Info exchange and identity & social relationships of comm. partners
Everyday communicative activities & situations
- Therapy on discourse level features: Topic maintenance tasks; turn-taking skills; flow of conversation; therapy tasks.
- Therapy though discourse to target word retrieval at higher levels: Improve an aspect of word or sentence level processing, using interaction involving discourse or conversation; promote word retrieval during a story-telling task; promote word retrieval during a role-play service encounter.
- Therapy through discourse to address psychosocial consequences of aphasia: Improve aspect of psychosocial recovery; use therapeutic interaction to promote self esteem; group activities; development of personal portfolios or life stories; counseling.
- Discover the social order within the structure of interaction & build an understanding of the resources employed by speakers to accomplish their interactive goals
- Collaborative construction of meaning among participants
- The moment of talking within conversational context of preceding & subsequent turns of talk
- 2-way interactions focus, additional conversational partners, real world contexts.
factors impacting QOL
Emotional state; social participation social support; well-being; life satisfaction
factors impacting health-related QOL
- The impact of a health state on a person’s ability to lead a fulfilling life
- Subjective eval of his/her physical, mental/emotional, family & social functioning
issues concerning QOL in aphasia
Distinguished from people w/o stroke; functional comm. ability predicts health-related QOL; people with severe aphasia have significantly lower HQOL when compared to people with aphasia of lesser severity; significant others rate a person with aphasia’s general HQOL worse than what a person with aphasia would rate him/herself.
factors concerning depression & stroke & aphasia
Depression- 62-70% of all people with aphasia; 1/3 major issues in post-stroke care; emotional distress; mood; range of responses to aphasia over time; caregiver depression.
assessment in QOL & HQOL
- Generic scales- sickness impact profile; Nottingham health profile; short-from 36 health survey
- Condition specific scales- stroke & aphasia HQOL scale; specific populations, increased validity & sensitivity.
- (living with aphasia- framework for outcome measurement) an organizational tool to assist SLPs in the integration of participation in life situations, personal identity, attitudes & feelings, severity of aphasia & the comm. & lang environment as aspects in which to facilitate goal selection.
- Facilitates thinking in regards to goals that are not limited to linguistic functioning in a therapy room alone.
methods to assess social networks in aphasia
social convoy model
impacts of sensory loss on social networks
Individuals that had some sort of sensory loss were noted to have a greater number of intense networks mainly of family & a lesser number of broad networks, notable friends. Did not impact the quantity of the network, but it did impact the composition of that network.
social network of aphasia profile
Predictors of social participation- list where & who & how long. Severity of aphasia was the biggest predictor of social participation in PWA
client centered approaches
Underpins therapy that is responsive to the priorities & needs of people with aphasia & their families.
10 factors related to client centered approaches in aphasia
respect for individuality & values; meaning; therapeutic alliance; social context & relationships; inclusive model of health & well being; expert lay knowledge; shared responsibility; comm.; autonomy; professional as person.
client centered assessment & intervention tools
- participation observation; social network analysis; use of structured diaries; direct observation & qualitative interviewing
- recall of videotaped comm. events, especially conversations; conversation or discourse analysis; use of rating scales related to dimensions of everyday comm., mood, self esteem, identified as important by people with aphasia.
- Life participation approach; group therapy; conversation therapy; working with family, friends, caregivers; community engagement approaches; counseling.
client centered approaches involve you doing...
- be a participant observer; listen to the personal stories; make your expert knowledge accessible; engage with the person; collaborate with the person in discussing goals & deciding on therapy approaches.
- Be flexible & resourceful; recognize that the aphasia therapist’s role encompasses a focus on living life with aphasia as well as lang intervention celebrate successes with your clients.
comm partner training in aphasia
- training any comm. partner with strategies designed to improve the comm. participation & effectiveness of adults with aphasia.
- Results in improved comm. access & participation for adults with aphasia
- Training partners may result in direct improvement in the comm. behavior of the adult with aphasia
who are candidates for comm partner training
- although often thought of for individuals with more severe impairments, can be useful for even mild aphasia
- often used in post-acute & chronic stages of aphasia.
sample goals related to comm partner training
- the patient & his comm. partner will increase the quality of comm. interactions as the comm. partner increases response time given to the patient by 50% or greater during a 15 min conversational sample.
- The patient will decrease social isolation as the comm. partner increases supportive conversational behaviors from 3-7 during a 15 min conversational sample
- The patient & his comm. partner will increase the quality of comm. interactions as the comm. partner decreases inappropriate interruptions from 10 to 4 during a 15 min conversational sample
- Overview- effective comm. strategies for both the person with aphasia & the primary comm. partner are targeted. The clinician acts as a comm. strategy coach for both partners. The primary comm. partner plays an equal role in improving conversation.
- Candidacy- effective for a variety of types & severities of aphasia. Best outcome will be achieved when there is a primary comm. partner who is willing & able to learn & maintain comm. strategies.
- Goals & outcomes- the desired outcome is the implementation of effective comm. strategies in conversation by both the person with aphasia & the comm. partner.
- Procedures- effective strategies for each partner are collaboratively identified; a comm. situation is created, such as viewing a short video clip. Both partners should be using their identified comm. strategies to achieve a collaborative result; the clinician acts as a coach to each of the 2 partners.
supported conversation for aphasia
- acknowledge competence- techniques to help PWA feel competent
- reveal competence- techniques to give & receive accurate info from PWA.
- 2 training workshops (one with activities department & one with healthcare personnel)
- provide- info about aphasia; examples of strategies; experiential learning, ideally interactions; train interactional strategies (acknowledging competence); train transactional strategies (revealing competence)
3 stages- raising awareness of the aspect of conversation that is being addressed; raising awareness of one’s own contribution to this particular aspect of conversation; identifying & practicing strategies for change.
historical milestones for group therapy & aphasia
WWII; popular in 1950s; decreased in popularity in 60s & 70s; slight uptake in 80s & 90s to maintain integrity in tx in the face of declining reimbursement
purpose of groups therapy in aphasia
Family support groups; psychosocial groups; lang stimulation groups; life participation groups