Jacqueline J. Hinckley

Finding Messages in Bottles: Living Successfully with Stroke and Aphasia

Abstract The question “What does it take to live successfully with stroke and aphasia?” was posed and answers were sought within already published accounts written by people living with aphasia. Published accounts that were identified as eligible and included in the study had to meet the following criteria: they had to be a published book or journal article that would be nationally available; they had to be authored or co-authored by a person with chronic aphasia due to stroke; and they had to be a personal narrative of some type. 28 publications meeting these criteria were identified through a search of bibliographic databases and websites, and 20 were available for analysis. 4 themes emerged. First, social support was identified as a critical factor in living successfully. Second, successful living appears to require an adaptation of one’s perception of self. Third, most of the writers of the accounts looked to the future and set new goals. Finally, all of the published accounts noted the importance of taking charge of one’s own continued communication improvement. Characteristics of the writers are discussed. The 4 themes are linked to the professional literature, and implications for future clinical work are explored. The potential bias of the interpreter is acknowledged.

Vocational and social outcomes of adults with chronic aphasia.

UNLABELLED Vocational and social outcomes of rehabilitation, such as employment, Social Integration, and life satisfaction, are critical determinants of the usefulness of rehabilitation. The purpose of this study was to describe the employment status, Social Integration, and perceived life satisfaction of adults with chronic aphasia 2 years after discharge from an intensive treatment program. Among the 20 survey respondents, 62% of those who had been working prior to aphasia onset were also working at the time of follow-up. Those who were working before but not after onset had higher Home Integration scores. There was a relatively large perceived change in communication from clinic discharge to the 2-year follow-up. Eighty-five percent of the respondents indicated a positive life satisfaction rating. There was a significant positive relationship between Home Integration and life satisfaction ratings. The results are discussed in relation to other reports of employment and social outcomes for stroke and aphasia. LEARNING OUTCOMES As a result of this activity, the participant will be able to: (1) identify factors that may contribute to the successful return to work for adults with chronic aphasia; (2) describe the vocational and social outcomes of a select group of adults with chronic aphasia after participation in an intensive treatment program; and (3) discuss future need areas in understanding vocational and social participation for adults with chronic aphasia after intervention.

Family Education Seminars and Social Functioning of Adults with Chronic Aphasia.

UNLABELLED Aphasia affects functional activities and participation in social roles years after onset. Some group and individual programs have reported success in improving social activities and perceived wellness. These programs typically last several weeks or months. A short, 2-day seminar style program designed for adults with chronic aphasia and their families is described in this report. Six-month follow-up data from participant pairs demonstrates a significant improvement in functional activity level, improved knowledge of aphasia, and improved family relationships. Nonparticipant pairs did not demonstrate any changes over the same period. These findings replicate and extend those of a previous study on the same 2-day seminar [Top. Stroke Rehabil. 2 (1995) 53.]. The results of this study demonstrate the important outcomes of even a very brief program designed to address the long-term psychosocial needs of adults living with aphasia and their families. EDUCATIONAL OBJECTIVES As a result of this activity, the participant will be able to: (1) describe a brief family education seminar for adults with chronic aphasia; (2) discuss outcomes in family adjustment, community reintegration, and activities of daily living associated with participation in a family education seminar; and (3) evaluate areas of programming and outcomes that should be addressed in future research.

Comparing the outcomes of intensive and non-intensive context-based aphasia treatment

Background : Intensive rates of treatment have been shown to have positive outcomes but have rarely been directly compared with non-intensive treatment. Certain types of treatment may be more effective at intensive rates than others. Aims : The purpose of this study was to compare intensive and non-intensive rates of one particular, highly specified type of treatment termed “context-based treatment”. Methods & Procedures : Thirteen adults with moderately severe aphasia were assigned to either intensive or non-intensive treatment. A battery of assessments was designed to measure the effectiveness of the treatment and the transfer of the treatment to more and less similar contexts. Outcomes & Results : There was no advantage of intensive treatment for achieving mastery of the trained context, or in transferring those skills to similar environments, or challenging environments. Conclusions : If replicated, the results could suggest that context-based treatment may be a treatment type of choice when treatment time is limited.

Differential effects of context- and skill-based treatment approaches: Preliminary findings

Context- and skill-based treatment approaches, as embodied by functional and cognitive neuropsychological interventions, predict different patterns of acquisition and transfer of skill based on their theoretical foundations. This project was designed to compare the relative outcomes of these two treatment approaches on a comprehensive set of functional and psycholinguistic measures among aphasic adults. Twelve subjects with chronic, nonfluent aphasia were randomly assigned to each of the two treatments, and their performance compared to that of a baseline group consisting of five nonfluent aphasic subjects. Context-based training focused on role-plays of a functional task, and skill-based training focused on a naming intervention divorced from a functional context. Preliminary findings suggested that patterns of improvement and transfer at post-treatment testing were generally consistent with predictions. The results are a preliminary step towards making empirically based clinical decisions about what treatment type is appropriate for which individual.

Neural correlates of semantic activation spreading on the path to picture naming in adults who stutter.

OBJECTIVE On the path to picture naming, words that relate semantically to the pictured object become activated in the mental lexicon. We used a neuroscientific approach to investigate this semantic activation spreading process in adults who stutter (AWS). METHODS Fourteen AWS and 14 adults who do not stutter (AWNS) completed a picture-word priming task. On each trial, a picture was named at a delay. On some trials, an unattended auditory probe word was presented after the picture, before naming commenced. Event-related potentials recorded to probe words Semantically-Related to the picture labels, and to probe words Semantically- and Phonologically-Unrelated to the picture labels, were compared using spatial-temporal principal component analysis. RESULTS Posterior N400 amplitude was attenuated for Semantically-Related versus Unrelated probes in AWNS, while in AWS posterior N400 amplitude was enhanced for Semantically-Related versus Unrelated probes. Marginal albeit potentially relevant group differences in the morphology of other ERP components were also observed. CONCLUSIONS The posterior N400 results point to a strategic, inhibitory influence on semantic activation spreading in AWS on the path to naming. Group differences in the amplitude of other ERP components tentatively suggest that AWS allocated attentional resources differently than the AWNS during the task. Preliminary ERP evidence of intact conceptual (as opposed to lexical-semantic) priming in the AWS is also discussed. SIGNIFICANCE This study contributes to a growing body of research describing linguistic performance in AWS.

Cognition and discourse production in right hemisphere disorder

Abstract This study sought preliminary relationships between discourse deficits and cognitive abilities in persons with right hemisphere disorder (RHD). Seven participants with RHD were matched with a non-neurologically impaired control group. One narrative and two procedural samples were elicited: the story of Cinderella and two procedural discourse samples based on familiar tasks. Macrostructural and microstructural measures of the discourse samples were correlated to cognitive domain scores achieved on a cognitive assessment, the Cognitive Linguistic Quick Test ( CLQT [Helm-Estabrooks, N. (2001). Cognitive Linguistic Quick Test . San Antonio, TX: The Psychological Corporation]). Two-tailed t -tests indicated that there were no statistically significant differences in cognitive scores between the RHD and control groups, nor were there differences in discourse measures between the two groups on either procedural task. The narrative production task yielded significant group differences on four measurements—CIU, CIU/minute, total main concept points, and number of absent main concepts. Within the RHD group, there were correlations between the attention, clock drawing, and visuospatial domains of the cognitive measure and narrative measures. The results of this study indicated that although there were no significant differences between the two groups on the cognitive measure, the RHD group produced insufficient narratives. Narrative discourse appears to be a sensitive context in which to pursue the exploration of cognitive–discourse relationships in RHD.

The piano lesson: An autoethnography about changing clinical paradigms in aphasia practice

Background : Managing the clinical relationship in the therapeutic process is a difficult issue to study, because it is based on cognitive knowledge as well as emotional processing. Addressing the emotional work of the clinician is particularly important in developing expertise as a therapist. In order to effectively change between therapeutic schools of thought, emotional aspects must be acknowledged, because different therapeutic schools of thought rely more or less on the authoritative role of the clinician. Aims : The purpose of this paper is to discuss narrative autoethnography as a qualitative research tool with potential applications in aphasiology, and to demonstrate its usefulness through an example. Methods & Procedures : An evocative story about a single aphasia therapy session is presented, written according to introspective autoethnographic techniques. The narrative reflects the inner emotional processes of a clinician and illustrates the emotional aspects of negotiating clinical roles. The story is an example of an autoethnographic narrative. Outcomes & Results : One of the interpretive themes that can be identified in this autoethnography is the emotional work and experience of the clinician. The clinicians emotional processing is discussed in the context of cultural expectations and influences. Narratives in general and narrative autoethnography in particular are tools that can be used to explore the emotional experiences of clinicians. Conclusions : The emotional work and experiences of clinicians are an important part of the therapeutic process. Narrative autoethnography may be one technique that clinical aphasiologists can use to discuss this aspect of the clinical process and with which research questions can be generated.

Perceptions of Speech-Language Pathologists Linked to Evidence-Based Practice Use in Skilled Nursing Facilities

PURPOSE This study explored whether perceptions of evidence or organizational context were associated with the use of external memory aids with residents with dementia in skilled nursing facilities (SNFs). METHOD A survey design, supplemented by a small sample of exploratory interviews, was completed within the Promoting Action on Research Implementation in Health Services framework. Ninety-six speech-language pathologists (SLPs) and 68 facility rehabilitation directors (FRDs) completed the Organizational Readiness to Change Assessment (Helfrich, Li, Sharp, & Sales, 2009) in relationship to the use of external memory aids. Five SLPs completed an interview exploring perceptions of evidence and context in relationship to memory aid use. RESULTS SLPs and FRDs had favorable perceptions of evidence supporting memory aids. FRDs perceived the organizational context of the SNF more favorably than SLPs. SLP participants used external memory aids in the past 6 months in 45.89% of cases of residents with dementia. For SLP participants, a 26% (p < .05) increase of external memory aid use was associated with every 1-unit change in favor of the evidence. Interview data revealed barriers to external memory aid implementation. CONCLUSIONS Part of evidence-based practice implementation may be influenced by clinician perceptions. Efforts to increase implementation of external memory aids in SNFs should address these clinician perceptions.

Towards a consumer-informed research agenda for aphasia: preliminary work

Abstract Purpose: Person-centeredness in clinical practice incorporates the values of clients into a shared decision-making approach. The values of person-centeredness can be extended into the realm of research when the views of consumers towards relevant and important research topics are sought. Work in other health domains has shown the importance of gathering consumer views on health care research, which ultimately extends into health care policy and practice. The purpose of this paper is to report methods used successfully to gather the views of individuals living with aphasia on research topics they view as important. Methods: The project is founded on principles of community-based participatory research. Using a modified nominal group technique, members of an aphasia support group generated a list of research topics. Results: The Aphasia Support Group identified twenty-two potential research questions. Although a majority (59%) of the research questions generated by persons with aphasia could be addressed with accumulated scientific evidence, the remainder of the generated questions has not been addressed in the research literature. Conclusions: This project demonstrates that consumers with aphasia can participate as stakeholders in the discussion of research needs in aphasia. Additional work is needed to fully develop a consumer-informed research agenda for aphasia. Implications for Rehabilitation The perspectives of individuals with post-stroke aphasia on research needs can be successfully collected using nominal group techniques. Consumer input to research agendas and priorities can help to address potential research biases. Clinicians and researchers can use these techniques and other communication supports to foster collaborative, patient-centered care in their practice and work.