![. Communication Confidence Rating Scale for Aphasia (CCRSA) results [median (interquartile range)] for overall CCRSA ratings (average of Questions 1-10) and for each time point for Question 9.](https://www.researchgate.net/profile/Suzanne-Purdy/publication/324401013/figure/tbl4/AS:669287446507534@1536581970549/Communication-Confidence-Rating-Scale-for-Aphasia-CCRSA-results-median-interquartile_Q320.jpg)
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Gavel Club for people with aphasia: communication confidence and quality of communication life
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.
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... Although the primary purpose of a GC is to provide support for PWA, we sought to understand any impact on the family of GC members. Previous research has shown that GC membership is associated with improvements in communication confidence and quality of communication life [21] as well as improvements in conveying linguistic content and grammaticality [22]. This qualitative study will add to existing literature in the area of aphasia-specific community groups. ...
... This subtheme suggests that the GC can be a useful way for family members of PWA to achieve their own goals of support [11]. The communication benefits of GC attendance have been documented previously [21,22], as have the psychosocial benefits of aphasia group participation [18]. The sense of community depicted in the current study further reinforces this relationship between psychosocial wellbeing and communication support. ...
... The impact of this improvement on the family included decreasing feelings of isolation, and feeling that the PWA was less dependent on them in day-today life. This theme supports previous findings that GCs can improve the communication confidence of PWA [21]. It also suggests that improvement in confidence extends beyond GC performance and impacts their communication in daily life. ...
Purpose: Aphasia impacts not just the individual with aphasia, but also their family members and friends. Known as third-party disability, it is largely hidden but can be as pervasive as aphasia itself. Gavel Clubs are a Toastmasters International-affiliated group where members participate in public-speaking tasks. Participation has been associated with improvements in quality-of-life and communication confidence but the extent to which it can impact family members of people with aphasia is not yet known. This study explored family member perspectives of participation in a Gavel Club for people with aphasia, to reveal any benefits or challenges perceived by family members and/or close friends.Methods: Semi-structured interviews were undertaken with 13 family members or close friends of people with aphasia who regularly participated in a weekly Gavel Club. The interviews were analysed using thematic analysis.Results: Three themes were identified: (1) Something to do, (2) Sense of community and (3) I can see great improvements, along with two subthemes (i) This is not just us and (ii) Support of knowing other people go through it. The themes reflected a largely positive experience of Gavel Club participation as perceived by family members. The theme names were derived from quotes from the participants.Conclusions: Regular participation in a Gavel Club for people with aphasia has a positive impact beyond just the person with aphasia, extending to their family members and close friends. This impact can be direct, if the family members themselves participate, or indirect, through the perceived benefits for the person with aphasia.
... Additionally, members of Toastmasters International serve as consultants for Gavel Clubs. In this way, the Toastmasters experience has been extended to Gavel Clubs and implemented in affiliated groups of Special Olympics athletes and with groups for adults with aphasia (Plourde et al., 2019). ...
... A second study investigated public speaking confidence in adults with aphasia who participated in weekly Gavel Club meetings for 4-5 years (Plourde et al., 2019). The participants' speech performance was not directly measured; however, quality of life (i.e., described as quality of communication life) and public speaking confidence were assessed using self-report measures. ...
... Based on limited research with adolescents and adults with learning and cognitive disabilities (Plourde et al., 2019;Scheeler et al., 2010), athletes were expected to identify goals and show at least some progress on goals and self-reports of public speaking abilities in 4.5 months. The study outcomes may have implications for incorporating similar programs into speech and language intervention, education programs, and community coaching programs for adolescents and adults with continuing communication needs and limited access to clinical services. ...
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.
... Increased awareness o gains made may contribute to the ICAP model's potential to improve psychosocial well-being by reducing depression and improving quality o lie (Grin-Musick et al., 2020). Group treatment has been associated with improved communication condence (Plourde et al., 2019). ...
Background
Stroke survivors with aphasia who participate in intensive post-acute aphasia rehabilitation programs make a variety of significant investments. As the number of Intensive Comprehensive Aphasia Programs (ICAPs) increase across healthcare settings worldwide, patient perspectives of this innovative service delivery become increasingly important. Stakeholder perspectives can provide meaningful contributions to intervention implementation, growth, and sustainability.
Aims
The purpose of this pilot study was to qualitatively explore patient perspectives about the experience of participating in a university-based ICAP implemented by graduate student clinicians.
Methods & Procedures
Researchers used an interpretive phenomenological approach to analyze nine structured interviews from five stroke survivors with aphasia who described their lived experiences during an ICAP. Thematic analysis involved an iterative and collaborative coding process. Transcripts were coded and themes were developed from the patients’ shared perspectives. Trustworthiness was maximized through acknowledgement of the researchers’ positionality and bias, variation in the sample, member checks, and sustained relationships between stakeholders.
Outcomes & Results
Three primary themes emerged from patient interviews: (1) the ICAP is hard work; (2) the impact of the ICAP on communication is noticeable, and (3) relationships “make” the ICAP.
Conclusions
Themes support emerging evidence that ICAPs implemented by graduate student clinicians may be a worthwhile investment for many stroke survivors with aphasia, thereby contributing to the cost-benefit utility and implementation feasibility of this service delivery model. Stroke survivors with aphasia reported mixed levels of acceptability pertaining to the perceptible impact on communication improvement, and the challenging, rewarding, frequent, and varied opportunities to interact with others.
... • Providing challenging communicative opportunities (e.g., public speaking, radio interviews, ToastMasters) (Plourde et al., 2019) • Encouraging people with aphasia to write or co-construct and record their story for newsletters, websites, or their own family (Hinckley, 2006;Strong, Lagerwey, & Shadden, 2018) or express their experiences through painting, drawing, or other media (Sit et al., 2014) • Forming a book club so that people are challenged to read (Bernstein-Ellis & Elman, 2007). ...
Objectives The reader will be able to: 1. Describe what therapy is and what it encompasses. 2. Distinguish among the International Classification of Functioning, Disability, and Health (ICF) disability components. 3. Determine who the target of therapy is and who determines the type of therapy provided. 4. Outline when therapy should start and finish and how often it should take place. 5. Broadly distinguish between the different therapy approaches. 6. Gain an understanding of the process of therapy using the cycle of five steps at each stage of rehabilitation. 7. Delineate the usual course of rehabilitation experienced by a person with aphasia and his or her family members.
... This finding is particularly encouraging, indicating that the participants felt they were able to achieve a communication act despite their communication impairment. Being given a forum where the PWA shared their views may have been an empowering experience, especially if the aphasia was always viewed as a 'barrier' in one's life (Plourde et al., 2019). ...
Aims
The purpose of this study is to evaluate the outcomes of a remotely delivered collaborative storytelling program based on the TimeslipsTM approach in persons with aphasia (PWA). The program aims to improve social interaction, communication, and participation through a guided experience.
Methods
Six PWA of mild-moderate severity and of fluent and nonfluent types participated in the program twice a week for seven weeks. They collaboratively created 28 free-form stories from staged pictures. PWA were tested pre- and post-treatment on several validated outcome measures representing each of the Living with Aphasia: Framework for Outcome Measurement (A-FROM) domains. PWA self-rated on group therapeutic factors and program satisfaction scales. To assess the benefits of the program, the results were analysed for clinical significance (reliable change index) and meaningfulness for each of the outcome measures.
Results
Comparison between pre- and post-test scores yielded clinical significance among all participants on at least one A-FROM domain and most participants improved on communication confidence, functional communication, and overall language abilities. All participants’ ratings of perceived group therapeutic factors and satisfaction with the program were high.
Conclusions
The findings provide preliminary evidence for the effectiveness of a collaborative storytelling program for PWA. Such a program may have an important place in aphasia rehabilitation in improving psychosocial and communication deficits through engagement in creative arts. Large-scale studies with rigorous mixed-methods designs are needed to build on the present findings.
... 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). ...
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.
Purpose:
Self-efficacy and resilience are important for various aspects of rehabilitation outcome after stroke. However, little is known about how these factors are affected and related to communication outcome in stroke survivors with aphasia. The purpose was to investigate self-efficacy and resilience, and associations to language and functional communication, in people with severe post-stroke aphasia.
Materials and methods:
37 participants with severe aphasia rated their self-efficacy and resilience, using adapted versions of the existing instruments DLSES and CD-RISC. In addition, linguistic ability, executive function and functional communication were assessed.
Results:
Participants rated their self-efficacy and resilience as expected based on reports in the literature; somewhat lower than general populations and at similar levels as clinical populations. There were no association between self-efficacy, resilience and linguistic ability. In the sample as a whole, there were no associations between self-efficacy, resilience and functional communication. However, when results were stratified by executive function, associations emerged in the group with stronger executive function.
Conclusions:
People with severe aphasia have decreased self-efficacy and resilience compared to general populations, but not necessarily in proportion to their language impairment. Among participants with relatively spared executive functions there were indications of an association between self-efficacy, resilience and functional communication.
Introduction:
The ultimate aim of speech-language therapy for adults with aphasia is to enhance their life participation. One key factor which may influence an individual's decisions to participate in meaningful life activities is their confidence in communication. The aim of the current study was to explore what helps confidence in communication from the perspective of adults with aphasia.
Methods:
The study, part of a larger investigation, used a qualitative descriptive research approach underpinned by an interpretivist paradigm. Fifteen adult participants who had post-stroke aphasia and lived at home or in long-term care were recruited. Due to COVID-19 restrictions, participants had to be able to complete an online qualitative interview, given conversational support. Maximum variation sampling was used to ensure diversity within the sample. The researchers conducted individual interviews over Zoom based on a topic guide exploring the person's experiences with confidence in communicating and their perceptions about what has helped their confidence in communication since the onset of aphasia. The interviews were video-recorded and transcribed verbatim. The transcripts were analyzed using qualitative content analysis.
Results:
Categories of what helps confidence in communication included: Attitudes, Advocating for themselves, Having individualized strategies to deal with communication difficulties, Practicing communication, Other people with aphasia (PWA), Factors related to communication partners, Factors related to the communication context, and Other factors.
Conclusions:
To enhance confidence, speech-language pathologists could help PWA to develop strategies to deal with inevitable communication breakdowns. They could also support PWA to experience communication success in everyday situations and to advocate for themselves.
Purpose
Aphasia is a post-stroke condition that can dramatically impact a person with aphasia’s (PWA) communication abilities. However, clinicians often focus on level of impairment as their primary outcome of interest. An emerging literature suggests that greater emphasis should be placed on the impact that aphasia has on communication confidence and how it is influenced by the level of aphasia impairment.
Methods
To examine the interrelationship between aphasia impairment and communication confidence in individuals with mild aphasia, data from 12 PWA related to impairment and communication confidence were collected at the time of enrollment in a telepractice rehabilitation program. Impairment was measured with the Western Aphasia Battery – Revised (WAB-R) aphasia quotient (AQ) as well as individual subtest scores and communication confidence was measured using the Communication Confidence Rating Scale for Aphasia (CCRSA). Bayesian descriptive statistics and regression estimation were used to examine the interrelationship between these instruments controlling for basic demographic heterogeneity.
Results
Bayesian discrete dependent variable analysis showed that CCRSA was positively correlated with age (β =0.015, sd=0.00012), education level (β=0.023, sd=0.00052), and WAB-R repetition (β=0.0276, sd=0.00321), but only slightly, negatively related to WAB-R AQ (β= -0.0013, sd=0.0002), WAB-R auditory comprehension (β= -0.223, sd=0.26926), and WAB-R naming (β= -0.5425, sd=0.38406).
Conclusions
Communication of confidence was only slightly correlated with aphasia impairment, but significantly and positively correlated with age and educational level in individuals mild with aphasia. These findings suggest that in individuals with the mildest form of aphasia, communication confidence is primarily driven by specific individual, nonclinical characteristics unique to the PWA and their communication demands rather than the absolute level of communication impairment.
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.
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.
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.
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.
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.
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.
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.
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.