Lise Randrup Jensen

Luria's neuropsychological and neurolinguistic testing

Abstract In this paper Lurias neuropsychological and neurolinguistic theory is briefly reviewed in order to relate it to his neuropsychological testing. Lurias neuropsychological and neurolinguistic testing is based on his general theory of brain-behaviour relations, which emphasizes the overlap between different functional systems. Lurias goal was to provide a principled approach to testing and rehabilitation, based upon an understanding of the factors underlying complex psychological activities and derived from observations and studies of normal and pathological populations. A case history illustrates these principles.

Canonical structure without access to verbs

Agrammatic sentence production in aphasia has been connected to disturbances of verbs and the role played by verbs in determining the structural expression of thematic roles assumed by other words in the sentence. Apparently contradictory data are presented from an aphasic patient, who had difficulties in retrieving verbs in spite of a relatively well preserved use of canonical structure in written sentence production, where he frequently left a blank or dash between agent and theme to signal that a word was missing. A therapy study is reported where the focus was on differentiating verb meanings and integrating verbs in sentence production. After therapy the patient showed significant improvement in verb production, but only for trained items. He also showed a significant increase in use of canonical sentence structure on trials with trained, but not untrained verbs. It is suggested that the patient was relying on a general schema for canonical sentence structure which may interact with verb-specific knowledge in normal processing.

Complexity in measuring outcomes after communication partner training: alignment between goals of intervention and methods of evaluation

ABSTRACT Background: Researchers are currently discussing the need for consensus on a core set of outcome measures to assess interventions in aphasia. For indirect, environmental approaches to aphasia intervention, such as communication partner training (CPT), the roadmap to obtaining consensus on core outcome measures seems especially complex. While the purpose of CPT is to improve communication for people with communication disorders, the intervention is aimed at the communication partner. There is also a variety of goals, activities, and possible settings for CPT. This complexity increases the risk of a mismatch between the goals and content of the intervention and measures used to evaluate the outcome. Aims: The purpose of this paper is to describe the complexity of measuring outcomes from CPT. The aim is to enable clinicians and researchers to reflect on the outcomes to be measured and also on how different types of measures may or may not be aligned with the goals and content of a specific CPT intervention. Main contribution: The current proliferation of outcome measures used in CPT is considered in the light of a survey of general factors to be considered in evaluating intervention outcomes. The complexity of measuring outcomes in CPT is illustrated and the importance of alignment of main objectives, intervention tasks, and projected outcomes is exemplified by referencing two common types of CPT approaches. Objectives relating to knowledge of aphasia, interactional behaviour, and feelings and attitudes are considered in relation to specific outcome measurements. It is suggested that both study-specific and more general measures are needed for capturing and comparing outcomes. The measurement of relevant outcome in CPT is discussed along with implications for future research and clinical practice. Conclusions: Different CPT approaches share the same purpose of facilitating communication in aphasia, but their application in research studies or in the clinic, is specific to the particular context. Special care must thus be taken in both clinical practice and research to safeguard the alignment between objectives, tasks, and projected intervention outcomes and the actual measures used. Further, it is concluded that there is a need for the development of new measures based on a consensus on key outcomes to be measured in CPT.

The (S)CAse of Denmark: multisite implementation of supported conversation for adults with aphasia (SCA™)

Background: SCATM is a method to train conversation partners of people with aphasia in supporting conversation (Kagan, 1998). SCATM has been used and studied with different types of communication partners including health care professionals and students (Legg, Young, & Bryer, 2005), and in various settings, acute and rehabilitation wards, and care facilities with positive outcomes regardless to aphasia severity and types of communication partners (Jensen et al., 2015; Simmons-Mackie et al., 2007). SCATM was enhanced as an evidence-based method for training health care professionals to support conversation with people with aphasia in an evaluation of neuro rehabilitation from the Danish Health Authority back in 2011. Since then the method has since been implemented at 12 hospitals in Denmark with more hospitals to come in near future. Aims: This study aims to provide a thorough description of the barriers and facilitators experienced by Danish SLTs involved in SCATM implementation from the point of view of current approaches to implementation research and implementation drivers (Fixsen et al.). Methods & Procedures: Prior to this study all hospitals involved in implementation of SCATM to staff were identified through personal network, social media, direct email contact and mouth-to-mouth. Following a questionnaire with closed and open-ended questions was distributed to the SLT team at each of the 12 identified hospitals. All 12 teams responded. Analyses were made through descriptive statistics and thematic analysis. Outcomes & Results: While using the same approach and material for teaching SCATM, the implementation model and outcome measures are locally decided if considered at all. The implementation of SCATM at Danish hospitals was reported to be a bottom-up led process largely driven by SLTs with variable managerial and staff support. Teaching SCATM to hospital staff has resulted in their increased awareness of aphasia and seemingly improved communication with patients with aphasia. However, staffs’ adherence to implementation goals, and maintenance of the learned strategies, and the impact on the people with aphasias’ point of view remains un-investigated. The SLTs report similar challenges such as lack of managerial support, knowledge of implementation design, materials, and suitable outcome measures.

Humanising communication between nursing staff and patients with aphasia: potential contributions of the Humanisation Values Framework

ABSTRACT Background: Research in the lived experience of people with aphasia has provided insight in difficult experiences of discomfort, but also in some cases of great comfort, arising in interactions with healthcare professionals. Feeling isolated, distraught, and disconnected from oneself and one’s own sense of identity are not uncommon in the early period after onset of aphasia, and as such feelings are bound to surface in the interaction with healthcare professionals, they seem to merit attention in the education of healthcare staff about aphasia. Current approaches to communication partner training (CPT) tend to focus on supportive strategies in communication and do not explicitly address more fundamental, existential needs of patients with aphasia. Accordingly, it is relevant to explore ways of enriching such approaches with a deeper knowledge and understanding of general sources of discomfort and comfort to patients with aphasia. Todres, Galvin, and Holloway (2009) describe eight theoretically informed dimensions of humanisation, which constitute a values-based framework for considering what practices can make people feel more (or less) human. Reviewing experiences of people with aphasia in communication with healthcare staff against the eight suggested dimensions of what it means to be human may offer fresh insights into the experiences of patients with aphasia and healthcare professionals and may offer potential implications for communication partner training. Aims: The purpose of this article is to explore the relevance and applicability of the Humanisation Values Framework to the experiences of patients with aphasia in health care situations and in communicating with healthcare staff. Focusing particularly on nursing staff, it will be considered whether the framework may have particular relevance in exploring the caring relationships and caring conversations between people with aphasia and nurse practitioners. Main contribution: The Humanisation Values Framework is described and applied to interpret research findings describing the lived experience of communication with healthcare staff from the perspectives of people with aphasia. Implications for nursing and caring for patients with aphasia are discussed in order to suggest ways of humanising communication in care situations. The perspective of nursing staff is considered and implications for CPT for nursing staff are discussed. Conclusions: Drawing on the Humanisation Values Framework provides insights into the lived experience of aphasia in healthcare interactions and may be useful in empowering healthcare practitioners to attend to subtle, empathetic aspects of caring for patients with aphasia as well as supporting them to facilitate caring communication.

Overview of special issue on complexity, alignment, and enrichment in communication partner training for aphasia

ABSTRACT Background: Communication partner training (CPT) is a widely recognized approach in aphasia; yet, the critical ingredients that contribute to successful CPT remain unclear. Further scrutiny of theoretical constructs, rationales, approaches, and outcomes is needed in order to further the development of CPT and ensure effective and efficient practices. Aims: The objective of this introduction is to describe the rationale and create a context for the papers in this special issue on CPT in aphasia. Main Contribution: This introduction defines CPT, briefly describes significant research and approaches to CPT in aphasia, and explains how the concepts of complexity, alignment, and enrichment might expand our understanding of CPT and contribute to innovative research and practice in the area. Conclusions: This introduction and special issue expands our understanding of CPT and challenges clinicians and researchers to consider additional perspectives on CPT. By considering additional perspectives a greater appreciation of the critical elements of CPT will be possible.