Kyla Hudson

Living successfully with aphasia during the first year post-stroke: A longitudinal qualitative study

Background: Studies exploring the concept of living successfully with aphasia have advanced the understanding of positive adaptive factors, which may inform clinical interventions provided to people with aphasia. Adaptation over time has been identified as a critical component of living successfully with aphasia. Yet, the experiences of individuals with aphasia and factors they perceive to influence living successfully over time remain ill-described. Longitudinal research might add an important perspective to existing literature in the area of living successfully with aphasia and provide clarification regarding the needs of people with aphasia over time. Aims: To describe the insider’s perspective of what is important to living successfully with aphasia and changes that occur throughout the first year post-stroke. Methods & Procedures: A qualitative, prospective longitudinal design was used. Fifteen participants took part in semistructured interviews at four time points: 3, 6, 9, and 12 months post-stroke. A total of 50 interviews were conducted. Data analysis sought to identify common features or the shared experiences of the participants. Outcomes & Results: Findings from this study indicated one overarching theme: actively moving forward. This theme described the importance of participants taking positive actions in order to promote living successfully with aphasia across time. Factors relating to perceived communication improvement, engagement in activities, social support, and maintaining positivity were important in facilitating a more successful life with aphasia across time. Conclusions: Findings from this study suggest a holistic approach to aphasia management is necessary with direct intervention efforts consistent with the broader context of an individual’s everyday life. Speech language pathologists may play a crucial role in the delivery of timely services to ensure that people with aphasia and their families are supported in their endeavours to live successfully with aphasia.

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.

A systematic review of rehabilitation interventions to prevent and treat depression in post-stroke aphasia

Abstract Purpose: Stepped psychological care is the delivery of routine assessment and interventions for psychological problems, including depression. The aim of this systematic review was to analyze and synthesize the evidence of rehabilitation interventions to prevent and treat depression in post-stroke aphasia and adapt the best evidence within a stepped psychological care framework. Method: Four databases were systematically searched up to March 2017: Medline, CINAHL, PsycINFO and The Cochrane Library. Results: Forty-five studies met inclusion and exclusion criteria. Level of evidence, methodological quality and results were assessed. People with aphasia with mild depression may benefit from psychosocial-type treatments (based on 3 level ii studies with small to medium effect sizes). For those without depression, mood may be enhanced through participation in a range of interventions (based on 4 level ii studies; 1 level iii-3 study and 6 level iv studies). It is not clear which interventions may prevent depression in post-stroke aphasia. No evidence was found for the treatment of moderate to severe depression in post-stroke aphasia. Conclusions: This study found some interventions that may improve depression outcomes for those with mild depression or without depression in post-stroke aphasia. Future research is needed to address methodological limitations and evaluate and support the translation of stepped psychological care across the continuum. Implications for Rehabilitation Stepped psychological care after stroke is a framework with levels 1 to 4 which can be used to prevent and treat depression for people with aphasia. A range of rehabilitation interventions may be beneficial to mood at level 1 for people without clinically significant depression (e.g., goal setting and achievement, psychosocial support, communication partner training and narrative therapy). People with mild symptoms of depression may benefit from interventions at level 2 (e.g., behavioral therapy, psychosocial support and problem solving). People with moderate to severe symptoms of depression require specialist mental health/behavioral services in collaboration with stroke care at levels 3 and 4 of stepped psychological care.

Does communication partner training improve the conversation skills of speech-language pathology students when interacting with people with aphasia?

BACKGROUND Aphasia is a common consequence of stroke. Despite receiving specialised training in communication, speech-language pathology students may lack confidence when communicating with People with Aphasia (PWA). This paper reports data from secondary outcome measures from a randomised controlled trial. OBJECTIVE The aim of the current study was to examine the effects of communication partner training on the communication skills of speech-language pathology students during conversations with PWA. METHOD Thirty-eight speech-language pathology students were randomly allocated to trained and untrained groups. The first group received a lecture about communication strategies for communicating with PWA then participated in a conversation with PWA (Trained group), while the second group of students participated in a conversation with the PWA without receiving the lecture (Untrained group). The conversations between the groups were analysed according to the Measure of skill in Supported Conversation (MSC) scales, Measure of Participation in Conversation (MPC) scales, types of strategies used in conversation, and the occurrence and repair of conversation breakdowns. RESULTS The trained group received significantly higher MSC Revealing Competence scores, used significantly more props, and introduced significantly more new ideas into the conversation than the untrained group. The trained group also used more gesture and writing to facilitate the conversation, however, the difference was not significant. There was no significant difference between the groups according to MSC Acknowledging Competence scores, MPC Interaction or Transaction scores, or in the number of interruptions, minor or major conversation breakdowns, or in the success of strategies initiated to repair the conversation breakdowns. CONCLUSION Speech-language pathology students may benefit from participation in communication partner training programs.

A pre–post intervention study investigating the confidence and knowledge of health professionals communicating with people with aphasia in a metropolitan hospital

ABSTRACT Background: Communication partner training (CPT) is a social intervention approach that can be used to educate and train volunteers, family members, significant others and professionals, in addition to providing skills and strategies for people with aphasia (PWA). This body of CPT research extends the current research in the area by implementing CPT with health professionals (HPs) in using PWA as trainers in a sub-acute care setting, but some previous research in acute care setting has primarily focused on caregivers and volunteers in a community setting. Aims: The aim of this study was to investigate implementing a CPT programme in an Australian metropolitan hospital by training professionals and utilising PWA as a key component of the training to facilitate “real-time” practical skill acquisition. Method & Procedures: Fifty-two HPs from multidisciplinary teams (allied health assistants, audiology, dietetics, occupational therapy, pharmacy, physiotherapy, social work and nursing staff in a rehabilitation unit) participated in a pre–post intervention study. HPs completed a questionnaire to collect demographic information, identify current knowledge of aphasia-related communication strategies and ascertain their confidence levels (using a 100-mm visual analogue scale) related to interacting with people with communication impairments and list any strategies/resources that could be used as an adjunct to facilitate exchanges with PWA. These open-ended responses were categorised into four main groups using content analysis. The CPT component, adapted from two programmes run by “Connect—Communication Disability Network” in the United Kingdom, consisted of an educational lecture on communicating with PWA given by a speech-language pathologist and a practical conversation with a person with aphasia. The PWA provided “expert” practical feedback to the professionals participating in the training. Outcomes & Results: HPs reported mean confidence levels of 46.56 mm (SD = 15.71) prior to training and 75.81 mm (SD = 12.16) post-training, t(51) = 12.479 (p < .001). More HPs were able to identify relevant strategies to assist with communication following the training (median total responses = 52, interquartile range [IQR] = 50–52), than prior to the training (median total responses = 15, IQR = 9–38). Conclusions: The results provide preliminary evidence to suggest that a CPT programme may be an effective method to increase the confidence and knowledge of communication strategies of HPs, in an acute care setting, when interacting with PWA.

The confidence and knowledge of health practitioners when interacting with people with aphasia in a hospital setting

Abstract Purpose: The aim of the study was to describe and compare the confidence and knowledge of health professionals (HPs) with and without specialized speech-language training for communicating with people with aphasia (PWA) in a metropolitan hospital setting. Methods: Ninety HPs from multidisciplinary teams completed a customized survey to identify their demographic information, knowledge of aphasia, current use of supported conversation strategies and overall communication confidence when interacting with PWA using a 100 mm visual analogue scale (VAS) to rate open-ended questions. Conventional descriptive statistics were used to examine the demographic information. Descriptive statistics and the Mann–Whitney U test were used to analyse VAS confidence rating data. The responses to the open-ended survey questions were grouped into four previously identified key categories. Results: The HPs consisted of 22 (24.4%) participants who were speech-language pathologists and 68 (75.6%) participants from other disciplines (non-speech-language pathology HPs, non-SLP HPs). The non-SLP HPs reported significantly lower confidence levels (U = 159.0, p < 0.001, two-tailed) and identified fewer strategies for communicating effectively with PWA than the trained speech-language pathologists. The non-SLP HPs identified a median of two strategies identified [interquartile range (IQR) 1–3] in contrast to the speech-language pathologists who identified a median of eight strategies (IQR 7–12). Conclusion: These findings suggest that HPs, particularly those without specialized communication education, are likely to benefit from formal training to enhance their confidence, skills and ability to successfully communicate with PWA in their work environment. This may in turn increase the involvement of PWA in their health care decisions. Implications for Rehabilitation Interventions to remediate health professional’s (particularly non-speech-language pathology health professionals) lower levels of confidence and ability to communicate with PWA may ultimately help ensure equal access for PWA. Promote informed collaborative decision-making, and foster patient-centred care within the health care setting.

Is an educational lecture a critical component of communication partner training

Abstract Purpose: Little is known about the critical ingredients of successful Communication Partner Training (CPT) programmes. The aim of this randomised controlled trial was to investigate the effects of including an educational component before a conversation with a person with aphasia compared to a conversation only. Method: Thirty-eight speech–language pathology students were randomly allocated to either the Full programme or Conversation only groups. The Full programme group received a lecture about communication strategies then participated in a conversation with a person with aphasia, while the other group participated in the conversation only. Both groups received feedback on performance from the people with aphasia. Students completed a customised mixed-methods questionnaire at study commencement and following the conversation. Result: Generalised linear models indicated confidence ratings improved after receiving either the Full programme or Conversation only (p < 0.001), however, greater improvements were observed following the Full programme (p < 0.001). More communication strategies were identified after the interventions (p = 0.001) with greater improvement occurring among the Full programme group (p < 0.01). Conclusion: An educational lecture before a conversation with a person with aphasia is a critical component of CPT programmes, enhancing their knowledge base and increasing their confidence levels compared to only a conversation.