Screening by nurses for aphasia in stroke--the Ullevaal Aphasia Screening (UAS) test

PURPOSE

In Norway, the speech therapist is responsible for the assessment of language impairment after stroke, but many hospitals have no speech therapist. This study therefore developed and evaluated a simple method to be used by nurses to detect aphasia in the acute stage of stroke; the Ullevaal Aphasia Screening (UAS) test.

METHOD

The study was carried out among 37 stroke patients admitted to an acute stroke unit. They were assessed by nurses using the UAS, while the results of a comprehensive assessment by a speech therapist acted as the 'gold standard'.

RESULTS

The predictive value of a positive test was 0.67 and that of a negative test 0.93; only two out of 28 who screened negative on the UAS were diagnosed with mild aphasia by the speech therapist. The weighted kappa coefficient of agreement was 0.83, indicating a strong agreement between the nurses' and speech therapists' scoring. The screening took 5-15 minutes to complete.

CONCLUSION

The Ullevaal Aphasia screening test seems to be a short and valid screening instrument for aphasia in the acute stage of stroke, but further studies would be needed to substantiate the efficacy of the UAS test.

Pragmatics: right brain communication

Neuroscience nurses as well as other health care providers are called upon to assess and implement intervention strategies to assist clients and family members and significant others to communicate in the presence of communication deficits. Language, high level language skills and speech are frequently addressed in presentations and in the literature but pragmatics which includes prosody, attitude, emotions and gestural behaviors is rarely addressed. Pragmatic competence mediated by the right hemisphere, is an equally important and essential component of human communication. An understanding of pragmatics permits the neuroscience nurse to identify and evaluate pragmatic deficits so interventions to facilitate communication can be undertaken. Specifically prosody, that is melody, pause, intonation, stresses and accents, affective tone, subtle grades of meaning and varied emphasis; its components; and aprosodia (lack of prosody) will be discussed. Kinesics, that is limb, body and facial movements, and referred to as pantomime and gestures, will be examined also as will facial expression. Suggestions for pragmatic assessment and therapeutic nursing interventions will be given.

Stroke. Communication difficulties

This paper highlights the problem of non-fluid dysphasia and provides an overview of the complex physical, psychological and social dimension to consider when caring for this client group.

Aphasia: a care study

Aphasia is a term used to describe any deficit in the production or comprehension of speech. Damage to various parts of the brain can give rise to aphasia. The communication problems experienced by patients with aphasia present a unique challenge to the nurse. It is vital that all patients receive a proper assessment of their needs. A holistic approach is required. Nurses should be non-judgmental in their approach and remember the person behind the aphasia.

The Peyote way: implications for Culture Care theory

The development and provision of culturally sensitive and meaningful nursing care is a challenging yet essential element in our rapidly changing health care environment. This article describes the use of the theory of Culture Care to assess, understand, and plan care for an aphasic Navajo man who followed very traditional ways. It is an example of how nursing praxis can be applied to a clinical setting. A description of a Navajo peyote ceremony serves to illustrate the importance of incorporating traditional healing practices into nursing and collaborative care for individuals from diverse culture backgrounds. It also describes how the participation in the Native American Church benefitted the client and his family. By using the Culture Care theory, the authors were able to make predictions about the influences of a culture specific expression, the peyote ceremony, had on the client's care.

Psychological responses in aphasia: theoretical considerations and nursing implications

Patients experiencing aphasia from brain damage due to cerebrovascular accident or craniocerebral trauma manifest psychological and behavioral changes resulting from communication deficits. Although literature is controversial regarding the etiology of the psychological responses, the major determinant of these responses depends upon the premorbid personality. Specific nursing diagnoses focusing on communication, knowledge deficits and grieving are presented with suggested interventions.

Guidelines for treatment of chronic depression in the aphasic patient

This article defines the language disorder of aphasia and the motor speech disorders of apraxia of speech and the dysarthrias. Discussion includes depression and the five definable sets of behaviors related to the phenomenon: motor-expressive behaviors, affective, cognitive, motivational, and somatic, and the relationship of self-concept to both depression and visual and verbal thought. Detailed discussion of treatment of chronic depression inpatients with non-organic reactive factors is presented. These include positive reinforcement of desirable behaviors, avoidance of verbal punishment, labeling the disorder for the client and family, and time structuring or scheduling to assist in motivation. In addition, implementation of support from family, friends, and social relationships, tolerance of expressions of frustration and anger by the client, and environmental manipulation are considered therapeutic interventions.