How Do You Do Talk Therapy With Someone Who Can't Talk? Perspectives From Mental Health Providers on Delivering Services to Individuals With Aphasia

Knowledge, Beliefs, and Experiences With Mental Health Services and Help-Seeking in People With Aphasia and Care Partners

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.

The Acceptability of Relationship-Centered Communication Partner Training for Couples Impacted by Aphasia: A Mixed-Methods Pilot Investigation

PURPOSE

This study explored the acceptability and impact of relationship-centered communication partner training (RC-CPT) in couples impacted by aphasia. In particular, couples considered whether discussing their relationship roles and responsibilities was important and relevant to the changes they desire. Preliminary quasi-experimental data regarding perceived communication confidence and the marriage relationship were also obtained.

METHOD

Three couples participated in RC-CPT across two sessions. Surveys were used to measure communication confidence and the marital relationship before and after participation in RC-CPT. The quantitative findings were analyzed using descriptive statistics. Couples also participated in a semistructured interview about the acceptability of RC-CPT during a third session. The interviews were transcribed and analyzed using reflexive codebook analysis.

RESULTS

Quantitative data indicated that participants generally maintained or improved self-rated accessibility, responsiveness, engagement, conflict resolution, and communication within their marriage after participating in RC-CPT. Additionally, individuals with aphasia demonstrated enhanced communication confidence scores. Qualitative analysis revealed three themes: (a) Impact on Communication, (b) Impact on Relationship, and (c) Impact on Psychosocial Well-Being. Feedback from participants regarding future development was also included.

CONCLUSIONS

The convergence of quantitative and qualitative data supports the conclusion that couples experienced positive changes in their communication, relationship, and psychosocial well-being during the intervention, suggesting that RC-CPT has the potential to positively impact both communicative and psychosocial effects of aphasia on couples. Moreover, this study highlights the promise of RC-CPT as a relationship-centered counseling tool, warranting further exploratory and experimental research.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.25937383.

Aphasia Depression and Psychological Therapy (ADaPT): Perspectives of People with Post-Stroke Aphasia on Participating in a Modified Cognitive Behavioral Therapy

Aphasia, a communication disability commonly caused by stroke, can profoundly affect a person's mood and identity. We explored the experiences of stroke survivors with aphasia and depression who received a modified cognitive behavioral therapy (CBT)-based psychological intervention. The therapy is manualized with a flexible treatment protocol, including 10 individually based therapy sessions (+2 booster sessions) either via telehealth or in person. Six participants with chronic aphasia (60% of the total sample) participated in in-depth interviews that were analyzed using reflexive thematic analysis. Two core themes were derived from the data: the first theme, helpful elements of therapy-doing enjoyable activities, new ways of thinking, problem solving, working with the experienced therapist, and using telehealth; and the second theme, making progress-mood, communication, acceptance of the 'new me', and improving relationships. All participants found the therapy to be helpful in managing mood problems with various elements being beneficial depending on the individual, highlighting the importance of tailoring the intervention. Therefore, delivering modified CBT to individuals with aphasia is likely to be acceptable both in person and through telehealth. Further evaluation of the intervention and its impact on mood would be beneficial.

Person-centered care for people with aphasia: tools for shared decision-making

Shared decision-making is a fundamental aspect of person-centered care, and can and should be part of many different aspects of the rehabilitation process. Communication disabilities like aphasia, which affects people's ability to use and understand spoken and written language, can make shared decision-making especially challenging to the resources and skills of rehabilitation practitioners. The purpose of this narrative review is to provide a comprehensive description of tools that can support successful shared decision-making with people with aphasia in the rehabilitation environment. These tools and strategies are appropriate for use by physicians, nurses, social workers, physical therapists (also referred to as physiotherapists), occupational therapists, and other service or care providers. The important role of speech-language pathologists as consultants is also described. Case scenarios throughout the paper illustrate the application of recommended tools and strategies along with best practices.

Perspectives of U.S. speech-language pathologists on supporting the psychosocial health of individuals with aphasia

INTRODUCTION

Individuals living with aphasia (IWA) are more likely than stroke survivors without aphasia to experience depression, anxiety, stress, and social isolation due to communication difficulties, social and life barriers, and neurobiological changes (Hilari, 2011). Researchers in the U.K., Australia, and elsewhere have surveyed speech-language pathologists (SLPs) to ascertain their training and confidence in addressing the psychosocial well-being of IWA (Northcott et al., 2017; Sekhon et al., 2015). To date, no similar survey has been performed in the U.S. The aim of this study was to survey the perspectives of U.S. SLPs on addressing the psychosocial well-being of IWA.

METHODS

The survey questions were drawn from Northcott et al. (2017), with adjustments for a U.S. audience and additional questions. We conducted a Qualtrics survey which remained open from November 2021 through May 2022 and collected 101 responses. Responses to the closed questions were analyzed using descriptive statistics and open-ended responses were analyzed with qualitative content analysis.

RESULTS

Some of the most significant findings of this survey include the low levels of confidence in addressing psychological health, lack of training among SLPs, and rarity of successful collaboration with mental health professionals. In comparison to surveys conducted in other countries, many overarching themes were similar, but there was some variation in specific responses and patterns. Categories emerging from the open-ended responses included the need for more trained mental health professionals, improved collaboration, and emphasis on the importance of the topic.

CONCLUSIONS

This research highlights the necessity of increased training, as well as improved interprofessional collaboration between SLPs and mental health professionals. Limitations of the study include the potential bias of respondents, as well as the number and scope of the questions and responses. Future studies can employ interviews, trial models for collaboration, and partner with IWA to explore their experiences with psychosocial health support and services.

Reversing the Ruin: Rehabilitation, Recovery, and Restoration After Stroke

PURPOSE OF REVIEW

Stroke is a common cause of disability in aging adults. A given individual's needs after stroke vary as a function of the stroke extent and location. The purpose of this review was to discuss recent clinical investigations addressing rehabilitation of an array of overlapping functional domains.

RECENT FINDINGS

Research is ongoing in the domains of movement, cognition, attention, speech, language, swallowing, and mental health. To best assist patients' recovery, innovative research has sought to develop and evaluate behavioral approaches, identify and refine synergistic approaches that augment the response to behavioral therapy, and integrate technology where appropriate, particularly to introduce and titrate real-world complexity and improve the overall experience of therapy. Recent and ongoing trials have increasingly adopted a multidisciplinary nature - augmenting refined behavioral therapy approaches with methods for increasing their potency, such as pharmaceutical or electrical interventions. The integration of virtual reality, robotics, and other technological advancements has generated immense excitement, but has not resulted in consistent improvements over more universally accessible, lower technology therapy.

Understanding How Older Adults with Communication Difficulties Access Health Services: What We Can Learn from the National Health and Aging Trends Study (NHATS)

People with communication disorders face barriers to accessing safe and respectful healthcare. These barriers result in increased healthcare complications and inefficiencies, both of which contribute to increased healthcare costs. One obstacle to advocating for accommodations that could improve healthcare for this population is the absence of cost effectiveness studies of such accommodations specifically, as well as a paucity of data defining the needs of this population in general. The purpose of this study was to explore how people with communication and swallowing difficulties are characterized in the National Health and Aging Trends Study (NHATS), a nationally representative survey of Medicare beneficiaries aged 65 and older, and how they manage their healthcare. Cross-sectional data from the NHATS rounds 5 to 9 (2015-2019) resulted in 8,038 unique respondents, 3,243 of who reported speech, memory, hearing, and/or swallowing difficulties. More than 90% of respondents with communication difficulties reported having a regular doctor. Less than 60% of respondents with communication difficulties had a family member or caregiver go to medical appointments with them, and around 70% of that subset of participants received help from that caregiver with communication during appointments. Fewer than 15% of respondents with communication difficulties used the internet for healthcare communication or information. Less than 5% of respondents across all communication difficulty categories had received rehabilitation services for communication in the year prior to their survey responses. While the information gleaned from NHATS points to likely gaps between the needs people with communication disorders may have for safe and accessible healthcare, and the support available, future research is needed to improve and clarify how communication disorders are defined and characterized in large-scale surveys to generate more interpretable data. These stronger empirical foundations are needed to support cost-effectiveness analyses to advocate for better communication accessibility of healthcare settings.