ArticlePDF Available

Abstract and Figures

Background: Many factors that contribute to successful living with aphasia intersect with the benefits one can get from attending an aphasia group. Affiliated with Toastmasters International, Gavel Clubs (GCs) for people with aphasia (PWA) provide a range of communication activities that promote public speaking and leadership skills. The constructs of communication confidence and quality of communication life (QCL) were introduced over a decade ago but have not been widely investigated. Aims: This study aims to investigate the association between weekly participation in GC public speaking activities for PWA and the constructs of QCL and communication confidence. In addition, the study aims to explore the association between the severity of aphasia, QCL and communication confidence. Methods & Procedures: Eight members of a GC for PWA, who attended 31–33 weekly GC meetings per year between 2012 and 2016, participated in assessments of their QCL (using the ASHA Quality of Communication Life (ASHA QCL)), communication confidence (using the Communication Confidence Rating Scale for Aphasia (CCRSA)), and aphasia severity (using the Western Aphasia Battery-Revised (WAB-R)). A link was sought between severity of aphasia and the constructs of QCL and communication confidence. Outcomes & Results: QCL improved significantly over four years of participation in the GC (Z = 2.103, n = 8, p = .035, r = .74). Communication confidence also improved significantly (Z = 1.973, p = .049, r = .70). No associations were found between the two scales or between the scales and severity of aphasia. Conclusions: Weekly participation in GC group activities was associated with improved QCL, as measured by the ASHA QCL, and improved communication confidence as measured by the CCRSA. Decision-making (measured by the CCRSA) and the Roles and Responsibilities domain (in the ASHA QCL) also improved. More research is needed to verify these findings using a study design that includes a control group, to identify the links between the various psychosocial aspects at play in the life of PWA and to conceptualise how the gains achieved with GC participation can be applied more broadly to successful living with aphasia.
Content may be subject to copyright.
A preview of the PDF is not available
... Although internal consistency data for QCL has been reported to range from .76-90 (Cranfill & Wright, 2010;Plourde et al., 2018), this data included PWA, significant others and SLPs, not distinguishing between the different participants. QCL did not meet this criterion because consistency data was required from PWA, not their proxies. ...
... Chue et al., 2010). QCL total score met internal consistency criterion for grouplevel decision-making but reproducibility data was not available (Plourde et al., 2018). BOSS did not meet this criterion because data were not available in PWA, although extensive reliability data were available for the general stroke population. ...
... For QCL, known groups data were available for mild, moderate and severe aphasia, in addition to fluent and nonfluent aphasia (Cranfill & Wright, 2010;Paul et al., 2004). Longitudinal data were also reported for PWA but significance was variable in small samples (Cherney et al., 2011a;Johnson et al., 2008;Plourde et al., 2018;Rodriguez et al., 2013). ...
Article
Full-text available
Background Aphasia affects approximately one-third of stroke survivors and has a significant impact on their health-related quality of life (HRQL). Aims This study assessed the psychometric properties of HRQL instruments and related constructs designed for use in people with aphasia (PWA) for use in individual clients or clinical trials, i.e., individual-level and group-level decision-making, respectively. Instruments were identified by conducting a comprehensive literature review of condition-specific, self-report measures of HRQL used in PWA. Evaluation of identified instruments was based on the 2002 Scientific Advisory Committee of the Measurement Outcomes Trust (SAC) criteria: conceptual model, burden (respondent and administrator), versatility, validity (content and construct), depth (floor and ceiling effects), reliability (internal consistency and test-retest), responsiveness and interpretability (norms and quality). SAC criteria totalled 13 for individual-level and 13 for group-level decision-making. Main contribution Most SAC criteria (%individual-level: %group-level) were met by the Assessment of Living with Aphasia (ALA) (92%:85%), followed closely by Communication Outcome after Stroke (COAST)(84%:77%) and Stroke and Aphasia Quality of Life (SAQOL-39g) (77%:77%), for instruments’ total scores. Not meeting burden and versatility criteria limited suitability of SAQOL-39g in PWA, while COAST lacked construct validity and reliability data to support its domain structure. Unmet criteria for evaluated instruments were predominantly due to unavailable data in PWA. Investigators need to continue to publish their psychometric findings in the context in which they were obtained, specifically population and setting. Conclusions Of reviewed instruments, ALA showed the most promise to measure HRQL in PWA. In instrument selection, practitioners should consider the desired construct of measurement and characteristics of the target population including aphasia severity and type. For PWA, instruments including pictures and allowing for nonverbal cues will provide broader applicability in this population.
... Three of the interventions were more structured and involved communication and conversation therapy with education about identity, stroke, aphasia, and disability (Attard, Loupis, Togher, & Rose, 2018;Ross, Winslow, Marchant, & Brumfitt, 2006;van der Gaag et al., 2005). Two of the interventions focused on telling their stories and sharing experiences and using role-play to practice certain communication situations and skills or activities similar to toastmasters et al., (2006) 5/10 van der Gaag et al., (2005) 8/10 * score out of 9 if one question was deemed 'not applicable' (Brumfitt & Sheeran, 1997;Plourde et al., 2019 ...
... Four of the studies (Attard et al., 2018;Brumfitt & Sheeran, 1997;Ross et al., 2006;Zumbansen et al., 2017) measured mood/personality using tools such as the Rosenberg Self-Esteem Scale (Rosenberg, 1965) and the HADS (Zigmond & Snaith, 1983). The remaining studies (DeDe et al., 2019;Fogg-Rogers et al., 2016;Hoen et al., 1997;Lanyon et al., 2018;Pitt et al., 2017Pitt et al., , 2018Plourde et al., 2019;Purves et al., 2013;van der Gaag et al., 2005) did not evaluate the constructs of mood or personality in their work. ...
... Hoen et al. (1997 used the Ryff Scale of Psychological Well-Being (Ryff, 1989) and reported an overall positive change in HRQL related to self-acceptance, independence, and growth. Pitt et al. (2017Pitt et al. ( , 2018 and Plourde et al. (2019) reported an improvement in communication-related QoL. No statistically significant HRQL related changes were reported in the Ross et al. (2006), Zumbansen et al. (2017, and van der Gaag et al. (2005) studies. ...
Article
Aphasia is a communication disorder, resulting in difficulty with speaking, understanding, reading, and writing. Aphasia has been linked to decreased social networks, depression, and low health-related quality of life (HRQL). Speech-language pathologists provide therapy through various models for adults with aphasia, including group speech and language therapy. This scoping review aimed to identify, summarize, and appraise peer-reviewed texts that consider HRQL in adults with aphasia who are receiving group speech and language therapy. The research questions that guided the review were: What measures were used to capture HRQL outcomes? Does HRQL change as a result of participation in group language treatment? A systematic literature search developed and implemented by a health sciences librarian identified full-text journal articles via electronic searches of five databases. To be included, studies had to explore adults with aphasia, participating in group language therapy, with a HRQL outcome measure. Relevant studies were assessed for methodological quality and level of evidence. Thirteen articles met inclusion criteria, including two randomized control trials, eight case studies, and three qualitative studies. HRQL measures used and type of intervention varied across studies. HRQL measures showed generally positive outcomes of group language therapy, and participants reported improved HRQL after group language therapy. The current evidence is not comprehensive due to the overall lack of high-quality studies and the low level of evidence available. Further well-designed studies would benefit our understanding of how group therapy may improve HRQL for adults with aphasia.
... Involvement in the study required no additional commitment on the part of the participants (than their usual weekly GC attendance and participation). A detailed description of the GC meeting format can be found elsewhere (Plourde et al., 2019). Throughout the 30 weeks of the GC year, members presented weekly TT speeches and four to five prepared speeches. ...
... Engaging in weekly speaking activities such as those offered by GC appears to be associated with an improvement in conveying content and in grammaticality through an increase in total number of words and of correct words produced. This is consistent with anecdotal reports from family members that their partner/family member's verbal expression is better after a meeting and with prior research showing improved communication confidence after GC attendance (Plourde et al., 2019). ...
Article
Public speaking has been described as one of the most daunting tasks one can engage in, even more so for people with aphasia (PWA). Gavel Clubs (affiliated with Toastmasters International) were established over 20 years ago for those who want to engage in public speaking but do not meet the eligibility criteria for Toastmasters membership. This study is the first of its kind to systematically evaluate changes in the speeches of PWA attending a weekly Gavel Club. The aims were to compare Table Topics (TT) and Prepared Speeches (PS) which are two different tasks regularly performed in a Gavel Club; to measure linguistic change over time in the two speech types; and to determine the feasibility of a discourse measure for analysing public speeches. Thirty-six speeches (four each from nine PWA) were audio-recorded, transcribed and analysed using the Linguistic Communication Measure (LCM). The nine participants represented a wide range of aphasia severity. Analysis revealed that engaging in weekly speaking activities in the GC was associated with an improvement in conveying content and in grammaticality through an increase in total number of words and number of correct words produced. The LCM is a comprehensive analysis tool but proved to be challenging in its speed and utility when measuring linguistic change in public speeches of PWA. Regular GC participation appears to facilitate improved language abilities, but we have yet to find the best tool to demonstrate this.
... The CBR has also supported a Gavel Club for people with aphasia, established by a SLP volunteer with support from Speech Science staff and students at the University of Auckland. Participants report high levels of support received from peers in the Gavel Club (Lyon, 2018;Plourde et al., 2019): "Even with the family, they're a little bit impatient with aphasia, but with them, they're very, very patient … all (1985) Te taha hinengaro Mind "thoughts and feelings", "a side of health that encompasses styles of thinking and the way in which emotion is expressed" Te taha wairua Spiritual "most basic and essential requirement for health", "includes religious beliefs and practices but is not synonymous with regular church-going or strong adherence to a particular denomination" Te taha tinana Body "physical health", "leans heavily on ritualised procedures regarding most bodily functions", "clear separation of the sacred and the common … .the head as very special", "preparation and consumption of food … particular ritual is observed" Te taha wh anau Family "denotes an extended kinship system, rather than a nuclear family", "many implications for health. ...
... Research methodologies evaluating the Gavel Club have included questionnaires (Plourde et al., 2019;Purdy et al., 2016), lexical analysis of recorded speeches and focus groups (Lyon, 2019), with findings showing that weekly participation in Gavel Club group activities is associated with improvements in spoken language, quality of life and communication confidence in people with aphasia. Models of health and wellbeing that consider emotional, physical, spiritual and family impacts of a health condition and treatment, such as te whare tapa wh a, fit well with community-based therapy approaches. ...
Article
Purpose: Te whare tapa whā represents a Māori view of health and wellness in four dimensions: taha wairua (spiritual health), taha hinengaro (mental health), taha tinana (physical health) and taha whānau (family health). This model of health focuses on indigenous Māori in Aotearoa/New Zealand but has relevance for all people. Speech-language pathologists, including those not familiar with this model, recognise that all four dimensions are needed to support health and wellbeing. Taha wairua includes the importance of culture and heritage to personal identity, an area that speech-language pathology (SLP) recognises as key to clinical competency. Taha hinengaro includes the need to express thoughts and feelings, another area particularly salient to SLP. The other two dimensions taha tinana (physical health) and taha whānau (family health) are arguably more familiar in the day-to-day work of speech-language pathologists. Method: Two broad strands of research are examined within this model of health exploring the challenges faced by vulnerable populations namely: (1) two community based groups (a Choir and a Gavel Club) for people with acquired neurological conditions such as stroke and Parkinson’s disease, and (2) diagnosis and management of hearing loss and auditory processing disorder. Result: Community based groups, explored through the CeleBRation Choir and the Gavel Club, highlighted the application of all aspects of te whare tapa whā to the experiences of people with neurological conditions participating in these community therapies. In the area of hearing loss and auditory processing disorder, gaps across all four dimensions of taha wairua, taha hinengaro, taha tinana and taha whānau were identified in the available literature and in examination of clinical provision for participants. Conclusion: Te whare tapa whā provides a framework to consider all the elements that contribute to people living well while experiencing communication challenges within their whānau (extended family). This approach relies on strong partnerships between clinicians, extended family, researchers, communities, organisations and other professionals. Clinicians and researchers are encouraged to consider how their beliefs, practices and impact could improve through consideration of Indigenous health models such as te whare tapa whā.
... Many researchers have found that the Quality Management System (QMS) interferes with service quality that is directly related to manufacturing performance, according to the understanding of textile workers (Ashraf et al., 2021;Siegmund et al., 2021). When it comes to the manufacturing process, it has been found that having organizational knowledge and experience is critical to the success of the process (Kim et al., 2020;Plourde et al., 2019). ...
Article
Full-text available
The recent surge in demand in Pakistan's textile industry coincides with quality control issues. Pakistan's textile industry has successfully received more orders than its competitors during the Covid-19 crisis, thanks to a better government policy that has kept the industry out of lockdown. However, in order to keep up with the increase in demand, the industry faces a major quality assurance challenge as a result of the pandemic. The purpose of this research is to look into the factors that influence quality assurance in the textile industry in Pakistan. Data were collected from 450 front-line quality assurance workers in the textile industry of Pakistan. The proposed research model was empirically investigated using IBM AMOS to apply structural equation modeling. Continuous improvement, communication, and quality check and control are all found to be significant predictors of quality assurance in Pakistan's textile industry. In addition, the study shows that when the extrinsic motivation of front-line workers is high in the pandemic context, the relationship between quality assurance and its determinants is stronger. According to the findings of this study, human resource managers should include extrinsic rewards in employee performance management plans to ensure effective employee outcomes in quality control departments, particularly during crises.
... Rehabilitation services could consider what factors are important for helping people have hope and address these in treatment planning and by supporting patients to engage with different services and supports after formal rehabilitation ends. Clinicians might consider how they support people to maintain existing friendships, not just establish new connections through peer support groups, for instance (41). It is not to say that these are not important, and indeed, our participants reported a sense of hope from seeing others' progress and from seeing others living happily even in the context of significant impairment. ...
Article
Full-text available
Background: Hope is a critical resource for people with aphasia after stroke, sustaining people though times of distress and uncertainty and providing motivation. In the first months after stroke, hope is vulnerable to different influences, and people can struggle to identify and work towards hopes for the future. We have little knowledge about how people with aphasia experience hope in the longer term after stroke. Objectives: To identify how people with aphasia experience hope 1 year after stroke and how hope may change in the year after stroke. Methods: The study used an Interpretive Description methodology. Interviews were conducted with four people with aphasia who had been interviewed 1 year previously. These were analysed using content analysis. Results: All people reported a broad sense of hope for the future. They described an active process of recalibrating their early poststroke hopes through a process of reflecting on past progress, current function and what they considered might be possible and desirable in the future. People were able to develop 'new' hopes that were meaningful and seemingly achievable when they had a sense of a possible, desirable future. Those who struggled to see a possible future maintained a hope that things will be good. Social supports, a sense of progress, engagement in meaningful activities and interactions appeared crucial in helping people (re)develop hopes for their future. Conclusions: Hope and hopes for the future gradually changed after stroke. Hope, identity and social connectedness were closely entwined and could enable people to both dwell in the present and move towards desired futures. This research suggests clinicians should prioritise creating hope-fostering environments which support people to develop hope for their future.
Article
Background: Major neurocognitive disorder (MND) alters cognition, memory and language, and consequently affects communication. Speech-language therapy (SLT) may alleviate communication difficulties. Aims: This pilot study explored the effects of intensive SLT emphasizing memory, language, and discourse impairment and complementary communication strategies, called Aid for Communication-For Persons Who Live with MND (AID-COMp). Methods & procedures: We employed a mixed design using quantitative and qualitative methods with four dyads, including a person living with MND (PwMND) and a family carer. The design included a control period, and we tested participants before (T1) and after 2 months without therapy (T2). AID-COMp was then provided intensively three times per week for 10 sessions and participants were tested again (T3). Participants were also involved in an individual qualitative interview after therapy ended, probing their experience and possible effects on their lives. AID-COMp included: (1) spaced retrieval to teach the use of a memory book; (2) semantic and phonological therapy for lexical access; (3) discourse treatment based on the analysis of the macrostructure and microstructure of stories in pictures and texts; and (4) PACE therapy for generalization. Carers were not included in treatment, did not attend sessions and were only involved in the evaluations. Measures included language, communication, cognitive and well-being tests. Paired t-tests (one-tailed) compared scores for the control period, that is, T1 versus T2. We compared scores after therapy (T3) with those at T2. Interviews were transcribed verbatim and analysed qualitatively. Outcomes & results: For the control period, only text comprehension scores significantly decreased in PwMND. After therapy, improvements occurred on the Boston Naming Test (BNT), the Mini-Mental State Exam (MMSE) and the well-being measure for the PwMND. Carer scores were unchanged after therapy except for their perception of the PwMND's communication which improved. Qualitative findings comprised three themes: (1) understanding therapy; (2) recovering abilities and relationships; and (3) naming further needs. Conclusions & implications: We hypothesize that AID-COMp addressed the underlying impairments associated with MND and provided various tools to PwMND for composing effectively with them. Indeed, AID-COMp appears to provoke some degree of improvement of language skills, cognition and emotional well-being. These improvements may lead to more confidence in conversation and the recovery of relationships between the PwMND and their entourage. It is also possible that improvements acted positively on one another. These preliminary findings warrant further controlled studies with more participants, including a qualitative exploration of participant experiences. What this paper adds: What is already known on the subject MND affects cognition and communication, which are crucial to a good relationship between a carer and a person with MND. Interventions involving only PwMND have been shown to be effective, but do not address all the communication impairments in the mild stage of MND. These interventions may require many therapy sessions. Generally, SLT interventions do not examine the potential effects of an intervention on carers. What this paper adds to existing knowledge AID-COMp, an intensive intervention of 10 sessions over 1 month, was provided to people living with MND in the community. It included training the person with MND in using a memory notebook combined with semantic and phonological therapy, a new discourse therapy and PACE therapy, addressing several communication deficits. After a control period of 2 months without intervention and a 1-month intensive intervention, the results showed significant improvement in naming, cognition and communication, and PwMND well-being. Moreover, the carers witnessed the impacts of therapy in their everyday life interactions with the PwMND. What are the potential or actual clinical implications of this work AID-COMp can provide communication support for PwMND that has further benefits reported by both PwMND and carers. We described AID-COMp in detail to inspire clinicians in providing SLT for unserved PwMND. Future research studies should use controlled designs, more participants and a qualitative component.
Article
Purpose Individuals with intellectual disabilities often face communication challenges that can impact verbal communication, social interactions, and public speaking effectiveness. These challenges include decreased speech intelligibility, eye contact, and storytelling organization. The purpose of this study was to investigate the benefit of a 4.5-month public speaking coaching program for adult Special Olympics athletes with intellectual disabilities. Method Using a pre–post design, four athletes and their parents or caregivers completed questionnaires that rated the athletes' public speaking skills in 10 areas relevant for effective public speaking before and after the 4.5-month program. Graduate students in communication sciences and disorders worked with the adults on individualized goals identified from a preliminary speech and the self-report questionnaires. Differences in pre- and post-program response ratings and pre- and post-program speech behaviors were evaluated. Results Participation in the program resulted in positive changes in the athletes' public speaking ratings and behaviors, as measured by the athletes' and familiar-listeners' pre- and post-program questionnaires and the athletes' observed public speaking performance. Conclusions The results support the benefit of individualized coaching in public speaking programs. Because public speaking skills are important for communicating effectively in community interactions more broadly, the program also has potential relevance for use in clinical settings and education programs for adults and adolescents with and without intellectual disabilities.
Chapter
Parkinson disease is the most common neurodegenerative disease reported worldwide and presents multiple diverse and disparate manifestations over a prolonged disease course. At any point, speech and swallowing functions may be disturbed, and dysfunctional swallowing, leading to aspiration pneumonia, is the most common cause of death. Current treatments demonstrate limited benefit for speech and swallowing impairments, but novel approaches and greater insight into disease pathogenesis offer hope of improved management of Parkinson disease and its sequelae.
Article
Full-text available
People with aphasia and their family members are at high risk of experiencing post stroke depression. The impact of early interventions on mood and quality of life for people with aphasia is unknown. This study will determine whether an early intervention for both the person with aphasia after stroke and their family members leads to better mood and quality of life outcomes for people with aphasia, and less caregiver burden and better mental health for their family members. This is a multicenter, cluster-randomized controlled trial. Clusters, which are represented by Health Service Districts, will be randomized to the experimental intervention (Aphasia Action Success Knowledge Program) or an attention control (Secondary Stroke Prevention Information Program). People with aphasia and their family members will be blinded to the study design and treatment allocation (that is, will not know there are two arms to the study). Both arms of the study will receive usual care in addition to either the experimental or the attention control intervention. A total of 344 people with aphasia and their family members will be recruited. Considering a cluster size of 20, the required sample size can be achieved from 18 clusters. However, 20 clusters will be recruited to account for the potential of cluster attrition during the study. Primary outcome measures will be mood and quality of life of people with aphasia at 12 months post stroke. Secondary measures will be family member outcomes assessing the impact of caregiving and mental health, and self-reported stroke risk-related behaviors of people with aphasia. This is the first known program tailored for people with aphasia and their family members that aims to prevent depression in people with aphasia by providing intervention early after the stroke. Trial registration This trial is registered in the Australian New Zealand Clinical Trials Registry (ANZCTR) as ACTRN12614000979651. Date registered: 11 September 2014.
Book
Full-text available
Covering an array of evidence-based content, including aphasia, traumatic brain injury, dementia, and language in aging, Aphasia and Other Acquired Neurogenic Language Disorders: A Guide for Clinical Excellence is a must-have textbook for clinicians and students studying to be speech-language pathologists. This clinical guide strategically addresses scientific foundations, service delivery, international and multicultural perspectives, assessment, and treatment. Key features include: • A rigorous approach to the art and science of clinical practice, integrating diverse theoretical perspectives for a global readership • Guidance on advocacy, ethics, reimbursement, legal aspects, and counseling • An emphasis on person-centered, empowering approaches to maximize life participation • Extensive assessment resources and a process analysis approach for analyzing communicative performance and interpreting assessment results • How-to content on over 50 intervention approaches • Diagrams, charts, illustrations, summary tables, a substantial glossary, a detailed index, and rich up-to-date references • Complementary online materials with links to videos and other teaching/learning resources • Systematic queries that enliven clear learning objectives Organized to maximize adult learning, the book is adaptable for multiple pedagogic methods for classroom-based courses, independent study, and online learning. Aphasia and Other Acquired Neurogenic Language Disorders: A Guide for Clinical Excellence provides clinicians and students a clear pathway for quality and effectiveness in clinical practice.
Article
Full-text available
Objectives To develop and validate a national set of best practice statements for use in post-stroke aphasia rehabilitation. Design Literature review and statement validation using the RAND/UCLA Appropriateness Method (RAM). Participants A national Community of Practice of over 250 speech pathologists, researchers, consumers and policymakers developed a framework consisting of eight areas of care in aphasia rehabilitation. This framework provided the structure for the development of a care pathway containing aphasia rehabilitation best practice statements. Nine speech pathologists with expertise in aphasia rehabilitation participated in two rounds of RAND/UCLA appropriateness ratings of the statements. Panellists consisted of researchers, service managers, clinicians and policymakers. Main outcome measures Statements that achieved a high level of agreement and an overall median score of 7–9 on a nine-point scale were rated as ‘appropriate’. Results 74 best practice statements were extracted from the literature and rated across eight areas of care (eg, receiving the right referrals, providing intervention). At the end of Round 1, 71 of the 74 statements were rated as appropriate, no statements were rated as inappropriate, and three statements were rated as uncertain. All 74 statements were then rated again in the face-to-face second round. 16 statements were added through splitting existing items or adding new statements. Seven statements were deleted leaving 83 statements. Agreement was reached for 82 of the final 83 statements. Conclusions This national set of 82 best practice statements across eight care areas for the rehabilitation of people with aphasia is the first to be validated by an expert panel. These statements form a crucial component of the Australian Aphasia Rehabilitation Pathway (AARP) (http://www.aphasiapathway.com.au) and provide the basis for more consistent implementation of evidence-based practice in stroke rehabilitation.
Article
Full-text available
Background: Community aphasia groups (CAGs) for people living with chronic aphasia are known to be efficacious for improving various aspects of communication and psychological functioning based on empirical quantitative evidence. However, the specific mechanisms and processes involved are not well understood and only a small number of groups exist. Further, there is a paucity of evidence on this topic from consumers, potentially limiting the development and uptake of these services. In order to proliferate and maintain groups of high quality, a deeper understanding of the potential mechanisms of positive outcomes is required.
Article
Objective: To determine factors that contribute to living well with aphasia in the first 12 months post stroke. Design: Prospective longitudinal cohort study SETTING: Hospitalized care, ambulatory care and general community PARTICIPANTS: A referred sample of 58 people with a first incidence of aphasia after stroke was assessed at 3, 6, 9 and 12 months post onset. Participants were recruited through speech- language pathologists in two capital cities of Australia. Presence of aphasia was determined through the Western Aphasia Battery Revised (WAB-R)(6) by an experienced speech-language pathologist. Interventions: N/A MAIN OUTCOME MEASURES: The main outcomes were the five domains of the Assessment for Living with Aphasia at 3, 6, 9 and 12 months post stroke. The independent variables included demographics, physical functioning, social network, mood, aphasia severity and a self-rating of successfully living with aphasia at the same time points. Mixed effects modelling was used to determine which factors contributed to the trajectory of each of the five domains of Participation, Impairment, Environment, Personal Factors, Life with Aphasia. Results: Higher household income, larger social network size, being female and having a milder aphasia were positively associated with the Participation domain. Graduate or postgraduate educational levels, low mood and poor physical functioning were negatively associated with the Participation domain. Factors positively associated with other domains included higher income, self-ratings of successfully living with aphasia and aphasia severity. Low mood was consistently negatively associated with all domains. Conclusion: Psychosocial determinants were the most significant predictors of living well with aphasia in the first 12 months post onset. Aphasia rehabilitation needs to attend more to these factors to optimise outcomes.
Article
The Aphasia Center is a service delivery model that provides an interactive community for persons with aphasia. This model has been increasing in popularity over the last 20 years. Aphasia Centers are consistent with a social model of health care and disability. They offer the potential for linguistic, communicative, and psychosocial benefits. The purpose of this article is to describe the historical context that served as the catalyst for Aphasia Centers as well as to offer a firsthand account of their development. Included is a summary of the research evidence, as well as other factors that support the science underlying aphasia group treatment, Aphasia Centers, and the Life Participation Approach to Aphasia. Finally, examples are provided that show how this service delivery model is being incorporated into clinical guidelines, clinical pathways, and clinical best practices.
Article
Background: The construct of communication confidence was introduced by participants and family members during qualitative post-treatment interviews as part of a research study using a computer programme to deliver language therapy. However, there was no standardised method of evaluating communication confidence. Therefore the Communication Confidence Rating Scale for Aphasia (CCRSA) was developed, asking persons to self-rate communication confidence. Aims: This study reports data from the second phase of the project in which the CCRSA was revised to include 10 items. This revised 10-item self-rating scale of communication confidence (CCRSA) was evaluated psychometrically. Methods Procedures: The revised 10-item questionnaire was administered 94 times to 47 participants with aphasia from a variety of settings. Psychometric properties of the 10-item CCRSA were investigated using rating scale (Rasch) analysis. Outcomes Results: Person reliability of the 10-item CCRSA was .81. The four-category rating scale demonstrated monotonic increases in average measures from low to high ratings. However, one item (oHow confident are you that you can participate in discussions about your finances?o) slightly misfitted the construct defined by the other items (mean square infit = 1.54, item-measure correlation = .48). Conclusions: Our findings suggest that the CCRSA is a psychometrically sound tool for assessing participants' self-report of communication confidence. Further evaluation of the CCRSA is warranted to examine sensitivity to change and inter- and intra-rater reliability.