Happiness and aphasia groups

Conference posterTITLE OF POSTER: HAPPINESS AND APHASIA GROUPS KEYWORDS: INTERACTION, WELLBEING, OUTCOME WHY THE STUDY WAS UNDERTAKEN The National Clinical Guidelines for stroke (Royal College of Physicians, 2012) highlight the importance of long term, continuing support for people living with aphasia (PWA). It is recognised that PWA may have difficulties maintaining psychological wellbeing post stroke especially after discharge from Speech and Language Therapy services. There is an emerging evidence base to support the premise that attending support groups may enhance the PWA’s feelings of confidence and wellbeing in the community (Van der Gaag, 2005). This undergraduate project was designed to add to this evidence base. Fourteen PWA were asked to share their feelings about how meeting others with aphasia contributed to their overall feelings of happiness and wellbeing. • HOW THE STUDY WAS DONE The Fourteen PWA, seven from two different community groups, volunteered to participate in this research. Average age Women Men Boston Diagnostic Aphasia Examination Severity Rating Scale (Goodglass and Kaplan, 2001) Severe 0 1 2 3 4 Mininal 5 65.7 8 6 - - 4 PWA 4 PWA 3 PWA 3 PWA Volunteers were interviewed and asked to rate their feelings of happiness using a version of Ryff’s (1989) psychological wellbeing scale that had been adapted for PWA by Hoen et al (1997). Ryff’s (1989) happiness scale is made up of six dimensions that are thought to contribute to emotional wellbeing: self acceptance, independence, positive relations with others, purpose in life, personal growth and the ability to control different environmental situations. Within each of these dimensions PWA were asked to rate four statements on a five point likert scale. The addition of an additional statement “Attending this support group has made me happier” resulted in a twenty five question scale with a possible strength of agreement total of 125. WHAT WAS FOUND 12/14 PWA reported that that their participation in support groups had made them happy. The average total score on Ryff’s (1989) psychological wellbeing scale was 89.5 (71.6%). Statistical analysis was used to compare the differences between the mean score of each dimension. Levene’s test and subsequent independent t tests suggested that PWA felt more positively their ability to be autonomous, (mean 15.21, p 0.001) experience personal growth (mean 15.14, p0.001) and enjoy positive relations with others (mean 15.5, p0.002) compared to their ability to control their environment (mean 11.93). There did not appear to be a relationship between the severity of aphasia and psychological wellbeing overall score. IMPLICATIONS FOR FUTURE POLICY AND PRACTICE These results add to the growing evidence base that demonstrates the beneficial effects of support groups for PWA. This project also suggests that Ryff’s (1989) scale may be a useful outcome measure for this client group. The results from this limited sample of participants suggest that PWA experience happiness within support groups. Whilst ratings in response to statements such as: “The demands of every day life often get me down” “I can manage the many responsibilities of my daily life” “I feel defeated because I can’t keep up with everything I have to do” suggest that daily life with aphasia is challenging and at times overwhelming. This is despite the ongoing and valuable care provided by support groups such as those described in this research. REFERENCES Goodglass, H. & Kaplan, E. (1983). Boston Diagnostic Aphasia Examination Test. (2nd edition). Baltimore: Lippincott, Williams and Wilkins. Hoen, B., Thleander, M. and Worsley, J. (1997). Improvement in psychological wellbeing of people with aphasia and their families: evaluation of a community based programme. Aphasiology, 11, 681-691. Royal College of Physicians (2012). National Clinical Guideline for Stroke. (4th Edition). London: Royal College of Physicians. Ryff, C. (1989). Happiness is everything, or is it? Explorations on the meaning of psychological wellbeing. Journal of Personality and Social Psychology, 57, 6, 1069-1081. Van der Gaag, A., Smith, L., Davis, S., Moss, B., Cornelius, V., Laing, S. and Mowles, C. (2005). Therapy and support services for people with long term stroke and aphasia and their relatives: a six-month follow up study. Clinical Rehabilitation, 19, 4, 372-380

Sound cues are not always easier than meaning cues

Conference posterTITLE OF PAPER: SOUND CUES ARE NOT ALWAYS EASIER THAN MEANING CUES KEYWORDS: APHASIA, CUEING, TECHNOLOGY • WHY THE STUDY WAS UNDERTAKEN This work was undertaken as part of an undergraduate programme of study. People with aphasia (PWA) experience word finding difficulties (WFD). One of the aims of Speech and Language Therapy is to provide intervention to help PWA find words more easily (Royal College of Speech and Language Therapists, 2005). It is thought that the cueing hierarchy therapy technique (Rochford and Williams, 1962) may help PWA to access words more easily. Linebaugh and Lehner (1997) suggest that some cues are harder than others and that these cues should be used first, giving the PWA the opportunity to access the word with little external help. Easier cues should then be presented in descending order of difficulty until the PWA is able to find the word. Proponents of this therapy technique such as Thompson et al (2006), suggest that PWA are able to respond to sound cues more easily than they can respond to meaning based cues. This research project was designed to investigate whether people without aphasia have an inherent ability to use sound cues more readily than those based on meaning. • HOW THE STUDY WAS DONE 40 people agreed to participate in this research and were randomly allocated to either the meaning cue assessment condition or the sound cue assessment condition. In standardised computer administered assessments, the volunteers were asked to name 107 images of low frequency words. 57 of these images were objects or living things and the remaining 50 were corporate logos. After saying the word, the volunteer was asked to press the space bar to enable the next image to appear. If the volunteer was unable to find a word, cues were provided. In the meaning condition, a highly associated word was provided as a cue and in the sound condition, the first sound of a word was provided. These cues were given to try and stimulate word finding. If the participant was entirely unable to access the word, they were asked to identify the target word from a choice of three written words. • A SUMMARY OF MAIN RESULTS Results suggested that when participants were asked to find words for objects and living things, sound cues were more effective than meaning cues. Statistical analysis using Levene’s test of equivalence (p0.618) and subsequent t-test (p 0.00014) revealed a significant difference between the two conditions. This significant difference was not evident when participants were asked to name corporate logos. For this type of vocabulary, meaning cues showed a slight advantage over sound cues. • IMPLICATIONS FOR FUTURE POLICY AND PRACTICE The results of this research suggest that cueing hierarchies are dependent, not only on the client, but also on the concept selected as the target for therapy. Low frequency words and abstract concepts do not respond to cueing in the same way as frequent and imageable words. This has implications for the way in which therapists provide cueing therapy for PWA. This project also provides support and direction for the use of technology in the assessment and remediation of word finding difficulties for people with aphasia. • REFERENCES Linebaugh, C.W. and Lehner, L.H. (1997) Cueing hierarchies and word retrieval: A therapy program. In R.H. Brookshire (Ed.) Clinical Aphasiology Conference Proceedings. Minneapolis: BRK Publishers. Rochford, G. and Williams, M. (1962). Studies in the development and breakdown in the use of names. Journal of Neurology, Neurosurgery and Psychiatry, 25, 222-227. Royal College Of Speech And Language Therapists (2005) Clinical Guidelines. Bicester: Speechmark. Thompson, C.K., Kearns, K.P., Edmonds, L.A. (2006) An experimental analysis of acquisition, generalisation and maintenance of naming behaviour in a patient with anomia. Aphasiology, 20, 12, 1226-1244

A small scale investigation in to the perceived effect of music on the quality of life for a person with aphasia.

Background This small scale study was undertaken as part of the final year undergraduate degree programme at De Montfort University. In 1997 the Norwegian music therapist and author Even Ruud suggested that music was an intrinsic part of everyday life that supported health and wellbeing. The notion that aphasia rehabilitation should encompass more than the repair of language and communication has been supported by living with aphasia therapy advocates such as Lyon (2004) and Pound, Parr, Lindsay & Woolf (2000). This study was designed to investigate whether music function, music activity and music participation were thought to improve the quality of life of people with aphasia. Method 15 people with aphasia completed a twenty question music interview. The interview was divided into four dimensions. Within each dimension 5 questions were constructed that were designed to elicit information about each area: music function, music activity, music participation and perceived effect on quality of life. The questions in each section were derived from the concepts and vocabulary presented in WHO International Classification of Impairment, Activity and Participation (2002) and the Cruice, Worrall, Hickson and Murison (2003) Communication Related Quality of Life Model. Interview question presentation and response format was derived from the Stroke and Quality of Life Scale-39 designed by Hilari, Byng, Lamping and Smith (2003). Results were analysed statistically to evaluate significant responses to individual questions and significant relationships between dimensions. Results and Discussion Statistical analysis identified these significant results. The fifteen people who participated in the study reported that music evoked physiological and psychological changes. Music was perceived as a positive experience that was accessible to the fifteen people with aphasia despite the varying level of functional and physical restriction they experienced following their stroke. Finally statistical analysis revealed that music function was significantly related to perceived quality of life whilst music activity and music participation did not show a significant relationship to quality of life. The results of this small scale study suggest that the ability to include music in everyday life should be viewed as an accessible, beneficial and cost effective addition to the therapy tool kit of those who work alongside people with aphasia to help improve quality of life following stroke and aphasia

A mixed method investigation into the impact of activation therapy with and without word finding for people with aphasia

Background Information Impairment based therapy studies for people with aphasia indicate that therapy which involves word finding practice can help people with aphasia find words. Research has also suggested that the impact of therapy can generalise to other words not used in therapy and that it can have a positive impact on communication skills and feelings of wellbeing. This research project introduces a novel word finding therapy. Activation therapy was designed for people with all types of aphasia, even those who have difficulty representing their own views or cannot express their thoughts at all. There is very little evidence base to support a word finding therapy that does not involve overt word finding practice and this limited support is based on the results of three separate therapy studies and its beneficial impact on the word finding skills of five people with aphasia. This therapy trial compared the impact of activation therapy with and without word finding to see if its impact was contingent on the opportunity to practise word finding out loud. It was also designed to evaluate two additional therapy outcomes; the impact of activation therapy on sentence grammar and its impact on the experience of living with aphasia. Methodology This research was designed to conform to therapy trial standards as far as practicable. Seven people with aphasia and their therapy trial partners volunteered to participate in this study. All participants had suffered a left sided cerebrovascular stroke and were at least nineteen months post onset of their aphasia. Participants were diverse in terms of aphasia severity, type of aphasia, age, and pre stroke occupation, however they were all united in their need to receive more aphasia therapy than they had been offered. ttps were related to participants in different ways and were either spouses, partners, parents or the offspring of the seven participants with aphasia. The research design was informed by aphasia therapy trial precedents and followed an “a b a c a” design. Participants were provided with three pre therapy assessment sessions, six activation therapy with or without word finding sessions, three mid therapy assessment sessions, a further six sessions of activation therapy with or without word finding, and finally three post therapy assessments. Random allocation to counterbalanced pathways, verification of stable baselines, and three types of control tasks were used to address possible threats to the integrity of the crossover research design. Participants completed three 260 word finding assessments in each assessment phase. Participants and their therapy trial partners were also interviewed during each assessment phase. Assessments of sentence comprehension and non-verbal problem solving were conducted during pre and post therapy assessment phases and were used as two of the control measures from which the impact of activation therapy could be inferred. Initial word finding assessments were used to identify words which had caused word finding difficulties. For each participant, the words that they had found difficult to say were allocated to one of three equivalent word finding sets, activation therapy with word finding set, activation therapy without word finding set and a control group set. During activation therapy sessions participants listened to the therapist describing each word. Descriptions included at least eight relevant pieces of information about the word. Its appearance, function, most obvious feature, location, category membership, co-ordinates, closely related objects, synonyms, antonyms, subtypes, parts, use in collocations, use in idioms, use in frequent sentences and idiosyncratic associations. Participants were then asked to identify the object that had just been described from an array of five pictures that contained the target picture and four of its coordinates. The only difference between the two activation therapy techniques was that activation therapy with word finding sessions included participants practising saying the word that had just been described and participants were provided with the opportunity to practise saying the word eleven times before listening to the description of the next therapy item. Results Statistical analysis of group results suggested that activation therapy improved the word finding skills of the seven participants with aphasia. A lack of comparable improvement in control tasks suggested that improved word finding skills could be attributed to activation therapy rather than other possible factors such as improved attention, executive functioning, therapeutic alliance or other non-specific effects of attending Speech and Language Therapy sessions. There was however, no statistical difference between the impact of activation therapy with word finding and activation therapy without word finding, suggesting that spoken word finding practice was not an essential part of successful word finding therapy. Grammatical analysis of word, phrase and sentence level output elicited during therapy experience interviews identified only one indicator of the generalisation activation therapy to everyday speech. All seven participants used longer noun phrases after twelve weeks of aphasia therapy. Finally, thematic analysis therapy experience interviews with participants and their therapy trial partners suggested that activation therapy had resulted in positive perceptions of changes in language use and participants’ relationships with themselves, their close others and their interactions with people in the wider community, the other others. Triangulation and integration of these findings suggested that activation therapy may have altered the accessibility of nouns and noun syntax which was apparent in word finding assessments and spontaneous language use. Discussion This small scale therapy trial supports the implementation of aphasia therapy for people who are not happy living with their aphasia. Three complementary evaluation methods identified the meaningful impact of activation therapy in improved word finding in assessments, improved noun phrase structure, and enhanced wellbeing, a triangulation and integration of converging evidence. In this therapy trial, changes in word finding skills could not be attributed to overt word finding practice. The need to practise words is a notion that has guided aphasia therapy research and has framed the way that outcomes have been measured in this field. It has also dictated the type of participant that can take part in research and by implication has affected which type of person with aphasia can be provided with intervention that is evidence based. The equal impact of activation therapy with and without word finding on the words analysed in this therapy trial can be explained by both prominent models of single word processing, interactive and modular. Analysis of meaning word finding difficulties and generalisation to words not targeted in therapy aligned more closely to the interactive models of conceptualisation of single word processing. Neither model adequately explained the overuse of plural markers and relative lack of sound processing difficulties experienced by the seven participants in the study. It is hoped that the findings of this small scale therapy study may contribute to future discussions about the nature of word finding with and without aphasia. It is also hoped that it this study will contribute to the evidence base that supports the implementation of aphasia therapy for those who live with language difficulties

What do untrained conversation partners know about communicating with people with aphasia?

Background This study was undertaken as part of the final year undergraduate degree programme at De Montfort University. In 2006 Turner & Whitworth identified that teaching conversational partners about supportive communication strategies was a key theme of the three main approaches to conversational therapy; the conversational analysis approach, the supported conversation approach and the conversational coaching approach. This research project was designed to investigate whether potential conversation partners who had not received conversational partner training could identify ways to support conversations with people with aphasia. The results of this investigation may help to inform speech and language therapists about what prospective untrained conversational partners may know about supporting communication with people with aphasia. Method 30 people participated in this small scale study. Participants were asked to look at a DVD clip (Kagan, Winckel, & Shumway (1996)) of a doctor interacting unsuccessfully with a person with aphasia. After seeing this unsuccessful interaction the participants were asked to complete two measures designed to assess knowledge of supportive conversational strategies. For the first knowledge measure participants were asked to think of ways to support conversations with people with aphasia and write these onto a blank mind map. For the second knowledge measure participants were asked to complete the Rayner & Marshall (2003) communication strategy identification questionnaire. Results The mind map knowledge measure elicited 17 communication strategies that participants thought might support a conversation with a person with aphasia. Some strategies were thought to be less helpful than others. The responses to the second measure, the Rayner & Marshall (2003) strategic questionnaire, showed that participants were able to differentiate between supportive and unsupportive strategies with 75% accuracy. Discussion The results of this small scale undergraduate study suggest that people who volunteer for conversational partner training may have quite detailed knowledge about how to support conversations with people with a aphasia before undergoing training. The responses elicited in the study suggest that the blank mind map technique and the Rayner & Marshall (2003) strategic questionnaire may be used to gauge the prior knowledge of conversational therapy trainees before conversational therapy begins.. References Kagan, A., Winckel, J. & Shumway, E. (1996). Supported conversation for aphasic adults: Increasing communicative access. DVD. Toronto: Aphasia Centre, North York. Rayner, H. & Marshall, J. (2003) Training volunteers as conversation partners for people with aphasia. International Journal of Language and Communication Disorders, 38, 2, 149-164. Turner, S. & Whitworth, A. (2006) Conversational partner training programmes in aphasia: A review of key themes and participant roles. Aphasiology, 20, 6, 483-510

Aphasia teaching by the experts: A collaborative approach to undergraduate education

Background information DMU4 is a once monthly conversation group for people with aphasia (PWA). It started in 2008 and is part of the Aphasia Leicester Group, an organisation created and run by PWA. The main purpose of the DMU4 conversation group is to give PWA an opportunity to meet and practise talking. Since October 2009 the group has provided teaching for second year Speech and Language Therapy students. Theoretical teaching is provided alongside the DMU4 learning experience to encourage students to link theory to practice. The conversation group learning opportunity also responds to clinical teacher feedback from student feedback that suggested that second year students would benefit from more confidence and greater skill in talking to PWA. Student training Although DMU4 is not directly modelled on the conversational partner scheme outlined by McVicker, Parr, Pound and Duchan (2007), the conversation group has adapted elements of the CONNECT training programmes to suit undergraduate conversation training. Before the group students are asked to prepare themselves by reading one of three noteworthy conversation based resources: Kagan & Gailey (1993), Kagan (1998) & Simmons-Mackie (1998). In a lecturer led pre group tutorial students are asked to discuss these papers and also discuss their perceptions about: their role in the group, how to start a conversation with a PWA, how to synthesise theory with practice and how to design an aphasia friendly feedback sheet. Students then participate in a two hour conversation group. In the first hour students experience talking to a PWA. At the end of the hour the students receive feedback from their conversational partner using the aphasia friendly feedback sheet created in the pre group tutorial. After coffee the students have a new conversation with different conversational partner and at the end of this hour the students receive feedback from their new partner. At the end of the group students are asked to evaluate the DMU4 learning experience and reflect on what they have learnt in a post group tutorial led by a PWA. Teaching evaluation Quantitative module evaluation has suggested that students think that the DMU4 experience is valuable. Qualitative module evaluation also suggested that students have benefiited from the experience as they reported gains in theoretical understanding (understanding of aphasia), gains in skill levels (increased ablity to use multi modality communication and increased ability to know how to adapt their level of language) and gains in clinical confidence. References KAGAN, A. & GAILEY, G. (1993) Functional is not enough: Training conversation partners for aphasic adults. In A. Holland & M. Forbes (Eds.) Aphasia Treatment: World Perspectives. San Diego: Singular Press. KAGAN, A. (1998). Supported conversation for adults with aphasia: Methods and resources for training conversation partners. Aphasiology, 12, 9, 816-830. McVICKER, S., PARR, S., POUND, C. & DUCHAN, J. (2007) The communication partner scheme: a project to develop long term, low cost access to conversation for people living with aphasia. Aphasiology, 23, 1, 52-71. SIMMONS MACKIE, N. (1998) Communiciation strategies used by “good” vs “poor” speaking partners of individuals with aphasia. Aphasiology, 12, 9, 831-838

Exploring accounts of joint working between Speech and Language Therapists and Stroke Association Communication Support Coordinators

Exploring accounts of joint working between Speech and Language Therapists and Stroke Association Communication Support Coordinators Introduction Both Speech and Language Therapists (SLTs) and Stroke Association Communication Support Coordinators (CSCs) are employed across the UK to provide services for people with communication difficulties following Stroke. The two roles are usually employed by different sectors and are subject to very different levels of qualification and professional regulation. Despite recommendations that the two roles work together, there is little existing literature examining current practices of joint working between SLTs and CSCs. Method Data were collected through a series of in depth individual interviews with five CSCs and seven SLTs working within the East of England. Data were analysed inductively using Thematic Analysis (Braun & Clark, 2006). Results Six themes were developed which highlighted the perceived benefits and challenges in this example of cross sector working. Both SLTs and CSCs identified strong incentives for joint working. The themes developed suggested a number of processes are engaged in negotiating the joint working relationship. These include ‘Developing and earning trust and respect’; ‘Pushing to establish place’; and ‘Struggling against external pressures and threats’. In addition, two further themes were developed to explore the process of finding agreement in the division of workload: ‘Sharing Out’ of aphasia; and ‘Local level Negotiation and Matching of expectations’. Conclusions: The findings suggest a number of unique features which characterise joint working relationships between SLTs and CSCs. Clinical applications based on the findings are discussed, along with suggested areas for further research

Communication confidence in different settings: perceptions of nineteen people with aphasia

Communication confidence in different settings: perceptions of nineteen people with aphasia Background This small scale study was undertaken as part of an undergraduate degree. Aphasia is a clinical entity that can be defined in a literal way. It can also be described as a catalyst that results in a change in identity, and therefore also has emotional meaning for the people it affects. This latter description can be aligned with the social model that suggests that individuals are not intrinsically disabled, rather they are disabled by the society in which they live. Understanding and measuring the emotional effects of communication disability is challenging. In a recent single case study investigation Babbit & Cherney (2010) introduced a measure that examined the relationship between aphasia, communicative confidence and identity after a stroke, the Communication Confidence Rating Scale for Aphasia (CCRSA). Our study widened the scope of the original Babbit & Cherney (2010) study and used the CCRSA to investigate whether the communicative confidence of nineteen people with aphasia (PWA) was affected by their environment. Method Participants were recruited from two aphasia support groups operating in two different parts of Britain. The 12 men and 7 women who participated in this study were aged between 41 and 77 and had lived with their aphasia for an average of seven years. The PWA were asked to complete the CCRSA. Adaptations were introduced to enable a comparison between communicative confidence in three different settings: home, community and support group. Aphasia friendly adaptations (Dalemans et al, 2009 and Bixley et al, 2011) also ensured that the PWA, irrespective of the severity of their aphasia, were able to respond to the questionnaire independently. Results Questionnaires were collated and analysed statistically. Results suggested that participants were confident communicating at home and within support groups. PWA were not confident communicating in public. Findings were statistically significant. Participants reported that they were most confident (80%) talking to family and friends and were least confident when they used the telephone (26%). Discussion The results of this study suggest that PWA do not feel confident communicating in public or using the telephone. These findings confirm the perception that the societal barriers described by Pound et al (2000) prevent PWA accessing the society in which they live. The very similar positive confidence ratings for home and support groups provide a rationale for the benefits of long term group intervention and support for PWA. Our findings also suggest that the CCRSA may be a useful outcome measure that could be used to evaluate the positive effect that Speech and Language Therapy intervention can have on the communicative confidence of PWA. References BABBIT, E.M. & CHERNEY, L.R. (2010) Communication confidence in persons with aphasia. Topics in Stroke Rehabilitation, 17, 3, 214-223. BIXLEY, M., DMU4 & HAMILTON, C. (2011) Aphasia – an information leaflet designed by people with aphasia. British Aphasiology Society Biennial International Conference Book of Abstracts, 12. DALEMANS, R. (2009) Facilitating the participation of people with aphasia in research: A description of strategies. Clinical Rehabilitation, 23, 2, 948-959. POUND, C., PARR, S., LINDSAY, J. & WOOLF, C. (2000) Beyond Aphasia: Therapies for Living with Communication Disability. Bicester: Winslow

In search of consensus on aphasia management.

Morag Bixley and colleagues discuss their analysis of current UK aphasia practice