Madeline Cruice

Strategies Used in the Pursuit of Achievability During Goal Setting in Rehabilitation

We used conversation analysis of six audio- and video-recorded goal-setting meetings that were attended by patients and their respective treating team to explore and describe the interaction of participants during interdisciplinary goal setting, and to identify the strategies used to agree on goals. The health care professionals involved in the six sessions included four physiotherapists, four occupational therapists, four nurses, one speech and language therapist, and one neuropsychologist. The participants included 3 patients with multiple sclerosis, 2 patients with spinal cord lesions, and 1 patient with stroke from an inpatient neurological rehabilitation unit. Detailed analysis revealed how the treating team shaped the meetings. The most notable finding was that there was rarely a straightforward translation of patient wishes into agreed-on written goals, with the treating team leading goal modification so that goals were achievable. Despite professional dominance, patients also influenced the course of the interaction, particularly when offering resistance to goals proposed by the treating team.

Boston Naming Test results for healthy older Australians: A longitudinal and cross-sectional study

This study reports on a sample of normal Australian elderly who were assessed for naming ability using the Boston Naming Test (BNT). The study aimed to examine and compare the changes in naming ability, using both longitudinal and cross-sectional analysis, and determine the relationships between naming ability and age, educational level, visual acuity and gender and cultural relevance. Contradictory findings were produced regarding age and were dependent on the research design. Longitudinal analysis showed no age-related change in naming ability in subjects over a four-period. In contrast, cross-sectional analysis showed a weak but significant correlation between age and naming ability. Educational level, visual acuity and gender were unrelated to changes in naming ability over time, and unrelated to naming ability across the cohort of elderly. The Australian elderly performed better on the modified Australian version of the BNT than on the original American version. Thus, clinicians need to be cautious when interpreting the results of the BNT for elderly and for populations outside North America. The results of this study also indicate a need for further longitudinal research of a greater duration to establish age-related decline in naming ability.

Perspectives of Quality of Life by People with Aphasia and Their Family: Suggestions for Successful Living

Abstract Understanding the client’s perspective is essential for good practitioner care in rehabilitation after stroke, and nothing is more relevant than enquiring directly about our clients’ quality of life to inform our management. Relatively little is known about how older people with aphasia consider the quality of their current lives, and this article seeks to explore this issue. Four women’s accounts of their life quality are presented, as well as their husbands’ or daughter’s accounts of their lives. Their stories share some common elements. Who you love or share your life with; where you live; feeling independent and/or in control; and engaging in satisfying activities mattered to these women’s life quality. The impact of aphasia varies across the cases, and the need to accept change for successful living is illustrated in all accounts.

The evidence for a life-coaching approach to aphasia

Background: A life-coaching and positive psychology approach to aphasia has recently been advocated by Audrey Holland, to whom this issue is dedicated. Aims: This paper reviews our recent research which informs the three basic assumptions behind a life-coaching approach to aphasia: (1) learning to live successfully with aphasia takes time; (2) aphasia is a family problem; and (3) the goal is to help people with aphasia fit it into their lives. Methods & Procedures: We assimilate results from three independent qualitative data sets: (1) a project that sought the perspective of 50 people with aphasia, their families, and their treating speech-language pathologist about their goals over time; (2) a project that seeks the views of 25 people with aphasia, their family, and speech-language pathologists about what it means to live successfully with aphasia; and (3) a qualitative structured interview on quality of life with 30 people with aphasia. Outcomes & Results: The three basic assumptions of the life-coaching approach to aphasia are supported and extended by the data. Participants with aphasia in our studies report how their goals change over time to reflect how they are learning to live with aphasia, but the journey is different for each person. The stories from families elucidate how aphasia is indeed a family concern and requires family involvement. Finally, not only did participants in our studies fit aphasia into their lives, but they also fitted it into a new lifestyle after their stroke. Conclusions: The assumptions behind the life-coaching approach are well supported by the narratives of people living with aphasia. Even if the life-coaching approach is not adopted wholeheartedly by the profession, the principles of positive psychology and the life goal perspective appear highly relevant to living successfully with aphasia.

Which outcomes are most important to people with aphasia and their families? an international nominal group technique study framed within the ICF

Abstract Purpose: To identify important treatment outcomes from the perspective of people with aphasia and their families using the ICF as a frame of reference. Methods: The nominal group technique was used with people with aphasia and their family members in seven countries to identify and rank important treatment outcomes from aphasia rehabilitation. People with aphasia identified outcomes for themselves; and family members identified outcomes for themselves and for the person with aphasia. Outcomes were analysed using qualitative content analysis and ICF linking. Results: A total of 39 people with aphasia and 29 family members participated in one of 16 nominal groups. Inductive qualitative content analysis revealed the following six themes: (1) Improved communication; (2) Increased life participation; (3) Changed attitudes through increased awareness and education about aphasia; (4) Recovered normality; (5) Improved physical and emotional well-being; and (6) Improved health (and support) services. Prioritized outcomes for both participant groups linked to all ICF components; primary activity/participation (39%) and body functions (36%) for people with aphasia, and activity/participation (49%) and environmental factors (28%) for family members. Outcomes prioritized by family members relating to the person with aphasia, primarily linked to body functions (60%). Conclusions: People with aphasia and their families identified treatment outcomes which span all components of the ICF. This has implications for research outcome measurement and clinical service provision which currently focuses on the measurement of body function outcomes. The wide range of desired outcomes generated by both people with aphasia and their family members, highlights the importance of collaborative goal setting within a family-centred approach to rehabilitation. These results will be combined with other stakeholder perspectives to establish a core outcome set for aphasia treatment research. Implications for Rehabilitation Important outcomes for people with aphasia and their families span all components of the ICF. The relevancy and translation of research findings may be increased by measuring and reporting research outcomes which are important to people living with aphasia. The results of this study indicate that important treatment outcomes for people living with aphasia most frequently link to the activity/participation and body function components of the ICF. The outcomes identified in this study suggest a broad role for clinicians working in aphasia rehabilitation. The categories of identified outcomes may be used clinically as a starting point in goal-setting discussions with clients and their families.

Personal factors, communication and vision predict social participation in older adults

Social isolation is a predictor of morbidity and mortality in older people. Speech pathologists often consider that communication disabilities associated with normal ageing (sensory loss, language and discourse changes) contribute to social isolation. The aims of this study were to describe the functioning of older people using the International Classification of Functioning, Disability and Health (WHO, ) as a conceptual framework for language and sensory functioning, communicative activity, and social participation, and to explore the relationship between communication (both at an impairment level and an activity level), social participation and personal factors (demographics and emotional health). In a prospective study, 47 women and 28 men aged 62 to 98 years (mean = 74 yrs) completed objective and subjective assessments of functioning and participation, and provided personal information. Assessments were individually conducted in a face-to-face interview situation with the primary researcher, who was a speech pathologist. Assessments revealed the sample had predominantly mild hearing and vision impairments, unimpaired naming ability, frequent involvement in a wide range of communication activities, and variable social network size and social activities participation. Social participation was shown to be associated with vision, communication activities, age, education and emotional health. Naming and hearing impairments were not reliable predictors of social participation. It was concluded that professionals interested in maintaining and improving social participation of older people could well consider these predictors in community-directed interventions. Speech pathologists should therefore promote older peoples involvement in everyday communicative activities while also limiting the impact of communication-related impairments, so that social participation is maintained in our ageing population.

Why the WHOICF and QOL constructs do not lend themselves to programmatic appraisal for planning therapy for aphasia. A commentary on Ross and Wertz, "Advancing appraisal: Aphasia and the WHO"

Background : Focusing treatment for aphasia requires systematic collection and analysis of an individuals biographical, medical, and behavioural data including, ideally, appraisal of his or her health, functioning, and quality of life. Determining treatment outcomes requires methodical indexing of therapeutic effect(s), ranging from a decrease in one or more specific communication impairments to an increase in overall quality of life. Despite the abundance of available measures, current appraisal of aphasia may be insufficient for focusing socially valid treatment and evaluating its outcomes, because most tests were developed without the advantage of a widely accepted, programmatic framework for evaluating the interaction between an individuals health condition and personal factors, and the external factors that represent the circumstances in which he or she lives. Aims : This paper urges incorporation of the World Health Organisations (WHO) international classifications of functioning, disability, and quality of life into the appraisal of aphasia to facilitate both more meaningful treatment planning, designed to address the entire consequences of aphasia for each individual, and more meaningful comparison of treatment outcomes, within and among healthcare disciplines and providers. Main Contribution : Limitations of the current appraisal of aphasia are listed, and suggestions for using the WHO framework to evaluate existing instruments and develop new measures are provided. Conclusions : If proven applicable, incorporation of the WHO international classifications of functioning, disability, and quality of life into the appraisal of aphasia should facilitate: development of meaningful and practical health policy; methods to assess quality assurance; improved outcome evaluation; and, most importantly, development of socially relevant treatment for people with aphasia.

Issues of access and inclusion with aphasia

The relatively early development of this field is reflected in the varying individual interpretations made by researchers and clinicians when referring to access and inclusion. A starting point for...

Common issues but alternative solutions and innovations

As an Australian speech pathologist now based in the United Kingdom (UK), I am sharing a blended view of my experience of clinical education in both countries, as well as from the perspectives of lecturer, researcher, clinical educator, clinical tutor (facilitating weekly university clinical tutorials and frequently dialoguing with clinical supervisors), and student (not-so-distant memories). With this background to reading McAllister’s (2005) sterling paper, I agree with the clinical education issues she has presented, but would like to challenge the solutions that are presented, and offer some alternative innovations (focusing more on learning) to meet our clinical education crisis.

Quality of life for people with aphasia: performance on and usability of quality of life assessments

Abstract Quality of life (QOL) assessment for people with aphasia has been limited by many difficulties. Possibly the most important issue is altered language comprehension ability which raises concerns for response reliability and validity. Second, there are few appropriate assessments for communication-disordered populations. Recent advances in the QOL concept and theory (LaPointe, 1999; Cruice et al, 2000a,b; Hirsch and Holland, 2000), have prompted greater in-depth study of the issues associated with QOL assessment in aphasia. Based on a synthesis of information from two distinct Australian and American studies, and a collaborative research study, this paper outlines a number of QOL assessments, presents performance data on these assessments, and offers information regarding the usability of these assessments for people with aphasia.