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Laures-Gore J, Freestone EJ, Griffey HW, Lesandrini J, James-Jones R, Reis D. Aphasia Awareness Among Spiritual Healthcare Providers in the United States. JOURNAL OF RELIGION AND HEALTH 2024:10.1007/s10943-024-02123-3. [PMID: 39287880 DOI: 10.1007/s10943-024-02123-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/29/2024] [Indexed: 09/19/2024]
Abstract
Spiritual healthcare providers (e.g., chaplains) working in healthcare settings across the United States were surveyed with the goals of (1) understanding their awareness of aphasia (a language disorder affecting reading, writing, verbal communication, and auditory comprehension); (2) determining whether they have received any training in aphasia and what type of training has been received; (3) whether they altered their approach to assessing the spiritual well-being of a person with aphasia; and, (4) what tools were used to augment communication. From a convenience sample of 203 respondents, the results indicated that 96% of respondents had previously heard of aphasia and 85% of respondents correctly identified the definition of aphasia. Seventy-three percent of respondents (N = 128) altered their approach to spiritual well-being assessment due to the aphasia diagnosis. Most respondents did not indicate receiving any formal training related to aphasia.
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Affiliation(s)
- Jacqueline Laures-Gore
- Department of Communication Sciences and Disorders, Georgia State University, PO Box 3979, Atlanta, GA, 30302-3979, USA.
| | - Erica Johns Freestone
- Department of Communication Sciences and Disorders, Georgia State University, PO Box 3979, Atlanta, GA, 30302-3979, USA
| | - Hannah Wendel Griffey
- Department of Communication Sciences and Disorders, Georgia State University, PO Box 3979, Atlanta, GA, 30302-3979, USA
| | | | | | - David Reis
- Wellstar Health System, Atlanta, GA, USA
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Hernandez NJ, Pettigrove K, Mellahn K, Isaksen JK, Pierce JE, Rose ML. Carers in post-stroke aphasia: a scoping review of interventions and outcomes beyond communication partner training. Disabil Rehabil 2024:1-12. [PMID: 39259192 DOI: 10.1080/09638288.2024.2399221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 07/25/2024] [Accepted: 08/28/2024] [Indexed: 09/12/2024]
Abstract
PURPOSE Carers of people with aphasia face unique challenges. Research has demonstrated that these carers have a higher burden of care and more negative stroke-related outcomes in comparison to carers of stroke survivors without aphasia. The aim of this scoping review was to map the range of interventions for carers other than communication partner training and to examine their outcomes. MATERIALS AND METHODS We conducted a scoping review on this topic. RESULTS Twenty studies were included. Most studies were case series with four randomised control trials. Both quantitative and qualitative approaches were used. Most studies occurred during the long-term phase of care. Two interventions had only carers as participants. Interventions were comprised of different combinations of intervention components including psychoeducation, skill-building, and support. There was high variability on who led the interventions, the format, and the dose/schedule. Twenty-eight different outcome measures for carers and dyads were used across various domains with overall positive outcomes post-intervention. CONCLUSIONS This review uncovered a wide range of formats, dosages, and outcome measures in interventions for carers. Encouragingly, the majority of these interventions included psychoeducation, skill-building, and support components. While most studies were case series, there are promising interventions that have the potential to enhance carer wellbeing.
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Affiliation(s)
- Nelson J Hernandez
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia
- Centre for Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University, Melbourne, Australia
| | - Kathryn Pettigrove
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia
- Centre for Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University, Melbourne, Australia
| | - Kathleen Mellahn
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia
- Centre for Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University, Melbourne, Australia
| | | | - John E Pierce
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia
- Centre for Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University, Melbourne, Australia
| | - Miranda L Rose
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia
- Centre for Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University, Melbourne, Australia
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Kelleher K, Obermeyer J, Crutchley S, Stalker S, Silverman M, Morrow-Odom KL. Knowledge, Beliefs, and Experiences With Mental Health Services and Help-Seeking in People With Aphasia and Care Partners. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2024:1-28. [PMID: 39121506 DOI: 10.1044/2024_ajslp-23-00365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/11/2024]
Abstract
PURPOSE Supporting psychological well-being in persons with aphasia (PWA) can improve social and health outcomes; however, PWA and their care partners (CPs) are often not receiving mental health support. Previous research explores this from the perspective of health care professionals. AIMS The aim of this study was to examine knowledge, beliefs, and experiences related to mental health services directly from PWA and CPs. METHOD The study included 11 PWA and 11 CPs. Participants completed a guided survey (virtual) with opportunities for elaboration related to the knowledge, beliefs, and experiences of mental health. RESULTS There was variability in personal preferences for referrals, types of coping strategies, and confidants for general thoughts and feelings and those specific to aphasia. PWA identified health care professionals as people to share thoughts and feelings, whereas CPs chose family and friends more often. Both CPs and PWA reported communication difficulty and finding a counselor as "sometimes" preventing access to services but cited fear and trust as "always" preventing access. CONCLUSIONS Knowledge, beliefs, and experience with help-seeking and mental health services are personal and variable. Assessing barriers unique to living with aphasia, such as communication challenges and locating a suitable counselor, must also be considered within more complex and personal barriers of fear and trust that are consistently reported in the general public. Health professionals across the continuum of aphasia care need to understand the communication challenges of living with aphasia in tandem with understanding individual differences to personalize approaches to mental health services and help-seeking.
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Affiliation(s)
- Kate Kelleher
- Department of Communication Sciences and Disorders, Western Carolina University, Cullowhee, NC
- Department of Communication Sciences and Disorders, University of North Carolina at Greensboro
| | - Jessica Obermeyer
- Department of Communication Sciences and Disorders, University of North Carolina at Greensboro
| | - Sena Crutchley
- Department of Communication Sciences and Disorders, University of North Carolina at Greensboro
| | - Sage Stalker
- Department of Communication Sciences and Disorders, University of North Carolina at Greensboro
| | | | - K Leigh Morrow-Odom
- Department of Communication Sciences and Disorders, Western Carolina University, Cullowhee, NC
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Odendaal I, Tönsing KM. Augmentative and alternative communication for individuals with post-stroke aphasia: perspectives of South African speech-language pathologists. Augment Altern Commun 2024:1-9. [PMID: 38995208 DOI: 10.1080/07434618.2024.2374303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 06/25/2024] [Indexed: 07/13/2024] Open
Abstract
This qualitative study aimed to describe speech-language pathologists' (SLPs') perspectives on augmentative and alternative communication (AAC) use for people with post-stroke aphasia focusing on: (a) current AAC practice, (b) factors that influence the use of AAC, and (c) the success and relevance of AAC interventions. Semi-structured interviews took place with ten South African SLPs with experience in aphasia intervention. The transcribed interviews were thematically analyzed using a six-phase process of inductive and deductive analysis within a phenomenological framework. All the participants use AAC with their clients, employing a variety of approaches that reflect their diverse settings, experiences, and perspectives on AAC. AAC use is complex, and SLPs make conscious choices considering multiple factors. Barriers to use were often associated with limited resources in the low- and middle-income country (LMIC) context, but most participants retained a positive view of AAC, actively working to circumvent barriers to use. Participants consistently emphasized the vital role of partners in communication interactions, linked to the importance of defining AAC broadly. It is necessary to advance the integration of AAC into rehabilitation plans to improve communication and social participation outcomes for people with post-stroke aphasia, especially in LMICs such as South Africa.
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Affiliation(s)
- Inge Odendaal
- Centre for Augmentative and Alternative Communication, University of Pretoria, Pretoria, South Africa
| | - Kerstin M Tönsing
- Centre for Augmentative and Alternative Communication, University of Pretoria, Pretoria, South Africa
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Jewell CC, Harnish SM, Brello J, Lanzi AM, Cohen ML. Poststroke Communication Ability Predicts Patient-Informant Discrepancies in Reported Activities and Participation. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2024; 33:1854-1867. [PMID: 38625105 DOI: 10.1044/2024_ajslp-23-00322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/17/2024]
Abstract
BACKGROUND Participation in life situations has been identified by people with aphasia (PWA) as an ultimate outcome of rehabilitation and is often measured with patient-reported outcome measures (PROMs) or informant-reported measures. It is known that PWA and informants do not always produce similar scores on measures of activities and participation. However, systematic differences between PWA and informants and the causes of these differences are not well understood. Here, we investigated these differences as a function of language impairment, perceived level of activity and participation success, and depressive symptoms. METHOD Participants were 29 PWA-informant dyads who completed a performance-based language assessment and three measures related to different aspects of activities and participation. Outcome variables were PWA-informant difference scores in the activities and participation measures. RESULTS PWA ratings of activities and participation were not statistically significantly associated with performance-based language severity. Hierarchical regression models with both language impairment and informant-reported scores as predictor variables explained 53%-71% of the variance in PWA-informant difference scores (all p < .05). In particular, mild communication challenges were associated with the PWA reporting significantly worse participation than the informant perceived. In contrast, more severe communication challenges were associated with the PWA reporting significantly better participation than the informant perceived. DISCUSSION These findings highlight the importance of measuring participation by PROM. The PWA's experience of participation is not related to their level of language impairment and is predictably different from their care partners' perspective. As others have also reported, "mild" aphasia is not so mild to the PWA. Similarly, "severe" may not be so severe to the PWA. Further research is needed to connect these findings with counseling and caregiver education. Research on response processes (e.g., response shift) is also warranted.
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Affiliation(s)
- Courtney C Jewell
- Department of Speech and Hearing Science, The Ohio State University, Columbus
| | - Stacy M Harnish
- Department of Speech and Hearing Science, The Ohio State University, Columbus
| | - Jennifer Brello
- Department of Speech and Hearing Science, The Ohio State University, Columbus
| | - Alyssa M Lanzi
- Department of Communication Sciences and Disorders, University of Delaware, Newark
- Delaware Center for Cognitive Aging Research, Newark
| | - Matthew L Cohen
- Department of Communication Sciences and Disorders, University of Delaware, Newark
- Delaware Center for Cognitive Aging Research, Newark
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Fitzmaurice Y, Beeke S, Isaksen J, Cunningham U, Jagoe C, Shé ÉN, McMenamin R. Communication partner training for student health and social care professionals engaging with people with stroke acquired communication difficulties: A protocol for a realist review. HRB Open Res 2024; 6:60. [PMID: 38384971 PMCID: PMC10879762 DOI: 10.12688/hrbopenres.13783.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/26/2024] [Indexed: 02/23/2024] Open
Abstract
Background Stroke acquired communication impairments impede effective communication. Consequently, in stroke care, communicative interactions can be challenging for both patients and staff and can predispose patients to increased risk of preventable adverse events. Communication partner training (CPT) can mitigate such negative outcomes by optimising communicative interactions. Providing CPT to student health and social care professionals (SH&SCPs) has the potential to enhance their clinical expertise and experiences and enhance the future clinical care of patients with stroke acquired communication impairments. This research aims to expand our understanding of how CPT is operationalised for SH&SCPs in higher education institutions and determine: what works; for whom; in what contexts; how and why? Methods This review is Phase 1 of a research project employing a realist approach with public and patient involvement (PPI). It incorporates five iterative steps: 1.) Clarifying the scope; 2.) Searching for evidence; 3.) Selecting and appraising evidence; 4.) Data extraction; 5.) Synthesising data and developing a middle range theory explaining how CPT is expected to work for SH&SCPs. An advisory panel, including PPI advisors, content advisors, student advisors, realist advisors and educationalist advisor has been set up to consult throughout the review and collaboratively agree the middle range theory. Discussion While there is an evolving evidence base for CPT, including stroke specific CPT for SH&SCPs, it is acknowledged that there are challenges to its implementation in complex real-world settings. In combining empirical evidence with theoretical understanding, realist review permits synthesis of data from diverse sources and goes beyond determining efficacy to explore generative causation and solutions for real world practice. A middle range realist programme theory that coherently explains how CPT is expected to work when teaching SH&SCPs to communicate with people with stroke acquired communication impairments will provide educators with new insights into CPT development and implementation in their higher education institutions.
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Affiliation(s)
- Yvonne Fitzmaurice
- School of Health Sciences, University of Galway, Galway, H91 TK33, Ireland
| | - Suzanne Beeke
- Division of Psychology and Language Sciences, University College London, London, England, WC1E 6BT, UK
| | - Jytte Isaksen
- Department of Language, Culture, History and Communication, University of Souhern Denmark, Odense, Denmark
| | - Una Cunningham
- Mater Misericordiae University Hospital, Dublin, D07 R2WY, Ireland
| | - Caroline Jagoe
- School of Linguistics, Speech and Communication Sciences, The University of Dublin Trinity College, Dublin, Leinster, D02 PN40, Ireland
- Speech Pathology and Audiology, School of Human and Communication Development, University of Witwatersrand, Johannesburg, South Africa
| | - Éidín Ní Shé
- Graduate School of Healthcare Management, RCSI University of Medicine and Health Sciences, Dublin, D02 YN77, Ireland
| | - Ruth McMenamin
- School of Health Sciences, University of Galway, Galway, H91 TK33, Ireland
- PPI Ignite Network @ University of Galway, University of Galway, Galway, H91 TK33, Ireland
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Privitera AJ, Ng SHS, Kong APH, Weekes BS. AI and Aphasia in the Digital Age: A Critical Review. Brain Sci 2024; 14:383. [PMID: 38672032 PMCID: PMC11047933 DOI: 10.3390/brainsci14040383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Revised: 04/11/2024] [Accepted: 04/14/2024] [Indexed: 04/28/2024] Open
Abstract
Aphasiology has a long and rich tradition of contributing to understanding how culture, language, and social environment contribute to brain development and function. Recent breakthroughs in AI can transform the role of aphasiology in the digital age by leveraging speech data in all languages to model how damage to specific brain regions impacts linguistic universals such as grammar. These tools, including generative AI (ChatGPT) and natural language processing (NLP) models, could also inform practitioners working with clinical populations in the assessment and treatment of aphasia using AI-based interventions such as personalized therapy and adaptive platforms. Although these possibilities have generated enthusiasm in aphasiology, a rigorous interrogation of their limitations is necessary before AI is integrated into practice. We explain the history and first principles of reciprocity between AI and aphasiology, highlighting how lesioning neural networks opened the black box of cognitive neurolinguistic processing. We then argue that when more data from aphasia across languages become digitized and available online, deep learning will reveal hitherto unreported patterns of language processing of theoretical interest for aphasiologists. We also anticipate some problems using AI, including language biases, cultural, ethical, and scientific limitations, a misrepresentation of marginalized languages, and a lack of rigorous validation of tools. However, as these challenges are met with better governance, AI could have an equitable impact.
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Affiliation(s)
- Adam John Privitera
- Centre for Research and Development in Learning, Nanyang Technological University, Singapore 637335, Singapore;
| | - Siew Hiang Sally Ng
- Centre for Research and Development in Learning, Nanyang Technological University, Singapore 637335, Singapore;
- Institute for Pedagogical Innovation, Research, and Excellence, Nanyang Technological University, Singapore 637335, Singapore
| | - Anthony Pak-Hin Kong
- Academic Unit of Human Communication, Learning, and Development, The University of Hong Kong, Pokfulam, Hong Kong;
- Aphasia Research and Therapy (ART) Laboratory, The University of Hong Kong, Pokfulam, Hong Kong
| | - Brendan Stuart Weekes
- Faculty of Education, The University of Hong Kong, Pokfulam, Hong Kong
- Melbourne School of Psychological Sciences, University of Melbourne, Parkville 3010, Australia
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Watanabe M, Cartwright J, Pierce JE. Positive effects of speech and language therapy group interventions in primary progressive aphasia: A systematic review. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2024. [PMID: 38602276 DOI: 10.1111/1460-6984.13031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 03/08/2024] [Indexed: 04/12/2024]
Abstract
BACKGROUND Primary progressive aphasia (PPA) is a neurodegenerative condition characterised by a prominent and progressive deterioration in language abilities, which significantly impacts quality of life and interpersonal relationships. Speech and language therapy plays a crucial role in offering interventions. Group intervention is one mode of delivery that could benefit communication functioning and overall wellbeing of people with PPA (pwPPA) and their care partners. Group interventions are also more efficient than one-to-one intervention and may facilitate peer support. AIMS The aim of this review was to systematically evaluate the current evidence for the effectiveness of speech and language therapy groups for pwPPA and their care partners. Specifically, this paper considered three questions: 1.What evidence-based speech and language therapy groups for pwPPA and their care partners have been reported to date? 2.Are group communication interventions effective in improving quality of life and communication function for pwPPA and their care partners? 3.Are group communication interventions that are designed for people with communication difficulties of other aetiologies (such as stroke) effective for pwPPA? In addition, this review aimed to describe the structure and content of groups, including aims, disciplines involved, size and frequency of group meetings, and outcome measures. METHODS MEDLINE, CINAHL and PsycINFO were used to retrieve articles of interest. A total of 10 studies published between 2009 and 2022 met the eligibility criteria and therefore were included in this study. Data were extracted from the articles regarding the structure and content of groups. MAIN CONTRIBUTION Although evidence is currently limited, results suggest that speech and language therapy group intervention can improve specific linguistic processes, the use of communication strategies and psychosocial well-being. The importance of multidisciplinary input and care partners' involvement in groups was highlighted, along with the benefits of creative non-verbal activities as tools for self-expression. There is also initial evidence that telehealth group provision and one-off group sessions may be feasible and can benefit psychosocial well-being. Lastly, intentional recruitment and explicit education on different aphasia types are described as important when pwPPA participate in groups with mixed diagnoses. CONCLUSIONS The literature on speech and language therapy group interventions for PPA shows promise of positive effects on communication function and psychosocial well-being of both pwPPA and their care partners. Speech and language therapists can consider these published interventions when designing and implementing similar groups, but more robust evidence is required to confirm the relative effectiveness of this approach. WHAT THIS PAPER ADDS What is already known on this subject Speech pathology led group intervention shows some promise in benefitting communication functioning and overall well-being of pwPPA and their carers, but there has been no systematic evaluation of all the evidence regarding the efficacy of speech and language therapy led groups. Establishing feasibility, acceptability and efficacy of speech and language therapy group interventions for pwPPA and their carers may present a valuable addition for managing this progressive language disability. What this paper adds to existing knowledge Although evidence is currently limited, results from this systematic review suggest that speech and language therapy led group intervention can improve specific linguistic processes, the use of communication strategies and psychosocial well-being for pwPPA and their carers. The importance of multidisciplinary input and carers' involvement in groups was highlighted, along with the benefits of creative non-verbal activities as tools for self-expression. There is also initial evidence that telehealth group provision for carers may be feasible and can benefit psychosocial wellbeing. Lastly, intentional recruitment and explicit education on different aphasia types are described as important when pwPPA participate in groups with mixed diagnoses. What are the potential or actual clinical implications of this work? A synthesis of the evidence base for speech and language therapy led PPA groups, as well as a description of the group components and formats, will be valuable for clinical service planning, and will guide future examination of group options for pwPPA and their carers. Speech and language therapists can also consider the research findings from this systematic review when designing and implementing similar groups in their local context.
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Affiliation(s)
| | - Jade Cartwright
- School of Health Sciences, College of Health and Medicine, University of Tasmania, Launceston, Australia
| | - John E Pierce
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University, Melbourne, Victoria, Australia
- Speech Pathology, La Trobe University, Melbourne, Victoria, Australia
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Power E, Attard MC, Lanyon LE, Togher L. Efficacy of online communication partner training package for student healthcare professionals. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2024; 59:304-326. [PMID: 37661291 PMCID: PMC10952497 DOI: 10.1111/1460-6984.12947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Accepted: 07/30/2023] [Indexed: 09/05/2023]
Abstract
BACKGROUND People with aphasia are vulnerable recipients of healthcare. The nature of the communicative environment and the communication disability can adversely impact access to timely and quality healthcare. Student healthcare professionals are often underprepared to interact successfully with people with aphasia and may benefit from communication partner training (CPT). AIMS To investigate the potential effectiveness and acceptability of a brief, two-part introductory Supported Conversation for Adults with Aphasia (SCA™)-based CPT package, delivered to a sample of students across a diverse range of healthcare disciplines. METHODS & PROCEDURES A pre-post-within group experimental design was used to investigate the potential effectiveness and acceptability of an online CPT package (50 minute module + 1 hour workshop) for healthcare students. The Aphasia Attitudes, Strategies and Knowledge (AASK) survey measured participants' knowledge of aphasia, facilitative communication strategies and attitudes towards people with aphasia. Data were collected pre-training, following the training module and following the workshop, and 6 weeks post-training. Statistical analysis was conducted on the AASK data. In addition, participant feedback (ratings and open text responses) was collected after the workshop. Ratings were analysed descriptively, and thematic content analysis was used for open text responses. OUTCOMES & RESULTS 236 participants completed the pre-training AASK and 106 completed the AASK at subsequent time points. Statistically significant gains were demonstrated from pre- to post-module completion. Between the end of the module and the end of the workshop, some gains were maintained and others showed further statistically significantly improvements. While all gains were not maintained at the 6-week follow-up, statistically significantly improvements from pre-training scores remained evident. Student feedback was predominantly positive, with suggested improvements for training content and length. CONCLUSIONS & IMPLICATIONS The results provide preliminary evidence that a brief, online CPT package can support student healthcare professionals' knowledge and attitudes towards aphasia and communicating with people with aphasia. Online training was acceptable to students and feasible as an embedded or optional component of curriculum. Ongoing training (e.g., in the form of refresher sessions) and inclusion of a skills-based component are recommended to maximize communication skill development. WHAT THIS PAPER ADDS What is already known on the subject Student healthcare professionals recognize the need to develop knowledge and skills to successfully support people with communication disability, such as aphasia, to participate effectively in their healthcare. Evidence in favour of online communication partner training for student healthcare professionals is currently limited. What this study adds to the existing knowledge This study demonstrates that a brief introductory online communication partner training program can be efficacious for improving knowledge and attitudes regarding communicating with people who have aphasia. What are the potential or actual clinical implications of this work? Students will likely need further ongoing refresher training with inclusion of practical components to develop and maintain the knowledge and skills required to be proficient communication partners with people with aphasia.
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Affiliation(s)
- Emma Power
- University of Technology SydneySydneyNSWAustralia
- Centre of Research Excellence in Aphasia Recovery and RehabilitationLa Trobe UniversityMelbourneVICAustralia
| | - Michelle C. Attard
- Centre of Research Excellence in Aphasia Recovery and RehabilitationLa Trobe UniversityMelbourneVICAustralia
- La Trobe UniversityMelbourneVICAustralia
- The University of SydneySydneyNSWAustralia
| | - Lucette E. Lanyon
- Centre of Research Excellence in Aphasia Recovery and RehabilitationLa Trobe UniversityMelbourneVICAustralia
- La Trobe UniversityMelbourneVICAustralia
| | - Leanne Togher
- Centre of Research Excellence in Aphasia Recovery and RehabilitationLa Trobe UniversityMelbourneVICAustralia
- The University of SydneySydneyNSWAustralia
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Kagan A, Simmons-Mackie N, Villar-Guerrero E, Chan MT, Turczyn I, Victor JC, Shumway E, Chan L, Cohen-Schneider R, Bayley M. Improving communicative access and patient experience in acute stroke care: An implementation journey. JOURNAL OF COMMUNICATION DISORDERS 2024; 107:106390. [PMID: 38103420 DOI: 10.1016/j.jcomdis.2023.106390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 10/19/2023] [Accepted: 11/09/2023] [Indexed: 12/19/2023]
Abstract
INTRODUCTION Patient experience for people with aphasia/families in acute care is frequently reported as negative, with communication barriers contributing to adverse events and significant long-term physical and psychosocial sequelae. Although the effectiveness of providing supported communication training and resources for health care providers in the stroke system is well documented, there is less evidence of implementation strategies for sustainable system change. This paper describes an implementation process targeting two specific areas: 1) improving Stroke Team communication with patients with aphasia, and 2) helping the Stroke Team provide support to families. The project aimed for practical sustainable solutions with potential contribution toward the development of an implementation practice model adaptable for other acute stroke contexts. METHODS The project was designed to create a communicatively accessible acute care hospital unit for people with aphasia. The process involved a collaboration between a Stroke Team covering two units/wards led by nurse managers (19 participants), and a community-based Aphasia Team with expertise in Supported Conversation for Adults with Aphasia (SCA™) - an evidence-based method to reduce language barriers and increase communicative access for people with aphasia. Development was loosely guided by the integrated knowledge translation (iKT) model, and information regarding the implementation process was gathered in developmental fashion over several years. OUTCOMES Examples of outcomes related to the two target areas include provision of accessible information about aphasia to patients as well as development of two new products - a short virtual SCA™ eLearning module relevant to acute care, and a pamphlet for families on how to keep conversation alive. Potential strategies for sustaining a focus on aphasia and communicative access emerged as part of the implementation process. CONCLUSIONS This implementation journey allowed for a deeper understanding of the competing demands of the acute care context and highlighted the need for further work on sustainability of communicative access interventions for stroke patients with aphasia and their families.
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Affiliation(s)
- Aura Kagan
- Aphasia Institute, 73 Scarsdale Road, Toronto, Ontario M3B 2R2, Canada; University of Toronto, Faculty of Medicine, Department of Speech-Language Pathology, Rehabilitation Sciences Building, 160-500 University Avenue, Toronto, Ontario M5G 1V7, Canada.
| | - Nina Simmons-Mackie
- Southeastern Louisiana University, Department of Health & Human Sciences, White Hall, Room 206, 310W Dakota Street, SLU Box 10863, Hammond, Louisiana 70402, USA
| | - Elizabeth Villar-Guerrero
- North York General Hospital, General Medicine (7SE) & Neurology / Stroke (8SE), 4001 Leslie Street, Toronto, Ontario M2K 1E1, Canada
| | - Melodie T Chan
- Aphasia Institute, 73 Scarsdale Road, Toronto, Ontario M3B 2R2, Canada.
| | - Ilona Turczyn
- North York General Hospital, 5WEST General Medicine, 4001 Leslie Street, Toronto, Ontario, M2K 1E1, Canada
| | - J Charles Victor
- ICES - Institute for Clinical Evaluative Sciences, 2075 Bayview Ave., Toronto, Ontario M4N 3M5, Canada; University of Toronto, Institute of Health Policy, Management and Evaluation, Health Sciences Building, 155 College Street, Suite 425, Toronto, Ontario M5T 3M6, Canada
| | - Elyse Shumway
- Aphasia Institute, 73 Scarsdale Road, Toronto, Ontario M3B 2R2, Canada
| | - Lisa Chan
- Aphasia Institute, 73 Scarsdale Road, Toronto, Ontario M3B 2R2, Canada
| | | | - Mark Bayley
- Toronto Rehabilitation Institute, The University Centre, Room 3-131, 550 University Avenue, Toronto, Ontario M5G 2A2, Canada
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Barberis M, Vandermosten M. The role of education, concept knowledge, work setting and clinical experience in communication partner training: A survey of Flemish speech and language therapists. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2023; 58:2117-2130. [PMID: 37408507 DOI: 10.1111/1460-6984.12928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 06/18/2023] [Indexed: 07/07/2023]
Abstract
BACKGROUND Aphasia can affect the communication between the person with aphasia (PWA) and the communication partner (CP). It is therefore necessary to support both the PWA and their CPs. Communication partner training (CPT) focuses on training communication between dyads of whom one person has aphasia. Although there is increasing evidence supporting CPT as an effective intervention to improve communication and reduce the psychosocial consequences of stroke, implementation in clinical practice remains limited. AIM To understand the mechanisms behind the practice-evidence gap currently hindering CPT implementation, this study investigated the role of (1) education, (2) concept knowledge, (3) work setting and (4) clinical experience in CPT. METHODS & PROCEDURES Flemish speech and language therapists (SLTs) clinically involved in aphasia rehabilitation were surveyed online regarding CPT. Statistical analyses include descriptive statistics to report survey results and non-parametric group comparisons to investigate the role of the four variables on CPT. OUTCOMES & RESULTS In this study 72 SLTs were included, of whom 73.61% indicated they deliver CPT but of whom only 43.10% indicated CP presence during therapy. The most frequently identified barriers to CPT delivery were lack of time and CPT-specific knowledge. Other barriers were lack of resources, work setting dependent factors, PWA or CP dependent factors, individual therapy to the PWA being of higher priority, existing CPT methods and interventions being perceived as unclear and feeling uncertain about CPT delivery. Concerning the role of the four variables on CPT delivery, neither education nor concept knowledge had a significant effect on CPT delivery. Work setting and clinical experience did, however, influence CPT delivery. More specifically, CPT delivery and CP presence were higher in the private practice (chronic phase) compared to the other three settings and experienced SLTs deliver CPT more often compared with less experienced SLTs. CONCLUSIONS & IMPLICATIONS To reduce the practice-evidence gap, we suggest prioritising the two most frequently identified barriers, that is, lack of time and CPT-specific knowledge. To overcome the time barrier in CPT, we propose implementing automated natural speech analysis to reduce the workload. To enhance CPT-specific knowledge, speech and language therapy curricula should provide more in-depth theory and hands-on practice for CPT. In addition, increased awareness about CPT-specific methods is needed to further support clinical practice. WHAT THIS PAPER ADDS What is already known on the subject Communication partner training (CPT) is an effective intervention to improve communication and reduce the psychosocial consequences of stroke. Despite this evidence base, a current practice-evidence gap exists. What this study adds This is the first study to characterise CPT delivery in a Flemish cohort of speech and language therapists (SLTs). In addition, on a more international perspective, few studies have investigated the role of education, concept knowledge, work setting and clinical experience in CPT. We found that neither education nor concept knowledge has a significant effect on CPT delivery. CPT delivery and communication partner presence are significantly higher in the private practice compared to the hospital, rehabilitation centre or nursing home settings. Experienced SLTs deliver CPT more often compared with less-experienced SLTs. The two most prominent reported barriers include lack of time and CPT-specific knowledge. What are the clinical implications of this work? This study suggests reducing the practice-evidence gap by alleviating the main barriers identified, that is, lack of time and CPT-specific knowledge. Time-barriers can be addressed by implementing automated natural speech analyses. We additionally advocate for more in-depth theory and hands-on practice for CPT in speech and language therapy curricula.
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Affiliation(s)
- Mara Barberis
- Experimental Otorhinolaryngology (ExpORL), Department of Neurosciences, Faculty of Medicine, KU Leuven, Leuven, Belgium
| | - Maaike Vandermosten
- Experimental Otorhinolaryngology (ExpORL), Department of Neurosciences, Faculty of Medicine, KU Leuven, Leuven, Belgium
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Nikkels A, Berns P, Neijenhuis K. Communication partner training for SLT students: Changes in communication skills, knowledge and confidence. JOURNAL OF COMMUNICATION DISORDERS 2023; 105:106366. [PMID: 37541131 DOI: 10.1016/j.jcomdis.2023.106366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 07/12/2023] [Accepted: 07/13/2023] [Indexed: 08/06/2023]
Abstract
This paper describes the changes in communication skills, knowledge and confidence in Speech Language Therapy (SLT) students in conversations with People With Aphasia (PWA) after Training Con-tAct, a Dutch Communication Partner Training. METHODS On a voluntary basis, nine SLT students (2nd yr) completed Training Con-tAct, in which People With Aphasia (PWA) were involved as co-workers. A mixed method design with pre- and post-measures was used to analyze the students' communication skills, knowledge and confidence. A quantitative video analysis was used to measure changes in students' communication skills. Besides, a self-report questionnaire was used to measure the changes in students' knowledge and confidence regarding their communication with PWA. To evaluate the perspectives of the students on Training Con-tAct, additionally a focus group interview was held. RESULTS Regarding students' communication skills the outcomes revealed a significantly higher score on the 'supporting' competence in students who took part in Training Con-tAct. The mean scores for the 'acknowledging' and 'checking information' competences did not improve significantly. The outcomes of the questionnaire showed students gained more knowledge and confidence regarding communication with PWA. The focus group interview provided insights into: motivation for participating in Communication Partner Training, content and structure of the training, feedback in CPT, and learning experiences. CONCLUSION The present study suggests that SLT students may benefit from Training Con-tAct as the training leads to better skills, more knowledge about aphasia and more confidence in communicating with PWA. Training Con-tAct could be a valuable addition to the curricula of all healthcare disciplines, and eventually support interprofessional collaboration, resulting in improved access to health care, which is important for communication vulnerable people. Further research with a larger sample size and a control group is required.
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Affiliation(s)
- Alissa Nikkels
- Rotterdam University of Applied Sciences, Research Centre Innovations in Care, Postbus 25035, Rotterdam, the Netherlands.
| | - Philine Berns
- Rotterdam University of Applied Sciences, Research Centre Innovations in Care, Postbus 25035, Rotterdam, the Netherlands
| | - Karin Neijenhuis
- Rotterdam University of Applied Sciences, Research Centre Innovations in Care, Postbus 25035, Rotterdam, the Netherlands
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Wei W, Jiang Z. A bibliometrix-based visualization analysis of international studies on conversations of people with aphasia: Present and prospects. Heliyon 2023; 9:e16839. [PMID: 37346333 PMCID: PMC10279826 DOI: 10.1016/j.heliyon.2023.e16839] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 05/29/2023] [Accepted: 05/30/2023] [Indexed: 06/23/2023] Open
Abstract
In recent years, there has been a rapid increase in the number of people with aphasia due to brain lesions worldwide, which has prompted researchers to carry out in-depth studies on the pathogenesis, inducement and prognosis of aphasia from neurology, clinical medicine, psychology and other disciplines. With the deepening of research and understanding of aphasia, it is generally believed that a single discipline can no longer meet the needs of the academic community. Therefore, multidisciplinary integration has emerged and achieved fruitful results. This paper, based on the biblioshiny package run by R, conducts bibliometric analysis on the international interdisciplinary research status of conversation and aphasia, predicts its future development direction, and provides reference for relevant domestic research from international source journals. The results indicate that led by Australia, the United Kingdom, the United States and other countries, the international conversational aphasia research has formed a complete system, and formed a "descriptive study of patients with language disorders" and "applied study of rehabilitation treatment". In the future, while continuing to focus on these two categories of research, the empathy ability of conversational partners and medical staff may be taken into account, in order to better contribute to improving patients' quality of life.
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Affiliation(s)
- Wei Wei
- Graduate School, Xi'an International Studies University, School of Foreign Studies, Xi'an Medical University, Xi'an, China
| | - Zhanhao Jiang
- School of Foreign Languages, Southeast University, Nanjing, China
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Mavragani A, Beeke S, Volkmer A, Dangerfield L, Bloch S. A Communication Partner Training Program Delivered via Telehealth for People Living With Parkinson's (Better Conversations With Parkinson's): Protocol for a Feasibility Study. JMIR Res Protoc 2023; 12:e41416. [PMID: 36735301 PMCID: PMC9938441 DOI: 10.2196/41416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 11/17/2022] [Accepted: 12/05/2022] [Indexed: 12/09/2022] Open
Abstract
BACKGROUND Parkinson's can impact people's speech, cognition, pragmatics, and language, significantly affecting their conversations with others. The speech and language therapy approach called communication partner training (CPT) is effective for a range of communication difficulties. However, speech and language therapy interventions for people with Parkinson's predominantly focus on impairments, with little provision of CPT for this population. Better Conversations is a CPT approach that involves working with a dyad (the person with the communication difficulty and a conversation partner [CP]) to build conversation skills. It is effective at reducing barriers to conversation, and for some, it significantly increases targeted facilitatory strategies. Some approaches to CPT have been adapted to be delivered via telehealth. This can maximize ecological validity and convenience. Furthermore, telehealth is widely accepted as a delivery method for other interventions for Parkinson's. This study presents the protocol for a pilot feasibility study of a Better Conversations CPT delivered via telehealth to people living with Parkinson's and their CPs, called Better Conversations with Parkinson's (BCP). OBJECTIVE The primary aim is to evaluate the feasibility of the BCP program delivered via telehealth with a treatment group from a collaborating National Health Service (NHS) site to establish for a main trial whether BCP can be delivered as intended in an NHS setting. The aim is to establish: (1) the acceptability of the program for people living with Parkinson's, family members, and speech and language therapists (SLTs); (2) the feasibility of delivering the BCP program; (3) the recruitment and retention rates; (4) a sample size calculation; and (5) the most appropriate primary outcome measure. METHODS Ethical approval for this study was obtained from London-Central Research Ethics Committee (reference: 22/LO/0332). This case-series feasibility pilot study will recruit 10-12 dyads to ensure 10 complete data sets. Participants will be recruited by a collaborating NHS site located in England. Participants will be involved for 16 weeks (weeks 1-2 preintervention measures, weeks 3-8 intervention, weeks 10-12 postintervention measures, week 16 follow-up interview). Quantitative and qualitative methods will be used to analyze the study data. Speech, communication, and quality of life assessment data will be analyzed statistically to determine a suitably sensitive outcome measure. Descriptive statistics will be used to report on recruitment, attendance, and attrition. Finally, acceptability and feasibility will be evaluated using participant feedback, interviews, and the reflective diary and feedback of the SLT administering the therapy (by the research assistant who is the first author). This data will be analyzed using descriptive statistics and reflexive thematic analysis. RESULTS This study was approved for funding from Parkinson's UK. Study recruitment commenced in July 2022. The results of the data analysis are expected to be available by September 2024. CONCLUSIONS Insights from this study will provide valuable information about the acceptability and feasibility of a remotely delivered Better Conversations CPT approach for people living with Parkinson's and their CPs. An outcome of this study will be a manualized BCP program coproduced by people living with Parkinson's, their families, and a group of expert SLTs. The study results will guide the next stages of intervention development. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/41416.
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Affiliation(s)
| | - Suzanne Beeke
- Division of Psychology and Language Sciences, University College London, London, United Kingdom
| | - Anna Volkmer
- Division of Psychology and Language Sciences, University College London, London, United Kingdom
| | - Lynn Dangerfield
- Adult Community Speech and Language Therapy, Solent NHS Trust, Portsmouth, United Kingdom
| | - Steven Bloch
- Division of Psychology and Language Sciences, University College London, London, United Kingdom
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Isaksen J, Beeke S, Pais A, Efstratiadou EA, Pauranik A, Revkin SK, Vandana VP, Valencia F, Vuksanović J, Jagoe C. Communication partner training for healthcare workers engaging with people with aphasia: Enacting Sustainable Development Goal 17 in Austria, Egypt, Greece, India and Serbia. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2023; 25:172-177. [PMID: 36927168 DOI: 10.1080/17549507.2022.2145355] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
PURPOSE This commentary describes how a grassroot-led partnership initiated by members of the organisations World Federation of NeuroRehabilitation and Collaboration of Aphasia Trialists is addressing the marginalisation of people with aphasia, through education and knowledge exchange related to communication partner training of health professionals. RESULT A partnership between academics and healthcare professionals across Austria, Denmark, Egypt, Ireland, Greece, India, Serbia and the United Kingdom was established in 2020. Through bimonthly online sessions in 2021-2022 a Danish communication partner training program was introduced while six teams adapted and translated the training and its materials to their local contexts. CONCLUSION A collaborative partnership enabled multiple translations of an existing communication partner training program for healthcare professionals working with people with aphasia to support a sustainable delivery model that is linguistic and culturally sensitive. This commentary paper focusses on Sustainable Development Goal (SDG) 17 and also addresses SDG 10.
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Affiliation(s)
- Jytte Isaksen
- Department of Language and Communication, University of Southern Denmark, Denmark
| | | | | | | | | | | | - V P Vandana
- National Institute of Mental Health and Neurosciences, Bangalore, India
| | | | | | - Caroline Jagoe
- Trinity College Dublin, The University of Dublin, Ireland
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Nichol L, Wallace SJ, Pitt R, Rodriguez AD, Diong ZZ, Hill AJ. People with aphasia share their views on self-management and the role of technology to support self-management of aphasia. Disabil Rehabil 2022; 44:7399-7412. [PMID: 34657536 DOI: 10.1080/09638288.2021.1989501] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
PURPOSE Self-management can lead to increased self-efficacy and improved quality of life for individuals with chronic conditions; however, there is little research exploring how self-management approaches can be used for chronic communication disorders, such as aphasia. Modifications to self-management approaches would be required to accommodate for aphasia; therefore, the input of people with aphasia (PwA) should be sought. The aims of the present study were: (1) To investigate and document the experiences and perspectives of PwA regarding self-management; (2) To explore how technology can be used to support aphasia self-management. MATERIALS AND METHODS In-depth, semi-structured interviews were conducted with 26 PwA living in Australia. Qualitative content analysis was used to analyse interview data. RESULTS Analysis resulted in six themes: (1) In self-management, PwA take control of life with aphasia and assume responsibility for engaging in opportunities to improve overall communication; (2) Community aphasia groups are important enablers of self-management because they facilitate peer support; (3) Communication partners (CPs) provide multifaceted support in aphasia self-management; (4) SLPs provide integrated support and coordination in aphasia self-management; (5) Technology supports PwA to self-manage speech therapy and communication in daily life; (6) Psychological and physical health issues and societal factors may impact aphasia self-management abilities. CONCLUSION From the perspective of PwA, aphasia self-management involves enhancing skills enabling communication and life participation. PwA are central to aphasia self-management, with support provided by CPs, peers, and SLPs. Technology has a range of applications in aphasia self-management. PwA identified potential personal and contextual barriers that may impact self-management.IMPLICATIONS FOR REHABILITATIONFor people with aphasia, engaging in conversation and social interaction are primary means of managing/improving communicative life participation; therefore, this should be a key focus of aphasia self-management programs.Aphasia self-management approaches should maximise the use of available support and provide tailored information, education, and training in the area of self-management to key stakeholders (people with aphasia, communication partners, and speech-language pathologists).People with aphasia should be supported to use technology for aphasia self-management, encompassing communication specific and daily life use.People with aphasia should be heavily involved in the development of structured aphasia self-management approaches.
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Affiliation(s)
- Leana Nichol
- Queensland Aphasia Research Centre, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Sarah J Wallace
- Queensland Aphasia Research Centre, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia.,NHMRC Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Melbourne, Australia
| | - Rachelle Pitt
- Queensland Aphasia Research Centre, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia.,NHMRC Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Melbourne, Australia.,West Moreton Health, Ipswich, Australia
| | - Amy D Rodriguez
- Center for Visual and Neurocognitive Rehabilitation, Atlanta VA Medical Center, Decatur, GA, USA.,Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | - Zhi Zhi Diong
- Queensland Aphasia Research Centre, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Annie J Hill
- Queensland Aphasia Research Centre, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia.,Surgical, Treatment and Rehabilitation Service (STARS), Metro North Hospital and Health Service, Brisbane, Australia
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Azios JH, Archer B, Simmons-Mackie N, Raymer A, Carragher M, Shashikanth S, Gulick E. Conversation as an Outcome of Aphasia Treatment: A Systematic Scoping Review. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2022; 31:2920-2942. [PMID: 36356216 DOI: 10.1044/2022_ajslp-22-00011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
PURPOSE Conversation-focused speech-language pathology services are a top priority for people living with aphasia, but little is known about how researchers measure conversation as an outcome of treatment. This scoping review was undertaken to systematically review the evidence regarding the measurement of conversation in aphasia studies and to identify current practices and existing gaps. METHOD A systematic literature search was conducted for studies published between January 1995 and September 2019 in multiple electronic databases. Covidence software was used to manage search results, study selection, and data charting processes. Data were extracted from each study and then collated and organized to elucidate the breadth of approaches, tools, or procedures oriented to measuring conversation as an outcome and identify gaps in the existing literature. RESULTS The systematic search of the literature resulted in 1,244 studies. A total of 64 studies met inclusion criteria and were included in the review. The review summarizes the various tools and procedures used to measure conversation as an outcome of aphasia intervention, including variations in data collection and analysis procedures. The review also evaluates the quality of conversation measures in terms of psychometric properties and informal measures of validity. There was a total of 211 measures used across the 64 studies. CONCLUSIONS While there was no clear measure that was objectively superior, several measures show promise and warrant future exploration. Some of the orientations, conceptualizations, and procedures we have presented can be seen as options that might be included in a future conversation-focused core outcome set. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.21514062.
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Affiliation(s)
- Jamie H Azios
- Department of Communicative Disorders, University of Louisiana at Lafayette
| | - Brent Archer
- Department of Communication Sciences and Disorders, Bowling Green State University, OH
| | - Nina Simmons-Mackie
- Department of Health & Human Sciences, Southeastern Louisiana University, Hammond
| | - Anastasia Raymer
- Department of Communication Disorders & Special Education, Old Dominion University, Norfolk, VA
| | - Marcella Carragher
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
- Centre for Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University, Melbourne, Victoria, Australia
| | - Shriya Shashikanth
- Department of Communicative Disorders, University of Louisiana at Lafayette
| | - Eleanor Gulick
- Department of Communication Sciences and Disorders, Bowling Green State University, OH
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Thiel L, Conroy P. 'I think writing is everything': An exploration of the writing experiences of people with aphasia. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2022; 57:1381-1398. [PMID: 35929726 PMCID: PMC9805004 DOI: 10.1111/1460-6984.12762] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 06/20/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Written communication has become an increasingly important part of everyday life in social, educational and professional spheres. The substantial increase in writing via the internet and mobile technologies provides both an opportunity for social engagement and distinct challenges for people with aphasia. Within the current literature there has been limited research into the lived experiences of people with aphasia of their writing difficulties and how these affect their ability to communicate. AIMS This qualitative study aimed to explore the experiences of people with aphasia of living with language-related writing difficulties and the impact of these on their lives. METHODS & PROCEDURES Eight people with post-stroke aphasia and writing difficulties took part in semi-structured interviews. The interviews were analysed using inductive reflexive thematic analysis. OUTCOMES & RESULTS Two themes were found in the data. The first theme was a gradual and effortful improvement to writing: Participants described how writing had improved since their stroke due to strategies and support, but they still found writing to be difficult and frustrating and described many barriers to writing. The second theme was the importance of writing for fulfilling adult social roles: Participants found writing to be important for communicating with family, friends and organizations, but their participation in society and self-esteem and confidence were impacted by writing difficulties; reduced social roles meant reduced need for writing, but participants were still motivated to work towards writing goals. CONCLUSIONS & IMPLICATIONS The findings demonstrate the emerging importance of writing skills for people with aphasia with respect to communication, well-being, participation and inclusion in society, and carrying out social roles. They provide an insight into the process of improvement, including the difficulties, facilitators and barriers. Implications for speech and language therapy assessment and management are discussed. WHAT THIS PAPER ADDS What is already known on the subject People with aphasia have difficulties with writing that can affect their ability to communicate. A small body of qualitative research has provided insights into individuals' experiences of literacy difficulties. More research is needed to understand the writing experiences of people with aphasia to help design appropriate assessments and interventions. What this paper adds to existing knowledge Participants experienced gradual and effortful improvement since their stroke. They felt negative about aspects of their writing, including speed, accuracy and range of vocabulary. Writing was facilitated through assistive technologies, spelling practice and support from others; barriers included technology, lack of time, stroke-related symptoms and others' lack of awareness about aphasia. Participants considered writing skills to be important, particularly for communication, carrying out adult social roles and participating in society, and were therefore still working towards goals related to everyday writing activities. What are the potential or actual clinical implications of this work? This study suggests that speech and language therapy assessment should include interviewing participants about their activities, strengths, difficulties, facilitators and barriers in writing, and informal assessment of a range of functional writing tasks. Intervention should be tailored to the individual's needs. This should include meaningful activities that relate to functional everyday writing and, where appropriate, self-management, compensatory technologies and group approaches, while making use of existing strategies identified by the individual.
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Affiliation(s)
- Lindsey Thiel
- Leeds School of Social SciencesLeeds Beckett UniversityLeedsUK
| | - Paul Conroy
- Division of Human Communication Development and Hearing, School of Health SciencesUniversity of ManchesterManchesterUK
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Oosthuizen I, Manchaiah V, Launer S, Swanepoel DW. Hearing aid Experiences of Adult Hearing aid Owners During and After Fitting: A Systematic Review of Qualitative Studies. Trends Hear 2022; 26:23312165221130584. [PMID: 36300258 PMCID: PMC9618746 DOI: 10.1177/23312165221130584] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
There has been an increasing number of qualitative studies exploring the experiences and perceptions of adult hearing aid owners throughout their hearing aid journey. As these studies and reported experiences vary greatly, a systematic review was conducted to identify and synthesize the key concepts in adult hearing aid owners' experiences during and after fitting. A systematic search of three electronic databases was conducted, yielding 443 results. Articles were evaluated for inclusion based on pre-determined eligibility criteria, including conventional, smartphone-connected, and direct-to-consumer hearing devices. Twenty-five studies met the inclusion criteria. The quality of the included articles was evaluated using the Rating of Qualitative Research scale. Guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) and the Synthesis Without Meta-Analysis (SWiM) were followed. A narrative synthesis was conducted, and studies were grouped into three main domains, namely experiences of owners related to a) hearing aid adoption and fitting (n = 3), b) hearing aid use (n = 20), and c) hearing aid sub-optimal use (n = 25). Hearing aid owners mainly reported on how their attitude towards hearing aids affected experiences during the fitting stage. Improved psychosocial functioning was the most prevalent perceived benefit of hearing aid use. Owners described sub-optimal use in terms of hearing device-related and non-device-related concepts. The COM-B (capability, opportunity, motivation-behavior) model is used to discuss specific service-delivery, hearing-device, and hearing-aid-owner related concepts and clinical implications, including behavior change techniques to enhance understanding of the concepts that hearing aid owners perceive as essential to improve hearing aid experiences.
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Affiliation(s)
- Ilze Oosthuizen
- Department of Speech-language Pathology and Audiology, University of Pretoria, Pretoria, South Africa,Virtual Hearing Lab, Collaborative initiative between University of Colorado School of Medicine, Aurora, Colorado, USA, and University of Pretoria, Pretoria, South Africa,Ilze Oosthuizen, Department of Speech-language Pathology and Audiology, University of Pretoria, South Africa.
| | - Vinaya Manchaiah
- Department of Speech-language Pathology and Audiology, University of Pretoria, Pretoria, South Africa,Virtual Hearing Lab, Collaborative initiative between University of Colorado School of Medicine, Aurora, Colorado, USA, and University of Pretoria, Pretoria, South Africa,Department of Otolaryngology–Head and Neck Surgery, University of Colorado School of Medicine, Aurora, Colorado, USA,UCHealth Hearing and Balance, University of Colorado Hospital, Aurora, Colorado, USA,Department of Speech and Hearing, School of Allied Health Sciences, Manipal Academy of Higher Education, Manipal, India
| | - Stefan Launer
- Department of Audiology and Health Innovation, Sonova AG, Staefa, Switzerland,School of Health and Rehabilitation Science, University of Queensland, Saint Lucia, Australia
| | - De Wet Swanepoel
- Department of Speech-language Pathology and Audiology, University of Pretoria, Pretoria, South Africa,Virtual Hearing Lab, Collaborative initiative between University of Colorado School of Medicine, Aurora, Colorado, USA, and University of Pretoria, Pretoria, South Africa,Ear Science Institute Australia, Subiaco, Australia
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Jokel R. Maintenance and Generalization of Lexical Items in Primary Progressive Aphasia: Reflections From the Roundtable Discussion at the 2021 Clinical Aphasiology Conference. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2022; 31:2395-2403. [PMID: 35623322 DOI: 10.1044/2022_ajslp-21-00275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
PURPOSE Our capacity to engage in society and maintain meaningful relationships is dependent on intact communication skills. They are compromised in a neurodegenerative language disorder termed primary progressive aphasia (PPA). Behavioral interventions for PPA are sparse and often limited to impairment-based approaches or communication skills training, although various functional interventions have been also described. The slow but relentless language decline does not naturally support maintenance and/or generalization of treatment gains, which should be the ultimate goal of any therapy. However, in some cases and under certain conditions, maintenance and generalization may be accomplished. While each type of intervention has much to offer to the PPA population, the clinical and research realms can benefit from a collective professional discussion on aspects of intervention conducive to maintenance and/or generalization of treatment gains in PPA. Such a discussion took place at the 2021 Clinical Aphasiology Conference during two roundtable sessions. The aims of the sessions were to review the premises of successful treatment approaches in PPA and to discuss factors fostering or inhibiting maintenance and generalization in PPA. CONCLUSIONS Current literature delivers, albeit in small doses, encouraging evidence for clinicians providing language intervention to patients with PPA. Although PPA is a progressive disorder, both the immediate treatment effects and, in many cases, evidence of maintenance and generalization demonstrate that improvements may be long lasting and transferrable. Several factors may enhance maintenance and generalization effects, including repeated practice, working with multiple exemplars of treatment items, booster sessions, group programs with built-in individual sessions, spared semantics, and personal relevance, to name a few. With this evidence in hand, we need to become more diligent about measuring and reporting clinical outcomes and delivering interventions that support maintenance and generalization of therapeutic gains beyond the clinician's office. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.19836370.
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Affiliation(s)
- Regina Jokel
- Rotman Research Institute, Toronto, Ontario, Canada
- Baycrest Health Sciences, Toronto, Ontario, Canada
- University of Toronto, Ontario, Canada
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21
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Edmonds LA, Morgan J. Two-Year Longitudinal Evaluation of Community Aphasia Center Participation on Linguistic, Functional Communication, and Quality of Life Measures Across People With a Range of Aphasia Presentations. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2022; 31:2378-2394. [PMID: 36260759 DOI: 10.1044/2022_ajslp-21-00308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
PURPOSE The purpose of this study was to evaluate potential changes on a hierarchy of language tasks and measures of functional communication and quality of life in a group of people with aphasia (PWA) who attended a community aphasia center for 2 years. A secondary purpose was to determine whether there were any predictors of change. METHOD Twenty-seven PWA who attended Brooks Rehabilitation Aphasia Center (BRAC) were evaluated on an aphasia battery, confrontation naming, and structured discourse in addition to completing self-reported measures of functional communication and quality of life at three time points: before attending BRAC and after 1 (N = 27) and 2 (N = 20) years of BRAC participation. Twenty-six communication partners who communicated regularly with the PWA completed a questionnaire about their functional communication at the same time points. A mixed linear model was conducted for all dependent variables to determine change over time. Tau-b correlations were conducted between demographic and aphasia-related variables and difference scores for outcome measures that exhibited significant improvements. RESULTS At 1-year testing, significant improvements were observed on the aphasia battery, object and action naming, and all self- and communication partner-reported measures. At 2-year testing, all improvements were maintained except for the self-reported measure of functional communication. Structured discourse showed increases in average number of words, percentage of meaningful words and utterances, and efficiency of meaningful word production after 2 years. No significant correlations were observed between predictor variables and difference scores. CONCLUSIONS Participation in aphasia centers can result in significant changes in language, functional communication, and quality of life in people with chronic aphasia. These findings support the importance of aphasia centers in the continuum of care for PWA. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.21313689.
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Affiliation(s)
- Lisa A Edmonds
- Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY
| | - Jodi Morgan
- Brooks Rehabilitation Aphasia Center, Jacksonville, FL
- Department of Communication Sciences and Disorders, Jacksonville University, FL
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Mc Menamin R, Isaksen J, Manning M, Tierney E. Distinctions and blurred boundaries between qualitative approaches and public and patient involvement (PPI) in research. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2022; 24:515-526. [PMID: 35762365 DOI: 10.1080/17549507.2022.2075465] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Purpose: International health and social care policy increasingly draws on stakeholder experiences and opinions. The distinctions between various approaches to researching "insider" perspectives are contentious. This article explores features (e.g. philosophy, ethics, and power dynamics) of qualitative approaches and public and patient involvement (PPI) in communication disorder research and explicates the blurred boundaries between them.Method: We use two case studies involving PPI contributors with aphasia - an Irish mixed methodologies study and a Danish qualitative study - to illustrate PPI in research and thus demonstrate how researchers can bridge the gap between theoretical considerations and research implementationResult: There are important distinctions between PPI in research and qualitative approaches (e.g. origins, roles, and reimbursement) and many blurred boundaries (e.g. inclusion, openness to mutual learning and "insider" perspectives). A key difference is that PPI contributors take an active role at project level and more flexibility in roles is required in PPI research. These flexible and varied roles reflect the shared decision-making powers between lay and professional researchers.Conclusion: PPI can add innovation to qualitative and mixed methods communication disorder research as illustrated in both case studies. However, researchers wishing to include PPI must embrace and respond to the evolving and flexible nature of PPI relationships and processes. Flexibility, negotiation and continuous reflection on methodological approaches, power dynamics, roles and co-created knowledge will impact and transform the field of research in communication disorders.
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Affiliation(s)
- Ruth Mc Menamin
- Discipline of Speech and Language Therapy, School of Health Sciences, National University of Ireland, Galway, Ireland
| | - Jytte Isaksen
- Department of Language and Communication, University of Southern Denmark, Odense M, Denmark
| | - Molly Manning
- Speech & Language Therapy, School of Allied Health and Public & Patient Involvement Research Unit, Health Research Institute, University of Limerick, Limerick, Ireland, and
| | - Edel Tierney
- National Research Officer, National Research Office, Tusla Child and Family Agency, Dublin, Ireland
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El‐Wahsh S, Balandin S, Bogaardt H, Kumfor F, Ballard KJ. Managing communication changes in persons with multiple sclerosis: Findings from qualitative focus groups. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2022; 57:680-694. [PMID: 35338749 PMCID: PMC9311724 DOI: 10.1111/1460-6984.12717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 02/21/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND There is growing recognition that communication can be affected in multiple sclerosis (MS) and can negatively impact relationships, employment and psychological well-being. Some persons with MS (PwMS) implement strategies to facilitate their communication; however, some do not. Most PwMS who report communication changes do not engage with speech-language pathology (SLP) services. This raises concerns that a large portion of communication changes associated with MS go under-recognized and unmanaged. Little is known about what PwMS want and need to facilitate effective communication. AIM To explore what PwMS want and need to better manage their communication changes. METHODS & PROCEDURES Three focus groups were conducted online using Zoom, with a total of 12 PwMS. Participants were an opportunistic sample of PwMS within Australia recruited via advertisements distributed to various MS organizations and clinics. Data were transcribed verbatim and analysed using thematic content analysis to provide a qualitative analysis of the data. OUTCOMES & RESULTS Two main themes emerged: (1) accessible knowledge and a holistic approach; and (2) partnerships. Specifically, the identified wants and needs of participants included: (1) assessment; (2) information; (3) raising awareness; (4) support groups; (5) a whole-person approach to intervention; (6) geographically and economically accessible and navigable services; (7) effective patient-physician interactions; and (8) a multidisciplinary team-based approach (e.g., SLP, psychology, neuropsychology, occupational therapy). CONCLUSIONS & IMPLICATIONS This study identified a wide range of unmet wants and needs of PwMS related to communication changes. Participants wanted improved collaborative partnerships with healthcare professionals to better manage their communication changes. For example, healthcare professionals could ask PwMS about potential communication changes, provide education and make appropriate referrals. Education and information provision could focus on communication changes in MS, factors that trigger or exacerbate communication changes, impacts, self-management strategies, and available supports and services. Specific implications for clinical practice and future research are suggested in this paper, including ideas for patient education materials and content, suggestions for communication-specific screening and information that could be shared in patient-physician interactions, the development of guidelines to systematically screen, assess, manage and monitor communication changes in MS, and the design of evidence-based communication interventions for this clinical population. The results from this study can be used to guide the design of supports and services to help PwMS better manage communication changes, with the aim to reduce the negative impacts. WHAT THIS PAPER ADDS What is already known on this subject PwMS can experience communication changes across a range of domains, including speech, voice, fluency, expressive and receptive language, and cognitive-linguistic functions. These changes can have profound and far-reaching negative impacts on educational and vocational outcomes, social participation, relationships, psychological well-being, and quality of life. Most PwMS who report communication changes do not engage with SLP services. There has been little research exploring what PwMS want and need to help manage their communication changes. What this paper adds to the existing knowledge This research is the first study of its kind that sets out specifically to explore what PwMS want and need to better manage their communication changes. This study increases our understanding of, and provides valuable insights into, the specific types of supports and services PwMS desire to access, and the partnerships and kinds of interactions PwMS dream of having with healthcare professionals to manage these changes. This information can facilitate the development of future interventions to manage communication changes in MS. What are the potential or actual clinical implications of this work? PwMS wanted healthcare professionals to ask about potential communication changes, provide education and make appropriate referrals. When providing education and information on communication changes in MS, healthcare professionals should focus on covering symptoms, triggers, impacts, self-management strategies, and available supports and services. There is a timely need to develop guidelines and interventions to manage communication changes in MS to reduce their negative impacts.
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Affiliation(s)
- Sarah El‐Wahsh
- Faculty of Medicine and Health, School of Health SciencesThe University of SydneyCamperdownNSWAustralia
| | | | - Hans Bogaardt
- School of Allied Health Science and PracticeThe University of AdelaideAdelaideSAAustralia
| | - Fiona Kumfor
- Faculty of ScienceSchool of PsychologyThe University of SydneySydneyNSWAustralia
- Brain and Mind CentreThe University of SydneySydneyNSWAustralia
| | - Kirrie J. Ballard
- Faculty of Medicine and Health, School of Health SciencesThe University of SydneyCamperdownNSWAustralia
- Brain and Mind CentreThe University of SydneySydneyNSWAustralia
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Simic T, Laird L, Brisson N, Moretti K, Théorêt JL, Black SE, Eskes GA, Leonard C, Rochon E. Cognitive Training to Enhance Aphasia Therapy (Co-TrEAT): A Feasibility Study. FRONTIERS IN REHABILITATION SCIENCES 2022; 3:815780. [PMID: 36188983 PMCID: PMC9397805 DOI: 10.3389/fresc.2022.815780] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 03/03/2022] [Indexed: 11/17/2022]
Abstract
Persons with aphasia (PWA) often have deficits in cognitive domains such as working memory (WM), which are negatively correlated with recovery, and studies have targeted WM deficits in aphasia therapy. To our knowledge, however, no study has examined the efficacy of multi-modal training which includes both WM training and targeted language therapy. This pilot project examined the feasibility and preliminary efficacy of combining WM training and naming therapy to treat post-stroke PWA. Chronic PWA were randomly assigned to either the a) Phonological Components Analysis (PCA) and WM intervention (WMI) condition (i.e., a computerized adaptive dual n-back task), or b) PCA and active control condition (WMC). Participants received face-to-face PCA therapy 3 times/week for 5 weeks, and simultaneously engaged in WM training or the active control condition five times/week, independently at home. Six PWA were enrolled, 3 in each condition. Feasibility metrics were excellent for protocol compliance, retention rate and lack of adverse events. Recruitment was less successful, with insufficient participants for group analyses. Participants in the WMI (but not the WMC) condition demonstrated a clinically significant (i.e., > 5 points) improvement on the Western Aphasia Battery- Aphasia Quotient (WAB-R AQ) and Boston Naming Test after therapy. Given the small sample size, the performance of two individuals, matched on age, education, naming accuracy pre-treatment, WAB-R AQ and WM abilities was compared. Participant WMI-3 demonstrated a notable increase in WM training performance over the course of therapy; WMC-2 was the matched control. After therapy, WMI-3's naming accuracy for the treated words improved from 30 to 90% (compared to 30–50% for WMC-2) with a 7-point WAB-R AQ increase (compared to 3 for WMC-2). Improvements were also found for WMI-3 but not for WMC-2 on ratings of communicative effectiveness, confidence and some conversation parameters in discourse. This feasibility study demonstrated excellent results for most aspects of Co-TrEAT. Recruitment rate, hampered by limited resources, must be addressed in future trials; remotely delivered aphasia therapy may be a possible solution. Although no firm conclusions can be drawn, the case studies suggest that WM training has the potential to improve language and communication outcomes when combined with aphasia therapy.
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Affiliation(s)
- Tijana Simic
- Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal (CRIUGM), Montreal, QC, Canada
- Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, Ottawa, ON, Canada
- *Correspondence: Tijana Simic
| | - Laura Laird
- Department of Speech-Language Pathology, University of Toronto, Toronto, ON, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
| | - Nadia Brisson
- School of Rehabilitation Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Kathy Moretti
- School of Rehabilitation Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Jean-Luc Théorêt
- School of Rehabilitation Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Sandra E. Black
- Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, Ottawa, ON, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
- Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
- KITE Research Institute, Toronto Rehab, University Health Network, Toronto, ON, Canada
| | - Gail A. Eskes
- Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, Ottawa, ON, Canada
- Departments of Psychiatry and Psychology and Neuroscience, Dalhousie University, Halifax, NS, Canada
| | - Carol Leonard
- Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, Ottawa, ON, Canada
- Department of Speech-Language Pathology, University of Toronto, Toronto, ON, Canada
- School of Rehabilitation Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Elizabeth Rochon
- Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, Ottawa, ON, Canada
- Department of Speech-Language Pathology, University of Toronto, Toronto, ON, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
- KITE Research Institute, Toronto Rehab, University Health Network, Toronto, ON, Canada
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Heard R, Anderson H, Horsted C. Exploring the communication experiences of stroke nurses and patients with aphasia in an acute stroke unit. SPEECH, LANGUAGE AND HEARING 2022. [DOI: 10.1080/2050571x.2020.1833284] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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El-Wahsh S, Layfield C, Bogaardt H, Kumfor F, Ballard KJ. Perspectives from the patient: A content analysis of communication changes, impact, and strategies to facilitate communication in multiple sclerosis. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2022; 24:173-189. [PMID: 34493141 DOI: 10.1080/17549507.2021.1973101] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Purpose: Communication changes in multiple sclerosis (MS) are under-explored and under-recognised. Persons with MS (PwMS) are experts in their condition and play a valuable role in informing clinicians and researchers of their condition. This study aimed to investigate the perspectives of PwMS on: (1) MS-related communication changes, (2) the impact of these communication changes across key aspects of a person's life, including work/studies, relationships, and general quality of life, and (3) strategies used to facilitate communication in daily interactions.Method: Two-hundred and sixty PwMS were recruited internationally and completed an online questionnaire. Content analysis was used to analyse open-ended questionnaire responses.Result: One-hundred and ninety-seven (75.8%) participants reported communication changes, including language, cognitive, speech, voice, and fluency changes. Participants described a variety of personal and environmental factors that influence communication negatively, such as fatigue, stress, and heat. Communication changes were reported to impact on psychological wellbeing, interpersonal relationships, participation and identity in the workforce and career pathways, and tertiary studies. Around 40% of participants reported using a range of overt and covert strategies to manage communication changes. Only 11.2% (n = 22/197) of participants who reported communication changes accessed speech-language pathology (SLP) services.Conclusion: PwMS can experience a wide spectrum of communication changes. These communication changes can have a profound and far-reaching impact on psychological wellbeing and societal participation. Engagement with SLP services is limited compared to the reported prevalence of communication changes. There is a need to raise awareness of the role of SLP in service provision for PwMS to manage communication changes. This paper discusses and provides suggestions for SLP services for PwMS with communication changes. There is a timely need to develop evidence-based interventions to support PwMS manage communication changes and reduce their impact.
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Affiliation(s)
- Sarah El-Wahsh
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Claire Layfield
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
| | - Hans Bogaardt
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Fiona Kumfor
- School of Psychology, The University of Sydney, Sydney, Australia, and
- Brain and Mind Centre, The University of Sydney, Sydney, Australia
| | - Kirrie J Ballard
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Brain and Mind Centre, The University of Sydney, Sydney, Australia
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Kuyler A, Johnson E, Bornman J. Unaided communication behaviours displayed by adults with severe cerebrovascular accidents and little or no functional speech: A scoping review. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2022; 57:403-421. [PMID: 34967962 DOI: 10.1111/1460-6984.12691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 11/15/2021] [Accepted: 11/18/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Unaided communication behaviours may provide communication support for persons with severe cerebrovascular accidents (CVA), as these individuals often experience severe communication difficulties, regardless of the aetiology. Though often subtle, these behaviours are present during all stages of recovery, and therefore communication partners need to know not only which unaided strategies are used as communication attempts, but also what their function is (i.e., what the person aims to achieve with the communication). AIM To identify the unaided communication behaviours that adults with severe CVA and little or no functional speech use to communicate, and to determine the communication functions addressed by these behaviours. METHODS & PROCEDURES The study used a scoping review methodology and included articles on communication partners of persons with CVA published between 1986 and 2020. Initially the searches yielded 732 studies from which 211 duplicates were identified. The remaining studies (n = 531) were then screened on title, abstract and full-text level resulting in a final inclusion of 18 studies. Of the 18 studies, five were qualitative and 13 consisted of quantitative methodologies. MAIN CONTRIBUTION The subtle communication behaviours used by persons with CVA (and resultant severe communication difficulties) are often misinterpreted or overlooked by their partners. If partners are trained to recognise such subtle or unaided communication behaviours, they can provide adequate support to access a range of communication functions. The unaided communication behaviours, which include 13 primary behaviours ranging from non-linguistic to linguistic, were utilised to convey 31 communication functions classified into four main communication categories. CONCLUSIONS & IMPLICATIONS Although unaided communication behaviours often appear as limiting, they can be utilised to communicate various communication functions. The findings of this review support the training of partners to identify these behaviours and improve person-partner communication. WHAT IS KNOWN?: Unaided communication has been widely researched. However, a summary is needed of the various unaided communication behaviours and of the different communication functions addressed by these behaviours. What the paper adds… This paper emphasises that unaided communication behaviours range from non-linguistic to linguistic, and they can support unintentional, pre-intentional and intentional communication functions. Clinical implications Even though aided communication is preferred, unaided communication behaviours are generally used in contexts with limited resources, as well as among culturally and linguistically diverse populations. This study advocates the identification of unaided communication behaviours by partners as well as the support and provision of access to communication strategies for persons with severe CVA. Future research should include more untrained communication partners.
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Affiliation(s)
- Ariné Kuyler
- Centre for Augmentative and Alternative Communication, University of Pretoria, Private Bag X20, Hatfield, 0028, South Africa
| | - Ensa Johnson
- Centre for Augmentative and Alternative Communication, University of Pretoria, Private Bag X20, Hatfield, 0028, South Africa
| | - Juan Bornman
- Centre for Augmentative and Alternative Communication, University of Pretoria, Private Bag X20, Hatfield, 0028, South Africa
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Cherney LR, Carpenter J. Behavioral interventions for poststroke aphasia. HANDBOOK OF CLINICAL NEUROLOGY 2022; 185:197-220. [PMID: 35078599 DOI: 10.1016/b978-0-12-823384-9.00010-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
There is a long history of behavioral interventions for poststroke aphasia with hundreds of studies supporting the benefits of aphasia treatment. However, interventions for aphasia are complex with many interacting components, and no one treatment is appropriate for all persons with aphasia. We present a novel, simple framework for classifying aphasia interventions. The framework is incorporated within the overarching International Classification of Functioning, Disability, and Health (ICF) model and is consistent with the commonly-held definition that aphasia is a multimodality disorder that impairs, in varying degrees, the understanding and expression of both oral and written language modalities. Furthermore, within the language impairment level, it distinguishes between the linguistic areas of phonology, semantics, and syntax that may be impaired individually or in combination. We define the terminology of the proposed framework and then categorize some common examples of behavioral interventions for post-stroke aphasia. We describe some of these interventions in greater detail to illustrate the extensive toolbox of evidence-based treatments for aphasia. We address some key issues that clinicians, usually speech-language pathologists, consider when selecting interventions for their specific patients with aphasia, including dose. Finally, we address various models of service delivery for persons with aphasia such as Intensive Comprehensive Aphasia Programs (ICAPs) and Aphasia Centers.
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Affiliation(s)
- Leora R Cherney
- Center for Aphasia Research and Treatment, Shirley Ryan AbilityLab, Chicago, IL, United States; Department of Physical Medicine & Rehabilitation, Northwestern University, Chicago, IL, United States; Department of Communication Sciences & Disorders, Northwestern University, Chicago, IL, United States.
| | - Julia Carpenter
- Center for Aphasia Research and Treatment, Shirley Ryan AbilityLab, Chicago, IL, United States
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What is Functional Communication? A Theoretical Framework for Real-World Communication Applied to Aphasia Rehabilitation. Neuropsychol Rev 2022; 32:937-973. [PMID: 35076868 PMCID: PMC9630202 DOI: 10.1007/s11065-021-09531-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Aphasia is an impairment of language caused by acquired brain damage such as stroke or traumatic brain injury, that affects a person’s ability to communicate effectively. The aim of rehabilitation in aphasia is to improve everyday communication, improving an individual’s ability to function in their day-to-day life. For that reason, a thorough understanding of naturalistic communication and its underlying mechanisms is imperative. The field of aphasiology currently lacks an agreed, comprehensive, theoretically founded definition of communication. Instead, multiple disparate interpretations of functional communication are used. We argue that this makes it nearly impossible to validly and reliably assess a person’s communicative performance, to target this behaviour through therapy, and to measure improvements post-therapy. In this article we propose a structured, theoretical approach to defining the concept of functional communication. We argue for a view of communication as “situated language use”, borrowed from empirical psycholinguistic studies with non-brain damaged adults. This framework defines language use as: (1) interactive, (2) multimodal, and (3) contextual. Existing research on each component of the framework from non-brain damaged adults and people with aphasia is reviewed. The consequences of adopting this approach to assessment and therapy for aphasia rehabilitation are discussed. The aim of this article is to encourage a more systematic, comprehensive approach to the study and treatment of situated language use in aphasia.
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Kong APH, Chan KPY, Jagoe C. Systematic Review of Training Communication Partners of Chinese-speaking Persons With Aphasia. Arch Rehabil Res Clin Transl 2022; 3:100152. [PMID: 34977535 PMCID: PMC8683840 DOI: 10.1016/j.arrct.2021.100152] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Objective To determine the aims, participants, and outcomes of training communication partners of Chinese-speaking persons with aphasia (PWA). Data Sources Sixty search terms related to communication partner training (CPT) in Chinese characters were searched in 8 electronic databases (published 1991-2020). Study Selection Journal articles written in Chinese that primarily target the Chinese audience and university theses were selected for review. Studies involving CPT and training to enable communication partner to deliver language tasks were included, but reports without PWA or direct training of communication partners were excluded. A final corpus of 37 articles, representing publications of group studies, case studies, qualitative studies, and opinion articles, were selected for full review. Data Extraction For all articles, 2 reviewers independently reviewed abstracts, excluding those without PWA or those that did not involve training of communication partners. One reviewer extracted descriptive data of participants with aphasia, communication partners, intervention details of the intervention (purpose, amount, setting, description), outcome measures, results, and clinical guidelines. A second reviewer performed accuracy verifications. Data Synthesis Quality of reviewed articles were classified using the American Academy of Neurology levels of evidence. The current review suggested an evidence base of low to medium quality supporting 2 intervention groups: (1) training partners to deliver therapy tasks and (2) training to improve communication between PWA and their communication partners. There was a higher proportion of persons with acute and subacute aphasia involved in these investigations, suggesting evidence on treatment efficacy of CPT in the acute stage. Conclusions Additional high-quality research with a better methodological quality, for example, randomized controlled trials or experimental design, are required to strengthen the current evidence of CPT. This systematic review suggests that the inclusion of studies published in languages other than English may influence the findings of mainstream reviews relating to aphasia.
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Affiliation(s)
- Anthony Pak-Hin Kong
- Academic Unit of Human Communication, Development, and Information Sciences, The University of Hong Kong, Hong Kong
| | - Kristie Pui-Yan Chan
- Department of Chinese and Bilingual Studies, Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
| | - Caroline Jagoe
- Department of Clinical Speech and Language Studies, Trinity College, University of Dublin, Dublin, Ireland
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van Rijssen M, Ketelaar M, Vandenborre D, Oostveen J, Veldkamp M, van Ewijk L, Visser-Meily JMA, Gerrits E. Evaluating communication partner training in healthcare centres: Understanding the mechanisms of behaviour change. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2021; 56:1190-1203. [PMID: 34370352 DOI: 10.1111/1460-6984.12659] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 06/08/2021] [Accepted: 06/27/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Communication between people with aphasia and their healthcare professionals (HCPs) can be greatly improved when HCPs are trained in using supportive conversation techniques and tools. Communication partner training (CPT) is an umbrella term that covers a range of interventions that train the conversation partners of people with aphasia. Several CPT interventions for HCPs have been developed and used to support HCPs to interact successfully with people with aphasia. AIMS The objective of this study was to identify the mechanisms of change as a result of a Dutch CPT intervention, named CommuniCare, in order to evaluate and optimise the intervention. METHODS & PROCEDURES A total of 254 HCPs from five different healthcare centres received CommuniCare. An explorative qualitative research design was chosen. Two interviews were conducted with 24 HCPs directly after and 4 months after receiving the training that was part of CommuniCare. Two conceptual frameworks were used to deductively code the interviews. HCPs' perspectives were coded into a four-part sequence following CIMO logic: the self-reported use of supportive conversation techniques or tools pre-intervention (Context), the intervention elements (Intervention) that evoked certain mechanisms (Mechanisms), resulting in the self-reported use of supportive conversation techniques and tools post-intervention (Outcomes). The Capabilities Opportunities Motivation-Behaviour (COM-B) model was used to fill in the Mechanisms component. OUTCOMES & RESULTS Three themes were identified to describe the mechanisms of change that led to an increase in the use of supportive conversation techniques and tools. According to HCPs, (i) information, videos, e-learning modules, role-play, feedback during training and coaching on the job increased their psychological capabilities; (ii) information and role-play increased their automatic motivations; and (iii) information, videos and role-play increased their reflective motivations. Remaining findings show HCPs' perspectives on various barriers to use supportive conversation techniques and tools. CONCLUSIONS & IMPLICATIONS HCPs in this study identified elements in our CPT intervention that positively influenced their behaviour change. Of these, role-play and coaching on the job were particularly important. HCPs suggested this last element should be better implemented. Therefore, healthcare settings wishing to enhance HCPs' communication skills should first consider enhancing HCPs' opportunities for experiential learning. Second, healthcare settings should determine which HCPs are suitable to have a role as implementation support practitioners, to support their colleagues in the use of supportive conversation techniques and tools. WHAT THIS PAPER ADDS What is already known on this subject? Several communication partner training (CPT) interventions for healthcare professionals (HCPs) have been developed and used to support HCPs to interact successfully with people with aphasia. To date, there is limited evidence of the mechanisms of change that explain exactly what changes in HCPs' behaviour after CPT and why these changes take place. What this paper adds to existing knowledge Evaluating our CPT intervention by identifying mechanisms of change from the perspectives of HCPs provided us with: (i) a better understanding of the elements that should be included in CPT interventions in different contexts; and (ii) an understanding of the important remaining barriers identified by HCPs to use supportive conversation techniques, even after CPT is implemented. What are the potential or actual clinical implications of this work? This study shows the different intervention elements in our CPT intervention that improve HCPs' capabilities, motivations or opportunities to use supportive conversation techniques and tools. Essential ingredients of CPT according to HCPs in this study were role-play and coaching on the job by an expert and were linked to an increase in HCPs' motivations or beliefs about self-competency. Healthcare settings wishing to enhance HCPs' communication skills should therefore consider appointing implementation support practitioners to coach and support HCPs, and facilitate these practitioners to fulfil this role.
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Affiliation(s)
| | - Marjolijn Ketelaar
- Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Centre, University Medical Center Utrecht, and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
| | | | - Judith Oostveen
- Donders Institute for Brain, Cognition and Behaviour, Department of Rehabilitation, Radboud University Medical Centre, Nijmegen, The Netherlands
| | | | | | - Johanna M A Visser-Meily
- Department of Rehabilitation, Physical Therapy Science & Sports, UMC Utrecht Brain Centre, University Medical Centre Utrecht, The Netherlands
- Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Centre, University Medical Center Utrecht, and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
| | - Ellen Gerrits
- HU University of Applied Sciences, Utrecht, The Netherlands
- Utrecht University, Utrecht, The Netherlands
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Schaffer KM, Henry ML. Counseling and Care Partner Training in Primary Progressive Aphasia. PERSPECTIVES OF THE ASHA SPECIAL INTEREST GROUPS 2021; 6:1015-1025. [PMID: 35935167 PMCID: PMC9351599 DOI: 10.1044/2021_persp-20-00296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
PURPOSE Individuals with primary progressive aphasia (PPA) experience loss of communication abilities in the context of neurodegenerative disease. Consequently, many individuals with PPA endorse negative psychosocial effects, including social isolation, reduced communication confidence, and depression. Incorporating communication-centered counseling early and often within the speech-language pathology treatment framework is a vital component in holistically addressing the multifaceted ramifications of living with this devastating disorder. Additionally, care partners are key stakeholders in the treatment dynamic. Involving these individuals in the treatment paradigm through care partner training is crucial for facilitating optimal communication in daily life. The purpose of this narrative literature review is to discuss existing research regarding counseling and care partner training in PPA and to outline additional treatment considerations and future research needs in this understudied area. CONCLUSIONS Relative to studies that delineate restitutive speech-language interventions for PPA, the literature pertaining to counseling and care partner training is limited. Available evidence supports the utility of these approaches, which serve as complementary components to restitutive and compensatory speech-language intervention. Additional research is warranted to support generalizability and long-term benefit of these interventions, and to address facets of counseling and care partner training that have not been explored in PPA (e.g., counseling interventions drawing from specific psychotherapeutic traditions; multicultural counseling) or have only been explored to a limited degree (e.g., interventions that jointly provide counseling and partner training).
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Affiliation(s)
- Kristin M. Schaffer
- Department of Speech, Language, and Hearing Sciences, The University of Texas at Austin
| | - Maya L. Henry
- Department of Speech, Language, and Hearing Sciences, The University of Texas at Austin
- Dell Medical School, The University of Texas at Austin
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Velez JA, Keene JR, Corwin M, Elko S, Potter RF. A Visual Interactive Narrative Intervention (VINI) for aphasia education: Can digital applications administer augmented input to educate stroke survivors with aphasia? PATIENT EDUCATION AND COUNSELING 2021; 104:2536-2543. [PMID: 33810913 DOI: 10.1016/j.pec.2021.03.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 03/11/2021] [Accepted: 03/13/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE Persons with aphasia (PWA) face additional barriers to proper healthcare due to inadequate patient education by health professionals unequipped to use augmentative and alternative communication (AAC). The current study examines a digital application that evokes and sustains health information processing through AAC specifically aimed at increasing comprehension with augmented input (AI). METHODS A digital application designed to educate PWA about their health condition was compared to a video-recorded doctor providing oral-only education. Sixteen PWA received both education interventions in a crossover manner. Health information processing was assessed through heart rate (HR) and skin conductance levels (SCL), which were collected continually during each administration of education interventions. RESULTS PWA demonstrated greater cognitive processing of health information via HR and SCL indices during the digital application compared to the typical oral-only education intervention. The oral-only intervention led PWA to disengage with health information. CONCLUSION By combining visuographic materials and adapted language into a customizable narrative structure, digital applications can utilize AI to educate PWA about basic health information (i.e., diagnosis and prognosis). PRACTICE IMPLICATIONS The current study's AAC requires minimal training and can be used as an aided support in conjunction with other techniques that increase PWA's access to health information.
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Affiliation(s)
- John A Velez
- Communication Science Unit, The Media School, College of Arts + Sciences, Indiana University, Bloomington, USA.
| | - Justin Robert Keene
- Department of Journalism and Creative Media Industries, College of Media and Communication, Texas Tech University, Lubbock, USA
| | - Melinda Corwin
- Department of Speech, Language, and Hearing Sciences, School of Health Professions, Texas Tech University Health Sciences Center, Lubbock, USA
| | - Stacy Elko
- School of Art, J.T. & Margaret Talkington College of Visual & Performing Arts, Texas Tech University, Lubbock, USA
| | - Robert F Potter
- Communication Science Unit, The Media School, College of Arts + Sciences, Indiana University, Bloomington, USA
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Therrien MCS, Madden EB, Bislick L, Wallace SE. Aphasia and Friendship: The Role and Perspectives of Speech-Language Pathologists. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2021; 30:2228-2240. [PMID: 34310195 DOI: 10.1044/2021_ajslp-20-00370] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Purpose Speech-language pathologists (SLPs) who work with people with aphasia focus on assessment and intervention to support improved communication outcomes for their clients. Friendship, a key component of quality of life, often depends on communicative interaction, and many people with aphasia report having reduced social circles. The purpose of this study was to explore the perceptions of SLPs working with clients with aphasia on their role in supporting friendship development and maintenance. Method An online survey composed of questions addressing SLP perspectives and goal setting, assessment, and treatment practices related to aphasia and friendship was distributed to SLPs across the United States. Survey data were analyzed using both quantitative and qualitative methods. Results Forty-seven SLPs completed the survey. While many SLPs reported that the friendships of their clients with aphasia were impacted by aphasia and that it was within their scope of practice to support friendship development and maintenance, many did not specifically assess or target friendship and friendship outcomes in the treatment plan. SLPs identified barriers and facilitators to focusing on friendship within the context of speech and language therapy. Conclusions Findings suggest the majority of participating SLPs were interested in addressing friendship with clients with aphasia; however, they experienced barriers in practice. Further examination of SLP perspectives and clinical practice regarding friendship and aphasia is warranted. Additionally, research investigating effective assessment and therapeutic methods that target friendship in aphasia is needed to support clinical practice and the well-being of clients with aphasia. Supplemental Material https://doi.org/10.23641/asha.15032217.
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Affiliation(s)
| | - Elizabeth B Madden
- School of Communication Science & Disorders, Florida State University, Tallahassee
| | - Lauren Bislick
- School of Communication Sciences and Disorders, University of Central Florida, Orlando
| | - Sarah E Wallace
- Department of Speech-Language Pathology, Duquesne University, Pittsburgh, PA
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Simic T, Leonard C, Laird L, Stewart S, Rochon E. The effects of intensity on a phonological treatment for anomia in post-stroke aphasia. JOURNAL OF COMMUNICATION DISORDERS 2021; 93:106125. [PMID: 34166970 DOI: 10.1016/j.jcomdis.2021.106125] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 05/12/2021] [Accepted: 05/18/2021] [Indexed: 06/13/2023]
Abstract
INTRODUCTION The evidence regarding optimal treatment intensity is mixed, and differing definitions have further confounded existing findings. The primary objective of this study was to compare the efficacy of Phonological Components Analysis (PCA) treatment for anomia delivered at intense and non-intense schedules, using a well-controlled design. The number of teaching episodes and active ingredients of therapy are important considerations when defining intensity. We hypothesized that an active ingredient of PCA is the self-generation of phonological components during therapy sessions. Our secondary aim was to examine whether component generation predicted treatment outcome. METHODS Sixteen adults (M = 52.63 years old, SD = 11.40) with chronic post-stroke aphasia (M = 4.52 years post-onset, SD = 5.55) were randomly assigned to intensive (IT) or standard (ST) PCA treatment conditions. Cumulative treatment intensity in both conditions was equivalent: ST participants received PCA 1 hour/day, 3 days/week for 10 weeks, whereas IT participants received PCA 3 hours/day, 4 days/week for 2.5 weeks. The primary outcome was naming accuracy on a set of treated and (matched) untreated words, measured pre- and post-treatment, and at four- and eight-week follow-ups. RESULTS IT and ST conditions were similarly efficacious. However, secondary analyses suggest an advantage for the IT condition in naming of the treated words immediately post-treatment, but not at follow-ups. The self-generation of phonological components emerged as a significant positive predictor of naming accuracy for both the treated and untreated words. However, this relationship did not reach significance once baseline anomia severity was accounted for. CONCLUSIONS Although replication in a larger sample is warranted, results suggest that PCA treatment is similarly efficacious when delivered at different intensities. Other factors related to the quality of treatment (i.e., active ingredients such as cue-generation) may play an important role in determining treatment efficacy and must also be considered when comparing treatment intensities.
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Affiliation(s)
- Tijana Simic
- Department of Speech-Language Pathology, University of Toronto, 160-500 University Avenue, Toronto, ON M5G 1V7, Canada; Rehabilitation Sciences Institute, University of Toronto, 500 University Avenue, Toronto, ON M5G 1V7, Canada; Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, 600 Peter Morand Cres., Suite 206, Ottawa, ON K1G 5Z3, Canada; KITE Research Institute, Toronto Rehab, University Health Network, 550 University Avenue, Toronto, ON M5G 2A2, Canada; Department of Psychology, Université de Montréal, 90 Vincent d'Indy Avenue, Montreal, QC H2V 2S9, Canada; Centre de Recherche de l'Institut Universitaire de Geriatrie de Montreal (CRIUGM), 4545 Queen Mary Rd., Montreal, QC H3W 1W4, Canada.
| | - Carol Leonard
- Department of Speech-Language Pathology, University of Toronto, 160-500 University Avenue, Toronto, ON M5G 1V7, Canada; Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, 600 Peter Morand Cres., Suite 206, Ottawa, ON K1G 5Z3, Canada; School of Rehabilitation Sciences, University of Ottawa, 451 Smyth Rd., Ottawa, ON K1H 8M5, Canada
| | - Laura Laird
- Department of Speech-Language Pathology, University of Toronto, 160-500 University Avenue, Toronto, ON M5G 1V7, Canada; KITE Research Institute, Toronto Rehab, University Health Network, 550 University Avenue, Toronto, ON M5G 2A2, Canada
| | - Steven Stewart
- KITE Research Institute, Toronto Rehab, University Health Network, 550 University Avenue, Toronto, ON M5G 2A2, Canada
| | - Elizabeth Rochon
- Department of Speech-Language Pathology, University of Toronto, 160-500 University Avenue, Toronto, ON M5G 1V7, Canada; Rehabilitation Sciences Institute, University of Toronto, 500 University Avenue, Toronto, ON M5G 1V7, Canada; Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, 600 Peter Morand Cres., Suite 206, Ottawa, ON K1G 5Z3, Canada; KITE Research Institute, Toronto Rehab, University Health Network, 550 University Avenue, Toronto, ON M5G 2A2, Canada
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Monnelly K, Marshall J, Cruice M. Intensive Comprehensive Aphasia Programmes: a systematic scoping review and analysis using the TIDieR checklist for reporting interventions. Disabil Rehabil 2021; 44:6471-6496. [PMID: 34445900 DOI: 10.1080/09638288.2021.1964626] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE Aphasia is an acquired language disorder that typically occurs as a result of a stroke. People with aphasia experience communication difficulties and risk secondary impacts, for example, affecting social and work life and mental health. Intensive Comprehensive Aphasia Programmes (ICAPs) aims to address the multiple consequences of aphasia using intensive intervention and a wide range of therapy approaches. Although basic parameters of ICAP intervention have been defined, a fuller characterisation is needed. This systematic scoping review aimed to determine what constitutes an ICAP. METHODS Peer-reviewed and Grey databases were searched for articles on ICAPs using Joanna Brigg's Institute methodology. Data was extracted following the Template for Intervention Description and Replication (TIDieR) checklist for reporting interventions and synthesised using a narrative synthesis. RESULTS AND CONCLUSIONS 17 ICAPs were reported in 20 peer-reviewed literature sources (9 ICAPs supplemented by Grey literature sources). There were high degrees of variation in dose, professionals involved, and no qualitative data from participants. Of note, ICAP intervention was highly tailored to individual participants on the same ICAP, and intervention content varied between ICAPs. ICAPs appear to be rationalised as intensive impairment-based programmes with other components added for comprehensiveness. Stronger rationale and a logic model are required to justify the core components of ICAPs. The input of stakeholders into designing future ICAP interventions is recommended.IMPLICATIONS FOR REHABILITATIONThe ICAP model is in its infancy when it comes to mainstream clinical application as only the intensity component of the ICAP has clear theoretical underpinning as reported in the peer-reviewed literature.There have been clinical uptakes of the ICAP model which is likely to continue and is valid in the context of an under-researched area of aphasia therapy and on a background of a less than perfect relationship between evidence base and practice.Aspects of the ICAP model are valid for clinicians to implement, for example, intensive evidence-based aphasia therapy in combination with therapy which addresses some of the broader implications of aphasia, for example, social isolation.Clinicians can use the ICAP model to review their existing service provision and explore whether their service provides aphasia therapy that addresses the multiple aspects of aphasia (i.e., ensuring the focus is not only on impairment-based therapy).
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Affiliation(s)
- Katie Monnelly
- Division of Language and Communication Science, University of London, London, UK
| | - Jane Marshall
- Division of Language and Communication Science, University of London, London, UK
| | - Madeline Cruice
- Division of Language and Communication Science, University of London, London, UK
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Kagan A, Simmons-Mackie N, Shumway E, Victor JC, Chan L. Development and evaluation of the Basic Outcome Measure Protocol for Aphasia (BOMPA). INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2021; 23:258-264. [PMID: 32693622 DOI: 10.1080/17549507.2020.1784278] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
PURPOSE The Basic Outcome Measure Protocol for Aphasia (BOMPA) is a practical tool that allows for a quick self-report on quality of life from the perspective of the person with aphasia, as well as a clinical evaluation of aphasia severity and the ability to participate in conversation. The primary aim of this paper is to describe development of BOMPA and report on results of an inter-rater reliability study involving speech-language pathology raters. METHOD The inter-rater reliability study utilised a fully crossed design and included independent ratings of 12 videos by 20 speech-language pathologists. RESULT Results indicate moderate to strong inter-rater reliability among participant speech-language pathology raters (0.65-0.96), as well as when comparing these participant ratings with an expert rater's gold standard (0.59-0.86). CONCLUSION BOMPA may be a useful outcome measurement tool for time-pressed clinicians in clinical settings.
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D'Souza S, Godecke E, Ciccone N, Hersh D, Janssen H, Armstrong E. Hospital staff, volunteers' and patients' perceptions of barriers and facilitators to communication following stroke in an acute and a rehabilitation private hospital ward: a qualitative description study. BMJ Open 2021; 11:e043897. [PMID: 33952543 PMCID: PMC8103362 DOI: 10.1136/bmjopen-2020-043897] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES To explore barriers and facilitators to patient communication in an acute and rehabilitation ward setting from the perspectives of hospital staff, volunteers and patients following stroke. DESIGN A qualitative descriptive study as part of a larger study which aimed to develop and test a Communication Enhanced Environment model in an acute and a rehabilitation ward. SETTING A metropolitan Australian private hospital. PARTICIPANTS Focus groups with acute and rehabilitation doctors, nurses, allied health staff and volunteers (n=51), and interviews with patients following stroke (n=7), including three with aphasia, were conducted. RESULTS The key themes related to barriers and facilitators to communication, contained subcategories related to hospital, staff and patient factors. Hospital-related barriers to communication were private rooms, mixed wards, the physical hospital environment, hospital policies, the power imbalance between staff and patients, and task-specific communication. Staff-related barriers to communication were staff perception of time pressures, underutilisation of available resources, staff individual factors such as personality, role perception and lack of knowledge and skills regarding communication strategies. The patient-related barrier to communication involved patients' functional and medical status. Hospital-related facilitators to communication were shared rooms/co-location of patients, visitors and volunteers. Staff-related facilitators to communication were utilisation of resources, speech pathology support, staff knowledge and utilisation of communication strategies, and individual staff factors such as personality. No patient-related facilitators to communication were reported by staff, volunteers or patients. CONCLUSIONS Barriers and facilitators to communication appeared to interconnect with potential to influence one another. This suggests communication access may vary between patients within the same setting. Practical changes may promote communication opportunities for patients in hospital early after stroke such as access to areas for patient co-location as well as areas for privacy, encouraging visitors, enhancing patient autonomy, and providing communication-trained health staff and volunteers.
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Affiliation(s)
- Sarah D'Souza
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Perth, Australia
- Centre for Aphasia Recovery and Rehabilitation Research, La Trobe University, Melbourne, Victoria, Australia
| | - Erin Godecke
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Perth, Australia
- Centre for Aphasia Recovery and Rehabilitation Research, La Trobe University, Melbourne, Victoria, Australia
| | - Natalie Ciccone
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Perth, Australia
| | - Deborah Hersh
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Perth, Australia
| | - Heidi Janssen
- School of Health Sciences, The University of Newcastle Hunter Medical Research Institute, New Lambton, New South Wales, Australia
| | - Elizabeth Armstrong
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Perth, Australia
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Weyer-Jamora C, Brie MS, Luks TL, Smith EM, Braunstein SE, Villanueva-Meyer JE, Bracci PM, Chang S, Hervey-Jumper SL, Taylor JW. Cognitive impact of lower-grade gliomas and strategies for rehabilitation. Neurooncol Pract 2021; 8:117-128. [PMID: 33898046 PMCID: PMC8049427 DOI: 10.1093/nop/npaa072] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Outcomes for patients with lower-grade gliomas (LrGGs) continue to improve with advances in molecular characterization and treatment. However, cognitive sequela from the tumor and its treatment leave a significant impact on health-related quality of life for these patients. Several factors affect each patient's cognition, such as tumor location, treatment, medication, and comorbidities. However, impairments of processing speed, attention, concentration, working memory, and executive function are common across LrGG patients. Cognitive rehabilitation strategies, well established in traumatic brain injury and stroke populations, are based on neural plasticity and functional reorganization. Adapting these strategies for implementation in patients with brain tumors is an active area of research. This article provides an overview of cognitive domains commonly impaired in LrGG patients and evidence for the use of cognitive rehabilitation strategies to address these impairments with the goal of improving health-related quality of life in this patient population.
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Affiliation(s)
- Christina Weyer-Jamora
- Department of Neurological Surgery, University of California San Francisco
- Department of Psychiatry and Behavioral Sciences, Zuckerberg San Francisco General Hospital, California
| | - Melissa S Brie
- Department of Neurological Surgery, University of California San Francisco
- Department of Psychiatry and Behavioral Sciences, Zuckerberg San Francisco General Hospital, California
| | - Tracy L Luks
- Department of Radiology and Biomedical Imaging, University of California San Francisco
| | - Ellen M Smith
- Department of Neurological Surgery, University of California San Francisco
| | - Steve E Braunstein
- Department of Radiation Oncology, University of California San Francisco
| | | | - Paige M Bracci
- Department of Epidemiology and Biostatistics, University of California San Francisco
| | - Susan Chang
- Department of Neurological Surgery, University of California San Francisco
| | | | - Jennie W Taylor
- Department of Neurological Surgery, University of California San Francisco
- Department of Neurology, University of California San Francisco
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Spitzer L, Binkofski F, Willmes K, Bruehl S. The novel cognitive flexibility in aphasia therapy (CFAT): A combined treatment of aphasia and executive functions to improve communicative success. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2021; 23:168-179. [PMID: 32354234 DOI: 10.1080/17549507.2020.1757152] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
PURPOSE Over and above language deficits, persons with aphasia can present with impairments in executive functions, including deficits in cognitive flexibility. Cognitive flexibility constitutes the ability to update behaviour quickly and flexibly in a changing environment. Its deficits can restrict communicative ability, e. g. the ability to change a topic. To date, these deficits have been neglected in aphasia therapy, even though their consideration regarding language treatment may be beneficial for the persons affected. The present study aimed to evaluate whether aphasia therapy including cognitive flexibility leads to more improvement than conventional aphasia therapy. METHOD A pilot group study with ten patients was conducted. The patients received both the novel Cognitive Flexibility in Aphasia Therapy (CFAT) and conventional aphasia therapy in a cross-over design. Each therapy method was delivered for 20 sessions within two weeks. An assessment battery was applied five times, including language skills, communicative ability and verbal/nonverbal cognitive flexibility. RESULT Patients profited from CFAT regarding language skills, communicative ability and verbal cognitive flexibility. Furthermore, compared to conventional therapy, CFAT was more effective for verbal cognitive flexibility. CONCLUSION This pilot study indicates that CFAT offers a novel opportunity to directly train cognitive flexibility in communicative settings and complements conventional therapy for optimal patient outcome.
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Affiliation(s)
- Lena Spitzer
- Clinical and Cognitive Neurosciences, Department of Neurology, Medical Faculty, RWTH Aachen University, Aachen, Germany
- Department of Neurology, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Ferdinand Binkofski
- Clinical and Cognitive Neurosciences, Department of Neurology, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Klaus Willmes
- Department of Neurology, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Stefanie Bruehl
- Clinical and Cognitive Neurosciences, Department of Neurology, Medical Faculty, RWTH Aachen University, Aachen, Germany
- Department of Neurology, Medical Faculty, RWTH Aachen University, Aachen, Germany
- St. Mauritius Rehabilitation Centre, Meerbusch, Germany, and
- Division of Neuroscience and Experimental Psychology, School of Biological Sciences, University of Manchester, Manchester, UK
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Schliep ME, Tilton-Bolowsky V, Vallila-Rohter S. Cue responsiveness as a measure of emerging language ability in aphasia. Top Stroke Rehabil 2021; 29:133-145. [PMID: 33761830 DOI: 10.1080/10749357.2021.1886636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Background: Prior research suggests that initial aphasia severity, lesion size, and lesion location are the most salient factors in predicting recovery outcomes. While these factors provide important prognostic information, information that is individualized and readily available to clinicians is limited. Deficits in naming are common to all aphasia types and are routinely targeted in aphasia assessment and treatment, with cues provided to facilitate lexical retrieval.Objectives: In this study, we examine aphasia recovery factors that are readily available to clinicians, examining whether a person's ability to improve naming with cues, indicating "stimulability," will be predictive of future word retrieval.Methods: Ten participants with aphasia following a left-hemisphere stroke participated in initial assessment, seven of whom met criteria for longitudinal assessment. Stroke and early clinical recovery data were collected for all participants. At four timepoints over one year we evaluated longitudinal participants' naming ability and measured the proportion of successful lexical retrieval with the presentation of phonemic, feature, and sentence cues.Results: For all participants, multiple descriptive factors regarding recovery, including lesion information, information from the acute inpatient timeframe, and communication opportunities, were examined. For individuals followed longitudinally, naming stimulability did not consistently predict naming accuracy at the subsequent assessment timepoint. Individuals' attempts at naming emerged as a metric related to future naming performance warranting further evaluation.Conclusions: Multiple factors related to recovery must be considered when providing prognostic information. Naming stimulability and attempts at naming provide some information regarding future performance, but are not consistently reliable across timepoints.
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Affiliation(s)
- Megan E Schliep
- School of Health and Rehabilitation Sciences, MGH Institute of Health Professions, Boston, Massachusetts, USA
| | - Victoria Tilton-Bolowsky
- School of Health and Rehabilitation Sciences, MGH Institute of Health Professions, Boston, Massachusetts, USA
| | - Sofia Vallila-Rohter
- School of Health and Rehabilitation Sciences, MGH Institute of Health Professions, Boston, Massachusetts, USA
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Convergence of heteromodal lexical retrieval in the lateral prefrontal cortex. Sci Rep 2021; 11:6305. [PMID: 33737672 PMCID: PMC7973515 DOI: 10.1038/s41598-021-85802-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Accepted: 03/03/2021] [Indexed: 01/31/2023] Open
Abstract
Lexical retrieval requires selecting and retrieving the most appropriate word from the lexicon to express a desired concept. Few studies have probed lexical retrieval with tasks other than picture naming, and when non-picture naming lexical retrieval tasks have been applied, both convergent and divergent results emerged. The presence of a single construct for auditory and visual processes of lexical retrieval would influence cognitive rehabilitation strategies for patients with aphasia. In this study, we perform support vector regression lesion-symptom mapping using a brain tumor model to test the hypothesis that brain regions specifically involved in lexical retrieval from visual and auditory stimuli represent overlapping neural systems. We find that principal components analysis of language tasks revealed multicollinearity between picture naming, auditory naming, and a validated measure of word finding, implying the existence of redundant cognitive constructs. Nonparametric, multivariate lesion-symptom mapping across participants was used to model accuracies on each of the four language tasks. Lesions within overlapping clusters of 8,333 voxels and 21,512 voxels in the left lateral prefrontal cortex (PFC) were predictive of impaired picture naming and auditory naming, respectively. These data indicate a convergence of heteromodal lexical retrieval within the PFC.
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van Rijssen MN, Veldkamp M, Bryon E, Remijn L, Visser-Meily JMA, Gerrits E, van Ewijk L. How do healthcare professionals experience communication with people with aphasia and what content should communication partner training entail? Disabil Rehabil 2021; 44:3671-3678. [PMID: 33529542 DOI: 10.1080/09638288.2021.1878561] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PURPOSE Aphasia after stroke has been shown to lead to communication difficulties between healthcare professionals (HCP) and people with aphasia. Clinical guidelines emphasize the importance of teaching HCP to use supportive conversative techniques through communication partner training (CPT). The aim of this study is to explore and describe the experiences of HCP in communicating with people with aphasia and their needs and wishes for the content in CPT. MATERIALS AND METHODS The data were collected through qualitative semi-structured interviews with 17 HCP. HCP were recruited from two geriatric rehabilitation centres in the Netherlands and one academic hospital in Belgium. The interviews drew upon the qualitative research methodologies ethnography and phenomenology and were thematically analysed using the six steps of Braun & Clarke. RESULTS Three themes were derived from the interviews. HCP experienced that communication difficulties impede healthcare activities (theme 1) and reported the need to improve communication through organizational changes (theme 2), changing the roles of SLTs (theme 3) and increasing knowledge and skills of HCP (theme 4). CONCLUSIONS According to HCP, communication difficulties challenge the provision of healthcare activities and lead to negative feelings in HCP. HCP suggest that communication can be improved by providing more time in the healthcare pathway of people with aphasia, adapting healthcare information to the needs of people with aphasia, commitment of physicians and managers, changing the roles of SLTs and improving knowledge and skills of HCP.Implications for rehabilitationCommunication between healthcare professionals (HCP) and people with aphasia can be improved by training HCP to use supportive conversation techniques and tools.An important condition for successful implementation of communication partner trainings in healthcare centres is to identify the experiences of HCP with communication with people with aphasia and their needs and wishes for training content.This study shows that communication problems between HCP and people with aphasia impede diagnosis and therapy with considerable implications for healthcare quality.The suggestions that HCP have concerning the content of communication partner trainings can be placed under "education" and "implementation and post-training support." HCP describe specific roles for speech-and language therapists to fulfil after the training and suggest two main changes that should be made at an organizational level.
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Affiliation(s)
| | | | - Els Bryon
- Thomas More University of Applied Sciences, Mechelen, Belgium
| | - Lianne Remijn
- HAN University of Applied Sciences, Health Studies, Nijmegen, Netherlands.,Radboud University Medical Center, Radboud Institute for Health Sciences, IQ healthcare, Nijmegen, Netherlands
| | - Johanna M A Visser-Meily
- UMC Utrecht Hersencentrum Rudolf Magnus, Rehabilitation, Physical Therapy Science and Sport, Utrecht, Netherlands.,UMC Utrecht Hersencentrum Rudolf Magnus, Center of Excellence for Rehabilitation Medicine, Utrecht, Netherlands
| | - Ellen Gerrits
- HU University of Applied Sciences Utrecht, Utrecht, Netherlands.,Clinical Language, Speech and Hearing Sciences, Utrecht University, Utrecht, Netherlands
| | - Lizet van Ewijk
- HU Utrecht University of Applied Sciences, Research Group Speech and Language Therapy, Utrecht, Netherlands
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Behn N, Francis J, Togher L, Hatch E, Moss B, Hilari K. Description and Effectiveness of Communication Partner Training in TBI: A Systematic Review. J Head Trauma Rehabil 2021; 36:56-71. [PMID: 32472837 DOI: 10.1097/htr.0000000000000580] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To evaluate the current evidence on communication partner training and its effectiveness on outcomes for people with traumatic brain injury (TBI) and/or their communication partners. METHODS Information sources: Systematic searches of 9 databases (AMED, CINAHL, EMBASE, Medline/EBSCOHOST, PsycINFO, PsycBITE, PsycARTICLES, PubMed, and Scopus) from database inception to February 2019. Eligibility criteria: Empirical studies on interventions for adult communication partners where the primary focus of the program (>50%) was on improving communication skills of people with TBI and/or communication partners. Data: Participants, characteristics of the training, outcome measures, and findings. Risk of bias: Standard checklists were used for methodological quality (PEDro, ROBiN-T) and intervention description (TIDieR). Synthesis: Narrative synthesis and effect sizes (Cohen's d) for group-level studies. OUTCOMES Ten articles (describing 8 studies) met eligibility criteria: 3 randomized controlled trials, 2 nonrandomized controlled trials, and 3 single-case experimental designs. Studies included a total of 258 people with TBI and 328 communication partners; however, all but one study had fewer than 65 participants. Methodological quality varied and intervention description was poor. Three studies in the final synthesis (n = 41 communication partners, n = 36 people with TBI) reported positive intervention effects. Effect sizes in group studies were d = 0.80 to 1.13 for TBI and d = 1.16 to 2.09 for communication partners. CONCLUSIONS The articles provided encouraging, though limited, evidence for training communication partners. Greater methodological rigor, more clearly described interventions, and consistent use of outcome measures and follow-up after treatment are needed. Further research on this topic is warranted.
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Affiliation(s)
- Nicholas Behn
- Divisions of Language and Communication Science (Drs Behn, Moss, and Hilari and Ms Hatch) and Health Services Research and Management (Dr Francis), School of Health Sciences, City, University of London, England; and Speech Pathology, Faculty of Medicine and Health, The University of Sydney, Australia (Dr Togher)
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Nguyen-Feng VN, Asplund A, Frazier PA, Misono S. Association Between Communicative Participation and Psychosocial Factors in Patients With Voice Disorders. JAMA Otolaryngol Head Neck Surg 2020; 147:2774498. [PMID: 33355630 PMCID: PMC7758827 DOI: 10.1001/jamaoto.2020.4956] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 11/02/2020] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Communicative participation can be conceptualized as taking part in life situations in which people are socially engaged. Communicative participation is an important aspect in the lives of patients with voice disorders, although it has not been formally assessed among a broad sample of patients with voice disorders. The associations between communicative participation and associated concepts (vocal impairment, psychosocial distress, and voice-specific perceived control) are unknown yet important for integrated treatment approaches. OBJECTIVE The primary objective was to examine the associations between communicative participation and vocal impairment, psychosocial distress, and voice-specific perceived control. The secondary objective was to examine whether perceived control moderates the association of distress with communicative participation and vocal impairment, the latter of which would replicate previous research. The hypotheses were that communicative participation would be associated with lower vocal impairment, lower distress, and higher perceived control and that higher perceived control would moderate the association between communicative participation and both vocal impairment and psychosocial distress. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study was conducted from June 2014 to May 2017 among a consecutive sample of adult patients with voice disorders at an academic voice clinic affiliated with the University of Minnesota. Of the 744 patients approached to participate in the survey study, 590 patients agreed. Data analysis was performed from January to June 2020. MAIN OUTCOMES AND MEASURES Communicative participation (measured by the 10-item general short form of the Communicative Participation Item Bank), vocal impairment (measured by the 10-item version of the Voice Handicap Index), psychosocial distress (measured by the 18-item version of the Brief Symptom Inventory), and voice-specific perceived control (measured by the 8-item present control subscale of the Perceived Control Over Stressful Events Scale). RESULTS The sample comprised 590 patients (mean [SD] age, 51.9 [17.1] years; 390 women [66.1%]) with voice disorders. Communicative participation was associated with lower vocal impairment (r = -0.73; 95% CI, -0.77 to -0.69), lower overall psychosocial distress (r = -0.22; 95% CI, -0.30 to -0.14), and higher voice-specific perceived control (r = 0.30; 95% CI, 0.23-0.37). Moderation analyses indicated that communicative participation was negatively associated with distress at all levels of perceived control and, replicating previous findings, greater vocal impairment was associated with higher psychosocial distress only in patients with lower perceived control. CONCLUSIONS AND RELEVANCE In this study, communicative participation was associated with, but distinct from, vocal impairment and was also associated with psychosocial distress and voice-specific perceived control. The study's results suggest that communicative participation is an important addition to voice research and clinical care.
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Affiliation(s)
| | - Alexa Asplund
- Department of Psychology, University of Minnesota Duluth, Duluth
| | | | - Stephanie Misono
- Department of Otolaryngology–Head and Neck Surgery, University of Minnesota, Twin Cities, Minneapolis
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Hansen D, Kristensen LF, Christensen ME, Eriksson K, Thunberg G. 'They get the opportunity to say what is important for them': exploring staff's early perceptions of the implementation of a new communicative approach to patients with aphasia. Disabil Rehabil 2020; 44:3071-3080. [PMID: 33280450 DOI: 10.1080/09638288.2020.1853829] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PURPOSE This study explored the perceptions of staff members regarding the implementation of a new communicative approach at a multidisciplinary neurorehabilitation centre in Denmark. Communication partner training according to Supported Conversation for Adults with Aphasia (SCATM) was combined with augmentative strategies from the KomHIT programme to increase the influence of patients with aphasia on their own rehabilitation process. METHODS A qualitative approach was used involving two semi-structured group interviews with multidisciplinary staff in two wards. Three staff members from each ward participated. The recorded interviews were transcribed, and a thematic analysis of the data was conducted. RESULTS Three main themes emerged from the analysis. Participants reported increased influence of patients with aphasia on their own rehabilitation process, as well as an increased focus on communication with patients with aphasia. Challenges included time restrictions and dilemmas in goal setting. CONCLUSIONS Increasing staff knowledge of communication support and augmentative strategies seemed to improve the influence of patients with aphasia on their own rehabilitation process. Because the results were based on interviews with a small number of staff, they cannot be generalized and require further investigation that should also include interviews with the patients themselves and their families.IMPLICATIONS FOR REHABILITATIONThe combination of partner training with augmentative strategies may increase staff understanding of all individuals' rights to have their communicative needs met.The combination of partner training with augmentative strategies may support the influence of persons with aphasia on their own rehabilitation.Goal setting discrepancies between staff and patients with aphasia can be brought to light by more successful communication.The implementation of a new communicative approach can be challenged by a number of factors, e.g., time restrictions.The implementation process needs to be supported by actions on a higher organisational level.
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Affiliation(s)
- Dorthe Hansen
- Hammel Neurorehabilitation Centre and University Research Clinic, Hammel, Denmark
| | | | | | - Karin Eriksson
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Region Västra Götaland, Department of Geriatrics, Pulmonary Disease and Allergology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Gunilla Thunberg
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Region Västra Götaland, DART Centre for AAC and AT, Sahlgrenska University Hospital, Gothenburg, Sweden
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Gallée J, Pittmann R, Pennington S, Vallila-Rohter S. The Application of Lexical Retrieval Training in Tablet-Based Speech-Language Intervention. Front Neurol 2020; 11:583246. [PMID: 33281721 PMCID: PMC7706007 DOI: 10.3389/fneur.2020.583246] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 10/08/2020] [Indexed: 11/13/2022] Open
Abstract
In the setting of shortened hospitalization periods, periods of confinement and social isolation, limited resources, and accessibility, technology can be leveraged to enhance opportunities for rehabilitative care (1). In the current manuscript, we focus on the use of tablet-based rehabilitation for individuals with aphasia, a language disorder that frequently arises post-stroke. Aphasia treatment that targets naming through effortful and errorful instances of lexical retrieval, where corrective feedback is generated on every trial, may enhance retention and generalizability of gains (2, 3). This pilot evaluation explored how six individuals with aphasia interacted with a tablet-based therapy application that targeted lexical retrieval. Participants with aphasia either (1) autonomously engaged with the therapy tasks or (2) received systematic encouragement to effortfully retrieve words. Behaviors of response latency and cue use were examined to gain insights into the behavioral patterns of both groups, as well as analyses of task accuracy and outcomes on standardized cognitive-linguistic assessments. Despite some variability, initial observations suggest that participants who received systematic training refrained from using cues to complete tasks and spent longer on each trial, which ultimately co-occurred with increased independent engagement with therapy and improved standardized outcomes. Preliminary results present an alternative means of leveraging technology to implement best-practice recommendations in the context of aphasia telerehabilitation.
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Affiliation(s)
- Jeanne Gallée
- Division of Medical Sciences, Harvard University, Cambridge, MA, United States.,Program in Speech and Hearing Bioscience and Technology, Harvard Medical School, Boston, MA, United States
| | - Rachel Pittmann
- Department of Communication Sciences and Disorders, MGH-Institute of Health Professions, Boston, MA, United States
| | - Suzanne Pennington
- Department of Communication Sciences and Disorders, MGH-Institute of Health Professions, Boston, MA, United States
| | - Sofia Vallila-Rohter
- Program in Speech and Hearing Bioscience and Technology, Harvard Medical School, Boston, MA, United States.,Department of Communication Sciences and Disorders, MGH-Institute of Health Professions, Boston, MA, United States
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Power E, Falkenberg K, Barnes S, Elbourn E, Attard M, Togher L. A pilot randomized controlled trial comparing online versus face-to-face delivery of an aphasia communication partner training program for student healthcare professionals. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2020; 55:852-866. [PMID: 32654395 DOI: 10.1111/1460-6984.12556] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 04/05/2020] [Accepted: 05/21/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Training conversation partners of people with aphasia who use facilitative communication strategies is one method that can improve access to healthcare for people with aphasia. However, the efficacy of communication partner training (CPT) has been investigated almost exclusively in the context of face-to-face (F2F) delivery. Online training may offer more cost-effective and accessible options to a wider range of conversation partners, including student healthcare professionals. AIMS To conduct a pilot randomized controlled trial with student healthcare professionals comparing (1) an online aphasia CPT program, (2) a F2F CPT program and (3) no program (control group) on outcomes relating to attitudes and knowledge of aphasia. METHODS & PROCEDURES A 45-min introductory aphasia CPT program was developed using the theories and techniques of Supported Conversations for Adults with Aphasia (SCA)™. A total of 30 first-year undergraduates studying occupational therapy at The University of Sydney were randomly allocated to one of three conditions: online CPT delivery, F2F delivery or delayed training control (no program). Outcomes measures included pre-post-testing with the Aphasia Attitudes, Strategies and Knowledge (AASK) survey. OUTCOMES & RESULTS A significant difference existed for the AASK survey pre-post-change scores between the online, F2F and control groups (χ2 (2) = 20.038, p = 0.000). Post-hoc analysis revealed that, compared with the control (Ctrl) group, participants in both the online and F2F groups had significantly higher knowledge of aphasia (Online versus Ctrl: p = 0.000; F2F versus control: p = 0.002), knowledge of facilitative strategies (Online versus Ctrl: p = 0.000; F2F versus Ctrl: p = 0.002), and positive attitudes towards aphasia (Online versus Ctrl: p = 0.031; F2F versus Ctrl: p = 0.032). No significant difference was observed between the online and F2F groups for the Total or any subtotals (p = 1.000). CONCLUSIONS AND IMPLICATIONS The results from this pilot randomized controlled trial indicate that online delivery of the 45-min introductory CPT is equally as efficacious as F2F delivery, and thus may be a viable mode of delivery for future aphasia CPT programs. These pilot results pave the way for a larger study that will comprehensively evaluate the efficacy of an online aphasia CPT program for improving attitudes, knowledge and skills in a broad range of student healthcare professionals. What this paper adds What is already known on this subject The efficacy of F2F CPT for aphasia is well established. Online delivery of CPT programs may offer more cost-effective and accessible services when compared with F2F approaches; however, there is a need to explore the efficacy of online programs. What this paper adds to existing knowledge The 45-min online aphasia CPT program was found to be efficacious for improving student healthcare professionals' knowledge and attitudes towards aphasia and communication, and produced equally successful outcomes when compared with F2F delivery. This is the first study to report the efficacy of an online CPT program that is aligned with SCA for use with student healthcare professionals that also uses a self-report outcome measure with validated psychometric properties. What are the potential or actual clinical implications of this work? Online CPT programs may be useful in both clinical and education contexts to support improved efficiency of services and to enhance communication environments for people with aphasia in healthcare contexts.
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Affiliation(s)
- Emma Power
- University of Technology Sydney, Sydney, NSW, Australia
- The University of Sydney, Sydney, NSW, Australia
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Australia
| | | | | | | | - Michelle Attard
- The University of Sydney, Sydney, NSW, Australia
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Australia
| | - Leanne Togher
- The University of Sydney, Sydney, NSW, Australia
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Australia
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Mahmoud SS, Kumar A, Tang Y, Li Y, Gu X, Fu J, Fang Q. An Efficient Deep Learning Based Method for Speech Assessment of Mandarin-Speaking Aphasic Patients. IEEE J Biomed Health Inform 2020; 24:3191-3202. [DOI: 10.1109/jbhi.2020.3011104] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Dietz A, Mamlekar CR, Bakas KL, McCarthy MJ, Harley D, Bakas T. A scoping review of PhotoVoice for people with post-stroke aphasia. Top Stroke Rehabil 2020; 28:219-235. [PMID: 33054682 DOI: 10.1080/10749357.2020.1806435] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND PhotoVoice is a qualitative research methodology designed to engage and empower marginalized members of a community and/or to understand community needs. PhotoVoice seems aphasia-friendly because it relies on personal photographs to convey opinions regarding prespecified topics. However, PhotoVoice is based on a procedure referred to as the SHOWeD method. Participants are asked to reflect upon their photos by discussing (1) what they See, (2) what is Happening, (3) the relation to Our life, (3) Why the issue or condition exists, and then to (4) explain what can be Done to address the issue(s) at hand. Due to the linguistic demand required to convey complex thoughts and ideas inherent in this methodology, adaptations are likely required to successfully implement with people who have aphasia. AIMS A scoping review was conducted to summarize the current literature regarding the use of PhotoVoice with people who have aphasia, to address two questions:(1) Are people with post-stroke aphasia included in PhotoVoice studies?(2) What, if any, modifications are required to address post-stroke aphasia and motor impairments? MAIN CONTRIBUTION This scoping review revealed that researchers often exclude people with aphasia from post-stroke PhotoVoice research. Three studies outlined adaptations that allowed successful implementation with people who have post-stroke aphasia. CONCLUSIONS Further inquiry regarding how best to adapt PhotoVoice for people with aphasia will facilitate their ability to be included in community-based research. This is an important step in ensuring that all post-stroke stakeholders are involved in projects related to social justice and policy for stroke survivors.
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Affiliation(s)
- Aimee Dietz
- Department of Communication Sciences and Disorders, University of Cincinnati College of Allied Health Sciences, Cincinnati, OH, USA
| | - Chitrali R Mamlekar
- Department of Communication Sciences and Disorders, University of Cincinnati College of Allied Health Sciences, Cincinnati, OH, USA
| | | | - Michael J McCarthy
- College of Social and Behavioral Sciences, University of Northern Arizona, Flagstaff, AZ, USA
| | - Dana Harley
- School of Social Work, University of Cincinnati College of Allied Health Sciences, Cincinnati, OH, USA
| | - Tamilyn Bakas
- University of Cincinnati College of Nursing, Cincinnati, OH, USA
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