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

Conversation therapy for agrammatism: exploring the therapeutic process of engagement and learning by a person with aphasia.

A recent systematic review of conversation training for communication partners of people with aphasia has shown that it is effective, and improves participation in conversation for people with chronic aphasia. Other research suggests that people with aphasia are better able to learn communication strategies in an environment which closely mirrors that of expected use, and that cognitive flexibility may be a better predictor of response to therapy than severity of language impairment. This study reports results for a single case, one of a case series evaluation of a programme of conversation training for agrammatism that directly involves a person with aphasia (PWA) as well as their communication partner. It explores how a PWA is able to engage with and learn from the therapy, and whether this leads to qualitative change in post-therapy conversation behaviours

Why do people lose their friends after a stroke?

Background: It is well-known that people lose friends after a stroke; what is less well understood is why this occurs. Aims: This study explored why people lose contact with their friends, and whether there are any protective factors. It also examined how friendship loss and change is perceived by the individual. Methods and Procedures: Participants with a first stroke were recruited from one acute stroke unit in the UK. In-depth qualitative interviews took place between 8 and 15 months post stroke. Outcomes and Results: 29 participants were recruited of whom 10 had aphasia. The main reasons given for losing friends were: loss of shared activities, reduced energy levels, physical disability, aphasia, unhelpful responses of others, environmental barriers, and changing social desires. The subset of participants who experienced the most extensive loss of friends were those who described a sense that they were ‘closing in’ on themselves leading to a withdrawal from social contact and a new preference for meeting only close friends and family. Those with aphasia experienced the most hurtful negative responses from others and found it more difficult to retain their friends unless they had strong supportive friendship patterns prior to the stroke. The factors which helped to protect friendships included: having a shared history, friends who showed concern, who lived locally, where the friendship was not activity-based, and where the participant had a ‘friends-based’ social network prior to the stroke. Conclusions and Implications: Given the link between depression and loss of friends post stroke, supporting an individual in maintaining a social network is likely to be beneficial. For intervention to be effective, however, it may need to take into account not only the impact of new physical and language disabilities, but also changing social desires

Aphasia blog talk: How does stroke and aphasia affect a person’s social relationships?

Background: Stroke and aphasia can negatively affect a person’s ability to maintain healthy social relationships, both within the family and also with friends and the wider network. To date, this has been explored predominantly through qualitative interviews and questionnaires. Blogs written by people with aphasia constitute a novel source of data, comprised of people’s own voices on issues that are of concern to them. Aims: To explore the impact of stroke and aphasia on a person’s relationships with family, friends and the wider network through analysing blogs written by people with aphasia. Methods & Procedures: Blog search engines were used to identify blogs sustained by a sole author who had aphasia following a stroke, and which reflected on their social network. The data were analysed qualitatively using framework analysis. Outcomes & Results: The systematic search resulted in 10 relevant blogs. Participants were aged between 26 and 69 years old, lived in the community, were at least 1 year post stroke and included six women and four men. Aphasia was a consistent thread running through the blogs affecting conversations with all parts of a person’s network and impacting on participants’ sense of self. They found it more difficult to take part in family activities and described higher degrees of dependence and changed family dynamics. Contact with friends was reduced, partly due to communication and physical difficulties. While some participants became motivated to become members of groups post stroke, contact with the wider network sometimes diminished, in part because of loss of work and community activities. An additional factor impacting on social relationships was other people’s positive or negative reaction towards the person with aphasia. Finally, the blogs reflected on the importance of support they had received, both from close family and also from the wider community. Conclusions: This study found that social relationships played a crucial role in people’s lives following a stroke and aphasia. Nonetheless, family relationships, friendships and social exchanges within the wider social network were all substantially affected. Exploring this area through online narratives offered a rich and highly authentic source of data. The findings suggest that clinicians should incorporate social approaches in rehabilitation and consider ways to foster the maintenance of social networks. The use of social media by people with aphasia should be further explored, both as a therapeutic outlet and also as a way for people with aphasia to feel connected to a wider community

Gesture and speech integration: an exploratory study of a man with aphasia

Background: In order to fully comprehend a speaker’s intention in everyday communication, we integrate information from multiple sources including gesture and speech. There are no published studies that have explored the impact of aphasia on iconic co-speech gesture and speech integration. Aims: To explore the impact of aphasia on co-speech gesture and speech integration in one participant with aphasia (SR) and 20 age-matched control participants. Methods & Procedures: SR and 20 control participants watched video vignettes of people producing 21 verb phrases in 3 different conditions, verbal only (V), gesture only (G) and verbal gesture combined (VG). Participants were required to select a corresponding picture from one of four alternatives: integration target, a verbal only match, a gesture only match, and an unrelated foil. The probability of choosing the integration target in the VG that goes beyond what is expected from the probabilities of choosing the integration target in V and G was referred to as multi-modal gain(MMG). Outcomes & Results: SR obtained a significantly lower multi-modal gain score than the control participants (p<0.05). Error analysis indicated that in speech and gesture integration tasks, SR relied on gesture in order to decode the message, whereas the control participants relied on speech in order to decode the message. Further analysis of the speech only and gesture only tasks indicated SR had intact gesture comprehension but impaired spoken word comprehension. Conclusions & Implications: The results confirm findings by Records (1994) which reported that impaired verbal comprehension leads to a greater reliance on gesture to decode messages. Moreover, multi-modal integration of information from speech and iconic gesture can be impaired in aphasia. The findings highlight the need for further exploration of the impact of aphasia on gesture and speech integration

Experiments with discourse-level choices and readability

This paper reports on pilot experiments that are being used, together with corpus analysis, in the development of a Natural Language Generation (NLG) system, GIRL (Generator for Individual Reading Levels). GIRL generates reports for individuals after a literacy assessment. We tested GIRL's output on adult learner readers and good readers. Our aim was to find out if choices the system makes at the discourse-level have an impact on readability. Our preliminary results indicate that such choices do indeed appear to be important for learner readers. These will be investigated further in future larger-scale experiments. Ultimately we intend to use the results to develop a mechanism that makes discourse-level choices that are appropriate for individuals' reading skills

Coping and psychological well-being in informal carers of stroke survivors with aphasia

This dissertation considers coping and psychological well-being in informal carers of stroke survivors with aphasia. Firstly, a literature review examines the main problemsreported by this group of carers, the coping strategies they use to manage these problems, and the links between coping and psychological well-being. This is followedby an empirical paper which reports on a study investigating how informal carers of stroke survivors with aphasia cope with communication problems, and examining thelinks between coping and an aspect of psychological well-being - depressive symptoms. Further, this study also explores the question of how best to measure how carers cope with communication problems, by including questions specifically developed for this topic alongside a traditional coping inventory. As expected, the results demonstrated a relationship between coping strategies and depressive symptoms in this group of carers. The use of avoidant coping strategies was associated with increased symptoms of depression. No links were found between problem-focused coping strategies and depressive symptoms, however it was shown that coping by ‘positive reframing’ was linked with reduced levels of depressive symptoms. The study also found that a traditional style coping inventory gives a useful assessment of the pertinent coping strategies used by informal carers of stroke survivors with aphasia to manage communication problems. However this is usefully supplemented by more specific questioning about the use of avoidance and withdrawal. The study concludes with a discussion of the clinical implications of the results and where future research in this area would be beneficially directed

Aphasic Speech In Interaction: Relearning To Communicate By Gesture When A Word Is Lacking

International audienceResolving the inability to produce a word through a gestural realization is often a compensatory strategy used with aphasic patients. However, context and interpersonal knowledge between participants are also essential factors for finding or guessing the right word or the right gesture. In the "Interactions between Aphasic people & Caregivers" project, we explore video-recorded interactions between a single patient with aphasia and her caregivers (family or speech therapists). Video recorded data involving this patient in interaction with different caregivers allows us to more accurately analyze the interactional compensatory strategies used by caregivers and patients according to their communicative habits