Carole Pound

The use of picture/word matching tasks to assist word retrieval in aphasic patients

Three single case studies and a small group study were undertaken to examine the effects of using picture to word matching tasks as a therapeutic technique in aiding word retrieval in aphasic patie...

A multinational comparison of aphasia management practices

The effect of restructuring of healthcare on the quality, quantity, and nature of aphasia management is largely unknown. The current study is the first to examine access, diagnostic, treatment, and discharge patterns of patients with aphasia in Australia, Canada, the UK, the US private sector (US-Private), and the US Veterans Health Administration in the Department of Veterans Affairs (US-VA). The authors developed a 37-item survey to be completed by clinicians working with aphasic patients. The survey focused on eight areas: access to care, evaluation procedures, group treatment, number and duration of treatment sessions, limitations of the number of sessions, termination of treatment, follow-up practices, and resumption of treatment. 394 surveys were distributed and 175 were returned completed (44% return rate). Respondents represented a range of ages, work experiences, and work settings. There was considerable consistency among respondents from our five healthcare systems. Results suggest that patients may be routinely denied treatment in direct contradiction to the research literature. Just as we carefully monitor the progress of patients receiving our treatment, we are obliged to monitor the effects of managed care on our patients, fellow clinicians, and our profession.

The Communication Partner Scheme: A project to develop long‐term, low‐cost access to conversation for people living with aphasia

Background: People with long‐standing aphasia and other stroke‐related impairments have difficulty accessing opportunities for conversation and social inclusion. This paper outlines the first 3 years of an ongoing project that has provided an innovative service for people with long‐standing aphasia who would not typically be accessing therapy or local support networks. We are grateful to the Henry Smith Charity who funded the first three years of this project. We would also like to thank the people with aphasia, referring therapists, and volunteers who contributed to the scheme and the ideas developed in this paper. Finally we acknowledge the work of the Aphasia Institute, Toronto, and Jon Lyon in inspiring the original idea for the project. Aims: The project aimed to set up, deliver, and evaluate a home‐based Conversation Partner Scheme to individuals with long‐term aphasia. Methods and Procedures: The paper reports on the processes involved in generating referrals, and recruiting, training, matching, and supporting the volunteer conversation partners who took part in the project. We report findings from 72 pairs of conversational partners who met for a period of 6 months. One member of each pair was a trained volunteer and the second was a partner with aphasia. Outcomes and Results: Informal evaluation of the project from the perspective of people with aphasia, referring therapists, and participating volunteers revealed a range of positive outcomes. These included changes in confidence and communication for people with aphasia, extension of long‐term service options for therapists, and development of communication and life skills for volunteers. Conclusions: This project shows how trained and supported volunteers can extend the services and opportunities for people living with ongoing aphasia. It offers an exciting means of implementing healthcare policy for people living with long‐term conditions.

Picture/word matching tasks and word retrieval: Some follow-up data and second thoughts

Abstract Marshall, Pound, White-Thomson and Pring (1990) reported the effects of using picture-to-word matching tasks on the subsequent naming of pictures by aphasic patients with word-finding problems. Further follow-up data collected more than a year after these experimental tasks continued to show that treated pictures were named better than untreated controls. Further discussion of the experimental task and of the abilities of the individual patients tested is offered in an attempt to isolate the source of this long-lasting effect on naming.

Communication access to organisations: Inclusionary practices for people with aphasia

Background: When speech and language therapists/pathologists talk about inclusion, they are usually referring to a client being included in events outside the clinic or the organisation that provides the speech and language therapy services. This article describes ways in which those providing services for and with people with aphasia can work to involve service users in their own organisations. A communication access pathway to inclusion and user involvement in organisations is presented. This draws on established methods in the field, as well as on methods and underpinning frameworks that require a shift in views about the nature of service provision. The pathway involves (1) targeting situations in which the “business” of the organisation takes place and then (2) designing ways of achieving communication access to those situations. Aims: The overall aim is to present ways in which an organisation can become more communicatively accessible to service users with aphasia and communication disabilities. We describe a range of involvement contexts and communication access conditions at Connect, a charity in the UK, where we have attempted to increase the engagement and power of people with aphasia in our organisations business. Main contribution: In order to show how organisations can create more inclusive practice, we present some of our own projects. We describe four different contexts in our organisation that we targeted for inclusion: (1) making therapy choices, (2) delivering therapy services, (3) providing courses to service providers, and (4) employment practices. For each of these contexts we present methods used to support the involvement of people with aphasia. Some types of support are tried and tested methods arising out of established theories, others are newer to the field and require a shift in thinking and values. Conclusions: In order to attain authentic communication access for people with aphasia, service providers need to look beyond established theories and practices. The result, judging from anecdotal evidence as well as evidence from qualitative evaluation, suggests that creating communication access in a service organisation can serve as a powerful means for involving people with aphasia and in so doing can improve on the services provided to them.

Communication Access to Health and Social Services.

This article describes the efforts of a group of people in the United Kingdom at Connect—the communication disability network—to make health and social services more communicatively accessible to people with aphasia. The project involved listening to people with aphasia talk about their experiences with health and social care services and working with them to design a training program to promote communication access. The result is a communication access tool-kit that offers an organized way for service providers, together with their service users, to go about auditing and changing their services to make them more communicatively accessible.

Using partners' autobiographical reports to develop, deliver, and evaluate services in aphasia

Four women whose husbands had aphasia were asked to talk about their lives in several in-depth interviews. Themes from their accounts were used to plan, deliver, and evaluate a support course. Themes from their initial interviews were used to create a course plan containing skill training, provision of information, and discussion topics. Themes emerging from their reports during course discussions provided a means for participants to explore and problem-solve their current issues. Evaluation of the course was based on themes drawn from two post-course interviews. Findings suggest that (1) aphasia affected these four participants differently, (2) themes from autobiographical reports were useful in planning content of a course to assure its relevance, (3) issues raised by participants during the course served to assure course relevance in its delivery, and (4) autobiographical descriptions offered a way of discovering whether and how the course experience had an ongoing impact on the lives of the participants. It is concluded that the collection and analysis of autobiographical reports provide an effective way to design, deliver and evaluate learning in a support course for partners of those with aphasia.

Writing remediation using preserved oral spelling: A case for separate output buffers

Abstract The performance of a brain-damaged subject with severely impaired written spelling but markedly superior oral spelling ability is described. In common with a case reported by Lesser (1990), the patient showed an effect of spelling regularity for oral spelling (where she was worse at irregular words and made phonologically plausible errors) but showed effects of lexicality and word length for written spelling (where she was better at words than non-words and at short words than long words). The patients initial writing performance and the significant improvements made in response to a remediation programme based on her superior oral spelling skills are reported. Models which suggest that both written and oral spelling share a common output buffer do not predict the occurrence of differing patterns of regularity, lexicality and word length for the two modes of spelling production. The paper will discuss the implementation and results of a theoretically motivated therapy programme, and the implicat...

Working from a modus operandi: Themes, changes, and parallels in research and clinical practices

Researchers and clinicians in the field of speech-language therapy/pathology are continuously making choices about what to do and how to do it. These choices, made by individuals at different times about different methods, are not likely to be isolated from one another. Rather, it should be possible to discern strong parallels that reveal an identifiable working style or pattern. Indeed, commonly experienced intuitions support this view. It is not unreasonable, for example, to think about the working style or interests of a particular researcher or clinician. Such considerations about a person’s way of working would suggest that there exists a commonality across that person’s activities that could be identified as their “modus operandi”. Although there has been considerable attention paid to examining and evaluating isolated research and clinical methods, the modus operandi of particular researchers, clinicians, or agencies has yet to be studied. We might expect that we could find someone’s research modus operandi by examining what questions are addressed over time and how he or she has gone about answering them. We could also expect that a clinician’s modus operandi could be discernable by examining the person’s choices of methods and how they are implemented. Finally, judging from our knowledge of service provided in group practices we might even expect to find a modus operandi operating when members of service agencies make group decisions about what sorts of services

Difficulties with discourse

Abstract Recent research into aphasia therapy has tended to focus either on the single word (e.g. Nettleton and Lesser 1991) or the sentence (e.g. Nickels et al. 1991). Treatments for language beyond the sentence are rare (although see Lesser and Milroy 1993). Of course, this is partly in response to the specific difficulties of the people involved, but also reflects the sheer complexity of the area. We do not understand the nature of discourse and how it can break down in aphasia, and we lack techniques for either treating or evaluating it.