Preliminary outcomes from a pilot study of personalised online supported conversation for participation intervention for people with Aphasia

Background Aphasia negatively impacts face-to-face social participation and the difficulties that people experience using the phone exacerbate these challenges in staying in touch with family and friends. Videoconferencing enables multimodal communication, and teamed with supported conversation, could facilitate access to conversation and thereby increase social participation for people with chronic aphasia. Aims This pilot study examined whether supported conversation provided over Skype could improve people’s social participation. It reports on preliminary outcomes of this intervention on people’s social network, communication confidence, aphasia-related quality of life, and mood. Methods & Procedures 29 participants with chronic aphasia received an initial 2-hour technology training session followed by 16hours of online supported conversation for participation intervention provided by qualified or student speech and language therapists. The intervention was personalised by individualising goals in technology, communication, and participation. An observational prospective cohort study design was used with baseline, immediately post-intervention, and 8-week follow-up assessments. Measures of social network and communication confidence (primary outcome measures), and aphasia-related quality of life, life participation, and mood (secondary outcome measures) were undertaken. Shapiro-Wilk tests were conducted to examine normality of distribution of each variable. Where data were normally distributed, one-way repeated-measures ANOVAs were used to examine the effect of time. Where data were not normally distributed, Wilcoxon Signed Ranks test was used. Outcomes & Results: 27 participants completed the intervention. As a group, participants reported significantly more social contacts, more life participation, and higher aphasia-related quality of life post-intervention, which were maintained. There was a group gain on the measure of communication confidence post-intervention, although this was not maintained. As a group, the participants’ mood did not significantly change through intervention and follow-up. Individual variability was noted across all outcome measures. Conclusions: These preliminary findings suggest that relatively low dose and non-intensive online supported conversation for participation intervention delivered by qualified or student speech and language therapists improved social participation in some people with aphasia and improved their quality of life. Communication confidence also improved for some, although benefits were short term. Findings make novel contributions to the existing supported conversation evidence base with positive social participation and quality of life outcomes, likely achieved by the explicit participation focus. Whilst preliminary findings are positive, study limitations need addressing. Further investigations are merited to refine the intervention and outcome measure choice and capture feasibility data. Finally, a definitive controlled trial is needed to explore the clinical efficacy and cost-effectiveness

‘Emotion is of the essence. … Number one priority’: A nested qualitative study exploring psychosocial adjustment to stroke and aphasia

Background: Stroke and aphasia can have a profound impact on people's lives, and depression is a common, frequently persistent consequence. Social networks also suffer, with poor social support associated with worse recovery. It is essential to support psychosocial well-being post-stroke, and examine which factors facilitate successful adjustment to living with aphasia. Aims: In the context of a feasibility randomized controlled trial of peer-befriending (SUPERB), this qualitative study explores adjustment for people with aphasia in the post-acute phase of recovery, a phase often neglected in previous research. Methods & Procedures: Semi-structured interviews were conducted with 20 people with aphasia and 10 significant others, who were purposively sampled from the wider group of 56 people with aphasia and 48 significant others. Interviews took place in participants’ homes; they were analysed using framework analysis. Outcomes & Results: Participants with aphasia were 10 women and 10 men; their median (interquartile range—IQR) age was 70 (57.5–77.0) years. Twelve participants had mild aphasia, eight moderate–severe aphasia. Significant others were six women and four men with a median (IQR) age of 70.5 (43–79) years. They identified a range of factors that influenced adjustment to aphasia post-stroke. Some were personal resources, including mood and emotions; identity/sense of self; attitude and outlook; faith and spirituality; and moving forward. Significant others also talked about the impact of becoming carers. Other factors were external sources of support, including familial and other relationships; doctors, nurses and hospital communication; life on the ward; therapies and therapists; psychological support, stroke groups; and community and socializing. Conclusions & Implications: To promote adjustment in the acute phase, hospital staff should prioritize the humanizing aspects of care provision. In the post-acute phase, clinicians play an integral role in supporting adjustment and can help by focusing on relationship-centred care, monitoring mental health, promoting quality improvement across the continuum of care and supporting advocacy. What this paper adds What is already known on the subject Anxiety and depression are common consequences of stroke, with depression rates high at 33% at 1 year post-onset. There is evidence that the psychological needs of people with aphasia are even greater than those of the general stroke population. Social support and social networks are also negatively impacted. Few studies have examined adjustment when people are still in hospital or in the early stages of post-stroke life in the community (< 6 months). Further, many stroke studies exclude people with aphasia. What this paper adds to existing knowledge Adjustment to living with stroke and aphasia begins in the early stages of recovery. While this partly depends on personal resources, many factors depend on external sources of help and support. These include doctors, nurses and hospital communication, their experience of life on the ward, and their therapists’ person-centred care. What are the potential or actual clinical implications of this work? Clinicians play an integral role in facilitating people with aphasia to utilize their personal resources and support systems to adjust to life after stroke. They can help by focusing on relationship-centred care, monitoring mental health, promoting quality improvement across the continuum of care and supporting advocacy

Technology-Enhanced Reading Therapy for People With Aphasia: Findings From a Quasirandomized Waitlist Controlled Study.

Purpose This study investigated the effects of technology-enhanced reading therapy for people with reading impairments, using mainstream assistive reading technologies alongside reading strategies. Method The study used a quasirandomized waitlist controlled design. Twenty-one people with reading impairments following stroke were randomly assigned to receive 14 hr of therapy immediately or after a 6-week delay. During therapy, participants were trained to use assistive reading technology that offered a range of features to support reading comprehension. They developed skills in using the technology independently and in applying the technology to their personal reading goals. The primary outcome measure assessed reading comprehension, using Gray Oral Reading Test-Fourth Edition (GORT-4). Secondary measures were as follows: Reading Comprehension Battery for Aphasia-Second Edition, Reading Confidence and Emotions Questionnaire, Communication Activities of Daily Living-Second Edition, Visual Analog Mood Scales, and Assessment of Living With Aphasia. Matched texts were used with the GORT-4 to compare technology-assisted and unassisted reading comprehension. Mixed analyses of variance explored change between T1 and T2, when the immediate group had received therapy but the delayed group had not, thus serving as untreated controls. Pretherapy, posttherapy, and follow-up scores on the measures were also examined for all participants. Results GORT-4 results indicated that the immediately treated group improved significantly in technology-assisted reading following therapy, but not in unassisted reading. However, the data were not normally distributed, and secondary nonparametric analysis was not significant. The control group was unstable over the baseline, improving significantly in unassisted reading. The whole-group analysis showed significant gains in assisted (but not unassisted) reading after therapy that were maintained at follow-up. The Reading Confidence and Emotions Questionnaire results improved significantly following therapy, with good maintenance of change. Results on all other secondary measures were not significant. Conclusions Technology-assisted reading comprehension improved following the intervention, with treatment compensating for, rather than remediating, the reading impairment. Participants' confidence and emotions associated with reading also improved. Gains were achieved after 14 therapy sessions, using assistive technologies that are widely available and relatively affordable, meaning that this approach could be implemented in clinical practice