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Kankam K, Murray L. Rehabilitation of post-stroke aphasia in Ghana. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2024; 59:1308-1321. [PMID: 38156768 DOI: 10.1111/1460-6984.13000] [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: 01/03/2023] [Accepted: 12/11/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND Aphasia, a common consequence of stroke, which affects both communication and social functioning, and in turn, quality of life, is on the rise due to increases in stroke prevalence and survival rate. The rehabilitation of post-stroke aphasia primarily falls within the purview of speech-language pathology and research supports the effectiveness of such services. However, provision of aphasia rehabilitation services in sub-Saharan Africa is associated with challenges. AIMS This study aimed to examine rehabilitation services for individuals with post-stroke aphasia in Ghana by exploring the roles of the stakeholder groups involved in the assessment and treatment of post-stroke aphasia in Ghana, as well as the challenges they encounter in providing or identifying services. The stakeholder groups included educational institutions, interdisciplinary healthcare professionals, and family caregivers of individuals with post-stroke aphasia. METHODS & PROCEDURES A qualitative case study approach was used to collect and integrate from multiple sources data such as demographic information, interview responses and program syllabi to develop a holistic image. Fifteen respondents from the stroke and speech therapy units at Komfo Anokye and Korle-Bu Teaching Hospitals, University of Ghana, and University of Health and Allied Sciences, Ghana were purposively sampled. Interview questions were developed and centred on aphasia education and training, knowledge of speech-language pathology services, speech-language pathology service delivery, access to speech-language pathology services, challenges in both delivery and access to speech-language pathology services and suggestions for improving speech-language pathology services. In-person and virtual interviews were conducted after demographic information was collected. Interviews were analysed thematically, and demographic information and program syllabi were triangulated with the interview data collected. OUTCOMES & RESULTS All stakeholder groups identified concerns with current aphasia services in Ghana. Issues raised included the insufficient number of speech-language pathologists, lack of awareness of speech-language pathology services for post-stroke aphasia (among healthcare professionals and the public), absence of aphasia management information and clinical training in educational programming, lack of interest in speech-language pathology training programs, financial challenges, spiritual and traditional beliefs and geographic barriers (i.e., speech-language pathology services are currently available in only a few cities). CONCLUSIONS & IMPLICATIONS These findings emphasised the need to improve post-stroke aphasia rehabilitation in Ghana. The process of data collection itself educated respondents on the importance of post-stroke aphasia rehabilitation, and by identifying barriers, strategies to improving services, such as designing standardised aphasia assessments for the Ghanaian context, can now be initiated. WHAT THIS PAPER ADDS What is already known on the subject To address post-stroke aphasia, evidence-based speech-language pathology services are provided. However, there is a paucity of studies on post-stroke aphasia services in Ghana, preventing an accurate report of services and practices in the country. What this study adds This study provides an overview of the existing rehabilitation services for post-stroke aphasia in Ghana. It highlights challenges facing the existing services and suggested strategies to improve post-stroke aphasia services. What are the clinical implications of this work? The study created awareness among healthcare professionals and general public (study participants) about the importance of rehabilitation services for post-stroke aphasia. Based on the study findings, appropriate stakeholders such as policy makers, researchers, and healthcare professionals can further design assessments and interventions to improve rehabilitation, including speech-language pathology services, for post-stroke aphasia in Ghana.
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Affiliation(s)
- Keren Kankam
- Health and Rehabilitation Sciences, Faculty of Health Sciences, University of Western Ontario, London, Ontario, Canada
| | - Laura Murray
- Health and Rehabilitation Sciences, Faculty of Health Sciences, University of Western Ontario, London, Ontario, Canada
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Anemaat L, Palmer VJ, Copland DA, Binge G, Druery K, Druery J, Mainstone K, Aisthorpe B, Mainstone P, Wallace SJ. Qualitative Exploration of Speech Pathologists' Experiences and Priorities for Aphasia Service Design: Initial Stage of an Experience-Based Co-Design Project to Improve Aphasia Services. Health Expect 2024; 27:e14105. [PMID: 38879788 PMCID: PMC11180296 DOI: 10.1111/hex.14105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 03/13/2024] [Accepted: 05/26/2024] [Indexed: 06/19/2024] Open
Abstract
INTRODUCTION AND AIMS Stroke survivors with aphasia (impaired language/communication) have poor outcomes and gaps in the clinical implementation of best practice contribute to this. Little is known, however, about speech pathologist perspectives on the touchpoints (key moments shaping experiences) in the clinical care pathway that have the greatest impact on service delivery nor how this varies by geographical location. We explored the experiences of speech pathologists who provide aphasia services to establish priorities for improvement and design. METHODS AND ANALYSIS This is the initial experience gathering and priority identification stage of an experience-based co-design (EBCD) project. Speech pathologists were recruited from 21 geographically diverse Hospital and Health Services in Queensland, Australia. Speech pathologists working in acute, rehabilitation and community services shared positive and negative experiences of delivering aphasia care in interviews and focus groups. Experiential data were analysed using qualitative thematic analysis to determine touchpoints. Priorities for service design were identified using an adapted nominal group technique. RESULTS Speech pathologists (n = 62) participated in 16 focus groups and nine interviews and shared 132 experiences of delivering aphasia care. Providing care in teams with poor awareness of the impacts of aphasia was identified as a key challenge, as poor patient-provider communication was perceived to increase risk of adverse outcomes for patients. Speech pathologists identified areas for improvement related to their own professional needs (e.g., greater access to clinical supervision); collaborative health care (e.g., better coordination and interdisciplinary care to increase therapy time); and the service context and environment (e.g., psychological services able to support diverse communication needs). CONCLUSIONS Speech pathologist delivery of aphasia services could be improved through increased access to clinical supervision, opportunities for peer debriefing and interdisciplinary care. Priorities for service design varied by geographical location and included: education to support care transitions (remote areas), improved referral pathways and service linkage (regional areas) and dedicated aphasia staffing (metropolitan areas). PATIENT OR PUBLIC CONTRIBUTION A consumer advisory committee comprising people with aphasia (n = 3, authors K.M., K.D. and B.A.), their significant others (n = 2, authors J.D. and P.M.), and a Cultural Capability Officer (author G.B.) guided this research. The team: (1) reviewed participant information; (2) co-designed surveys and workshop resources; (3) copresented research outcomes and contributed to publications. Research questions and study design (e.g., analysis methods and assessment measures) were developed by the research team (authors L.A., V.J.P., D.A.C. and S.J.W.).
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Affiliation(s)
- Lisa Anemaat
- School of Health and Rehabilitation Sciences, Queensland Aphasia Research Centre, The University of Queensland, Herston, Australia
- Surgical Treatment and Rehabilitation Service (STARS) Education and Research Alliance, The University of Queensland and Metro North Health, Australia
| | - Victoria J Palmer
- The ALIVE National Centre for Mental Health Research Translation, The University of Melbourne, Melbourne, Australia
| | - David A Copland
- School of Health and Rehabilitation Sciences, Queensland Aphasia Research Centre, The University of Queensland, Herston, Australia
- Surgical Treatment and Rehabilitation Service (STARS) Education and Research Alliance, The University of Queensland and Metro North Health, Australia
| | - Geoffrey Binge
- School of Health and Rehabilitation Sciences, Queensland Aphasia Research Centre, The University of Queensland, Herston, Australia
| | - Kent Druery
- School of Health and Rehabilitation Sciences, Queensland Aphasia Research Centre, The University of Queensland, Herston, Australia
| | - Julia Druery
- School of Health and Rehabilitation Sciences, Queensland Aphasia Research Centre, The University of Queensland, Herston, Australia
| | - Kathryn Mainstone
- School of Health and Rehabilitation Sciences, Queensland Aphasia Research Centre, The University of Queensland, Herston, Australia
| | - Bruce Aisthorpe
- School of Health and Rehabilitation Sciences, Queensland Aphasia Research Centre, The University of Queensland, Herston, Australia
| | - Penelope Mainstone
- School of Health and Rehabilitation Sciences, Queensland Aphasia Research Centre, The University of Queensland, Herston, Australia
| | - Sarah J Wallace
- School of Health and Rehabilitation Sciences, Queensland Aphasia Research Centre, The University of Queensland, Herston, Australia
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Manning MX, Cleary C, McCaughey C. How do speech and language therapists enact aphasia psychosocial support in Ireland? A cross-sectional online survey informed by normalization process theory. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2024; 59:698-714. [PMID: 37815803 DOI: 10.1111/1460-6984.12959] [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: 12/26/2022] [Accepted: 09/01/2023] [Indexed: 10/11/2023]
Abstract
BACKGROUND Supporting psychosocial well-being in aphasia is necessarily person-centred, interdisciplinary and coordinated. Shortcomings in such support are described in Ireland and elsewhere. Speech and language therapists (SLTs) are integral; and describing current practice and barriers they experience is important for enhancing service delivery. AIMS To understand how SLTs enact, and are supported to enact, aphasia psychosocial care in Ireland. METHODS & PROCEDURES This is a cross-sectional, online, self-administered clinician survey targeting SLTs working minimally 1 year post-qualification with persons with aphasia of any aetiology in Ireland. The survey questions were charted against key constructs of the implementation science framework, normalization process theory (NPT), and descriptive statistics were applied. OUTCOMES & RESULTS A total of 54 eligible datasets were included. SLTs believed psychosocial support to be part of their role, but perceived multiple barriers in enacting it. These included a lack of training, clinical supervision, management support, role recognition, and access to and joint working with mental health professionals and services. CONCLUSIONS & IMPLICATIONS SLTs in Ireland face a range of individual and structural barriers, including care coordination and resourcing. There is a clear need not only for training, upskilling and mentorship, but also for wider changes around access to mental health professionals and clarity around the processes of referral, coordination and integration of aphasia care across settings. These findings comprise preliminary insights into current practices. Further research is needed as well as clarity on best-practice pathways for different aetiologies of aphasia. Articulating current practices using NPT may have utility for developing empirically informed and principled interventions to improve service delivery. WHAT THIS PAPER ADDS What is already known on this subject People with aphasia of all aetiologies are at risk of psychosocial problems. Shortcomings in access and the availability of appropriate support have been documented both internationally and in Ireland. To address this issue, an important first step is to understand how SLTs in Ireland currently enact and are supported to enact aphasia psychosocial care. What this study adds to the existing knowledge The findings describe the potential levers and barriers to progressing aphasia psychosocial care in Ireland. A range of individual, team and structural factors were identified. These were locally contextualized but similar issues are reported in other countries. Linking attitudes with NPT constructs provides a first step for further principled implementation projects. What are the practical and clinical implications of this study? Addressing psychosocial problems is perceived as a legitimate part of the speech and language therapy role. SLTs in Ireland enact a range of therapeutic approaches but may need opportunities for formal training and supervision, and for better coordination and integration with other mental health services and disciplines. Understanding differences in care pathways across the range of aphasia aetiologies is additionally important given the emphasis on post-stroke aphasia in the literature.
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Affiliation(s)
- Molly X Manning
- School of Allied Health, University of Limerick, Limerick, Ireland
- Public and Patient Involvement Research Unit, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Caoimhe Cleary
- School of Allied Health, University of Limerick, Limerick, Ireland
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McKenna VB, Gilheaney Ó. Health literacy interventions in adult speech and language therapy: A scoping review. Health Expect 2024; 27:e13878. [PMID: 37746677 PMCID: PMC10726155 DOI: 10.1111/hex.13878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 08/29/2023] [Accepted: 09/12/2023] [Indexed: 09/26/2023] Open
Abstract
BACKGROUND Reduced health literacy can negatively impact care seeking, satisfaction with care and overall health outcomes. These issues are particularly common among people living with communication difficulties who are seeking care from speech and language therapists (SLTs). As such, the SLT must be aware of and sensitive to health literacy needs within their clinical practice, proactively adapting materials and resources to the health literacy needs of their patients. Despite this required core competency, little is known about the health literacy interventions used by SLTs when working with adult patients, and as such, there is limited and unclear guidance for the practicing clinician, leading to potentially suboptimal care delivery. OBJECTIVES To explore the characteristics of health literacy interventions discussed in the literature for use by SLTs with adult patients. SEARCH STRATEGY PubMed, CINAHL, Web of Science and The Cochrane Database of Systematic Reviews were searched. Conference proceedings of the annual scientific meetings of the European Society for Swallowing Disorders and the Dysphagia Research Society were also searched. Grey literature was searched via the Open Grey database and, hand-searches of reference lists from included studies were conducted by both authors. INCLUSION CRITERIA Published and unpublished research investigating health literacy interventions provided by qualified SLTs providing care to adult patients in any setting for any speech and language related concerns. No language, geographic, study design or publication date limitations applied. Eligible participants in these studies were classified as: (1) patients and (2) professionals. DATA EXTRACTION AND SYNTHESIS Data were charted in accordance with guidelines from the Joanna Briggs Institute and the PRISMA ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) independently by both authors. MAIN RESULTS A total of 1112 potentially eligible studies were identified in the initial search, with 15 studies ultimately included in the synthesis. Study design and quality varied significantly. Most explored basic functional health literacy or narratively described core components of health literacy, which an SLT should understand, without employing an investigative research design. DISCUSSION Limited research has been conducted on the use of health literacy interventions within adult speech and language therapy practices. This finding is significant as SLTs regularly work with people living with communication problems, and therefore, addressing health literacy should be a core tenet of service delivery. CONCLUSION There is a need for valid, reliable and rigorous investigations of health literacy interventions within speech and language therapy to ultimately improve future patient access to and benefit from the care provided. PATIENT OR PUBLIC CONTRIBUTION Patient public involvement in review studies is an emerging area. Due to resource issues, it was not possible to include this element in this study.
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Affiliation(s)
- Verna B. McKenna
- Discipline of Health Promotion, School of Health SciencesUniversity of GalwayGalwayIreland
| | - Órla Gilheaney
- School of Linguistic, Speech & Communication SciencesTrinity College DublinDublinIreland
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Monnelly K, Marshall J, Dipper L, Cruice M. Intensive and comprehensive aphasia therapy-a survey of the definitions, practices and views of speech and language therapists in the United Kingdom. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2023; 58:2077-2102. [PMID: 37394906 DOI: 10.1111/1460-6984.12918] [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: 08/18/2022] [Accepted: 05/30/2023] [Indexed: 07/04/2023]
Abstract
BACKGROUND Research evidence suggests aphasia therapy must be delivered at high intensity to effect change. Comprehensive therapy, addressing all domains of the International Classification of Functioning, Disability and Health, is also called for by people with aphasia and their families. However, aphasia therapy is rarely intense or comprehensive. Intensive Comprehensive Aphasia Programmes (ICAPs) were designed to address this challenge, but such programmes are not widely implemented. AIMS This study surveyed the views of UK-based speech and language therapists (SLTs) regarding intensive and comprehensive aphasia therapy. It explored definitions of intensive and comprehensive therapy, patterns of provision, views about candidacy and barriers/facilitators. It also investigated awareness of ICAPs and perceived potential of this service model. Differences across UK regions and workplace settings were explored. METHODS & PROCEDURES An e-survey ran for 5 months. Quantitative data were analysed using descriptive and inferential statistics. Qualitative free text comments were analysed using content analysis. OUTCOMES & RESULTS Two hundred twenty-seven respondents engaged in the e-survey. Definitions of intensive aphasia therapy did not reach UK clinical guideline/research-level thresholds for most of the sample. Those providing more therapy provided definitions with higher standards of intensity. Mean therapy delivered was 128 min/week. Geographical location and workplace setting influenced the amount of therapy delivered. The most frequently delivered therapy approaches were functional language therapy and impairment-based therapy. Cognitive disability and fatigue were concerns for therapy candidacy. Barriers included lack of resources and low levels of optimism that issues could be solved. 50% of respondents were aware of ICAPs and 15 had been involved in ICAP provision. Only 16.5% felt their service could be reconfigured to deliver an ICAP. CONCLUSIONS & IMPLICATIONS This e-survey evidences a mismatch between an SLT's concept of intensity and that espoused by clinical guidelines/research. Geographical variations in intensity are concerning. Although a wide range of therapy approaches are offered, certain aphasia therapies are delivered more frequently. Awareness of ICAPs was relatively high, but few respondents had experience of this model or felt it could be executed in their context. Further initiatives are needed if services are to move from a low-dose or non-comprehensive model of delivery. Such initiatives might include but not be confined to wider uptake of ICAPs. Pragmatic research might also explore which treatments are efficacious with a low-dose model of delivery, given that this model is dominant in the United Kingdom. These clinical and research implications are raised in the discussion. WHAT THIS PAPER ADDS What is already known on this subject There is a gap between the high intensity of aphasia treatment provided in research versus mainstream clinical settings. A lower standard of 45 min/day set by UK clinical guidelines is also not achieved. Although speech and language therapists (SLTs) provide a wide range of therapies, they typically focus on impairment-based approaches. What this study adds This is the first survey of UK SLTs asking about their concept of intensity in aphasia therapy and what types of aphasia therapy they provide. It explores geographical and workplace variations and barriers and facilitators to aphasia therapy provision. It investigates Intensive Comprehensive Aphasia Programmes (ICAPs) in a UK context. What are the clinical implications of this work? There are barriers to the provision of intensive and comprehensive therapy in the United Kingdom and reservations about the feasibility of ICAPs in a mainstream UK context. However, there are also facilitators to aphasia therapy provision and evidence that a small proportion of UK SLTs are providing intensive/comprehensive aphasia therapy). Dissemination of good practice is necessary and suggestions for increasing intensity of service provision are listed in the discussion.
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Affiliation(s)
- Katie Monnelly
- Department of Language and Communication Science, City University of London, London, UK
| | - Jane Marshall
- Department of Language and Communication Science, City University of London, London, UK
| | - Lucy Dipper
- Department of Language and Communication Science, City University of London, London, UK
| | - Madeline Cruice
- Department of Language and Communication Science, City University of London, London, UK
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Wang H, Cai Z, Li S, Zheng J, Xie Y, He Y, Li C, Zheng D. Research hotspots and frontiers of post-stroke aphasia rehabilitation: a bibliometric study and visualization analysis. Front Hum Neurosci 2023; 17:1176923. [PMID: 37250700 PMCID: PMC10213773 DOI: 10.3389/fnhum.2023.1176923] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 04/24/2023] [Indexed: 05/31/2023] Open
Abstract
Background Aphasia is a common complication of stroke and is associated with high morbidity and mortality rates. Rehabilitation plays a crucial role in the comprehensive management of post-stroke aphasia and its consequences. However, bibliometric analysis in the field of post-stroke aphasia rehabilitation is still lacking. This study aimed to comprehensively identify assistance networks, analyze research trends, focus on hot and cutting-edge health topics related to post-stroke aphasia rehabilitation, and inform future research guidelines. Methods The Web of Science Core Collection (WoSCC) electronic database was searched from inception to January 4, 2023 to identify studies related to post-stroke aphasia rehabilitation. Bibliometric analysis and visualization of country, institution, journal, author, reference, and keywords were performed using CiteSpace and VOSviewer software. Results A total of 2,325 papers were included in the analysis, with a progressive increase in the number of articles published each year. The USA was the country with the most publications (809 articles), and the University of Queensland was the institution with the most publications (137 articles). The subject area of post-stroke aphasia rehabilitation is dominated by clinical neurology (882 articles). Aphasiology was the journal with the most publications (254 articles) and the most cited journal (6,893 citations). Worrall L was the most prolific author (51 publications), and Frideriksson J was the most cited author (804 citations). Conclusion By using bibliometrics, we provided a comprehensive review of studies related to post-stroke aphasia rehabilitation. Future research hotspots on topics related to post-stroke aphasia rehabilitation will mainly focus on the plasticity mechanisms of neurolinguistics networks, language function assessment, language rehabilitation modalities, and patients' rehabilitation needs and participation experiences in post-stroke aphasia. This paper provides systematic information that is worth exploring in the future.
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Affiliation(s)
- Huan Wang
- College of Nursing, Jinan University, Guangzhou, China
| | - Ziping Cai
- Department of Neurology and Stroke Center, The First Affiliated Hospital, Jinan University, Guangzhou, China
| | - Shengjuan Li
- College of Nursing, Jinan University, Guangzhou, China
| | - Jiaxing Zheng
- College of Rehabilitation, Jinan University, Guangzhou, China
| | - Yuyao Xie
- College of Nursing, Jinan University, Guangzhou, China
| | - Yuanyuan He
- College of Nursing, Jinan University, Guangzhou, China
| | - Chen Li
- Department of Neurology and Stroke Center, The First Affiliated Hospital, Jinan University, Guangzhou, China
| | - Dongxiang Zheng
- Department of Neurology and Stroke Center, The First Affiliated Hospital, Jinan University, Guangzhou, China
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Pettigrove K, Lanyon LE, Attard MC, Vuong G, Rose ML. Characteristics and impacts of community aphasia group facilitation: a systematic scoping review. Disabil Rehabil 2022; 44:6884-6898. [PMID: 34632891 DOI: 10.1080/09638288.2021.1971307] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
PURPOSE Community aphasia groups (CAGs) can provide a range of benefits to people with aphasia and support long-term psychosocial wellbeing. However, the dominant speech-pathologist-led service delivery model is inherently limited in scope. Peer-led groups hold potential as a sustainable and empowering extension of this traditional model. The implementation of peer-led models likely requires targeted training and support, however little is known about the characteristics and impacts of CAG facilitation. This study reviews the literature on CAGs and their facilitation. MATERIALS AND METHODS We conducted a scoping review on this topic. RESULTS One hundred and seventy-seven texts were included, reporting on a heterogeneous range of activities. Most texts reported on speech-pathologist-led groups, however, a range of alternative models were also represented. While no studies directly compared the impacts of different facilitation models, some comparative benefits could be drawn from the literature. Facilitation was perceived as complex and challenging, and significant gaps were identified in the training of facilitators. Ten qualitative studies investigated characteristics and impacts of facilitator behaviours, providing a useful foundation for future development of training and evaluation tools. CONCLUSIONS Further investigation into alternative facilitation models and facilitator training needs will likely support the proliferation of high-quality CAGs.Implications for RehabilitationCommunity aphasia groups (CAGs) play an important role in supporting identity and wellbeing for individuals with chronic aphasia.The traditional speech-pathology led model of group service delivery is limited in scope; the addition of peer- and volunteer-led CAGs may facilitate access to groups and meet a range of different needs for individuals with aphasia.CAG facilitation is a complex and challenging task, likely requiring specialised training, however, this has not been widely available to facilitators.The development of specialised facilitator training will likely support the proliferation of sustainable and high-quality CAGs.
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Affiliation(s)
- Kathryn Pettigrove
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia.,Centre of Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University, Melbourne, Australia
| | - Lucette E Lanyon
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia.,Centre of Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University, Melbourne, Australia
| | - Michelle C Attard
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia.,Centre of Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University, Melbourne, Australia
| | - Genevieve Vuong
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University, Melbourne, Australia.,School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Australia
| | - Miranda L Rose
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia.,Centre of Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University, Melbourne, Australia
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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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Kristo I, Mowll J. Voicing the perspectives of stroke survivors with aphasia: A rapid evidence review of post-stroke mental health, screening practices and lived experiences. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e898-e908. [PMID: 34951068 DOI: 10.1111/hsc.13694] [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: 06/29/2021] [Revised: 10/26/2021] [Accepted: 12/13/2021] [Indexed: 06/14/2023]
Abstract
A rapid evidence review (RER) of empirical literature was conducted to explore aphasic stroke survivors' mental health outcomes and lived experiences, as well as the screening instruments for this cohort. The RER was informed by a critical disability theory approach and synthesised qualitative and quantitative evidence within and across 29 studies, published between 2000 and 2021, from a systematic search of three databases. Understanding the relationship between post-stroke aphasia and mental health outcomes is essential for developing comprehensive treatment strategies and designing appropriate long-term care. Available screening instruments currently only detect depression and anxiety, which are then used to detect further mental health issues. The RER revealed that the current screening instruments demonstrate reliability; however, research remains limited regarding their validity. Furthermore, limited studies include aphasic patients as participants and decision-makers in stroke research. Methodological limitations across studies include comparators and small sample sizes. Importantly, across the studies, there is a lack of representation of culturally diverse and minority participants. Overall, the RER results found a high prevalence of aphasic stroke survivors experiencing depression and other mental health outcomes, indicating that implementing mood screening in a timely manner is essential. In addition, the results support that psychological care pathways must be developed and evaluated in consultation with aphasic patients' and carers' lived experiences to identify stepped levels of care and establish appropriate screening instruments. Furthermore, the health system requires consistency, which would ideally be achieved by establishing staff roles and responsibilities regarding mood screening and supportive care in these psychological care pathways. Including mental health specialists such as social workers and establishing specialist training in the multidisciplinary team would support this endeavour. There is a need for further research regarding mood screening instruments, a diversity of aphasic stroke survivors' lived experiences and the clinical expertise of those providing psychological support.
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Affiliation(s)
- Isabella Kristo
- Royal Prince Alfred Hospital, New South Wales, Sydney, New South Wales, Australia
| | - Jane Mowll
- School of Social Sciences, University of New South Wales, Sydney, New South Wales, Australia
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Altaher AM, Chu SY, Park HR, Khoong ESQ, Mustaffa Kamal R, Mcconnell G. Current practices of Malaysian speech-language pathologists working with dysarthria. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2022; 24:122-132. [PMID: 34348530 DOI: 10.1080/17549507.2021.1958921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Purpose: This study investigated the practice patterns used by Malaysian speech-language pathologists (SLPs) with patients with dysarthria, identified challenges perceived by SLPs and explored strategies to address perceived barriers for improving dysarthria management.Method: Two studies were conducted. Study 1 disseminated a 30-item survey questionnaire electronically via google link to SLPs in the Malaysian Speech-Language-Hearing Association through e-mail lists. Responses were analysed using descriptive statistics. In Study 2, semi-structured interviews of twelve SLPs who managed patients with dysarthria were conducted. Data were transcribed verbatim and analysed using the thematic analysis method.Result: Three major themes and ten sub-themes emerged from the interviews, including "assessment and treatment practices", "challenges", and "overcoming challenges". SLPs' practice of assessment and treatment of dysarthria were predominantly impairment-based. Respondents (64%) who never used standardised assessment tools valued textbooks more as sources of evidence and had a lower level of confidence in their knowledge about dysarthria compared to those who used standardised tools.Conclusion: Focus now needs to be on the education needs of our SLPs, on both the university training and continuing education levels, for direction of the development of professional training courses. Ongoing research and public awareness are required to guide clinical management decisions.
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Affiliation(s)
- Abeer Muneer Altaher
- Faculty of Health Sciences, Jalan Raja Muda Abdul Aziz, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Shin Ying Chu
- Faculty of Health Sciences, Centre for Healthy Ageing and Wellness (H-CARE), Speech Sciences Programme, Jalan Raja Muda Abdul Aziz, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | | | - Elaine Shi Qing Khoong
- Faculty of Health Sciences, Jalan Raja Muda Abdul Aziz, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Rahayu Mustaffa Kamal
- Dept of Audiology and Speech-Language Pathology, Kulliyyah of Allied Health Sciences, International Islamic University Malaysia (IIUM), Kuantan, Malaysia
| | - Grace Mcconnell
- Communication Sciences and Disorders, College of Health and Human Services, Rockhurst University, Kansas City, MO, USA
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Manning M, MacFarlane A, Hickey A, Galvin R, Franklin S. Regulating emotional responses to aphasia to re-engage in life: a qualitative interview study. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2022; 57:352-365. [PMID: 35112780 PMCID: PMC9306601 DOI: 10.1111/1460-6984.12702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 12/16/2021] [Accepted: 01/04/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND People with post-stroke aphasia (PWA) are more likely to experience serious mood disorders compared with those without. Emotional regulation may be important for influencing life participation after stroke. Understanding emotional regulation in the context of aphasia is important for promoting personally defined recovery, psychological well-being and life participation. AIMS To explore how individuals experience and regulate negative emotional responses to aphasia as part of re-engaging with life. METHODS & PROCEDURES In-depth semi-structured qualitative interviews with 14 PWA were conducted. The focus and design were developed with public and patient involvement contributors. Reflexive thematic analysis was applied. OUTCOMES & RESULTS Analysis generated three themes, which captured inherent diversity across participants in terms of emotional experiences, responses and regulation strategies: (1) emotional upheaval at all stages of recovery; (2) regulating emotional upheaval; and (3) discerning possibilities for life participation. Emotional regulation occurred both within and without the context of formal support services. CONCLUSIONS & IMPLICATIONS Individuals may be differently (en)abled in responding positively, with implications for aphasia psychological support and self-management interventions. The findings may inform future interventions to optimize well-being and personally meaningful outcomes for PWA. WHAT THIS PAPER ADDS What is already known on the subject PWA experience significant psychosocial upheaval and are at risk of mood disorders. Emotional regulation may be important for influencing one's emotional state, social participation and relationships after stroke. There is a need to better understand the ways in which PWA experience and regulate their emotions to develop better support for personally defined recovery. What this paper adds to existing knowledge PWA may experience significant and pervasive mood disorders in the long term after stroke. This may be compounded by worries for their children's well-being. Some, but not all, regulate emotions by drawing on positivity, determination, gratitude or stoicism. Having (supportive) opportunities to experience the impact of aphasia is important for discerning helpful strategies and participation opportunities. What are the potential or actual clinical implications of this work? Confronting altered abilities requires supportive, responsive opportunities sensitive to emotional responses. Opportunities for peer support and/or meaningful emotional support and compassion from family and friends are important therapeutic targets. Therapeutic input should pay attention to any familial and parenting concerns that may be compounding low mood. Although emotional regulation and recovery may occur without formal support, mental health services must be organized in such a way that PWA can access as needed.
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Affiliation(s)
- Molly Manning
- School of Allied Health, Faculty of Education and Health SciencesUniversity of LimerickLimerickIreland
- Public and Patient Involvement Research Unit, Health Research InstituteUniversity of LimerickLimerickIreland
- Ageing Research Centre, Health Research InstituteUniversity of LimerickLimerickIreland
| | - Anne MacFarlane
- Public and Patient Involvement Research Unit, Health Research InstituteUniversity of LimerickLimerickIreland
- Graduate Entry Medical School (GEMS), Faculty of Education and Health SciencesUniversity of LimerickLimerickIreland
| | - Anne Hickey
- Department of PsychologyRoyal College of Surgeons in IrelandDublinIreland
| | - Rose Galvin
- School of Allied Health, Faculty of Education and Health SciencesUniversity of LimerickLimerickIreland
- Ageing Research Centre, Health Research InstituteUniversity of LimerickLimerickIreland
| | - Sue Franklin
- School of Allied Health, Faculty of Education and Health SciencesUniversity of LimerickLimerickIreland
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Miao M, Power E, Rietdijk R, Brunner M, Togher L. Implementation of online psychosocial interventions for people with neurological conditions and their caregivers: A systematic review protocol. Digit Health 2021; 7:20552076211035988. [PMID: 34567610 PMCID: PMC8456620 DOI: 10.1177/20552076211035988] [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: 11/02/2020] [Accepted: 07/11/2021] [Indexed: 11/17/2022] Open
Abstract
Background As the burden of neurological conditions increases globally, online psychosocial interventions offer a potentially scalable solution to enabling healthcare access. However, their successful development and implementation require research into electronic healthcare implementation specifically. Methods Using a search strategy combining the concepts of implementation, electronic healthcare, psychosocial interventions and neurological conditions, we will conduct comprehensive electronic searches for primary implementation evidence in MEDLINE, EMBASE, PsycINFO, CINAHL, Scopus, SpeechBITE and NeuroBITE databases. Included studies will be analysed according to the Non-adoption, Abandonment, Scale-Up, Spread, and Sustainability framework, appraised using the Mixed-Methods Appraisal Tool and evaluated for theoretical underpinning in implementation science, with hybrid studies of effectiveness-implementation research classified according to the type of hybrid design. Discussion This review will be the first to use a theoretical underpinning in the Non-adoption, Abandonment, Scale-Up, Spread, and Sustainability framework to evaluate strengths and gaps in existing implementation research into online psychosocial interventions for people with neurological conditions and/or their caregivers. The results may be useful to provide direction and recommendations for future clinical implementation and research into online psychosocial interventions for people with neurological conditions and/or their caregivers. Systematic review registration PROSPERO 2020: CRD42020186387.
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Affiliation(s)
- Melissa Miao
- Graduate School of Health, University of Technology Sydney, Australia
| | - Emma Power
- Graduate School of Health, University of Technology Sydney, Australia
| | - Rachael Rietdijk
- Faculty of Medicine and Health, The University of Sydney, Australia
| | - Melissa Brunner
- Faculty of Medicine and Health, The University of Sydney, Australia
| | - Leanne Togher
- Faculty of Medicine and Health, The University of Sydney, Australia
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Manning M, MacFarlane A, Hickey A, Galvin R, Franklin S. 'I hated being ghosted' - The relevance of social participation for living well with post-stroke aphasia: Qualitative interviews with working aged adults. Health Expect 2021; 24:1504-1515. [PMID: 34132006 PMCID: PMC8369109 DOI: 10.1111/hex.13291] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 03/01/2021] [Accepted: 04/23/2021] [Indexed: 01/16/2023] Open
Abstract
Background In the context of increasing incidence of stroke in working aged adults, there is a specific need to explore the views of working aged adults with post‐stroke aphasia, whose communication difficulties may result in restricted social participation, loss of employment and changed relationship and parenting roles. This study aimed to explore the perspectives of working aged adults with post‐stroke aphasia in relation to social participation and living well with aphasia (LWA). Design and participants We conducted qualitative interviews with 14 people with post‐stroke aphasia (PWA). Data were analysed following principles of reflexive, thematic analysis. Patient or Public Contribution: A Public and Patient Involvement aphasia advisory group inputted into the study design and interpretation of data. Results Social participation spanned 5 themes: Relationships and roles; Social support; Peer network, Aphasia awareness; and Employment and training. Meaningful, interesting social participation for LWA is individually defined. Working aged PWA may require flexible support with parenting, accessing a diverse social network and finding opportunities for meaningful social connection, training and employment. Conclusions The findings extend knowledge of social participation in the context of LWA for working aged adults by elucidating the individually defined nature of meaningful participation and how PWA may need flexible support with parenting, accessing a diverse social network and training and employment. For aphasia research, policy and services to be relevant, it is crucial that working aged PWA are meaningfully involved in setting the aphasia agenda.
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Affiliation(s)
- Molly Manning
- School of Allied Health, Faculty of Education and Health Sciences & Health Research Institute, University of Limerick, Limerick, Ireland
| | - Anne MacFarlane
- School of Medicine, Faculty of Education and Health Sciences & Health Research Institute, University of Limerick, Limerick, Ireland
| | - Anne Hickey
- Department of Psychology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Rose Galvin
- School of Allied Health, Faculty of Education and Health Sciences & Health Research Institute, University of Limerick, Limerick, Ireland
| | - Sue Franklin
- School of Allied Health, Faculty of Education and Health Sciences & Health Research Institute, University of Limerick, Limerick, Ireland
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Manning M, MacFarlane A, Hickey A, Galvin R, Franklin S. The relevance of stroke care for living well with post-stroke aphasia: a qualitative interview study with working-aged adults. Disabil Rehabil 2020; 44:3440-3452. [PMID: 33356970 DOI: 10.1080/09638288.2020.1863483] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
PURPOSE This study aimed to explore the perspectives of working-aged adults with post-stroke aphasia (PWA) towards what has or would help them in living well with aphasia (LWA). This paper reports the findings in relation to stroke care and its relevance for LWA. MATERIALS AND METHODS This qualitative study was designed with input from a Public and Patient Involvement advisory group. We conducted in-depth, semi-structured interviews with 14 PWA. Data were analysed following principles of reflexive thematic analysis. RESULTS Support services and LWA spanned five themes: Inpatient care; Support in the community; Speech therapy; Mental health; and Aphasia education and training. Per the findings, all aspects of stroke care were affected and challenged by aphasia. Access to services and information was variable. PWA of working-age, their families and children need access to person-centred stroke care and information responsive to their changing needs at all stages of recovery. Healthcare workers must be equipped with aphasia competency. CONCLUSIONS The results highlight a need for equitable, transparent, responsive access to services, information and stroke liaison support. The findings extend knowledge of the importance of stroke care for supporting working-aged adults and their families to live well in the context of aphasia.Implications for rehabilitationThere is a need for equitable, transparent access to a responsive integrated pathway of stroke care to support living well with aphasia.People with aphasia post-stroke and their families need access to person-centred stroke care and information responsive to their changing needs at all stages of recovery.This includes flexible access to mental healthcare and speech and language therapy.In order to access relevant care, people with post-stroke aphasia need access to information and stroke liaison support.Training to improve aphasia competency is imperative for healthcare workers.
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Affiliation(s)
- Molly Manning
- School of Allied Health, Faculty of Education and Health Sciences & Health Research Institute, University of Limerick, Limerick, Ireland
| | - Anne MacFarlane
- Graduate Entry Medical School (GEMS), Faculty of Education and Health Sciences & Health Research Institute, University of Limerick, Limerick, Ireland
| | - Anne Hickey
- Department of Psychology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Rose Galvin
- School of Allied Health, Faculty of Education and Health Sciences & Health Research Institute, University of Limerick, Limerick, Ireland.,Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Sue Franklin
- School of Allied Health, Faculty of Education and Health Sciences & Health Research Institute, University of Limerick, Limerick, Ireland
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