111 research outputs found
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Reporting on psychological well-being of older adults with chronic aphasia in the context of unaffected peers
Abstract
Purpose: It is important that professionals working with individuals with acquired neurogenic communication disorders consider their clientsâ psychological wellbeing. Much is known about the significant emotional, social and psychological consequences of aphasia after stroke, however little is known about individualsâ psychological wellbeing. This paper reports the psychological wellbeing of community-dwelling older adults with chronic aphasia in the context of their unaffected peers.
Method: Thirty participants affected by aphasia and 75 unaffected participants completed the 24-item measure How I Feel About Myself drawn originally from Ryff (1989) and the Geriatric Depression Scale (Sheikh & Yesavage, 1986).
Results: Individuals with aphasia after stroke had statistically similar range and average psychological wellbeing as the unaffected population, with the exception of lower environmental mastery (independence) and lower mood. Furthermore, a substantial number of individuals (affected and unaffected) reported lower than average psychological wellbeing.
Conclusions: Many persons with chronic aphasia need support to manage the demands and responsibilities of their everyday lives and raise their mood. Clinicians need to be aware of this possibility and formally assess all persons with aphasia, as well as explore the potential impact of physical limitations. Identifying low well-being in older adults is important for all professionals working with the ageing population. The implications for speech and language therapy and for multi-disciplinary research and cross-sector joint working (health, social and community services) are discussed
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Researching Across Two Cultures: Shifting Positionality
Embodied and creative research methods provoke honesty, emotion, and vulnerability in participants, which add to the richness of the stories they tell and are willing to share. The positionality of the researcher is less of âinterviewerâ and more âco-producerâ or participant in a dialogue. Visual and creative approaches invite participants to share in ways in which they are not able or willing through words alone. The data and outputs they produce, with film, art, or objects, can in turn affect those who see it more than written text and need to be analysed and disseminated along with more traditional transcripts, articles, and presentations. In the context of investigating sensitive issues such as those around embodied identity, these methods, which use embodied methods to explore embodied research questions, may feel the most appropriate. These approaches lie along the boundary of therapy and research, asking much of researchers who are unlikely to have received therapeutic training or ongoing support. Due to this deficit, the researched may find that their experience is not held or contained in a way that the content would demand. Similarly, the data themselves lie on the boundary of art and research, in that they can be seen as more than a tool to facilitate reflection, but as artifacts in their own right. What are the implications in this scenario? Where should we position ourselves and our work along these boundaries? Who holds the space for the researcher and the researched if both are made vulnerable
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The contribution and impact of the International Classification of Functioning, Disability and Health on quality of life in communication disorders
Past discussions of the International Classification of Functioning, Disability and Health (ICF) have focused minimally, if at all, on quality of life. This paper critically discusses the contribution of the ICF to quality of life concept development, and the impact that the ICF has had thus far on health-related quality of life measurement. âContributionâ focuses on modelling the relationship between disablement and quality of life, evaluating the content of existing instruments, and thinking holistically about the individual. âImpactâ relates to the association of quality of life with functioning, pathology and outcomes, the trend towards life compartmentalization, and the disproportionate emphasis on individuals' functioning at the expense of their life context. Examples are drawn from adult acquired conditions (mainly aphasia), and terminology used in the paper reflects a rehabilitation stage of service provision. The World Health Organization's approach to quality of life definition and measurement is also discussed. An operational definition of quality of life for adults with acquired communication and swallowing disorders is presented, alongside an alternative conceptualization of quality of life. This paper ends with recommendations for future research concerning the importance of context, the subjective or personal perspective, and having a goals orientation for life as well as rehabilitation. It is also argued here that the ICF and quality of life are different constructs and that quality of life should be the starting point for understanding the client's perspective of his/her goals and/or his/her disability
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Strategies used in the pursuit of achievability during goal setting in rehabilitation
We used conversation analysis of six audio- and video-recorded goal setting meetings that were attended by patients and their respective treating team to explore and describe the interaction of participants during interdisciplinary goal setting, and to identify the strategies used to agree goals. The health care professionals involved in the six sessions included four physiotherapists, four occupational therapists, four nurses, one speech and language therapist, and one neuropsychologist. The participants included 3 patients with multiple sclerosis, 2 patients with spinal cord lesions, and 1 patient with stroke from an inpatient neurological rehabilitation unit. Detailed analysis revealed how the treating team shaped the meetings. The most notable finding was that there was rarely a straightforward translation of patient wishes into agreed-on written goals, with the treating team leading goal modification so that goals were achievable. Despite professional dominance, patients also influenced the course of the interaction, particularly when offering resistance to goals proposed by the treating team
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Participantsâ perspectives of feasibility of a novel group treatment for people with cognitive communication difficulties following acquired brain injury
Purpose: To determine whether treatment was acceptable to participants and perceived as beneficial by exploring the experiences of people with cognitive communication difficulties following acquired brain injury who participated in a novel, group, communication, project-based treatment. The purpose of the treatment was to improve participantsâ communication skills and quality of life, by focusing group activity towards the production of a project and by incorporating individualised communication goals into group sessions.
Methods: Twenty-one people with acquired brain injury recruited from community settings participated in project-based treatment, which comprised one individual and nine group sessions (of 2-3 people) over six weeks. Structured interviews were conducted post-treatment as part of a broader assessment battery. Interviews were transcribed verbatim and analysed using content analysis to identify codes, categories and themes.
Results: Themes identified from the analysis centred around the treatment experience (general experience; group experience; project experience; working on goals) and benefit of treatment (communicative benefit; other benefits; emotional effects; meeting others; something to do). These themes were consistent with the treatment being perceived as acceptable and having initial efficacy for the participant group.
Conclusion: The qualitative data presented here provide positive feasibility findings (acceptability and initial efficacy) of project-based treatment for people with acquired brain injury. The results
highlight the value of incorporating participantsâ views in assessing feasibility in developing novel interventions
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Facilitating the involvement of people with aphasia in stroke research by developing communicatively accessible research resources
People with aphasia can be marginalized by a communicatively inaccessible society. Compounding this problem, routinized exclusion from stroke research leads to bias in the evidence base and subsequent inequalities in service provision. Within the United Kingdom (UK), the National Institute of Health Research (NIHR) Stroke Research Network (SRN) identified this problem and funded a 6-month project in 2013-14 that resulted in the creation of practical and freely available resources to equip researchers to engage more people with aphasia in research. Critical elements enabled authentic co-construction of new knowledge regarding accessible research documentation including the process structure, timescale and crucially the fundamental engagement of people with aphasia. Stages in this process included mapping existing resources, engaging with researchers, and with people affected by aphasia, and developing a new set of resources comprising images, accessible text, and templates for research forms. These resulted in high quality outputs, as indicated by preliminary feedback from the research community and people with aphasia
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An evaluation of communication-related and quality of life outcomes for people with aphasia accessing Early Supported Discharge stroke services
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Professionalsâ perspectives on delivering conversation therapy in clinical practice
Background: Aphasia and other acquired language impairments have the potential to impact greatly on quality of life by disrupting everyday conversation. Different intervention approaches are available to speech and language therapists (SLTs), such as targeting the language impairment itself and/or addressing activity or participation barriers. Conversation therapy is one approach that is gaining in popularity, with a growing evidence base. However, it is not clear how SLTs currently use conversation approaches and what factors may influence delivery.
Aims: To investigate how SLTs (i) define conversation therapy, (ii) deliver it in clinical practice, and identify (iii) any challenges faced.
Methods & Procedures: An online survey and focus group explored how SLTs working in the south east of England currently deliver conversation therapy to support people with a range of communication disorders, in particular aphasia. Data were analysed using descriptive statistics and thematic content analysis.
Outcomes & Results: A total of 50 SLTs completed the survey and 6 participants attended the focus group. Conversation therapy was found to be widely employed by participants, however there was considerable variation in the approaches used, and a number of major challenges were raised. SLTs reported delivering conversation therapy with a range of client groups and preferably working with the client and partner together. Conversation goals predominantly reflected an approach based on: (i) strategy use and/or total communication (TC), and (ii) Conversation Analysis. Three overarching themes around conversation therapy emerged from the focus group: (1) What is conversation therapy? (2) showing it works, and (3) complexities of delivering it. SLTs acknowledged the benefit of conversation therapy but felt they lacked the tools and skills needed to deliver it.
Conclusions: SLTs wanted to use conversation therapy and desired clear outcome measures to demonstrate its effectiveness, but were not accessing the available evidence base, highlighting the ongoing difficulty of translating research into clinical practice. Whilst these data are limited by the small number of participants, the study provides a first view of how conversation therapy is articulated in practice. Further investigation of conversation therapy delivery is warranted with a larger sample of SLTs based across the United Kingdom, as is comparison with practice in other countries
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Cliniciansâ views and practices in quality of life in aphasia rehabilitation: a preliminary study
Background: Quality of life (QOL) is important to people with aphasia and their family members and is influenced by a range of factors within the scope of practice for speech and language therapy. Interestingly though, clinicians largely assess patientsâ/ clientsâ QOL informally through discussion, and rarely measure QOL as an outcome from aphasia rehabilitation. Research is needed to understand why there is relatively little consideration of QOL in clinical practice and little use of formal assessments.
Aims: This study explores aphasia cliniciansâ views and reported practices regarding QOL as a concept and its assessment.
Methods & Procedures: Nineteen practising speech and language therapists working in rehabilitation with adult clients with neurogenic communication disorders volunteered and completed the study. They completed an online survey of 48 questions with a range of response options, including free text. Descriptive and inferential statistics were used for count and categorical data, and content analysis for text responses.
Outcomes & Results: These clinicians felt initially unprepared for practice, and had limited awareness, knowledge and confidence in using QOL assessments, but nonetheless thought QOL was important in clinical management. They considered QOL as being individualized, pertaining to life satisfaction and enjoyment, and additionally considered it as communication, participation in activities, education, and emotional support. The majority used informal methods, although some formal assessment use was reported. Many perceived barriers related to lack of resources (physical, staff, and time). Clinicians also reported scope of practice issues with the broader multidisciplinary rehabilitation team and specifically clinical psychology.
Conclusions: Training and access to existing available QOL assessments are clear implications from this study. Further research is needed to assess the extent to which these findings are representative of the broader aphasia clinician community in England
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An investigation of social activities of neurologically healthy older adults and relevance of the Social Activities Checklist (SOCACT-2)
Purpose: This preliminary study aimed to describe the type, range, partner and frequency of social activity among neurologically healthy older people in order to evaluate the content validity of the SOCial ACTivities Checklist (SOCACT-2).
Method: Ten neurologically healthy older people were recruited. Participantsâ social activities were investigated through the completion of the SOCACT-2. Naturalistically occurring social activities were then recorded in a social activity diary over 28 consecutive days. Items recorded in the diaries were compared with SOCACT-2 items, and new items not included in the SOCACT-2 were noted. Frequency and location of participation was also recorded.
Results: All SOCACT-2 items were recorded in the diaries, with the exception of two. Findings suggest that another two SOCACT-2 items could be rephrased to more accurately reflect naturalistically occurring social activities, and two new categories of social activities were identified.
Conclusions: The results provide preliminary evidence for the relevance of the majority of SOCACT items. Revisions to four existing items included in the SOCACT-2, as well as the inclusion of two additional items may be indicated to capture the range of activities participated in by older people
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