Adult Comm 3

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.

Emotional state; social participation social support; well-being; life satisfaction

• 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

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.

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.

• 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.

social convoy model

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.

Predictors of social participation- list where & who & how long. Severity of aphasia was the biggest predictor of social participation in PWA

Underpins therapy that is responsive to the priorities & needs of people with aphasia & their families.

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.

• 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.

• 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.

• 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

• 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.

• 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.

• 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.

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

Family support groups; psychosocial groups; lang stimulation groups; life participation groups