Daytime Sleepiness, Exertion Fatigue, and Task Vigilance in Persons with Aphasia
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1
Syracuse University, United States
Severe fatigue is a daily concern for millions of individuals who have experienced a stroke. Clinician reports have suggested that fatigue-related symptoms may impact progress in treatment (Riley, 2016), but fatigue is not typically measured in clinical practice. Standard practice for identifying fatigue involves subjective, questionnaire-based assessments (Shen et al., 2006); however, physiological measures (e.g., EEG) can be used to measure correlates of fatigue (e.g., task vigilance) and provide an alternative to using language-based assessments in persons with aphasia. The objective of this study was to quantify daytime sleepiness, exertion fatigue, and task vigilance in persons with aphasia. We sought to determine if persons with aphasia report higher levels of sleepiness and exertion fatigue and/or demonstrate lower levels of physiologically-measured task vigilance than age-matched control participants during a language therapy task.
We measured sleepiness, exertion fatigue, and task vigilance in 10 participants with aphasia and 10 age-matched control participants. To measure sleepiness, we administered the Epworth Sleepiness Scale (ESS; Johns, 1991), a tool that asks participants to self-assess their tendency to fall asleep in typical situations (e.g., sitting and reading, watching television). To measure exertion fatigue, we administered the Visual Analog Fatigue Scale (VAFS, Tseng, Gajweski, & Kluding, 2010) before and after a 75-minute session of computer-administered language treatment. To measure task vigilance, EEG was continuously recorded throughout the session. For analysis, EEG data for each treatment trial were classified into one of four levels of vigilance (high, low, distracted, sleepy) using a classification algorithm (Berka et al., 2004) customized to each participant using data collected during a series of baseline tasks.
Both groups showed a significant increase in VAFS score from pre- to post-session, suggesting that all participants experienced exertion fatigue. We did not find significant differences in ESS scores across groups, indicating that participants with aphasia did not report more daytime sleepiness than controls. For controls, there was a significant negative correlation between ESS score and post-session VAFS score, meaning that those with lower ESS scores were more likely to have higher post-session VAFS scores. Participants with aphasia showed a different pattern, with high post-session VAFS scores regardless of ESS score. This suggests that even when control participants reported having feelings of daytime sleepiness, they were better able to tolerate the 75-minute session without experiencing much fatigue. Counter to our hypothesis, participants with aphasia spent most of the session in a state of high vigilance, whereas controls spent most of the session in a state of low vigilance (Figure 1). This pattern suggests that maintaining a state of high vigilance is necessary when the task is perceived to be more challenging. Control participants do not have difficulty with language and subsequently do not need to maintain high levels of vigilance to perform the task; however, participants with aphasia inherently demonstrate difficulty with language and must be in a state of high vigilance in order to complete the session.
Acknowledgements
This project was funded by an ASHFoundation New Investigator Research Grant (PI: Riley). The authors would like to thank Madelyn Brouillard for assistance with data analysis.
References
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Keywords:
Aphasia,
Fatigue,
vigilance,
sleepiness,
EEG
Conference:
Academy of Aphasia 56th Annual Meeting, Montreal, Canada, 21 Oct - 23 Oct, 2018.
Presentation Type:
poster presentation
Topic:
not eligible for a student prize
Citation:
Riley
E,
Anderson
A,
Birenbaum
L,
McCleary
J and
Wu
Y
(2019). Daytime Sleepiness, Exertion Fatigue, and Task Vigilance in Persons with Aphasia.
Conference Abstract:
Academy of Aphasia 56th Annual Meeting.
doi: 10.3389/conf.fnhum.2018.228.00081
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Received:
26 Apr 2018;
Published Online:
22 Jan 2019.
*
Correspondence:
Dr. Ellyn Riley, Syracuse University, Syracuse, United States, earil100@syr.edu