Conceptualising quality of life for older people with aphasia

Background: There is an increasing need in speech and language therapy for clinicians to provide intervention in the context of the broader life quality issues for people with aphasia. However, there is no descriptive research that is explicitly focused on quality of life (QoL) from the perspectives of older people with aphasia. Aims: The current study explores how older people with chronic aphasia who are living in the community describe their QoL in terms of what contributes to and detracts from the quality in their current and future lives. The study is descriptive in nature, and the purpose is to conceptualize the factors that influence QoL. Methods & Procedures: Thirty older participants (16 women, 14 men) with mild to moderate aphasic impairment took part. All participants had adequate communication skills to participate: demonstrating reliable yes/no response and moderate auditory comprehension ability. Participants were interviewed in their own homes using six brief unprompted open questions about QoL, in a structured interview. The first five questions were drawn from previous gerontological research (Farquhar, 1995), and a sixth question specifically targeting communication was added. Content analysis was used, identifying discrete units of data and then coding these into concepts and factors. Additional demographic information was collected, and participants’ mood on day of interviewing was assessed using the Geriatric Depression Scale (Sheikh & Yesavage, 1986). Outcomes & Results: Activities, verbal communication, people, and body functioning were the core factors in QoL for these participants, and they described how these factors both contributed quality in life as well as detracted from life quality. Other factors that influenced QoL included stroke, mobility, positive personal outlook, in/dependence, home and health. Whilst the findings are limited by the lack of probing of participants’ responses, the study does present preliminary evidence for what is important in QoL to older people with aphasia. Conclusions: Quality of life for older people with predominantly mild to moderate chronic aphasia who are living in the community is multifactorial in nature. Some factors lie within the remit of speech and language therapy, some lie beyond the professional role, but all are relevant for consideration in rehabilitation and community practice. Further qualitative research is implicated to better understand QoL with aphasia, using in-depth interviewing with a broader range of people with aphasia

Health Literacy and Media Preferences with Stroke Survivors

Limited health literacy skills have been determined in the general population, yet studies on specific populations impaired by disease are lacking. These are the populations who utilize the health care system the most; however, they are also understudied. Various educational topics are provided to these populations in different formats and when health literacy ability is lower than the education being provided, the clients' abilities to understand are affected. This can lead to noncompliance, increased hospitalizations and/or poor health choices. This study examined a convenient sample of 30 stroke survivors who attend a community based education program in the greater Kansas City area. To be included in the study, the participants had to have functional vision with all visual fields intact and score above the dementia impairment zone on the SLUMS. Exclusion criteria included demonstration of aphasia and non-English speaking. In examining this group, their health literacy abilities were assessed using a health literacy screen which utilizes six questions about a nutrition label as its measure. The participants were also asked about their educational media preference type. Demographic information was collected which included age, income, educational level and computer use time. Results showed significant findings with relationships of educational level, income and health literacy levels. The participants did not indicate any educational media preference. Also more than two-thirds of the sample was identified as being at risk for limited health literacy using the literacy screen. The significant findings of education and health literacy levels must be examined with caution as education has been determined to be a poor indicator of literacy ability due to education quality variance. Income is also indirectly linked with education and health literacy levels. However, clinically this sample was identified as an increased risk for limited health literacy skills. Ascertaining the correct level of education allows for understanding with the provision of education. It was also of note this sample would be accepting of education in any format as long as they were being provided with information which was relevant to them

A "novel" reading therapy programme for reading difficulties after a subarachnoid haemorrhage

Background: Although several treatments for acquired reading difficulties exist, few studies have explored the effectiveness of treatment for mild reading difficulties and treatment for reading difficulties associated with cognitive impairment. Aims: This study explored the effectiveness of an individual strategy-based reading treatment of 11 sessions given to a female participant (IW) who had mild reading difficulties following a subarachnoid haemorrhage (SAH). The impact of treatment on reading ability, confidence and emotions associated with reading were investigated. Methods & Procedures: Treatment focussed on the use of strategies to support IW’s memory when reading books, the use of a checklist to select appropriate reading materials, and increasing IW’s confidence in discussing the book she was reading with others. A person-centred approach and personally relevant materials were used throughout the treatment. Reading ability was assessed using the Gray Oral Reading Tests (GORT-4; Lee Wiederholt & Bryant, 2001), and IW’s perspective was obtained using the Reading Confidence and Emotions Questionnaire (RCEQ; see Cocks et al., 2010. Pre-treatment, post-treatment and maintenance (7 weeks post) assessments were undertaken, with an additional exit interview at the final time point. Outcomes & Results: Gains were noted in reading rate, accuracy, comprehension, and confidence, with parallel increased pleasure gained from reading and reduced negative emotions and frustration. Self-reported gains included conversing with others about material read, verbal communication, and re-engagement with the identity of being a reader. Conclusions: Strategy-based treatment resulted in positive gains in reading for pleasure, conversation, and identity, for an individual with mild chronic reading difficulties. Participant self-report and interview reveal the true value of this treatment for the individual. The positive results suggest that further research is warranted that investigates the effectiveness of strategy-based reading therapy approaches for others with acquired reading difficulties

Preliminary Psychometric Analyses of Two Assessment Measures Quantifying Communicative and Social Activities: the COMACT and SOCACT

Background: There is a need for clinical tools that capture the real-life impact of aphasia (Simmons-Mackie, Threats & Kagan, 2005). This study reports on a psychometric investigation of two self-report tools: the Communicative Activities Checklist and the Social Activities Checklist (COMACT; SOCACT: Cruice, 2001), which assess the dimensions of communication activity and social participation in aphasia. Aims: (1) To investigate internal consistency, convergent and known validity of the COMACT and SOCACT; and (2) To investigate the impact of personal contextual factors: gender, age, years in education, linguistic ability and emotional health on communicative and social activities. Method: 30 participants with mild-moderate chronic aphasia (PWA: mean age 71 years, mean time post-onset 41 months, mean years in education 10.77) and 75 control neurologically healthy participants (NHP: mean age 74 years, mean years in education 13.18) completed the COMACT and SOCACT reporting how frequently they engaged in particular activities. The COMACT has 45 communication activities with sub-scales of Talking, Listening, Reading and Writing. The SOCACT contains 20 social activities with sub-scales of Leisure, Informal and Formal. Internal consistency (IC) was examined using Cronbach’s alpha (α). Correlations with published assessments, Western Aphasia Battery (WAB: Kertesz, 1982) and Communication Activities of Daily Living (CADL-2: Holland, Frattali & Fromm, 1999) were computed for COMACT only. Multiple regression models were examined for differences in participant (PWA vs. NHP) performance on COMACT and SOCACT. COMACT & SOCACT: psychometric investigation Results: Total COMACT IC was 0.83 (PWA), and 0.84 (NHP). Following deletion of four items, to further improve sub-scale ICs, total COMACT IC was 0.83 (PWA) and 0.86 (NHP). COMACT total score and WAB AQ were moderately correlated (r = 0.55). Total SOCACT IC was 0.58 (PWA) and 0.63 (NHP). Following single item deletion, total IC was 0.65 (PWA) and 0.64 (NHP). Statistical analysis revealed PWA, in comparison to NHP, participated in significantly fewer communication and social activities. Personal contextual factors impacted both groups differently; particular aspects were associated with communication activity (age and language severity) and social activity (age only). For NHP, ageing, emotional health and years in education were significant predictors of social and communication activity. Conclusion: This study finds the COMACT to be a reliable, valid measure of communication activity. The SOCACT had ‘questionable’ IC and requires further psychometric investigation. Both tools demonstrate known group validity. Relationships between impairment-level and personal contextual factors for communication activity and social participation are highlighted

Health Literacy of Individuals Living with Parkinson\u27s Disease

In the past two decades, there has been an increased interest in the development of self-management programs for people with chronic diseases. Fundamental to chronic disease management is adequate literacy and health literacy skills. Research on the health literacy skills of individuals managing Parkinson’s disease (PD) is seemingly absent from the research literature. The purpose of this study was to assess the health literacy skills of older adults managing PD and to examine the relationships of functional health literacy, self-efficacy, social support, and empowerment in this population. Using a cross-sectional design, this study surveyed 33 older adults living with PD within southwestern Ontario. Functional health literacy was positively correlated with self-efficacy (r=.13) and empowerment (r=.20) in individuals living with PD. As well, there was an association between functional health literacy and social support. Findings suggest that self-efficacy, social support, and empowerment may affect PD patients’ ability to find, read, understand, and communicate health-related information. Keywords: Parkinson’s disease, functional health literacy, self-efficacy, empowerment, social suppor

Health Literacy, Cognitive Impairment, and Medication Adherence in Veterans with Heart Failure

Background: Heart failure (HF) affects 5.8 million people in the United States, costly in terms of patient mortality and morbidity as well as healthcare dollars. One important manifestation of poor HF outcomes is the excessive admission-readmission cycle. Non-adherence to medication is responsible for the majority of HF readmissions. Identification and intervention for key factors contributing to poor medication adherence is critical to improving outcomes. Two such factors prevalent in persons with HF are cognitive impairment (CI) and poor health literacy (HL). There is a paucity of tested interventions designed to improve medication adherence by addressing underlying CI or HL. A recent study tested a pictorial medication sheet to improve medication adherence in veterans with HF and CI, however no information on HL was collected. This new study examines what mediating effects HL may have played in the adherence scores of subjects in the completed study. Study Aims: Aim 1. Describe the level of HL in the study population. Aim 2. Determine the strength and direction of the relationships between reading HL and numeracy HL and selected clinical and demographic variables in the study population. Aim 3. Determine the direct and indirect effects that reading HL and numeracy HL and other key variables (including the intervention) have upon medication adherence in cognitively impaired veteran outpatients with HF based on prior data from an interventional study testing a pictorial medication sheet to improve medication adherence. Study Design A retrospective, correlational, cross-sectional design was employed to analyze HL scores from medical records with data from the completed study using conventional statistics and structural equation modeling. Results: 27 subjects with a mean age of 65.3 years (SD 8.2, range 45-80) had evaluable data. HL was less than adequate in 19% of the sample. HL scores were strongly correlated with cognition. HL did not significantly affect relationships between study covariates (cognition scores, depression, number of medications) and medication adherence. Conclusions and Significance: HL scores were associated with cognitive function scores. More research is needed to evaluate the prevalence and effect of poor HL in veterans with HF upon adherence

Inclusion in digital environments for people with aphasia

PhD ThesisBackground: Individuals with aphasia may wish to engage with the Internet for work, communication, or leisure. Pre-stroke Internet skills will vary, as will other factors such as availability of equipment and support. This thesis aims to investigate how aphasia influences Internet use and skills. Further, it aims to explore and evaluate assessment, intervention, and outcome measurement to support Internet use with aphasia. Method: A supported questionnaire was used to compare Internet and technology use between people with and without aphasia post-stroke (stage one). Forty-two participants were recruited, twenty-five of whom had aphasia. The two groups shared known risk factors for digital exclusion. A series of four experimental single case studies followed using a structured assessment and decision-making process with a focus on exploring interventions for participants with post-stroke aphasia who had particular goals around Internet use (stage two). Results: There was a very broad spectrum of levels of independent and supported Internet use amongst people with and without aphasia. Age was a stronger predictor than aphasia for Internet use/non-use. People with aphasia were less likely to use linguistic tools such as emailing, text messaging, and e-readers. Level of education influenced self-perception of Internet skills. Case-study interventions differed according to individual needs and goals. Clinical decision-making and interventions were guided by a specific focus on cognitive and Internet skills alongside environmental factors relevant to Internet use. Assessment demonstrated that, for three of four participants, change was evident, with gains linked to their Internet related goals. Discussion: This study adds to knowledge by enhancing understanding of how people with aphasia may face specific risks related to digital exclusion. It demonstrates that a holistic understanding of factors influencing Internet use and skills can support the design and evaluation of tailored interventions to enable iv Internet use with aphasia. This provides guidance for clinical practice and for future aphasia research.Stroke Associatio

Effects of Diversity and Neuropsychological Performance in an NFL Cohort

Objective: The aim of this study was to examine the effect of ethnicity on neuropsychological test performance by comparing scores of white and black former NFL athletes on each subtest of the WMS. Participants and Methods: Data was derived from a de-identified database in South Florida consisting of 63 former NFL white (n=28, 44.4%) and black (n=35, 55.6%) athletes (Mage= 50.38; SD= 11.57). Participants completed the following subtests of the WMS: Logical Memory I and II, Verbal Paired Associates I and II, and Visual Reproduction I and II. Results: A One-Way ANOVA yielded significant effect between ethnicity and performance on several subtests from the WMS-IV. Black athletes had significantly lower scores compared to white athletes on Logical Memory II: F(1,61) = 4.667, p= .035, Verbal Paired Associates I: F(1,61) = 4.536, p = .037, Verbal Paired Associates: II F(1,61) = 4.677, p = .034, and Visual Reproduction I: F(1,61) = 6.562, p = .013. Conclusions: Results suggest significant differences exist between white and black athletes on neuropsychological test performance, necessitating the need for proper normative samples for each ethnic group. It is possible the differences found can be explained by the psychometric properties of the assessment and possibility of a non-representative sample for minorities, or simply individual differences. Previous literature has found white individuals to outperform African-Americans on verbal and non-verbal cognitive tasks after controlling for socioeconomic and other demographic variables (Manly & Jacobs, 2002). This highlights the need for future investigators to identify cultural factors and evaluate how ethnicity specifically plays a role on neuropsychological test performance. Notably, differences between ethnic groups can have significant implications when evaluating a sample of former athletes for cognitive impairment, as these results suggest retired NFL minorities may be more impaired compared to retired NFL white athletes

Distinguishing Performance on Tests of Executive Functions Between Those with Depression and Anxiety

Objective: To see if there are differences in executive functions between those diagnosed with Major Depressive Disorder (MDD) and those with Generalized Anxiety Disorder (GAD).Participants and Methods: The data were chosen from a de-identified database at a neuropsychological clinic in South Florida. The sample used was adults diagnosed with MDD (n=75) and GAD (n=71) and who had taken the Halstead Category Test, Trail Making Test, Stroop Test, and the Wisconsin Card Sorting Test. Age (M=32.97, SD=11.75), gender (56.7% female), and race (52.7% White) did not differ between groups. IQ did not differ but education did (MDD=13.41 years, SD=2.45; GAD=15.11 years, SD=2.40), so it was ran as a covariate in the analyses. Six ANCOVAs were run separately with diagnosis being held as the fixed factor and executive function test scores held as dependent variables. Results: The MDD group only performed worse on the Category Test than the GAD group ([1,132]=4.022, p\u3c .05). Even though both WCST scores used were significantly different between the two groups, both analyses failed Levene’s test of Equality of Error Variances, so the data were not interpreted. Conclusions: Due to previous findings that those diagnosed with MDD perform worse on tests of executive function than normal controls (Veiel, 1997), this study wanted to compare executive function performance between those diagnosed with MDD and those with another common psychological disorder. The fact that these two groups only differed on the Category Test shows that there may not be much of a difference in executive function deficits between those with MDD and GAD. That being said, not being able to interpret the scores on the WCST test due to a lack of homogeneity of variance indicates that a larger sample size is needed to compare these two types of patients, as significant differences may be found. The results of this specific study, however, could mean that the Category Test could be used in assisting the diagnosis of a MDD patient