Clare M. McCann

Understanding Hope After Stroke: A Systematic Review of the Literature Using Concept Analysis

Abstract Purpose: Hope is said to be important in recovery from illness or injury, supporting adjustment, perseverance, and positive outcomes. There has been little exploration of hope in people after stroke. This is reflected in the literature, which lacks consistent definition and terminology. This purpose of this article is to clarify the concept of hope after stroke and to synthesize the findings to propose a working model of hope. Method: A systematic literature search was completed. Articles were included if they explored hope from the perspective of people with stroke or if hope was reported as a key finding in a study. Coding, analytic questions, and matrices were used to extract data and to compare, contrast, and synthesize conceptualizations, processes, and outcomes of hope. This was guided by a concept analysis methodology. Results: The literature search identified 20 articles that met the inclusion criteria. Analysis of these articles suggested hope was conceptualized in 3 interrelated ways – as an inner state, as being outcome-oriented, and as an active process. Findings suggested that internal and external resources contributed to the development of hope. Hope was perceived to be linked with positive outcomes and functioned as a motivator and source of strength through recovery. Hope reflected elements also found in the concepts of expectations, goals, and optimism. Conclusion: This novel approach to analysis has furthered the understanding of hope. It has proposed a working model of hope that could be used by clinicians in considering hope with their clients and patients.

Hope in people with aphasia

Background: Hope is considered to be important for health, recovery, and rehabilitation outcomes in a range of healthcare populations. Little is known about hope in people following stroke, and even less is known about hope in people with aphasia following stroke as they are commonly excluded from research in this field. Aims: This study aimed to explore how hope was experienced by people with aphasia following stroke during the post-acute period of rehabilitation, and to identify factors influencing the experience of hope. Methods & Procedures: This study utilised an Interpretive Description methodology. Data were collected through semi-structured interviews with five people with aphasia. Supported conversation techniques were used to facilitate full contribution of participants. Data were analysed using a number of approaches—coding, thematic analysis, narrative construction, diagramming, and memoing. Outcomes & Results: Hope was experienced in two ways. Simply ‘having’ hope was a broad but passive sense of hope which appeared to be the primary, constant form of hope. Actively hoping was an active, future-oriented form of hope that was experienced intermittently by participants. The experience of hope appeared dynamic and complex and seemingly influenced by three primary factors: uncertainty about the future; viewing hope as double-sided; and a sense of disruption. These were in turn influenced by a persons past experiences, present reality and perceived future. Conclusions: Hope is considered important by people with aphasia. It appears related to how people engage in rehabilitation and may be influenced by clinicians. As such, it is a concept that therapists should be aware of. Suggestions for how clinicians may consider and address hope are provided and discussed.

Choral singing therapy following stroke or Parkinson’s disease: an exploration of participants’ experiences

Abstract Purpose: People with stroke or Parkinson’s disease (PD) live with reduced mood, social participation and quality of life (QOL). Communication difficulties affect 90% of people with PD (dysarthria) and over 33% of people with stroke (aphasia). These consequences are disabling in many ways. However, as singing is typically still possible, its therapeutic use is of increasing interest. This article explores the experiences of and factors influencing participation in choral singing therapy (CST) by people with stroke or PD and their significant others. Method: Participants (eight people with stroke, six with PD) were recruited from a community music therapy choir running CST. Significant others (seven for stroke, two for PD) were also recruited. Supported communication methods were used as needed to undertake semi-structured interviews (total N = 23). Results: Thematic analysis indicated participants had many unmet needs associated with their condition, which motivated them to explore self-management options. CST participation was described as an enjoyable social activity, and participation was perceived as improving mood, language, breathing and voice. Conclusions: Choral singing was perceived by people with stroke and PD to help them self-manage some of the consequences of their condition, including social isolation, low mood and communication difficulties. Implications for Rehabilitation Choral singing therapy (CST) is sought out by people with stroke and PD to help self-manage symptoms of their condition. Participation is perceived as an enjoyable activity which improves mood, voice and language symptoms. CST may enable access to specialist music therapy and speech language therapy protocols within community frameworks.

Using the Perturbation of the Contact Quotient of the EGG Waveform to Analyze Age Differences in Adult Speech

This study examines electroglottographic (EGG) recordings for 15 young and 14 old male speakers of New Zealand English. Analysis was performed on the sustained vowels /i:/ and /a:/ at three target levels for both pitch and loudness. Jitter was greater for older speakers, and the contact quotient (Qx) was significantly lower for older speakers. The greater jitter for older speakers indicates a decrease in the stability of the vocal production mechanism of the older speakers. The jitter is an acoustic measure, so to examine the stability at a physiological level, a perturbation measure of the Qx is developed and applied to the EGG recordings. The contact quotient perturbation (CQP) showed a significant increase for older speakers (1.55% and 3.54% for young and old, respectively), and this demonstrated more about the variability than the jitter data alone. When loudness is also considered, the Qx was significantly greater for louder vowels, whereas its perturbation was significantly lower for louder vowels. This relationship combined with the age effect, with the CQP for all three loudness levels being greater for the older speakers. The findings of this study will contribute to the development of vocal fold models that account for aging.

Verb retrieval in nonfluent aphasia: A replication of Edwards & Tucker, 2006

Abstract Verb retrieval deficits are a common feature associated with aphasia. Verbs play a pivotal role in the grammatical construction of sentences. We hypothesise that an improvement in single verb retrieval will result in an improvement in grammatically well formed sentences. We discuss the effectiveness of a single verb treatment study for three people with nonfluent aphasia. The study design was intended to replicate that of Edwards and Tucker (2006) whose participants had fluent aphasia. A stable baseline was established followed by twice-weekly single verb retrieval therapy over 6–9 weeks. Re-assessment occurred immediately post therapy and two months after therapy had ceased. All participants demonstrated improved verb retrieval to varying degrees. There was statistically significant improvement in single verb naming for each participant, but this only translated into statistically improved sentence construction for one of the three participants. There was no change in performance on the control tasks. Repetitive “drilling” treatments can produce significant improvements in verb retrieval in nonfluent aphasia. There is evidence of generalisation to untrained stimuli, which has positive clinical implications. As in previous studies, construction of grammatically well formed sentences is associated with improved verb retrieval, though this needs further investigation with a larger sample of participants.

Predictors of the time to attain full oral feeding in late preterm infants.

The aim of this study was to determine the factors that predict the timing and age at which preterm infants (born 32–36 weeks gestation) commenced and attained full oral feeding.

A phonation therapy approach for Mandarin-English bilingual clients with dysarthria

This study aims to measure the speech intelligibility of Mandarin-English speakers with dysarthria before and after phonation therapy, in order to determine the effectiveness of this approach. A within-group design was used with two case studies which allowed one to measure therapy variables (single word and sentences); language variables (Mandarin and English); and speech production variables (respiration, phonation, articulation, resonance, and prosody). Both participants demonstrated highly significant improvement in Mandarin intelligibility scores after therapy compared with minimal changes in English intelligibility. These results demonstrate for the first time that phonation therapy is effective in increasing intelligibility, for Mandarin more than for English. Phonation therapy is also effective in enhancing accurate tone production for all four tones of Mandarin. We discuss the evidence that phonation therapy is significantly more effective for rehabilitating Mandarin-English bilinguals with dysarthria in Mandarin (a tonal language) than in English (a non-tonal language).

Parent-rated measures of bilingual children’s speech accuracy: Implications for a universal speech screen

Abstract Purpose: This study investigated whether parents were reliable in judging their bilingual children’s speech and whether parent-rated measure of children’s speech could be used as a tool for a universal speech screen to identify children with speech sound disorder (SSD). Method: Single word samples from 33 Korean–English bilingual (KEB) pre-school children were analysed for percentage of consonants correct (PCC). Their parents completed the Intelligibility in Context Scale and a similarly constructed scale devised by Stertzbach and Gildersleeve-Neumann. Spearman rank correlations were used to examine the association between the PCC scores and the parent-rated measures. Result: A number of factors influenced parents’ reliability in judging their bilingual children’s speech, including language dominance and the nature of the questions that were asked. The perception of strangers on a child’s speech problems, as judged by the parents, could be significant in identifying children with SSD. When the cut-off ICS mean score derived from a previous monolingual research was applied to KEB children, over 40% of the sample was identified as requiring a comprehensive clinical assessment. Conclusion: Implementation of a universal speech screen utilising parent-rated measures of children’s speech cannot be introduced without further research.

Communication impairments in people with progressive supranuclear palsy: A tutorial.

Progressive supranuclear palsy (PSP) is a progressive neurological condition, whose main features include supranuclear gaze palsy, frequent falls, bradykinesia, axial rigidity, cognitive decline and communication impairments. Even though communication impairments are early and prominent manifestations, there is a significant lack of research on the nature of these impairments in PSP and the role of speech-language pathologists (SLPs). This tutorial article aims to describe the communication impairments observed in people with PSP; provide clinical guidelines for SLPs when assessing motor speech, language and other communication impairments; and to present facilitation and compensation approaches to treatment for people with PSP. The predominant motor speech impairment is mixed dysarthria, but there is a lack of consensus about the classification of language impairments. The involvement of SLPs in the assessment and treatment of people with PSP should be early, on-going and in collaboration with other health professionals, with the primary focus of maintaining quality of life for these patients and their family members.

Conceptualizing how group singing may enhance quality of life with Parkinson’s disease

Abstract Purpose: Group singing could be a promising component of neurorehabilitative care. This article aims to conceptualize how group singing may enable people with Parkinson’s disease (PD) to synchronize their movement patterns to musical rhythm and enhance quality of life. Method: Spanning the medical and social sciences, the article draws conceptually on literature on PD, group singing and rhythm in music; personal experience; and reasoning. Results: Conceptualizing PD in terms of disruptions to social and biological rhythms, we hypothesize how group singing may produce two socio-psychological states – connectedness and flow – that may entrain rhythm in people with PD. The states connect during group singing to elicit and enhance motor processes but may also reawaken after the group singing, through the recall and reactivation of the musical rhythms encoded during group singing. Conclusions: In people with PD, this continuity of flow is hypothesized to be conducive to rhythmic entrainment during and after group singing and in turn to reduced deficits in motor timing and emotional processing, and improvements in quality of life. Empirical studies are needed to test this hypothesis in people with movement disorders such as PD. Implications for Rehabilitation Musical rhythm in group singing may enhance quality of life, and rehabilitation, in people with PD. Use group singing to produce two socio-psychological states – connectedness and flow – that may yield these health benefits. Include people with PD in singing groups to facilitate perceptual exposure to familiar music with melodic distinctiveness and a regular beat.