Reporting interventions in communication partner training: a critical review and narrative synthesis of the literature

Background: Communication partner training (CPT) is an umbrella term for a complex behavioural intervention for communications partners (CPs) of people with aphasia (PWA) and possibly PWA themselves, with many interacting components, deployed in flexible ways. Recent systematic reviews (Simmons-Mackie, Raymer, Armstrong, Holland, & Cherney, 2010; Simmons-Mackie, Raymer, & Cherney, 2016) have highlighted the effectiveness of CPT in addressing the skills of conversation partners and the communicative participation of people with aphasia but have suggested that CPT has been variably delivered, with no clear picture of what the essential elements of CPT are and how CPT is expected to achieve its results through hypothesised mechanisms of change (Coster, 2013). Aim: This paper aims broadly to consider specification of CPT and describes how CPT has been conducted overall and in relation to treatment recipients. Recommendations for CPT and areas for future research are considered. Methods & Procedures: A critical review and narrative synthesis was carried out through: (i) the systematic application of the 12-item TIDieR checklist (Hoffmann et al., 2014) to the 56 studies appraised in the Simmons-Mackie et al. (2010, 2016)) reviews, providing a quantitative overview of the completeness of CPT intervention reporting; and (ii) a qualitative synthesis of the reviewed CPT literature according to TIDieR items. Outcomes & Results: Half of the TIDieR checklist items were reported by 71% or more of the studies, and the rest of the items were reported by 0–63% of studies. TIDieR items relating to the treatment (goal, rationale or theory of essential elements, materials and procedures) and provision (provider, mode, timing, dose) were more frequently reported; however, the level of detail provided was often inadequate or incomplete. The interventions were insufficiently specified to enable replication for most of the studies considered. The most infrequently reported items were: name, location, intervention tailoring and modification, and planned and actual intervention adherence/fidelity. Conclusion: For a better understanding of an intervention, it is necessary to identify and describe potentially central elements and perhaps especially in complex interventions as CPT, where it is likely also more difficult. Whilst the reviewed CPT studies are on average reporting on slightly more than half of the TIDieR items, they are overall insufficiently detailed. Some items appear easier to report on, whereas other items have not been attended to, are too complex in nature to give a full report on, or simply have not been relevant for the individual study to include

Imageability ratings across languages

Imageability is a psycholinguistic variable that indicates how well a word gives rise to a mental image or sensory experience. Imageability ratings are used extensively in psycholinguistic, neuropsychological, and aphasiological studies. However, little formal knowledge exists about whether and how these ratings are associated between and within languages. Fifteen imageability databases were cross-correlated using nonparametric statistics. Some of these corresponded to unpublished data collected within a European research network-the Collaboration of Aphasia Trialists (COST IS1208). All but four of the correlations were significant. The average strength of the correlations (rho = .68) and the variance explained (R (2) = 46%) were moderate. This implies that factors other than imageability may explain 54% of the results. Imageability ratings often correlate across languages. Different possibly interacting factors may explain the moderate strength and variance explained in the correlations: (1) linguistic and cultural factors; (2) intrinsic differences between the databases; (3) range effects; (4) small numbers of words in each database, equivalent words, and participants; and (5) mean age of the participants. The results suggest that imageability ratings may be used cross-linguistically. However, further understanding of the factors explaining the variance in the correlations will be needed before research and practical recommendations can be made

Psykisk ohälsa vanligt bland anhöriga

Det är välkänt att anhöriga till personer med afasi kan må dåligt på olika sätt. Men hur vanligt är det med psykisk ohälsa? En ny forskningsstudie har tittat på det

Psykisk ohälsa vanligt bland anhöriga

Det är välkänt att anhöriga till personer med afasi kan må dåligt på olika sätt. Men hur vanligt är det med psykisk ohälsa? En ny forskningsstudie har tittat på det

Experiences and need of support to significant others of persons with aphasia

Background and aims: Significant others (SOs) of people with aphasia (PWA) can affect the individual’s social participation, conversational ability, and rehabilitation outcome [1]. SOs have been called the most valuable but also the most vulnerable resource of a patient [2]. To be a supportive SO and to remain healthy in a challenging situation SOs may need support themselves. The aim of this study was to investigate what support SOs of PWA have received, how they experienced the support, and their need for further support.  Methods: 173 SOs responded to a study-specific questionnaire (response rate: 67.8%). Quantitative data were analysed with descriptive and comparative statistics and answers to open-ended questions were analysed with qualitative content analysis.  Results and main contribution: The SOs appreciated knowledge, devotion, helpfulness, and empathy of health care staff and community services. Community services were perceived as being characterised by long processing times, lack of continuity of staff and insufficient understanding of the needs of the PWA and the SO. Most respondents were satisfied with the informal support provided by disability organizations, family, and relatives. There was however still a pronounced need of a more understanding environment (family, friends, health-care services). The strongest need expressed by the SOs was having time of their own. Despite an acknowledged burdensome situation and low emotional well-being among SOs of PWA [3], the need for counselling was the least perceived need (expressed by 16%). Conclusions: Feeling seen and acknowledged as well as having time of their own are important but perhaps underestimated needs of SOs of PWA.  Implications: This study highlights the importance to include the SOs in the rehabilitation of PWA but also to provide separate support to them.In the list of poster session abstracts, the title is: Experiences and need of support to significant others of people with aphasia</p

Aphasia and Communication in Everyday Life : Experiences of persons with aphasia, significant others, and speech-language pathologists

The aims of this thesis were to describe the experiences of persons with aphasia and their significant others of their conversations and use of communication strategies, examine current practice of family-oriented speech-language pathology (SLP) services, and test a family-oriented intervention in the early phase of rehabilitation. The persons with aphasia valued having conversations despite perceiving their aphasia as a serious social disability. They acknowledged the importance of the communication partners’ knowledge and understanding of aphasia and their use of supporting conversation strategies. Their own use of communication strategies varied considerably. The persons with aphasia longed to regain language ability and to be active participants in society. A majority of the significant others perceived their conversations with the person with aphasia as being less stimulating and enjoyable than conversations before stroke onset. Aphasia was considered a serious problem. The significant others took on increased communicative responsibility, where two thirds had changed their communicative behaviour to facilitate conversations. Type and severity of aphasia were especially related to the communicative experiences of the significant others and their motivation to be involved in SLP services. Thirty percent of the speech-language pathologists worked with people with aphasia and typically met with their families. They considered the involvement of significant others in SLP services as very important, especially in providing information about aphasia and communication partner training (CPT). However, involvement of significant others was restricted because of a time shortage and perceived limited skills and knowledge. In addition, there were national differences regarding aphasia rehabilitation services. The intervention consisted of three sessions directed to significant others (primarily emotional support and information) and three directed to the dyads (a person with aphasia and a significant other) (primarily CPT). All six participants (three dyads) felt that their knowledge and understanding of aphasia had increased and that their conversations had improved. These improvements were also evident to some extent with formal assessments. These results suggest the following: CPT should be an integral part of SLP services, national clinical guidelines are needed, and further education of speech-language pathologists and implementation of new knowledge into clinical practice requires consideration

Aphasia and Communication in Everyday Life : Experiences of persons with aphasia, significant others, and speech-language pathologists

The aims of this thesis were to describe the experiences of persons with aphasia and their significant others of their conversations and use of communication strategies, examine current practice of family-oriented speech-language pathology (SLP) services, and test a family-oriented intervention in the early phase of rehabilitation. The persons with aphasia valued having conversations despite perceiving their aphasia as a serious social disability. They acknowledged the importance of the communication partners’ knowledge and understanding of aphasia and their use of supporting conversation strategies. Their own use of communication strategies varied considerably. The persons with aphasia longed to regain language ability and to be active participants in society. A majority of the significant others perceived their conversations with the person with aphasia as being less stimulating and enjoyable than conversations before stroke onset. Aphasia was considered a serious problem. The significant others took on increased communicative responsibility, where two thirds had changed their communicative behaviour to facilitate conversations. Type and severity of aphasia were especially related to the communicative experiences of the significant others and their motivation to be involved in SLP services. Thirty percent of the speech-language pathologists worked with people with aphasia and typically met with their families. They considered the involvement of significant others in SLP services as very important, especially in providing information about aphasia and communication partner training (CPT). However, involvement of significant others was restricted because of a time shortage and perceived limited skills and knowledge. In addition, there were national differences regarding aphasia rehabilitation services. The intervention consisted of three sessions directed to significant others (primarily emotional support and information) and three directed to the dyads (a person with aphasia and a significant other) (primarily CPT). All six participants (three dyads) felt that their knowledge and understanding of aphasia had increased and that their conversations had improved. These improvements were also evident to some extent with formal assessments. These results suggest the following: CPT should be an integral part of SLP services, national clinical guidelines are needed, and further education of speech-language pathologists and implementation of new knowledge into clinical practice requires consideration

Experiences and need of support to significant others of persons with aphasia

Background and aims: Significant others (SOs) of people with aphasia (PWA) can affect the individual’s social participation, conversational ability, and rehabilitation outcome [1]. SOs have been called the most valuable but also the most vulnerable resource of a patient [2]. To be a supportive SO and to remain healthy in a challenging situation SOs may need support themselves. The aim of this study was to investigate what support SOs of PWA have received, how they experienced the support, and their need for further support.  Methods: 173 SOs responded to a study-specific questionnaire (response rate: 67.8%). Quantitative data were analysed with descriptive and comparative statistics and answers to open-ended questions were analysed with qualitative content analysis.  Results and main contribution: The SOs appreciated knowledge, devotion, helpfulness, and empathy of health care staff and community services. Community services were perceived as being characterised by long processing times, lack of continuity of staff and insufficient understanding of the needs of the PWA and the SO. Most respondents were satisfied with the informal support provided by disability organizations, family, and relatives. There was however still a pronounced need of a more understanding environment (family, friends, health-care services). The strongest need expressed by the SOs was having time of their own. Despite an acknowledged burdensome situation and low emotional well-being among SOs of PWA [3], the need for counselling was the least perceived need (expressed by 16%). Conclusions: Feeling seen and acknowledged as well as having time of their own are important but perhaps underestimated needs of SOs of PWA.  Implications: This study highlights the importance to include the SOs in the rehabilitation of PWA but also to provide separate support to them.In the list of poster session abstracts, the title is: Experiences and need of support to significant others of people with aphasia</p

Relations between executive function, language and functional communication in severe aphasia

People who, due to aphasia, have severely limited ability to make themselves understood through speech, are forced to find other means of communication. However, the ability to flexibly and efficiently use gesture, drawing, writing, communication aids and so on differs widely in people with severe aphasia. Studies of interventions focusing on use of augmentative and alternative communication (AAC) in aphasia typically show that the participants have ability to learn to use the communication aid in the clinical context, but frequently fails to generalise the use to real-life functional communication (Jacobs, Drew, Ogletree, &amp; Pierce, 2004). The same problem is often seen for other kinds of alternative communication, such as gesture and drawing. Intervention in severe aphasia aims for access to meaningful social interaction in spite of great linguistic barriers (Darrigrand et al., 2011; Koleck et al., 2017),  and a profound understanding of the different factors affecting the functional communication in this population is therefore crucial. One factor that is thought to play an important role is executive function. It has been shown that people with aphasia often have impaired executive function, and there also seems to be a link to functional communication (Fridriksson, Nettles, Davis, Morrow, &amp; Montgomery, 2006; Murray, 2012; Purdy &amp; Koch, 2006; Ramsberger, 2005). However, the studies are few and conducted on small samples often including participants with a wide variation in aphasia severity. The aim of the present study was to expand the understanding of the relations between executive functions, linguistic ability and functional communication in severe aphasia. Executive functions, linguistic ability and functional communication were assessed in 47 participants with severe aphasia. Functional communication was assessed using the Scenario Test (van der Meulen, van de Sandt-Koenderman, Duivenvoorden, &amp; Ribbers, 2010). The results were analysed for the total sample as well as separated into a verbal and a non-verbal subgroup. Impairment of executive function was found in 79% of the participants. Moderate to strong correlations were found between linguistic ability and executive functions. In the total sample, partial correlation analysis showed that functional communication was mainly related to verbal output. In the verbal subgroup, no relations were found between functional communication and the other two variables. In the non-verbal subgroup however, the partial correlation analysis showed a strong relation between executive function and functional communication. Generally, there was large variation of executive functions and functional communication among the participants, especially in the nonverbal subgroup. The study led to several conclusions. Impairments of executive functions are, as expected, common in people with severe aphasia, and executive function is closely related to linguistic ability. The ability to produce verbal output is, also as expected, strongly related to functional communication and on the group level a small increase in verbal output results in a relatively large increase in functional communication, as measured by the Scenario Test. However, in people with extreme limitation or total absence of verbal output, where use of other modes of communication are ineluctable, executive functions seem to be an important factor. This suggests that executive functions need to be considered when planning intervention. In both design and training to use AAC and other forms of communication support, it is important to understand the demands the task puts on executive functions and, if possible, to minimise them. This also raises the importance of making sure people with severe aphasia are given a proper assessment of their cognitive abilities including executive functions, even though this is often challenging.     Darrigrand, B., Dutheil, S., Michelet, V., Rereau, S., Rousseaux, M., &amp; Mazaux, J.-M. (2011). Communication impairment and activity limitation in stroke patients with severe aphasia. Disabil Rehabil, 33(13-14), 1169-1178. doi:10.3109/09638288.2010.524271 Fridriksson, J., Nettles, C., Davis, M., Morrow, L., &amp; Montgomery, A. (2006). Functional communication and executive function in aphasia. Clinical Linguistics &amp; Phonetics, 20(6), 401-410. doi:10.1080/02699200500075781 Jacobs, B., Drew, R., Ogletree, B. T., &amp; Pierce, K. (2004). Augmentative and Alternative Communication (AAC) for adults with severe aphasia: where we stand and how we can go further. Disabil Rehabil, 26(21-22), 1231-1240. doi:10.1080/09638280412331280244 Koleck, M., Gana, K., Lucot, C., Darrigrand, B., Mazaux, J. M., &amp; Glize, B. (2017). Quality of life in aphasic patients 1 year after a first stroke. Quality of Life Research, 26(1), 45-54. doi:10.1007/s11136-016-1361-z Murray, L. L. (2012). Attention and other cognitive deficits in aphasia: Presence and relation to language and communication measures. Am J Speech Lang Pathol, 21(2), s51-s64. doi:10.1044/1058-0360(2012/11-0067) Purdy, M., &amp; Koch, A. (2006). Prediction of strategy usage by adults with aphasia. Aphasiology, 20(2-4), 337-348. doi:10.1080/02687030500475085 Ramsberger, G. (2005). Achieving conversational success in aphasia by focusing on non-linguistic cognitive skills: A potentially promising new approach. Aphasiology, 19(10-11), 1066-1073. doi:10.1080/02687030544000254 van der Meulen, I., van de Sandt-Koenderman, W. M., Duivenvoorden, H. J., &amp; Ribbers, G. M. (2010). Measuring verbal and non-verbal communication in aphasia: reliability, validity, and sensitivity to change of the Scenario Test. Int J Lang Commun Disord, 45(4), 424-435. doi:10.3109/13682820903111952

SLP services in Sweden and in Finland : A comparative study

Background: About ten years ago surveys were conducted in Sweden and Finland in order to investigate SLP services for people with aphasia [1, 2] and their significant others [3]. Both in Sweden and Finland there are national legislations that demands evidence-based practice. Although there are still no national clinical guidelines on aphasia rehabilitation in Sweden, such evidence-based guidelines can be found internationally, such as Australian Aphasia Rehabilitation Practice [4]. In addition, Simmons-Mackie et al. [5] has through an extensive consensus work developed the top ten best practice statements for aphasia rehabilitation. Aim: The overall aim of this study was to describe and compare how speech-language pathologists (SLPs) in Sweden and Finland work with persons with aphasia and their significant others and if these speech-language pathology (SLP) practices differ from those reported about ten years ago. Of special interest was if and how the services followed evidence-based clinical guidelines about aphasia rehabilitation. Methods: The study was conducted as a web-based survey in Sweden and Finland in September 2018. The 43-item questionnaire was responded to by 141 (78 Swedish and 63 Finnish) SLPs working with persons with aphasia and their significant others. Quantitative data were analyzed with descriptive and comparative statistics. Qualitative data (answers to open-ended questions) were analyzed with qualitative content analysis. Results: The findings suggested that despite some commonalities (such as allocated time for different types of interventions), SLP services differed both within and between the countries. Most within-countries differences were found in relation to in which rehabilitation phase (acute, sub-acute, and chronic) the participants worked but also between private or public SLP services (Finland) or between regions of the countries (Sweden). Differences between the countries concerned for instance time allocated for assessment, measures, goal setting, total number of sessions, the use of specific treatment methods, and the contact with significant others. The majority of the participants, particularly in Sweden, expressed dissatisfaction with the resources allocated to people with aphasia and their significant others. Other expressed barriers to SLP services were lack of treatment material, lack of courses for further education, long distances, too short treatment periods, and lack of SLP services after discharge from hospitals. When comparing today’s SLP services in Sweden and Finland with internationally agreed on aphasia rehabilitation guidelines several gaps were found, particularly regarding duration and intensity of interventions. Moreover, the participants expressed difficulties with evidence-based practice; barriers such as lack of psychometric sound measures, lack of evidence-based treatment methods, and the need for individual adaptations of treatment methods and materials were mentioned. In comparison with the studies of Blom Johansson et al [1, 3] and Klippi et al [2] some positive trends could be identified but no major differences were found. Conclusion:Today’s SLP services to people with aphasia and their relatives in Sweden and Finland do not fulfill internationally recommended clinical guidelines. To change SLP services and implement clinical guidelines seems to be a time-consuming process that encounters several barriers