphasia affecting language outcomes poststroke. A definitive trial with 230 participants is needed to confirm results.

• Becker, Frank; Laake, Jon Henrik & Hofsø, Kristin (2020). Rehabilitering etter Covid-19. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 140(9), p. 1–6. doi: 10.4045/tidsskr.20.0352. Full text in Research Archive
• Øra, Hege Prag; Kirmess, Melanie; Brady, Marian C.; Sørli, Hilde & Becker, Frank (2020). Technical Features, Feasibility, and Acceptability of Augmented Telerehabilitation in Post-stroke Aphasia—Experiences From a Randomized Controlled Trial. Frontiers in Neurology. 11(671). doi: 10.3389/fneur.2020.00671. Full text in Research Archive Show summary

  Background: Post-stroke aphasia is a communication disorder where existing evidence favors intensive therapy methods. Telerehabilitation represents a service model for geographically remote settings, or other barriers to clinic attendance or to facilitate an augmentation of therapy across a continuum of care. Evidence to support efficiency, feasibility, and acceptability is however still scarce. Appraising aphasia telerehabilitation in controlled trials beyond its effectiveness, by investigating feasibility and acceptability, may facilitate implementation into clinical practice. Methods: In our pilot randomized controlled trial, we investigated the feasibility and acceptability of speech and language therapy by videoconference, in addition to usual care, in people with aphasia following stroke. To improve functional, expressive language, a tailored intervention was given 1 h per day, five times per week over four consecutive weeks. Feasibility measures included evaluation of technical setup using diary logs. Acceptability was investigated by examining adherence and satisfaction with therapy alongside evaluation of data safety and privacy. Results: Feasibility and acceptability data were collected in relation to 556.5 h of telerehabilitation delivered to 30 participants over a 2-years intervention period by three speech-language pathologists. Protocol adherence was high, with a tolerable technical fault rate; 86 faults were registered over 541 video sessions. Most (80%; n = 30) of the participants experienced zero to three faults. The main cause of technical failures was flawed internet connection, causing delayed or interrupted therapy. Total satisfaction with telerehabilitation was rated good or very good by 93.1% (n = 29) of participants and two of three speech-language pathologists. Within a moderate variance of technical failure, participants experiencing more faults were more satisfied. No serious events regarding security and privacy were reported. Our model is feasibly and ready to be implemented across a range of clinical settings and contexts. Conclusions: Synchronous telerehabilitation for post-stroke aphasia is feasible and acceptable and shows tolerable technical fault rates with high satisfaction among patients and pathologists. Within a low rate of faults, satisfaction was not negatively influenced by fault frequency. Access to clinical and technical expertise is needed when developing telerehabilitation services. Telerehabilitation may be a viable service delivery model for aphasia rehabilitation.

• Walle, Kjersti Mæhlum; Nordvik, Jan Egil; Becker, Frank; Espeseth, Thomas; Sneve, Markus Handal & Laeng, Bruno (2019). Unilateral neglect post stroke: Eye movement frequencies indicate directional hypokinesia while fixation distributions suggest compensational mechanism. Brain and Behavior. 9:e01170(1). doi: 10.1002/brb3.1170. Full text in Research Archive Show summary

  Introduction: Eye movements and spatial attention are closely related, and eye‐tracking can provide valuable information in research on visual attention. We investigated the pathology of overt attention in right hemisphere (RH) stroke patients differing in their severity of neglect symptoms by using eye‐tracking during a dynamic attention task. Methods: Eye movements were recorded in 26 RH stroke patients (13 with and 13 without unilateral spatial neglect, and a matched group of 26 healthy controls during a Multiple Object Tracking task. We assessed the frequency and spatial distributions of fixations, as well as frequencies of eye movements to the left and to the right side of visual space so as to investigate individuals’ efficiency of visual processing, distribution of attentional processing resources, and oculomotoric orienting mechanisms. Results: Both patient groups showed increased fixation frequencies compared to controls. A spatial bias was found in neglect patients’ fixation distribution, depending on neglect severity (indexed by scores on the Behavioral Inattention Test). Patients with more severe neglect had more fixations within the right field, while patients with less severe neglect had more fixations within their left field. Eye movement frequencies were dependent on direction in the neglect patient group, as they made more eye movements toward the right than toward the left. Conclusion: The patient groups’ higher fixation rates suggest that patients are generally less efficient in visual processing. The spatial bias in fixation distribution, dependent on neglect severity, suggested that patients with less severe neglect were able to use compensational mechanisms in their contralesional space. The observed relation between eye movement rates and directions observed in neglect patients provides a measure of the degree of difficulty these patients may encounter during dynamic situations in daily life and supports the idea that directional oculomotor hypokinesia may be a relevant component in this syndrome.

• Rose, Miranda L.; Ali, Myzoon; Elders, Andrew; Godwin, Jon; Sandri, Anastasia Karachalia & Williams, Linda J. [Show all 74 contributors for this article] (2018). Tidier descriptions of speech and language therapy interventions for people with aphasia; consensus from the release collaboration. Aphasiology. ISSN 0268-7038. 32(1), p. 183–186. doi: 10.1080/02687038.2018.1487021. Full text in Research Archive
• Langhammer, Birgitta; Sunnerhagen, Katharina Stibrant; Lundgren-Nilsson, Åsa; Sällström, susanne; Becker, Frank & Stanghelle, Johan K (2018). En observasjonell multisenterstudie i spesialisert rehabilitering. Faktorer som forbedrer aktivitetene i dagliglivet etter slag. Best Practice. ISSN 1329-1874. Full text in Research Archive
• Walle, Kjersti Mæhlum; Nordvik, Jan Egil; Espeseth, Thomas; Becker, Frank & Laeng, Bruno (2018). Multiple object tracking and pupillometry reveal deficits in both selective and intensive attention in unilateral spatial neglect. Journal of Clinical and Experimental Neuropsychology. ISSN 1380-3395. 49(3), p. 270–289. doi: 10.1080/13803395.2018.1536735. Full text in Research Archive
• Langhammer, Birgitta; Sunnerhagen, Kathrina Skibrunt; Sällström, susanne; Becker, Frank & Stanghelle, Johan K (2018). Return to work after specialized rehabilitation-An explorative longitudinal study in a cohort of severely disabled persons with stroke in seven countries: The Sunnaas International Network stroke study. Brain and Behavior. 8(8). doi: 10.1002/brb3.1055. Full text in Research Archive Show summary

  Introduction: Stroke may impose disabilities with severe consequences for the individual, with physical, psychological, social, and work- related consequences. The objective with the current study was to investigate to what extent persons with stroke were able to return to work, to maintain their financial situation, and to describe the follow- up services and participation in social networks and recreational activities. Methods: The design was a prospective, descriptive study of specialized stroke rehabilitation in nine rehabilitation centers in seven countries. Semistructured interviews, which focused on the return to work, the financial situation, follow- up services, the maintenance of recreational activities, and networks, were performed 6 and 12 months post discharge from rehabilitation. Results: The working rate before the onset of stroke ranged from 27% to 86%. At 12 months post stroke, the return to work varied from 11% to 43%. Consequently, many reported a reduced financial situation from 10% to 70% at 6 months and from 10% to 80% at 12 months. Access to postrehabilitation follow- up services varied in the different countries from 24% to 100% at 6 months and from 21% to 100% at 12 months. Physical therapy was the most common follow- up services reported. Persons with stroke were less active in recreational activities and experienced reduced social networks. Associations between results from the semistructured interviews and related themes in LiSat- 11 were small to moderate. The study shows that education, age, and disability are predictors for return to work. Differences between countries were observed in the extent of unemployment. Conclusions: In this international multicentre study, return to work after severe stroke and specialized/comprehensive rehabilitation was possible, depending on the extent of the disability, age, and education. Altered financial situation, reduced social networks, and reduced satisfaction with life were common psychosocial situations for these patients.

• Langhammer, Birgitta; Sunnerhagen, Katharina Stibrant; Sällström, susanne; Becker, Frank & Stanghelle, Johan K (2018). Tilbake til arbeid etter hjerneslag- en studie fra sju land om personer med funksjonsnedsettelse etter hjerneslag SIN(Sunnaas International Network) stroke study. Best Practice. ISSN 1329-1874. p. 25–28. Full text in Research Archive
• Chatelle, Camille; Hauger, Solveig Lægreid; Martial, Charlotte; Becker, Frank; Eifert, Bernd & Boering, Dana [Show all 10 contributors for this article] (2018). Assessment of nociception and pain in participants in an unresponsive or minimally conscious state after acquired brain injury: the relation between the coma recovery scale-revised and the nociception coma scale-revised. Archives of Physical Medicine and Rehabilitation. ISSN 0003-9993. 99(9), p. 1755–1762. doi: 10.1016/j.apmr.2018.03.009. Full text in Research Archive
• Øra, Hege Prag; Kirmess, Melanie; Brady, Marian C.; Winsnes, Ingvild Elisabeth; Hansen, Silje Merethe & Becker, Frank (2018). Telerehabilitation for aphasia - Protocol of a pragmatic, exploratory, pilot randomized controlled trial. Trials. 19(208). doi: 10.1186/s13063-018-2588-5. Full text in Research Archive Show summary

  Background The Cochrane review on the effectiveness of speech and language therapy for aphasia following stroke suggests intensity of therapy is a key predictor for outcome. Current aphasia services cannot provide intervention at the intensity observed within trial contexts because of resource limitations. Telerehabilitation could widen access to speech-language pathologists (SLPs) in geographically remote contexts and reduce the time spent on travel by the therapist and patient. The current academic literature within this field is in its infancy, with few trials of speech and language therapy (SLT) delivered by videoconference. Our pilot randomized controlled trial (RCT) will explore feasibility aspects and effectiveness of telerehabilitation for aphasia in addition to standard SLT. Method/design Our study is a pragmatic, exploratory, pilot randomized controlled trial, where participants will be randomized to a telerehabilitation group or a control group. Both groups receive standard SLT (usual care) but the telerehabilitation group receives an additional 5 h of telerehabilitation per week over 4 weeks through videoconference. This additional telerehabilitation focuses on spoken language with an emphasis on word naming. We aim to include 40 patients in each group, with inclusion criteria being aphasia any time post stroke. Participants will be assessed blindly at pre-randomization (baseline), and 4 weeks and 4 months after randomization. The primary endpoint is naming ability 3 months after the completed intervention, measured by the Norwegian Basic Aphasia Assessment (NGA) naming subtest. Secondary endpoints include other subtests of the NGA, the VAST (Verb and Sentence Test) subtest sentence production, Communicative Effectiveness Index (CETI) and the Stroke and Aphasia Quality of Life scale (SAQOL-39). Experiences of patients and SLPs with telerehabilitation are assessed using questionnaires and semi-structured interviews. Statistical between group comparisons will be in line with an intention-to-treat analysis. Discussion This pilot RCT of intensive language training by videoconference will contribute new scientific evidence to the field of aphasia telerehabilitation. Here, we describe our trial which will explore the feasibility of telerehabilitation for aphasia as an intervention, our choice of primary and secondary outcome measures and proposed analyses. Our trial will provide information for the development and delivery of future definitive RCTs. Trial registration ClinicalTrials.gov, ID: NCT02768922 . Registered on 11 May 2016. Last updated on 17 November 2017.

• Wouda, Matthijs Ferdinand; Lundgaard, Eivind; Becker, Frank & Strøm, Vegard (2018). Effects of moderate- and high-intensity aerobic training program in ambulatory subjects with incomplete spinal cord injury–a randomized controlled trial. Spinal Cord. ISSN 1362-4393. 56, p. 955–963. doi: 10.1038/s41393-018-0140-9. Full text in Research Archive

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• Becker, Frank; Isaksen, Jytte Kjaergaard; Haaland-Johansen, Line; Söderhielm, Kajsa; Renvall, Kati & Halldórsdóttir, Þórunn [Show all 9 contributors for this article] (2025). Panel discussion about implementation of aphasia rehabilitation guidelines. Full text in Research Archive
• Holthe, Ingvil Laberg; Svendsen, Edel Jannecke; Rohrer-Baumgartner, Nina Marit; Hauger, Solveig; Borgen, Ida Maria Henriksen & Forslund, Marit Vindal [Show all 12 contributors for this article] (2024). Acceptability of an individualized and goal-oriented intervention in the chronic phase of pediatric acquired brain injury: the Child in Context intervention (CICI). Full text in Research Archive
• Johansen, Truls Sveløkken; Matre, Martin; Løvstad, Marianne; Lund, Anne; Martinsen, Anne Catrine Trægde & Olsen, Alexander [Show all 12 contributors for this article] (2024). Virtual reality as a method of cognitive training of processing speed, working memory, and sustained attention in persons with acquired brain injury: a protocol for a randomized controlled trial. Trials. 25(1). doi: 10.1186/s13063-024-08178-7. Full text in Research Archive Show summary

  Background Acquired brain injury (ABI) often leads to persisting somatic, cognitive, and social impairments. Cognitive impairments of processing speed, sustained attention, and working memory are frequently reported and may negatively affect activities of daily living and quality of life. Rehabilitation efforts aiming to retrain these cognitive functions have often consisted of computerized training programs. However, few studies have demonstrated effects that transfer beyond the trained tasks. There is a growing optimism regarding the potential usefulness of virtual reality (VR) in cognitive rehabilitation. The research literature is sparse, and existing studies are characterized by considerable methodological weaknesses. There is also a lack of knowledge about the acceptance and tolerability of VR as an intervention method for people with ABI. The present study aims to investigate whether playing a commercially available VR game is effective in training cognitive functions after ABI and to explore if the possible effects transfer into everyday functioning. Methods One hundred participants (18–65 years), with a verified ABI, impairments of processing speed/attention, and/or working memory, and a minimum of 12 months post injury will be recruited. Participants with severe aphasia, apraxia, visual neglect, epilepsy, and severe mental illness will be excluded. Participants will be randomized into two parallel groups: (1) an intervention group playing a commercial VR game taxing processing speed, working memory, and sustained attention; (2) an active control group receiving psychoeducation regarding compensatory strategies, and general cognitive training tasks such as crossword puzzles or sudoku. The intervention period is 5 weeks. The VR group will be asked to train at home for 30 min 5 days per week. Each participant will be assessed at baseline with neuropsychological tests and questionnaires, after the end of the intervention (5 weeks), and 16 weeks after baseline. After the end of the intervention period, focus group interviews will be conducted with 10 of the participants in the intervention group, in order to investigate acceptance and tolerability of VR as a training method. Discussion This study will contribute to improve understanding of how VR is tolerated and experienced by the ABI population. If proven effective, the study can contribute to new rehabilitation methods that persons with ABI can utilize in a home setting, after the post-acute rehabilitation has ended.

• Matre, Martin; Johansen, Truls Sveløkken; Olsen, Alexander; Tornås, Sveinung; Martinsen, Anne Catrine Trægde & Lund, Anne [Show all 13 contributors for this article] (2023). A protocol for the development and validation of a virtual reality-based clinical test of social cognition. BMC Digital Health. doi: 10.1186/s44247-023-00036-x. Full text in Research Archive Show summary

  Background Impairments in social cognition are common after traumatic brain injury (TBI) and may have severe negative consequences for patients and their families. Most tests of social cognition have limited ecological validity due to simplistic and contrived social stimuli with limited relevance to everyday social functioning. There is a need for measures of social cognition that reflect the dynamic, multimodal and contextualized nature of social situations and that predict real-world functioning. Three hundred sixty–degree (360°) Virtual Reality (VR) video can increase ecological validity through enhanced social presence, or a sense of “being there”. This paper describes the development and protocol design for validation of a Norwegian VR-version of The Awareness of Social Inference Test (TASIT), which is a widely used video-based test of social cognition. Methods Development of VR TASIT included filming 61 short videos depicting social interactions in both VR and desktop format, using a 360° camera. Software for standardized test administration and collection of performance data was developed in Unity, for administration on both VR and desktop interface. The validation study will test the reliability and validity of VR TASIT in participants with TBI (n = 100) and healthy controls (n = 100). Half of the participants will perform the desktop version, and the other half the VR version. Analyses will include known groups validity, convergent and divergent validity, as well as test–retest reliability of VR TASIT. A comparison of the ability of TASIT VR and desktop versions to predict real-world functioning (ecological validity) will be explored using the Social Skills Questionnaire for TBI and La Trobe Communication Questionnaire. Finally, the levels of perceived social presence of the stimulus materials and prevalence of cybersickness after exposure to the virtual environment will be documented. Discussion It is expected that VR TASIT will have comparable or better psychometric properties than the desktop version, and that the hypothesized increased level of social presence experienced in a virtual environment will result in improved ecological validity. More broadly, benefits and limitations of using VR video as stimulus material in assessment of social cognition and considerations for future development and clinical validation are discussed.

• Brady, Marian C.; Partee, Iselin Anne Cecilia; Becker, Frank & Kirmess, Melanie (2023). Telerehabilitation for post-stroke aphasia – results and experience from a randomised controlled trial on speech-language therapy by videoconference. Full text in Research Archive
• Brady, Marian C.; Partee, Iselin Anne Cecilia; Becker, Frank & Kirmess, Melanie (2023). Telerehabilitation for post-stroke aphasia – results and experience from a randomised controlled trial on speech-language therapy by videoconference. Full text in Research Archive
• Øra, Hege Prag; Kirmess, Melanie; Brady, Marian C & Becker, Frank (2023). Telerehabilitation for post-stroke aphasia - Results and experience from a randomised controlled trial on speech-language therapy by videoconference. Full text in Research Archive
• Rohrer-Baumgartner, Nina; Holthe, Ingvil Laberg; Svendsen, Edel Jannecke; Strand-Saugnes, Anine; Røe, Cecilie & Wade, Shari L. [Show all 13 contributors for this article] (2022). The Child in Context Intervention (CICI) Study: Protocol for a Randomized Controlled Trial Evaluating the Effectiveness of a Goal-Oriented and Individualized Rehabilitation for Children With Chronic Acquired Brain Injury. Full text in Research Archive
• Søberg, Helene L.; Moksnes, Håkon Øgreid; Anke, Audny Gabriele Wagner; Røise, Olav; Røe, Cecilie & Aas, Eline [Show all 20 contributors for this article] (2022). Erratum: Rehabilitation Needs, Service Provision, and Costs in the First Year following Traumatic Injuries: Protocol for a Prospective Cohort Study ((JMIR Res Protoc (2021) 10: 4 (e25980) DOI: 10.2196/25980). JMIR Research Protocols. 11(3). doi: 10.2196/37723. Full text in Research Archive
• Hauger, Solveig Lægreid; Holthe, Ingvil Laberg; Borgen, Ida Maria Henriksen & Becker, Frank (2022). SMART-mål metode i rehabilitering ved ervervet hjerneskade hos voksne og barn- erfaringer fra to randomiserte kontrollerte studier av rehabiliteringsprogram i kronisk fase. Full text in Research Archive
• Rohrer-Baumgartner, Nina; Holthe, Ingvil Laberg; Svendsen, Edel Jannecke; Strand-Saugnes, Anine; Røe, Cecilie & Wade, Shari L. [Show all 13 contributors for this article] (2021). The Child in Context Intervention (CICI) Study: Protocol for a randomized controlled trial evaluating the effectiveness of a goal oriented and individualized rehabilitation for children with chronic acquired brain injury. Full text in Research Archive
• Øra, Hege Prag; Kirmess, Melanie & Becker, Frank (2020). Språktrening rett hjem - intensiv språktrening via videokonferanse. Afasiposten. ISSN 0803-2467. p. 12–14. Full text in Research Archive
• Kirmess, Melanie; H., Kristin Vanebo & Becker, Frank (2020). 10 års jubileum for Sunnaas intensive språkgrupper «SunCIST». Afasiposten. ISSN 0803-2467. p. 12–14. Full text in Research Archive
• Gjellesvik, Tor Ivar; Becker, Frank; Tjønna, Arnt Erik; Indredavik, Bent; Nilsen, Halvard Knut & Brurok, Berit [Show all 10 contributors for this article] (2019). HIGH-INTENSITY INTERVAL TRAINING AFTER STROKE (HIIT-STROKE STUDY) – EFFECTS ON PEAK OXYGEN UPTAKE – A RANDOMIZED CONTROLLED TRIAL. Full text in Research Archive
• Vege, Kristine Marie Mamen; Becker, Frank; Månum, Grethe & Sunnerhagen, Kathrina Stibrant (2026). Medical complications in children with moderate to severe acquired central nervous system injury. Universitetet i Oslo. ISSN 9788234808685. Full text in Research Archive Show summary

  This thesis investigates medical complications in children with moderate to severe acquired central nervous system (CNS) injury within pediatric rehabilitation medicine. The thesis explores what is known from the literature about medical complications after acquired CNS injury in children, how frequently such complications occur during and after inpatient rehabilitation, and what consequences they have for the rehabilitation process and for patients and caregivers after discharge. The work comprises one scoping review, one questionnaire-based survey, and one prospective cohort study. The survey included children who sustained CNS injury between 2 and 17 years of age and had received inpatient rehabilitation at Sunnaas Rehabilitation Hospital. The cohort study followed children aged 2-17 years during inpatient rehabilitation. The findings show that the literature mainly describes single complications in isolation, while comprehensive rehabilitation-oriented studies are scarce. In the patient studies, medical complications were common both during rehabilitation and in the months and years after injury. Frequently reported complications included sleep disturbances, pain, spasticity, constipation, infections, anemia, malnutrition, and overweight. Their occurrence was associated with longer length of stay. Although most complications had limited impact on the rehabilitation process, pain, malnutrition, infections, and spasticity were more often associated with interrupted or prolonged stays, altered rehabilitation goals, and poorer functional prognosis. After discharge, patients and caregivers reported that complications affected daily functioning, participation in leisure activities, and psychological well-being, and were time-consuming to manage. Overall, the thesis demonstrates that medical complications are common after acquired CNS injury in children and may have important consequences for rehabilitation, long-term functioning, and family life.

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