Communication partner training for student health and social care professionals engaging with people with stroke acquired communication difficulties: A realist review. [version 1; peer review: 1 approved, 2 approved with reservations]

Background: Stroke acquired communication impairments impede effective communication. Consequently, in stroke care, communicative interactions can be challenging for both patients and staff and can predispose patients to increased risk of preventable adverse events. Communication partner training (CPT) can mitigate such negative outcomes by optimising communicative interactions. Providing CPT to student health and social care professionals (SH&SCPs) has the potential to enhance their clinical expertise and experiences and enhance the future clinical care of patients with stroke acquired communication impairments. This research aims to expand our understanding of how CPT is operationalised for SH&SCPs in higher education institutions and determine: what works; for whom; in what contexts; how and why? Methods: This review is phase 1 of a research project employing a realist approach with public and patient involvement (PPI). It incorporates five iterative steps: 1.) Clarifying the scope; 2.) Searching for evidence; 3.) Selecting and appraising evidence; 4.) Data extraction; 5.) Synthesising data and developing a middle range theory explaining how CPT is expected to work for SH&SCPs. An advisory group, including PPI advisors, content experts, SH&SCPs and realist experts has been set up to consult throughout the review and collaboratively agree the middle range theory. Discussion: While there is an evolving evidence base for CPT, including stroke specific CPT for SH&SCPs, it is acknowledged that there are challenges to its implementation in complex real-world settings. In combining empirical evidence with theoretical understanding, realist review permits synthesis of data from diverse sources and goes beyond determining efficacy to explore generative causation and solutions for real world practice. A middle range realist programme theory that coherently explains how CPT is expected to work when teaching SH&SCPs to communicate with people with stroke acquired communication impairments will provide educators with new insights into CPT development and implementation in their higher education institutions

Towards an asset-based approach to promoting and sustaining well-being for people with aphasia and their families: an international exploratory study

Background: There is growing interest in interventions that promote positive outcomes and well-being for people with aphasia (PWA) and their families, but provision is inconsistent. An asset-based approach, based on the theory of salutogenesis, focuses on what makes you well rather than ill. This approach has been used successfully across a variety of research fields, including health and social care research and practice, and has the potential to provide coherent strategies to support people living successfully with aphasia. Aim: To explore the relevance and potential of an asset-based approach to promoting and sustaining well-being for PWA and their families, across contexts and cultures. Methods & procedures: Exploratory case studies were carried out in the United Kingdom (UK), Norway, Israel, Ireland, and Denmark in a variety of settings. Following an interpretative paradigm, we used qualitative methods including: interviews; appreciative inquiry; group discussions; and participatory action research. 95 PWA and 25 family members were asked to identify assets within themselves and their communities that promote, sustain and maintain well-being, by responding to: “What makes you feel good/well/healthy?” Data were analysed using thematic analysis. Outcomes & results: An asset-based approach proved to be a powerful means for PWA and family members to explore what helps them live well with aphasia. Key themes were identified: (1) personal journey; (2) helping others; (3) connecting to self; (4) connecting to others; (5) recreation; and (6) personal attributes. Self-identification of assets, within the person and their community, and connections to these, helped PWA and their family members to maintain well-being, overcome barriers and regain confidence. Using this approach, focusing on the person’s recognition, activation and mobilisation of assets, could enhance the person’s understanding and restore meaning around the stroke and onset of aphasia. Conclusion: This novel exploratory research demonstrates the relevance and potential across diverse cultural contexts of taking an asset-based approach to promoting and sustaining well-being for PWA and their families. Focusing on maintaining connections to these assets and developing meaning around the event, could prevent some of the negative sequela of stroke. The “patient–professional” relationship must transform into a collaborative partnership, with time and flexibility needed to introduce this approach. Further research should examine how service providers and PWA could develop and operationalise an asset-based approach in clinical and community settings and identify if there is an optimum timing for introducing this approach along the stroke pathway

Conference of the Irish Association of Speech & Language Therapists

Pragmatic disruption is associated with a range of acquired communication disorders of both neurogenic and psychiatric origin. This chapter provides an overview of the main themes in the research into pragmatic disruption in people with aphasia, right hemisphere language disorder, schizophrenia, traumatic brain injury, Alzheimer?s dementia, non-Alzheimer dementia and Parkinson?s disease. These disorders are associated with particular patterns of pragmatic disruption, which, in some cases, have been linked to disturbances in cognitive abilities, most often in theory of mind and executive function. Pragmatic strengths have typically been overshadowed by a focus on the pragmatic deficits in any given population. However, it is argued that these strengths form a crucial component of the pragmatic presentation of any client or clinical group more generally. Pragmatic disorders have a pervasive impact on the individual with the disorder as well as on those around them. Assessment and intervention in pragmatic disorders of adulthood must account for the profile of deficits and strengths, while considering the broader impact of the disorder on the individual and their social network

Research in Clinical Pragmatics

Pragmatic disruption is associated with a range of acquired communication disorders, of both neurogenic and psychiatric origin. This chapter services as an overview of the issues raised in this the chapters which follow, by providing a brief overview of the main themes in the research with regards to pragmatic disruption in people with aphasia, right hemisphere language disorder, schizophrenia, traumatic brain injury, Alzheimer?s dementia, the non-Alzheimer?s dementia and Parkinson?s disease. These disorders are associated with particular patterns of pragmatic disruption, which have been in some cases been linked to disturbances in cognitive abilities, particularly related to Theory of Mind and Executive Function. Pragmatic strengths have typically been overshadowed by a focus on the pragmatic deficits in any given population, however it is argued that these strengths form a crucial component of the pragmatic presentation of any client or clinical group more generally. Pragmatic disorders have a pervasive impact the individual with the disorder as well as on those around them. Assessment and intervention in pragmatic disorders of adulthood must account for the profile of both pragmatic deficits and strengths, while considering the broader impact of the disorder on the individual and their social network

Disaggregation of humanitarian data by disability: a realist evaluation of the use of the Washington Group Questions to support more inclusive practices

Abstract People with disabilities make up approximately 16% of the world’s population and disproportionately experience the risks and negative impacts of humanitarian emergencies. In humanitarian contexts, understanding who has a disability, where they are located, and what their needs are is crucial to delivering the right assistance at the right place and time. In recent years, global attention to disability inclusion in the humanitarian sector has focused on the generation of disaggregated data, most commonly using one of the Washington Group Sets of Questions. The implicit assumption behind the collection of more and more data disaggregated by disability, that it will lead to more inclusive action and outcomes, is incorrect. Our findings nuance the current push for disability disaggregated data in all settings and advocate a shift away from the blanket application of disaggregation to a more bespoke approach. Humanitarian and development contexts present multiple challenges to disaggregating data sets by demographic factors such as disability, including the use of households rather than individuals as the unit of analysis, small and non-representative samples, and minority languages with limited translation capacity. Through evaluation of the use of the Washington Group set across the world’s largest humanitarian organization, and its cooperating partners, we present five decision-making criteria that can be flexibly but consistently applied across operating contexts. This enables contextualized decision-making that uses consistent logic to predict the likelihood of data disaggregation by disability leading to more inclusive action and outcomes