"I Could Not Talk . . . She Did Everything . . . She's Now My Sister": People With Aphasia's Perspectives on Friends Who Stuck Around

PURPOSE

Aphasia may decrease the capacity to develop and maintain friendships. The aim of this study was to better understand the perspectives of people with aphasia on why some friendship bonds remain strong and some do not. Furthermore, we wanted to explore how age and aphasia severity shape views on friendship.

METHOD

We interviewed 27 people with aphasia about their experiences of friendship before and after the onset of aphasia. We then used framework analysis and reflexive thematic analysis to interpret the interview data.

RESULTS

From the interviews, we created four major themes concerning how friend relationships had been impacted by aphasia: (a) Not all bonds have the same chance of surviving the onset of aphasia; (b) people with aphasia's closest friends took active steps to keep relationships strong; (c) if friends knew some basic information about aphasia, bonds would stay stronger; (d) positive affective aspects of friendship play an important role in keeping bonds strong. We also noted differences in friendship experiences that appeared to be influenced by age and aphasia severity of participants.

CONCLUSIONS

Interview data provided actionable ideas including focusing on friends who are likely to be responsive to help with maintaining the friendship, providing them with strategies to keep the friendship active and communication meaningful, and acknowledging the positive impact that this will have on the friend recovering from aphasia. More research is needed to develop programs that empower people with aphasia to maintain their friendships.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.24688671.

Improving communicative access and patient experience in acute stroke care: An implementation journey

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.

Preventing depression in aphasia: A cluster randomized control trial of the Aphasia Action Success Knowledge (ASK) program

BACKGROUND

Stroke patients with aphasia and their caregivers have higher incidence of depression than those without aphasia.

AIMS

The objective of the study is to determine whether a tailored intervention program (Action Success Knowledge; ASK) led to better mood and quality of life (QoL) outcomes than an attention control with a 12-month end point at cluster and individual participant level.

METHODS

A multi-site, pragmatic, two-level single-blind cluster randomized controlled trial compared ASK to an attention control (secondary stroke prevention program). Ten metropolitan and 10 non-metropolitan health regions were randomized. People with aphasia and their family members were recruited within 6 months post-stroke who scored ⩽12 on the Stroke Aphasic Depression Questionnaire Hospital Version-10 at screening. Each arm received manualized intervention over 6-8 weeks followed by monthly telephone calls. Blinded assessments of QoL and depression were taken at 12 months post-onset.

RESULTS

Twenty clusters (health regions) were randomized. Trained speech pathologists screened 1744 people with aphasia and 373 participants consented to intervention (n = 231 people with aphasia and 142 family members). The attrition rate after consent was 26% with 86 and 85 participants with aphasia in the ASK arm and attention control arm, respectively, receiving intervention. Of those 171 who did receive treatment, only 41 met the prescribed minimum dose. Multilevel mixed effects modeling under the intention-to-treat protocol showed a significant difference on the Stroke and Aphasia Depression Questionnaire-21 (SADQ-21, N = 122, 17 clusters) in favor of the attention control (β = -2.74, 95% confidence interval (CI) = -4.76 to -0.73, p = 0.008). Individual data analysis using a minimal detectable change score for the SADQ-21 showed the difference was not meaningful.

CONCLUSION

ASK showed no benefit over attention control in improving mood and preventing depression in people with aphasia or their family members.

A scoping review of friendship intervention for older adults: lessons for designing intervention for people with aphasia

PURPOSE

Map the landscape of friendship interventions/programs for older adults to guide intervention/program development inclusive of the unique needs of older people with aphasia (PWA).

METHODS

A search query of multiple databases was completed for articles published before 4 January 2021. Studies included all the following: (1) participants aged 55 years or older; (2) addressed an intervention/program designed to prevent social isolation and/or friendship loss; (3) used an outcome variable related to social isolation and/or friendship; and (4) published in a peer-reviewed journal. Title and abstract screening were conducted using Covidence software, which tracked disagreements across the study team. All studies included in the full-text review were identified as relevant by a minimum of two study authors, and a consensus was reached on all full-text reviews. Data were extracted according to (1) theoretical frameworks used; (2) interventionist and discipline; (3) participant characteristics; (4) intervention/program replicability; (5) format of intervention/program; (6) measures used in the intervention/programs; (7) and, reported effects of intervention/programs on individuals.

RESULTS

A total of 40 articles with 42 intervention/programs were included and represented 4584 intervention/program participants ranging in age from 40 to 104 years. Intervention/programs involved a wide range of theoretical frameworks (e.g., theories of loneliness, feminist theory, positive psychology). Disciplines such as psychology and exercise science informed intervention/programs. Interventionists included many types of individuals like therapists, volunteers and home health aides. Intervention/programs often lacked adequate description for replication and included individual and group formats, most commonly delievered in the participants homes. Outcomes usually included self-report measures of loneliness, social networks, or well-being, and intervention/programming was primarily educational, activity-based, or networking-based in nature.

CONCLUSIONS

The intervention/programs reviewed yield important lessons to support innovation in developing friendship intervention/programs for older PWA as most yielded positive results and were acceptable to participants.IMPLICATIONS FOR REHABILITATIONPeople with aphasia want their friendships addressed as part of their rehabilitation; however, the research literature has little guidance in this area.Studies reviewed of friendship intervention/programs for older adults yielded helpful lessons for consideration in developing this type of intervention/programming for people with aphasia.Interprofessional teams made up of rehabilitation professionals should address friendship for people with aphasia in both research and clinical practice.

Conversation as an Outcome of Aphasia Treatment: A Systematic Scoping Review

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.

Development and evaluation of the Basic Outcome Measure Protocol for Aphasia (BOMPA)

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.

Fidelity protocol for the Action Success Knowledge (ASK) trial: a psychosocial intervention administered by speech and language therapists to prevent depression in people with post-stroke aphasia

INTRODUCTION

Treatment fidelity is a complex, multifaceted evaluative process which refers to whether a studied intervention was delivered as intended. Monitoring and enhancing fidelity is one recommendation of the TiDIER (Template for Intervention Description and Replication) checklist, as fidelity can inform interpretation and conclusions drawn about treatment effects. Despite the methodological and translational benefits, fidelity strategies have been used inconsistently within health behaviour intervention studies; in particular, within aphasia intervention studies, reporting of fidelity remains relatively rare. This paper describes the development of a fidelity protocol for the Action Success Knowledge (ASK) study, a current cluster randomised trial investigating an early mood intervention for people with aphasia (a language disability caused by stroke).

METHODS AND ANALYSIS

A novel fidelity protocol and tool was developed to monitor and enhance fidelity within the two arms (experimental treatment and attention control) of the ASK study. The ASK fidelity protocol was developed based on the National Institutes of Health Behaviour Change Consortium fidelity framework.

ETHICS AND DISSEMINATION

The study protocol was approved by the Darling Downs Hospital and Health Service Human Research Ethics Committee in Queensland, Australia under the National Mutual Acceptance scheme of multicentre human research projects. Specific ethics approval was obtained for those participating sites who were not under the National Mutual Agreement at the time of application. The monitoring and ongoing conduct of the research project is in line with requirements under the National Mutual Acceptance. On completion of the trial, findings from the fidelity reviews will be disseminated via publications and conference presentations.

TRIAL REGISTRATION NUMBER

ACTRN12614000979651.

The Impact of Exposure With No Training: Implications for Future Partner Training Research

PURPOSE

This research note reports on an unexpected negative finding related to behavior change in a controlled trial designed to test whether partner training improves the conversational skills of volunteers.

METHOD

The clinical trial involving training in "Supported Conversation for Adults with Aphasia" utilized a single-blind, randomized, controlled, pre-post design. Eighty participants making up 40 dyads of a volunteer conversation partner and an adult with aphasia were randomly allocated to either an experimental or control group of 20 dyads each. Descriptive statistics including exact 95% confidence intervals were calculated for the percentage of control group participants who got worse after exposure to individuals with aphasia.

RESULTS

Positive outcomes of training in Supported Conversation for Adults with Aphasia for both the trained volunteers and their partners with aphasia were reported by Kagan, Black, Felson Duchan, Simmons-Mackie, and Square in 2001. However, post hoc data analysis revealed that almost one third of untrained control participants had a negative outcome rather than the anticipated neutral or slightly positive outcome.

CONCLUSIONS

If the results of this small study are in any way representative of what happens in real life, communication partner training in aphasia becomes even more important than indicated from the positive results of training studies. That is, it is possible that mere exposure to a communication disability such as aphasia could have negative impacts on communication and social interaction. This may be akin to what is known as a "nocebo" effect-something for partner training studies in aphasia to take into account.

Developing Accessible, Pictorial Versions of Health-Related Quality-of-Life Instruments Suitable for Economic Evaluation: A Report of Preliminary Studies Conducted in Canada and the United Kingdom

A key component of the current framework for economic evaluation is the measurement and valuation of health outcomes using generic preference-based health-related quality-of-life (HRQoL) instruments. In 2015, a research synthesis reported the absence of conceptual and empirical research regarding the appropriateness of current preference-based instruments for people with aphasia-a disorder affecting the use and understanding of language-and suggested the development and validation of an accessible, pictorial variant could be an appropriate direction for further research. This paper describes the respective rationale and development process for each of three preliminary studies that have been undertaken to develop pictorial variants of two widely used preference-based HRQoL instruments (EQ-5D-3L and EQ-5D-5L). The paper also proposes next steps for this program of research, drawing on the lessons learned from the preliminary work and the demand for a pictorial preference-based instrument in the research community. Guidance for the use of the preliminary, pictorial instruments is also provided.

Determinants of Living Well With Aphasia in the First Year Poststroke: A Prospective Cohort Study

OBJECTIVE

To determine factors that contribute to living well with aphasia in the first 12 months poststroke.

DESIGN

Prospective longitudinal cohort study.

SETTING

Hospitalized care, ambulatory care, and general community.

PARTICIPANTS

A referred sample of people (N=58) with a first incidence of aphasia after stroke was assessed at 3, 6, 9, and 12 months postonset. Participants were recruited through speech-language pathologists in 2 capital cities in Australia. Presence of aphasia was determined through the Western Aphasia Battery-Revised by an experienced speech-language pathologist.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

The main outcomes were the 5 domains of the Assessment for Living with Aphasia at 3, 6, 9, and 12 months poststroke. The independent variables included demographics, physical functioning, social network, mood, aphasia severity, and a self-rating of successfully living with aphasia at the same time points. Mixed effects modeling was used to determine which factors contributed to the trajectory of each of the 5 domains of participation, impairment, environment, personal factors, and life with aphasia.

RESULTS

Higher household income, larger social network size, being a woman, and having milder aphasia were positively associated with the participation domain. Graduate or postgraduate educational levels, low mood, and poor physical functioning were negatively associated with the participation domain. Factors positively associated with other domains included higher income, self-ratings of successfully living with aphasia, and aphasia severity. Low mood was consistently negatively associated with all of the domains.

CONCLUSIONS

Psychosocial determinants were the most significant predictors of living well with aphasia in the first 12 months postonset. Aphasia rehabilitation needs to attend more to these factors to optimize outcomes.

Let’s call it “aphasia”: Rationales for eliminating the term “dysphasia”

Health professionals, researchers, and policy makers often consider the two terms aphasia and dysphasia to be synonymous. The aim of this article is to argue the merits of the exclusive use of the term aphasia and present a strategy for creating change through institutions such as the WHO-ICD. Our contention is that one term avoids confusion, speech-language pathologists prefer aphasia, scholarly publications indicate a preference for the term aphasia, stroke clinical guidelines indicate a preference for the term aphasia, consumer organizations use the title aphasia in their name and on their websites, and languages other than English use a term similar to aphasia. The use of the term dysphasia in the broader medical community may stem from the two terms being used interchangeably in the ICD10. Aphasia United http://www.shrs.uq.edu.au/aphasiaunited , an international movement for uniting the voice of all stakeholders in aphasia within an international context, will seek to eliminate the use of the term dysphasia.

Reducing the psychosocial impact of aphasia on mood and quality of life in people with aphasia and the impact of caregiving in family members through the Aphasia Action Success Knowledge (Aphasia ASK) program: study protocol for a randomized controlled trial

BACKGROUND

People with aphasia and their family members are at high risk of experiencing post stroke depression. The impact of early interventions on mood and quality of life for people with aphasia is unknown.

METHODS/DESIGN

This study will determine whether an early intervention for both the person with aphasia after stroke and their family members leads to better mood and quality of life outcomes for people with aphasia, and less caregiver burden and better mental health for their family members. This is a multicenter, cluster-randomized controlled trial. Clusters, which are represented by Health Service Districts, will be randomized to the experimental intervention (Aphasia Action Success Knowledge Program) or an attention control (Secondary Stroke Prevention Information Program). People with aphasia and their family members will be blinded to the study design and treatment allocation (that is, will not know there are two arms to the study). Both arms of the study will receive usual care in addition to either the experimental or the attention control intervention. A total of 344 people with aphasia and their family members will be recruited. Considering a cluster size of 20, the required sample size can be achieved from 18 clusters. However, 20 clusters will be recruited to account for the potential of cluster attrition during the study. Primary outcome measures will be mood and quality of life of people with aphasia at 12 months post stroke. Secondary measures will be family member outcomes assessing the impact of caregiving and mental health, and self-reported stroke risk-related behaviors of people with aphasia.

DISCUSSION

This is the first known program tailored for people with aphasia and their family members that aims to prevent depression in people with aphasia by providing intervention early after the stroke.

TRIAL REGISTRATION

This trial is registered in the Australian New Zealand Clinical Trials Registry (ANZCTR) as ACTRN12614000979651 . Date registered: 11 September 2014.

A Set of Observational Measures for Rating Support and Participation in Conversation Between Adults with Aphasia and Their Conversation Partners

Conversation partners of individuals with aphasia, including health care professionals, families, and others, play a role that is as important for communication as the language disorder suffered by individuals with aphasia. Two complementary measures designed to capture elements of conversation between adults with aphasia and their speaking conversation partners have been developed. The first measure provides an index of the conversation partner's skill in providing conversational support. The second provides an index of the level of participation in conversation by the person with aphasia. This article describes the development of the measures, including preliminary psychometric data, and discusses applications.

Conversation therapy for aphasia: a qualitative review of the literature

BACKGROUND

A diverse literature addresses elements of conversation therapy in aphasia including intervention rooted in conversation analysis, partner training, group therapy and behavioural intervention. Currently there is no resource for clinicians or researchers that defines and organizes this information into a coherent synopsis describing various conversation therapy practices.

AIMS

To organize information from varied sources into a descriptive overview of conversation therapy for aphasia.

METHODS & PROCEDURES

Academic search engines were employed to identify research articles published between 1950 and September 2013 reporting on conversation therapy for aphasia. Thirty articles met criteria for review and were identified as primary sources for the qualitative review. Using qualitative methodology, relevant data were extracted from articles and categories were identified to create a descriptive taxonomy of conversation therapy for aphasia.

MAIN CONTRIBUTION

Conversation interventions were divided into descriptive categories including: treatment participants (person with aphasia, partner, dyad), primary guiding orientation (conversation analysis, social model, behavioural, relationship centred), service delivery (individual, group), focus of intervention (generic/individualized; problem/solution oriented; compensatory), training methods (explicit/implicit; external/embedded), activities or tasks, and outcomes measured. Finally, articles were categorized by research design. There was marked variation in conversation therapy approaches and outcome measures reported and a notable gap in information about one-on-one conversation therapy for individuals with aphasia.

CONCLUSIONS & IMPLICATIONS

This review provides a description of various conversation therapy approaches and identified gaps in the existing literature. Valid measures of natural conversation, research on one-on-one conversation approaches for individuals with aphasia, and a systematic body of evidence consisting of high quality research are needed.

The assessment for living with aphasia: reliability and construct validity

The Assessment for Living with Aphasia (ALA) is a pictographic, self-report measure of aphasia-related quality-of-life. Research was undertaken to assess test-re-test reliability, construct validity, and the ability to discriminate aphasia severity. The ALA was administered to 101 participants with aphasia on two occasions. Test-re-test reliability was evaluated using intra-class correlations and internal consistency using Cronbach's alpha. Three reference measures were administered to assess construct validity. A focus group reported on ease of administration and face validity. Analysis identified 15 out of 52 rated items for elimination. For the remaining items, test-re-test reliability was excellent for the total score (ICC = .86) and moderate-to-strong for a priori domains adapted from the WHO ICF (.68-.83). Internal consistency was acceptable-to-high. Significant correlations were observed between the ALA and reference tests (SAQOL-39, .72; p < .001; VASES, .62, p = .03; BOSS CAPD, -.69; p = .008). The language impairment domain discriminated between all aphasia severity groups, while mild aphasia was different from moderate and severe aphasia in participation and total scores. The ALA was reportedly easy to administer and captured key aspects of the experience of living with aphasia. Results suggest acceptable test-re-test reliability, internal consistency and construct validity of the ALA.

Systematic review of communication partner training in aphasia: methodological quality

Twenty-three studies identified from a previous systematic review examining the effects of communication partner training on persons with aphasia and their communication partners were evaluated for methodological quality. Two reviewers rated the studies on defined methodological quality criteria relevant to each study design. There were 11 group studies, seven single-subject participant design studies, and five qualitative studies. Quality scores were derived for each study. The mean inter-rater reliability of scores for each study design ranged from 85-93%, with Cohen's Kappa indicating substantial agreement between raters. Methodological quality of research on communication partner training in aphasia was highly varied. Overall, group studies employed the least rigorous methodology as compared to single subject and qualitative research. Only two of 11 group studies complied with more than half of the quality criteria. No group studies reported therapist blinding and only one group study reported participant blinding. Across all types of studies, the criterion of treatment fidelity was most commonly omitted. Failure to explicitly report certain methodological quality criteria may account for low ratings. Using methodological rating scales specific to the type of study design may help improve the methodological quality of aphasia treatment studies, including those on communication partner training.

A United International Voice for Aphasia

With aphasia on the rise worldwide, a new group will unite international efforts and drive change.

The first 3-months post-stroke: what facilitates successfully living with aphasia?

This study used a qualitative approach to describe the experience of the first 3 months post-stroke in order to identify factors which facilitate successfully living with aphasia. Fifteen participants completed semi-structured interviews and self-perceived ratings of how successfully he or she was living with aphasia. A number of themes were identified from the interviews, including: a need to do things in order to be actively engaged in rehabilitation; increase independence and have a purpose in life; the importance of social support; the value of rehabilitation; a need to adapt and make adjustments; and having a positive outlook. These results suggest that a range of service delivery models need to be considered during the early stages post-stroke in order to address individual needs and so that long-term outcomes of people with aphasia may be improved.

Aphasia centers in North America: a survey

There is a growing trend toward dedicated programs designed to improve the lives of people with aphasia and their families. We are referring to these programs collectively as "aphasia centers." These programs purportedly differ from more traditional medically based aphasia rehabilitation. However, there is no directory of aphasia centers and no definition of what constitutes such a program. Therefore, an online survey was designed to identify and describe aphasia centers in the United States and Canada. A 37-question survey was posted online via SurveyMonkey. An introductory letter was distributed by electronic mail to a listserv and mailing lists of programs associated with aphasia. Potential respondents who considered themselves an aphasia center were asked to complete the survey. A total of 33 survey responses were analyzed, and descriptive data were compiled resulting in a description of the following aspects of aphasia centers: demographic information, mission, admission and discharge policies, assessment practices, program logistics, staffing patterns, marketing, funding, and services offered. In addition, a qualitative analysis of written text responses revealed the following key themes that appear to characterize the responding programs: services that differ from traditional aphasia rehabilitation; a sense of community; a holistic focus on quality of life, psychosocial well-being, participation, and social support; the centrality of group interaction; and variety/intensity of services.

Negotiation of identity in group therapy for aphasia: the Aphasia Café

BACKGROUND

There has been increasing interest in ensuring that aphasia intervention includes attention to the negotiation of a robust identity after the life-altering changes that often accompany the onset of aphasia. But how does one go about simultaneously improving communication and positive identity development within aphasia therapy? Socially oriented group therapy for aphasia has been touted as one means of addressing both psychosocial and communicative goals in aphasia.

AIMS

This article describes the results of a sociolinguistic analysis of group therapy for aphasia in which positive personal and group identity are skilfully negotiated.

METHODS & PROCEDURES

Sociolinguistic microanalysis of discourse in a group therapy session was undertaken. The session, described as group conversation therapy, included eight adults with aphasia, a speech-language pathologist and an assistant. The session was videotaped and transcribed, and the data were analysed to identify 'indices of identity' within the discourse. This included discourse that exposed members' roles, values or beliefs about themselves or others. The data were further analysed to identify 'patterns' of discourse associated with identity. The result is a detailed description of identity-enhancing discourse within group therapy for aphasia.

OUTCOMES & RESULTS

The findings included several categories associated with the negotiation of identity in therapy including: (1) discourse demonstrating that group members were 'being heard', (2) that the competence of group members was assumed, (3) that 'solidarity' existed in the group, (4) that saving face and promoting positive personal identity was important, and (5) that markers of group identity were made visible via discourse that referenced both member inclusion as well as non-member exclusion.

CONCLUSIONS & IMPLICATIONS

The results suggest that it is possible to create identity-enhancing interactions as part of therapy for aphasia; the analysis demonstrates the potential role of the group leader/clinician in managing identity negotiation in aphasia therapy.

Exposed and embedded corrections in aphasia therapy: issues of voice and identity

BACKGROUND

Because communication after the onset of aphasia can be fraught with errors, therapist corrections are pervasive in therapy for aphasia. Although corrections are designed to improve the accuracy of communication, some corrections can have social and emotional consequences during interactions. That is, exposure of errors can potentially silence the 'voice' of a speaker by orienting to an utterance as unacceptable. Although corrections can marginalize speakers with aphasia, the practice has not been widely investigated.

AIMS

A qualitative study of corrections during aphasia therapy was undertaken to describe corrections in therapy, identify patterns of occurrence, and develop hypotheses regarding the potential effects of corrections.

METHODS & PROCEDURES

Videotapes of six individual and five group aphasia therapy sessions were analysed. Sequences consistent with a definition of a therapist 'correction' were identified. Corrections were defined as instances when the therapist offered a 'fix' for a perceived error in the client's talk even though the intent was apparent.

OUTCOMES & RESULTS

Two categories of correction were identified and were consistent with Jefferson's (1987) descriptions of exposed and embedded corrections. Exposed corrections involved explicit correcting by the therapist, while embedded corrections occurred implicitly within the ongoing talk. Patterns of occurrence appeared consistent with philosophical orientations of therapy sessions. Exposed corrections were more prevalent in sessions focusing on repairing deficits, while embedded corrections were prevalent in sessions focusing on natural communication events (e.g. conversation). In addition, exposed corrections were sometimes used when client offerings were plausible or appropriate, but were inconsistent with therapist expectations.

CONCLUSIONS

The observation that some instances of exposed corrections effectively silenced the voice or self-expression of the person with aphasia has significant implications for outcomes from aphasia therapy. By focusing on accurate productions versus communicative intents, therapy runs the risk of reducing self-esteem and communicative confidence, as well as reinforcing a sense of 'helplessness' and disempowerment among people with aphasia. The results suggest that clinicians should carefully calibrate the use of exposed and embedded corrections to balance linguistic and psychosocial goals.

Think Tank Deliberates Future Directions for the Social Approach to Aphasia

Purpose : This article describes the rationale and outcome of an international meeting held to explore evidence related to social approaches to aphasia intervention.

Method : A think tank and conference took place in Toronto, Canada, in September 2007 with the purpose of mobilizing a process of collaboration to document and collect evidence related to social approaches to aphasia. Using a framework called “Living with Aphasia: Framework for Outcome Measurement” (A-FROM), meeting participants worked to identify evidence available in the literature related to social approaches, identify gaps in evidence, and establish a plan to move forward in the process of establishing a comprehensive evidence base.

Results : A preliminary summary of evidence was defined according to A-FROM domains, and weaknesses and gaps were identified. Concrete directions for the future were set forth as action plans.

Conclusions: This report on the outcomes of the international think tank serves as an invitation to those interested in furthering the evidence for social approaches to aphasia to become involved in a collaborative process of evaluating and collecting evidence.

Translational research in aphasia: from neuroscience to neurorehabilitation

PURPOSE

In this article, the authors encapsulate discussions of the Language Work Group that took place as part of the Workshop in Plasticity/NeuroRehabilitation Research at the University of Florida in April 2005.

METHOD

In this narrative review, they define neuroplasticity and review studies that demonstrate neural changes associated with aphasia recovery and treatment. The authors then summarize basic science evidence from animals, human cognition, and computational neuroscience that is relevant to aphasia treatment research. They then turn to the aphasia treatment literature in which evidence exists to support several of the neuroscience principles.

CONCLUSION

Despite the extant aphasia treatment literature, many questions remain regarding how neuroscience principles can be manipulated to maximize aphasia recovery and treatment. They propose a framework, incorporating some of these principles, that may serve as a potential roadmap for future investigations of aphasia treatment and recovery. In addition to translational investigations from basic to clinical science, the authors propose several areas in which translation can occur from clinical to basic science to contribute to the fundamental knowledge base of neurorehabilitation. This article is intended to reinvigorate interest in delineating the factors influencing successful recovery from aphasia through basic, translational, and clinical research.

The negotiation of intelligibility in an aphasic dyad

Employing conversation analysis as a research technique, this study investigates the ways that unintelligibility is accounted for and overcome within a therapeutic encounter between an individual with aphasia and dysarthria and his clinician. The results emphasize the collaborative nature of intelligibility negotiation and demonstrate how both the individual with the impairment and his clinician employ various interactional strategies and knowledge resources to turn unintelligibility into intelligibility so that the therapeutic encounter may continue.

Outcome assessment in aphasia: a survey

There has been a marked increase in attention to the measurement of "outcomes" after speech-language intervention for adult aphasia. Consumers, speech-language pathologists (SLPs), and funding sources desire evidence of therapy outcomes that improve communication and enhance the quality of life for people with aphasia. While many assessment tools are available to measure outcomes after aphasia therapy, there is little information regarding the use of these tools in everyday practice by SLPs. Therefore, the current investigation was undertaken to identify and describe the practices of SLPs relative to outcome assessment in aphasia. An online survey of outcome assessment practices was distributed. Results revealed that 85% of the 94 respondents reportedly perform outcome assessment. A majority of respondents reported barriers to assessment such as time and funding limitations. Considerable variability existed in the types of assessments and the actual tools reported. The impact of the results on clinical practice is discussed.

LEARNING OUTCOMES

As a result of this activity the reader will be able to (1) define outcome assessment in aphasia, (2) describe patterns of outcome assessment in aphasia as reported by survey respondents, and (3) describe a conceptual framework for situating outcome assessment in aphasia.

"Speaking for another": the management of participant frames in aphasia

A sociolinguistic analysis of an interaction between a woman with aphasia and a nonaphasic speaking partner was conducted to investigate participant framing in aphasia. Participant frames, or the stances that people take in conversation, help conversational participants structure their talk and collaboratively negotiate meaning (I. Goffman, 1974). This analysis revealed a configuration in which a person with severe aphasia enlisted her speaking partner to speak for her. That is, the interaction was framed such that the nonaphasic speaking partner served as the "spokesperson" for messages that were authored by the person with aphasia. The clinical requirements of adopting a "speaking for another" framework are discussed.

Training volunteers as conversation partners using "Supported Conversation for Adults with Aphasia" (SCA): a controlled trial

This article reports the development and evaluation of a new intervention termed "Supported Conversation for Adults with Aphasia" (SCA). The approach is based on the idea that the inherent competence of people with aphasia can be revealed through the skill of a conversation partner. The intervention approach was developed at a community-based aphasia center where volunteers interact with individuals with chronic aphasia and their families. The experimental study was designed to test whether training improves the conversational skills of volunteers, and, if so, whether the improvements affect the communication of their conversation partners with aphasia. Twenty volunteers received SCA training, and 20 control volunteers were merely exposed to people with aphasia. Comparisons between the groups' scores on a Measure of Supported Conversation for Adults with Aphasia provide support for the efficacy of SCA. Trained volunteers scored significantly higher than untrained volunteers on ratings of acknowledging competence [F(1, 36) = 19. 1, p < .001] and revealing competence [F(1, 36) = 159.0, p < .001] of their partners with aphasia. The training also produced a positive change in ratings of social [F(1, 36) = 5.7, p < .023] and message exchange skills [F(1, 36) = 17.6, p < .001 ] of individuals with aphasia, even though these individuals did not participate in the training. Implications for the treatment of aphasia and an argument for a social model of intervention are discussed.