WASHINGTON — Patrick Doyle, PhD, has spent the last 31 years — the sum of his career as a communication disorder specialist — working with veterans struggling with aphasia. Aphasia is an acquired communication disorder typically caused by stroke, and is more common than Parkinson’s disease, cerebral palsy or muscular dystrophy, affecting approximately one million Americans.
After years of helping veterans recover their language skills following a stroke, Doyle is spearheading Pittsburgh VA’s Program for Intensive Residential Aphasia Treatment and Education (PIRATE) — a program that is slowly being recognized at VA as one of the most effective ways of assisting this cohort of veterans.
A Career Treating Stroke Victims
Doyle began his career at a VA neurobehavioral unit after getting his masters degree in speech language pathology. He was a trainee working toward a graduate degree focusing on communication science and disorders and workinsg with stroke victims.
Consequently, Doyle received a lot of up-close experience working with patients suffering from aphasia, which can range in severity from difficulty remembering words to being completely unable to speak, read or write. This experience helped kickstart a research career into communication disorders.
“I felt like I needed to understand better some of the mechanisms responsible for the communication problems I was seeing clinically,” he said.
His first merit review was funded in 1986 and looked at the cognitive mechanisms responsible for breakdowns in sentence processing. He also spent a brief period at the World Health Organization as a visiting scientist, helping create the group’s disability assessment schedule.
“It was that work that got me looking at more patient-centered outcomes in respect to clinical practice,” Doyle explained. “When I began at VA, we used to keep stroke survivors that had aphasia in the hospital, and we were able to deliver the treatment that they needed to recover and go on with their lives. But that has all changed.”
The move away from large inpatient facilities in the last decade means that stroke survivors are usually discharged without receiving the intensive communication therapy needed to treat aphasia.
“Once a stroke survivor can learn to dress themselves and move around, they are discharged. Then it’s up to them to obtain outpatient services for any other problems, including communications,” he said.
Veterans who have just spent a grueling time in the hospital recovering from a stroke are not in a hurry to go back, even as an outpatient. For those that did enter an outpatient program, there were high no-show rates, especially during winter months. The average treatment plan of 45-minute appointments two-to-three days a week was not a sufficient dose, Doyle said. “We were seeing poor outcomes and underserved veterans, because the service delivery model wasn’t meeting their needs.”
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