Patient Perspectives of an Intensive Comprehensive Aphasia Program for Stroke Survivors

Introduction: Persons with aphasia (PWA) who participate in intensive comprehensive poststroke language rehabilitation programs make a variety of significant investments. While intensive aphasia programs and intensive comprehensive aphasia programs (ICAPs) are becoming increasingly prevalent across health care settings, patient perspectives of ICAPs have not been explored. The purpose of this qualitative study was to examine patient perspectives about the experience of participating in an ICAP at the University of Montana. The primary research question of this study was: “what is it like to be a PWA in an ICAP?” Methods: Researchers used an interpretive phenomenological approach to conduct nine structured interviews from PWAs who described their lived experiences in the ICAP. All interviews were audiovisually recorded and transcribed from the video recordings. Analysis involved an iterative and collaborative coding process. Transcripts were coded and themes were developed from the PWAs’ shared perspectives. Results: Three primary themes emerged from patient perspectives including: (1) experience with each of the ICAP components is generally positive, (2) we notice the impact of the ICAP on our communication, and (3) relationships with people in the ICAP are important. Discussion: Results support emerging evidence that ICAPs can be a positive experience for PWA due to the perceptible impact on communication improvement and frequent and varied opportunities to interact with others. ICAPs may be a worthwhile investment for PWA, thereby contributing to the cost-benefit utility and implementation feasibility of the service delivery model

Exploring associations between a biological marker of chronic stress and reported depression and anxiety in people with aphasia

PURPOSE : Living with the communication impairment of aphasia can be stressful. Chronic stress, depression, and anxiety are intimately linked, may be more pervasive in people with poststroke aphasia than the general population, and may influence cognitive function and treatment outcomes. In this project, we explored the psychological constructs of depression and anxiety and their associations with a biomarker measure of chronic stress in people with aphasia. METHOD : Fifty-seven participants with aphasia completed measures of depression and anxiety and provided a hair sample from which to extract the stress hormone cortisol. Pearson product–moment correlational analyses were used to identify associations between depression, anxiety, and long-term level of cortisol via hair sample. RESULTS : While cortisol level was not associated with depression and anxiety across this sample of people with aphasia, a post hoc analysis showed a significant, positive correlation between a subset of participants with moderate and higher levels of depression and elevated cortisol level. CONCLUSIONS : Chronic stress, depression, and anxiety have been little explored in people with aphasia to date, yet they are associated with future health consequences and impaired cognitive function, motivating further research as well as consideration of these factors in aphasia rehabilitation.VA Rehabilitation Research and Developmenthttps://pubs.asha.org/journal/jslhrgl2020Speech-Language Pathology and Audiolog

Achieving Participation-Focused Intervention Through Shared Decision Making: Proposal of an Age- and Disorder-Generic Framework

Introduction: The World Health Organization's International Classification of Functioning, Disability and Health calls on speech-language pathologists (SLPs) to provide care that impacts all aspects of an individual's experience with a communication disorder, including their participation in valued life situations. However, SLPs often report feeling unprepared to implement and document interventions that target life participation. The purpose of this article is to propose a framework to guide participation-focused intervention practices. This age- and disorder-generic framework is designed to be applicable with clients across the variety of settings in which SLPs work. Method: In this clinical focus article, we draw on past research and clinical experience to propose a restructuring of World Health Organization's International Classification of Functioning, Disability and Health components such that participation is the primary focus and outcomes indicator for intervention. In this framework, a specific communicative participation situation is identified and assessed quantitatively, and a corresponding participation-focused goal is established through shared decision making. Following that, assessments are conducted and goals are established in the areas of communication skills, physical and social environments, and personal perspectives. Results: The proposed framework provides a concrete organizational structure as well as assessment, goal-writing, and intervention examples to assist SLPs in translating theoretical biopsychosocial frameworks into clinical practices. Conclusions: SLPs can and do provide holistic communication services to clients to help them achieve their life participation goals. This article provides an example as to how we can document the need for, as well as the value and impact of our important work, meeting the diverse life participation needs of clients.This item from the UA Faculty Publications collection is made available by the University of Arizona with support from the University of Arizona Libraries. If you have questions, please contact us at [email protected]

Incorporating the Principles of Self-Management into Treatment of Dysarthria Associated with Parkinson\u27s Disease

Although understanding patient perspectives on treatment is a major component of patient-centered care, little is known about patient perspectives related to dysarthria treatment in Parkinson\u27s disease (PD). This article attempts to explore the perspective of patients with dysarthria associated with PD by interviewing them before and after treatment. Treatment expectations and experiences are summarized along with a discussion of how patients are using the tools they learned once treatment was completed. Comments about treatment were generally positive and suggested increased awareness and improved speech loudness. However, areas for improvement were also identified including: (1) treatment was not addressing some communication problems that were of concern to patients; (2) therapy programs were not enjoyable; and (3) it was difficult to maintain gains after therapy ended. Principles of self-management are reviewed to address some of the shortcomings of current treatment approaches

Speech Versus Speaking: The Experiences of People With Parkinson\u27s Disease and Implications for Intervention

Purpose In this project, we explore the experiences of people who report speech changes associated with Parkinson\u27s disease as they describe taking part in everyday communication situations and report impressions related to speech treatment. Method Twenty-four community-dwelling adults with Parkinson\u27s disease took part in face-to-face, semistructured interviews. Qualitative research methods were used to code and develop themes related to the interviews. Results Two major themes emerged. The first, called “speaking,” included several subthemes: thinking about speaking, weighing value versus effort, feelings associated with speaking, the environmental context of speaking, and the impact of Parkinson\u27s disease on speaking. The second theme involved “treatment experiences” and included subthemes: choosing not to have treatment, the clinician, drills and exercise, and suggestions for change. Conclusions From the perspective of participants with Parkinson\u27s disease, speaking is an activity requiring both physical and cognitive effort that takes place in a social context. Although many report positive experiences with speech treatment, some reported dissatisfaction with speech drills and exercises and a lack of focus on the social aspects of communication. Suggestions for improvement include increased focus on the cognitive demands of speaking and on the psychosocial aspects of communication

Incorporating the Principles of Self-Management into Treatment of Dysarthria Associated with Parkinson\u27s Disease

Although understanding patient perspectives on treatment is a major component of patient-centered care, little is known about patient perspectives related to dysarthria treatment in Parkinson\u27s disease (PD). This article attempts to explore the perspective of patients with dysarthria associated with PD by interviewing them before and after treatment. Treatment expectations and experiences are summarized along with a discussion of how patients are using the tools they learned once treatment was completed. Comments about treatment were generally positive and suggested increased awareness and improved speech loudness. However, areas for improvement were also identified including: (1) treatment was not addressing some communication problems that were of concern to patients; (2) therapy programs were not enjoyable; and (3) it was difficult to maintain gains after therapy ended. Principles of self-management are reviewed to address some of the shortcomings of current treatment approaches

Is Disclosure of Spasmodic Dysphonia Recommended during a Telephone Interview? Advice from Employers

Are people with voice disorders at risk for discrimination during hiring? This project explored the reactions and recommendations of human resources personnel to a speaker with spasmodic dysphonia in mild and severe voice conditions during a simulated job interview. Guidance for understanding the ADA and advising clients will be explored

Are Clients With Voice Disorders at Risk for Hiring Discrimination? A Spasmodic Dysphonia Study

This study examined employer perceptions of a speaker with spasmodic dysphonia during a simulated telephone interview. Employers made judgments in one of two conditions: a) pre-BOTOX/severe, and b) post-BOTOX/mild. Results showed that unique concerns emerged for the applicant in the severe condition. Implications for disclosure during hiring will be discussed