Search

This paper synthesises critique from Māori patients with Bipolar Disorder (BD) and their whānau to identify barriers and propose changes to improve the structure and function of the New Zealand mental health system. A qualitative Kaupapa Māori Research methodology was used. Twenty-four semi-structured interviews were completed with Māori patients with BD and members of their whānau. Structural, descriptive and pattern coding was completed using an adapted cultural competence framework to organise and analyse the data. Three key themes identified the impact of structural features of the New Zealand mental health system on health equity for Māori with BD. Themes involved the accessibility, delivery and scope of the current health system, and described how structural features influenced the quality, utility and availability of BD services for Māori patients and whānau. Structural barriers in the existing design, and potential changes to improve the accessibility, delivery and scope of BD services for Māori, were proposed including a redesign of operational, environmental, staffing, and navigation points (information, transition, fatigue) to better meet the needs of Māori with BD. A commitment to equity when implementing structural change is needed, including ongoing evaluation and refinement. This paper provides specific recommendations that should be considered in health service redesign to ensure the New Zealand mental health system meets the needs of Māori patients with BD and their whānau. [ABSTRACT FROM AUTHOR]

There have been growing concerns that social distancing and stay-at-home mandates have exacerbated loneliness for older people. Empirical evidence about older people's experiences of loneliness and COVID-19 have quantified this phenomena without considering how older people themselves define and understand loneliness. This paper explores how older New Zealanders conceptualized and experienced loneliness under 'lockdown' stay-at-home measures. This multi-methods qualitative study combines data from letters (n = 870) and interviews (n = 44) collected from 914 people aged over 60 and living in Aotearoa, New Zealand during the COVID-19 pandemic. We conducted a reflexive thematic analysis to conceptualise this data. We identify three interconnected ways in which older people conceptualised and experienced loneliness: (1) feeling disconnected relating to lack of emotional closeness to another often resulting from being physically separated from others and not being able to touch; (2) feeling imprisoned relating to separation from preferred identities and activities and was frequently associated with boredom and frustration; and (3) feeling neglected which often related to feeling let down by generalised and idealised forms of support, such as one's neighbourhood and health care system. Older New Zealanders experienced lockdown loneliness in three interconnected ways rather than as a stable and homogenous experience. Māori, Pacific, Asian and New Zealand European older people often discussed loneliness in different ways; attesting to loneliness being a culturally-mediated concept shaped by expectations around desirable social interaction. We conclude the paper with implications for research and policy. [ABSTRACT FROM AUTHOR]

This paper explores teenage girls' responses to general advice, and formal prevention messages, designed to reduce sexting-related risk and prevent harm. We conducted workshops with seven groups of girls (28 in total), aged 16–17 years, in a New Zealand city. Each group participated in a series of three workshop sessions. Drawing on a Freirean 'problem-posing' approach, we designed the workshops as spaces in which girls were invited to observe and critically discuss norms related to sharing nudes as well as harm prevention messages. Girls noticed the problematic gender and sexual politics that shape abstinence-based models that target girls (implicitly) to not send nudes, but which leave boys who distribute or otherwise misuse them out of the picture. Participants navigated a careful path between attending to risk and protection on the one hand, and endorsing their right to freedom of expression on the other. We argue for a subtle, but significant, shift away from a focus on sexting safety to a focus on the prevention of image-based sexual coercion, harassment and abuse. This reframing would help to direct prevention efforts to the gendered drivers and dynamics of harm perpetration, and the ways in which they are problematically socially ignored or condoned. [ABSTRACT FROM AUTHOR]

Background: This paper draws on a 2015 study in New Zealand that examined perceptions of registered nurses (RNs) and general practitioners (GPs) regarding the role of Nurse Practitioners (NPs) in long-term aged care facilities (LTACF). Aim: To explore the attitudes of RNs and GPs regarding the role of NPs in LTACFs. Design: A descriptive, mixed methods design with a survey and invitation to interview was used. RNs and GPs who provided hospital-level care were invited to participate. Findings: The findings showed RNs and GPs are open to considering the NP role in aged care. However, there remains a lack of understanding of what NPs do. Conclusions: This study suggests a shift in attitude towards accepting the NP role by RNs and GP working in LTACFs. [ABSTRACT FROM AUTHOR]

Purpose: Little is known about the barriers and facilitators to pregnancy, birth and motherhood for disabled women within the New Zealand context. Our study explored this deficit with the aim of improving health care interventions and support for disabled mothers. Methods: This paper reports on the third phase of a mixed-methods study. The first two phases used semi-structured individual and focus group interviews with disabled women, and health professionals, involved in maternity and postnatal care and has been reported elsewhere. Phase 3 utilised a modified Delphi technique with both groups of participants to seek consensus on the prioritisation of recommendations from the study. This article focuses on the disabled women's recommendations. Results: In all, 20 disabled women took part in the Delphi phase of the study (28% of the cohort from Phase 1). In total, 11 key recommendations were identified by the disabled women, with the top seven discussed in detail here. Conclusions: Health professionals and health systems could, and arguably should, utilise a matrix of these recommendations to facilitate a review of service responsiveness to disabled women. [ABSTRACT FROM AUTHOR]

Prevailing discourses condemn funerals as a costly distress purchase where funeral directors have greedily preyed upon funeral arrangers’ grief laden vulnerability. They explain funerals as distress purchases and so debt as the outcome of irrational decisions made while emotionally overwhelmed. These discourses ignore how people might use funeral purchases in dealing with the experience of death as they obscure rather than explain the emotionally infused decision-making that incurs funeral debt. This paper aims to shed light on this aspect of funeral purchases through a New Zealand-based empirical investigation of how intense feelings connect with decision-making associated with funeral cost and debt. The examination highlights that arranging a funeral, rather than being a hurried, ill-informed, choice-limited, emotionally overwhelming distress purchase, is a complex socio-emotional process that crystallises multiple affects into the culturally sanctioned emotion of responsibility, itself mobilised on class lines embedded in existing societal attitudes to debt and socio-economic structures. [ABSTRACT FROM PUBLISHER]

Purpose: Across Australia and New Zealand, speech-language pathologists (SLPs) routinely assess and treat adults with cognitive-communication disorders following traumatic brain injury (TBI). Despite their regular involvement, little is known about how clinicians provide management to this client group, particularly in community-based contexts. Therefore the aim of this study is to explore the clinical practices of SLPs who have experience working in community-based rehabilitation services with adults with cognitive-communication disorders following TBI. Method: A qualitative descriptive study using one-on-one semi-structured interviews was conducted as part of an explanatory sequential mixed-methods design. Fourteen SLPs with experience working with individuals with TBI completed an interview with content analysis used to explore the data. Result: The overarching theme identified was that a "Client-centred and inclusive approach to community-based rehabilitation services" is required. The three subthemes to emerge from the data included the importance of utilising a (1) "flexible service delivery approach", with (2) "meaningful therapy focus", and (3) "collaboration" with multidisciplinary team members and significant others when managing this client group. Conclusion: SLPs play a crucial role in client-centred inclusive rehabilitation for community-dwelling adults with cognitive-communication disorders following TBI. The complexity of working with this population requires current and future models of care to incorporate an interdisciplinary approach that is flexible in its delivery and meaningful in focus. [ABSTRACT FROM AUTHOR]

Transracial adoptees continually navigate the paradoxes of adoption, which arise in bio-normative and racialized contexts. "Being-adopted-and-Māori" was explored with 15 Māori adult adoptees. Hermeneutic phenomenological analysis revealed experiences of adoptive and racial "differentness," centered around four key paradoxes: "as if born to"; the lived experience of transracial adoption; post-reunion biological kinship; and whaka-papa. Examining these paradoxes elucidated the discursive basis of lived and felt contradictions and ambivalence, as well as otherness and exclusion. Māori adoptee identities are considered paradoxical precisely because they disobey hegemonic discourses. Their experiences tell us how dominant discourses of adoption and identity need to change. [ABSTRACT FROM AUTHOR]

This study aimed to explore the experiences of civil rights of disabled children receiving physiotherapy in New Zealand. As yet there is limited attention given to this topic in rehabilitation literature. We conducted a qualitative study that drew on the fields of childhood studies and disability studies to address the study aim. Seven disabled children who used local physiotherapy services (aged between four and 14 years) were interviewed using child-centered methods. In addition, their parents were interviewed individually, and eight rehabilitation professionals and disability advocates took part in a focus group discussion. Interpretive thematic analysis was used to analyze findings. The participating disabled children all appreciated being informed about physiotherapy, but had individual preferences regarding involvement in decision making. They described positive and negative influences on their experiences, but indicated they may not have been asked by adults about these. Parents, professionals and advocates described that attempting to promote a positive experience for children is constrained by understandings regarding the purposes and practices of physiotherapy. Our findings suggest it is important to get an understanding of individual children's views and preferences regarding physiotherapy in order to promote opportunities for choice, control and satisfaction. In this way physiotherapists can ensure disabled children's civil rights are realized in practice. [ABSTRACT FROM AUTHOR]

The capacity of Indigenous communities to respond collectively to crises consistently shows the importance of shared traditions values and practices and genealogical ties. Government responses to traumatic events that affect whole communities tend to be generic in their scope overlooking the significant strengths and resources held by Indigenous peoples. This study presents a Kaupapa Māori case study of collaborative efforts to respond to traumatic events between several communities of local tribes, immigrant tribes, and tau-iwi (non-Indigenous people). Concentrated on a rural community prone to flooding, this study examined community efforts to provide support for those affected by flooding in the Southern Rangitīkei area of New Zealand. Key informants included 10 Indigenous community leaders (ICL), and 22 health and social service community practitioners. Four key themes were identified: Collective aspirations mobilise in traumatic events; genealogical relationships bring people together; collective leadership drives the vision; and Indigenous values inform responses to traumatic events. A salient outcome was that shared historical connection, and shared aspirations for cultural regeneration activated Indigenous communities to engage in collective action. Key barriers and enablers to collective action between Māori and tau-iwi are presented. Recommendations for analysing further responses to trauma in Indigenous communities are proposed. [ABSTRACT FROM AUTHOR]

Bronchiectasis is a chronic respiratory disease that impacts significantly on quality of life for those who have it. There is a paucity of literature exploring the perspectives of children and young people. The aim of this study was to examine the day-to-day life experience of a group of young people with bronchiectasis. A qualitative study using semi-structured interviews explored fifteen young people's perspectives of life with bronchiectasis. Key themes were identified using an inductive iterative approach through constant comparative analysis guided by Thorne's interpretive description. Life with bronchiectasis was conceptualized by participants as "Pretty Normal". This consisted of two co-existing life views which represented how young people balanced the ups and downs of adolescence while learning to accommodate the demands of living with bronchiectasis. Three key thematic elements "sore and tired", 'life interrupted and "looking after self", influenced and challenged these two views of life. Young people with bronchiectasis portray life as being the same as their peers. Despite this, they recognized that the symptoms, interruptions, and self-management responsibilities led them to find ways of coping and integrating their experience into a new and modified view of normal. [ABSTRACT FROM AUTHOR]

To enhance understanding of access to rehabilitation services in Australian and New Zealand acute care facilities for older adults living with dementia and/or living in residential aged care facilities (RACFs) following a hip fracture. Information on hip fracture rehabilitation was obtained from an online survey of 40 health professionals who were members of the Australian and New Zealand Hip Fracture Registry Network. This information was supplemented with key informant interviews with five geriatricians and five rehabilitation physicians. Availability of hip fracture rehabilitation services differed by region and country. Around one in 10 respondents indicated that their facility had specific rehabilitation protocols for people living in RACFs or who were living with dementia. Barriers to providing hip fracture rehabilitation were commonly related to availability of resources. Rehabilitation pathways were determined according to individual patient characteristics and perceived potential benefit. Decision making was mainly informed by the patient's pre-fracture morbidity and residence. Three key themes and nine sub-themes emerged from the interviews. The development of consistent decision criteria and pathways for access to hip fracture rehabilitation could provide a standard approach to access to rehabilitation, particularly for patients with cognitive impairment and/or who reside in RACFs. Need to establish evidence-based criteria for patients who will benefit from hip fracture rehabilitation. Consistent decision criteria for access to hip fracture rehabilitation will assist in guiding a standard approach to providing rehabilitation, particularly for patients with cognitive impairment and/or who reside in RACFs. There is a need to ensure the availability of physiotherapy services in RACFs to assist with rehabilitation provision. Rehabilitation provided to patients with cognitive impairment and/or who are living in RACFs should be tailored to their physical and mental ability. [ABSTRACT FROM AUTHOR]

Purpose: Our objective was to explore the intersection between mild traumatic brain injury (MTBI) recovery experiences and injury understandings, using both quantitative and qualitative methods. Materials and Methods: The quantitative component was a descriptive case–control study comparing participants (n = 76) who had recovered or not recovered after an MTBI, across demographic and psychological variables. A subset of participants (n = 10) participated in a semi-structured interview to explore experiences of recovery in more detail. We followed threads across the datasets to integrate findings from component methods. Results: The quantitative analyses revealed differences between the two groups in terms of injury recovery understandings and expectations. The qualitative analyses suggested that achieving consistency across information sources was important. By tracing threads back and forth between the component datasets, we identified a super-ordinate meta-theme that captured participants' experiences of wrestling with uncertainty about their recovery and the impacts in terms of heightened anxiety, confusion, and feelings of invalidation. Conclusion: The effectiveness of psychoeducation and reassurance after MTBI may be optimized when content is tailored to the individual. Clinicians are urged to attend both to the subjective interpretations patients make of information gained from formal and informal, internal and external sources, and where information across these sources conflicts and creates uncertainty. Effectiveness of psychoeducation and reassurance after injury may be optimized when content is tailored to the individual rather than being generic. Effectiveness of such interventions may also be optimized by understanding the subjective interpretations individuals make of injury knowledge gleaned from formal and informal, internal and external sources. Conflicting information from such multiple sources may create uncertainty with associated increased distress as an individual negotiates their recovery from injury. Attending to this uncertainty may be a helpful target for treatment. [ABSTRACT FROM AUTHOR]

Objective: The study investigated: (1) the effect of combining web-based patient education (WBPE) with action and coping plans on patients' adherence to physiotherapy and their subsequent functional outcomes; and (2) the participants' satisfaction with the WBPE program. Methods: One hundred and eight participants enrolled in this 8-week two group randomized controlled trial. They were allocated to either the WBPE planning group or the attention-control group. The WBPE group made action and coping plans and were familiarized with their web-based program. The attention control group was given access to a web-based neutral information program about shoulder injuries and physiotherapy rehabilitation. Throughout the 8-week study physiotherapists measured the participants' clinic-based adherence and participants recorded their home-based adherence using a self-report diary. Functional outcomes for all participants were measured at the beginning and end of the study. Participants provided feedback about their respective websites. Results: The intervention group had a significantly higher clinic based adherence than the control group (p < 0.04). Both groups had a significant improvement in shoulder function but there was no significant difference between them. Participants in the intervention group were highly satisfied with the WBPE program. The preferred delivery of physiotherapy by 87% of the intervention group was a combination of face-to-face appointments and WBPE. Control participants indicated that they would have appreciated information about shoulder exercises and the shoulder complex in their program. Discussion: The WBPE program was an effective adjunct to physiotherapy in terms of patient satisfaction and clinic-based treatment adherence. [ABSTRACT FROM AUTHOR]

This article examines cultural, individual, and familial risk and protective factors associated with depressive symptoms in Pacific youth living in New Zealand. At ages 11 (n = 950) and 14 (n = 931), Pacific youth participated in multidisciplinary interviews that included the Children’s Depression Inventory. Across time points, factors significantly associated with higher depressive symptoms were involvement in bullying and gang activities. Positive parenting was significantly associated with lower depressive symptoms, and Tongan youth were significantly less likely to report depressive symptoms than Samoan youth. Time-varying factors were gender, problem behaviour syndromes, and maternal education. Gaining more knowledge about modifiable risk and protective factors that contribute to depression in Pacific youth is an important tool to support new approaches that promote adaptive psychological adjustment during adolescence. [ABSTRACT FROM AUTHOR]

Volunteer counsellors face particular challenges in postdisaster interventions. This research investigates personal, professional, and ethical issues faced by mental health volunteer counsellors recruited to a counselling service that emerged following the 2011 earthquakes in the Canterbury region of New Zealand. Earthquakes create major community disruption that can overwhelm existing service systems and require new agency arrangements and increased use of volunteers to manage and provide services. The disaster exposed counsellors to personal challenges in their own lives as well as those of their clients and significantly affected their professional practice. The findings indicate that emergency organisations and professional registration bodies should give further consideration to the management of volunteers and their early intervention work in postdisaster counselling. IMPLICATIONS Delivery of postdisaster services must encompass service management, targeted interventions, and supervision. When counsellors and clients experience the same disaster personal, professional, and ethical aspects are intertwined. Counsellors need self-care and support to manage these events. Further arrangements could be made to ensure professional insurance is available for volunteer counsellors postdisaster. [ABSTRACT FROM AUTHOR]

Aims: Children are increasingly included in qualitative research and new methods for interviewing children are emerging. The aim of this article is to describe and discuss the strategies of a child-centered method of data collection for interviewing children with movement impairments to explore their leisure participation experiences. Methods: A study was conducted using an Interpretative Phenomenological Approach (IPA) to explore leisure participation experiences of children with movement impairments aged 6 to 12 years. Various strategies, guided by children, were used to facilitate children's active involvement in the interview process. Results: Twenty-two children (mean age 8.7 years) participated in the interview study, most of them in the presence of their parents or guardian (18 children) and some of them (9 children) with their siblings present. Children enjoyed and were actively engaged in the interview process. Along with talking, 19 children did drawings, 5 children used stickers, 4 children played quiet games, six children shared pictures of their leisure activities, and 16 children physically demonstrated some of their leisure activities, environment, and equipment. Conclusions: A wide range of data collection strategies facilitated children to communicate their leisure participation experiences and to represent children's views without being overly influenced by parental views. [ABSTRACT FROM AUTHOR]

Purpose:Qualitative research examining experiences of recovering from mild traumatic brain injury (MTBI) is limited. Findings from quantitative studies regarding predictors of persisting symptoms are inconsistent with limited attention directed to capturing broad perspectives and priorities of the wider stakeholders. More flexible research approaches may help advance the field. We used a mixed method design to generate patient perspectives of MTBI recovery, integrating these with quantitative investigation to isolate factors that might contribute to divergent MTBI outcomes. Methods:The qualitative component reported here involved semi-structured interviews with selected participants (n = 10) from the quantitative study cohort, sampling both recovered and non-recovered adult MTBI participants. Interviews focused on participants’ general description and understandings of their recovery and perceptions of what helped or hindered this. Data were analyzed using general thematic analysis. Results and conclusion:Participants regardless of recovery status identified the importance of having a coherent understanding of their injury and recovery. Factors facilitating coherence included social support, validation, reassurance, accessing credible evidence-based information and having a pathway to wellness. Findings suggested that coherence could be a helpful umbrella construct worthy of examination in future MTBI research. This construct appears broad and able to cope with the complexity of individual experiences after injury.Implications for rehabilitationSense of coherence may be a helpful umbrella construct that can facilitate resilience and positive recovery beliefs and expectations after mild traumatic brain injury.Reassurance, validation, and social support appear important and may facilitate injury recovery.Focus on the experiences of people recovering from mild traumatic brain injury may help to refine recovery models and understandings and thus provide more effective intervention targets. [ABSTRACT FROM AUTHOR]

Background:Young adults are highly-active users of social network sites such as Facebook for their everyday friendship socializing. Alcohol companies have strategically used Facebook to embed their alcohol marketing into young adults’ social networking friendship activities, blurring the lines between user and alcohol brand generated content. This study explored mechanisms through which commercial alcohol interests interact with young adults’ online friendship practices and how young adults engage with this online alcohol marketing. Method:Researcher-participant online Facebook interviews were conducted with seven (4 females, 3 males) New Zealand young adults (18–25 years). The interviews were recorded using data screen-capture software to track participants’ online navigation and audiovisual recording of the conversation and non-verbal behaviors. Results:Our social constructionist thematic analysis identified that online alcohol marketing is obscured within friendship endorsing and invitations to drink; taken up as content for Facebook friendship fun; and objected to as intrusions into online friendship activities. Conclusions:Social media alcohol marketing encourages alcohol consumption through new forms of promotion and the exploitation of networked peer group friendship practices. The interaction between young adults’ online friendship practices and alcohol marketers as “friends” inside these practices needs urgent attention by policymakers seeking to reduce alcohol consumption. [ABSTRACT FROM PUBLISHER]

Objectives: To describe implementation of an innovative gerontology nurse specialist role within one primary health organisation in Auckland, New Zealand. Quantitative outcomes of the screening tool as well as the nurse specialist assessment will be presented.Method: The intervention involved use of the Brief Risk Identification for Geriatric Health Tool (BRIGHT) to identify high-needs older people with subsequent comprehensive geriatric assessment (CGA) performed by the gerontology nurse specialist.Results: A total 384 of the 416 BRIGHTs were completed (92% response rate) and 15% of these were identified as high risk (n= 57). The BRIGHTs for high-risk older people revealed the highest scoring question was ‘needing help with housework’ (26%). The most frequent intervention by the gerontology nurse specialist was education (30%).Conclusions: The primary health care gerontology nurse specialist model delivers a proactive case finding and specialist gerontology intervention for older people at high risk of functional or health decline. [ABSTRACT FROM PUBLISHER]

Purpose: People with stroke or Parkinson’s disease (PD) live with reduced mood, social participation and quality of life (QOL). Communication difficulties affect 90% of people with PD (dysarthria) and over 33% of people with stroke (aphasia). These consequences are disabling in many ways. However, as singing is typically still possible, its therapeutic use is of increasing interest. This article explores the experiences of and factors influencing participation in choral singing therapy (CST) by people with stroke or PD and their significant others.Method: Participants (eight people with stroke, six with PD) were recruited from a community music therapy choir running CST. Significant others (seven for stroke, two for PD) were also recruited. Supported communication methods were used as needed to undertake semi-structured interviews (totalN = 23).Results: Thematic analysis indicated participants had many unmet needs associated with their condition, which motivated them to explore self-management options. CST participation was described as an enjoyable social activity, and participation was perceived as improving mood, language, breathing and voice.Conclusions: Choral singing was perceived by people with stroke and PD to help them self-manage some of the consequences of their condition, including social isolation, low mood and communication difficulties.Implications for RehabilitationChoral singing therapy (CST) is sought out by people with stroke and PD to help self-manage symptoms of their condition.Participation is perceived as an enjoyable activity which improves mood, voice and language symptoms.CST may enable access to specialist music therapy and speech language therapy protocols within community frameworks. [ABSTRACT FROM AUTHOR]

Objective:To investigate the efficacy of 3-D printed bone models as a tool to facilitate initiation of bisphosphonate treatment among individuals who were newly diagnosed with osteoporosis. Design:Fifty eight participants with estimated fracture risk above that at which guidelines recommend pharmacological intervention were randomised to receive either a standard physician interview or an interview augmented by the presentation of 3-D bone models. Main outcome measures:Participants’ beliefs about osteoporosis and bisphosphonate treatment, initiation of bisphosphonate therapy assessed at two months using self-report and pharmacy dispensing data. Results:Individuals in the 3-D bone model intervention condition were more emotionally affected by osteoporosis immediately after the interview (p = .04) and reported a greater understanding of osteoporosis at follow-up (p = .04), than the control group. While a greater proportion of the intervention group initiated an oral bisphosphonate regimen (alendronate) (52%) in comparison with the control group (21%), the overall initiation of medication for osteoporosis, including infusion (zoledronate), did not differ significantly (intervention group 62%, control group 45%,p = .19). Conclusion:The presentation of 3-D bone models during a medical consultation can modify cognitive and emotional representations relevant to treatment initiation among people with osteoporosis and might facilitate commencement of bisphosphonate treatment. [ABSTRACT FROM PUBLISHER]

This study explored Māori experiences of aphasia therapy, with a view to ascertaining what makes a service culturally safe as well as "accessible to and culturally appropriate for" Māori with aphasia and their whānau (extended family). Māori are the indigenous peoples of New Zealand. This study incorporated interpretive description (a qualitative methodology) within kaupapa Māori research (a Māori approach to research). In-depth semi-structured interviews were undertaken with 11 Māori with aphasia and 23 of their nominated whanau members. They reported a wide variety of experiences of aphasia therapy, in six themes: We're happy to do the work, but we can't do it alone; Relationship; Our worldview; The speech-language therapy setting; Aphasia resources; and Is this as good as it gets? While some Māori with aphasia reportedly received an accessible and culturally appropriate service, others did not. It is concluded that, for Māori with aphasia, a strong therapeutic relationship is central. The success of this relationship is shaped by the SLP's appreciation of the worldview of the person with aphasia and whanau, the setting of the therapy, and the resources used. Successful therapy will involve collaboration between clinician and whānau, and therapy resources that affirm the identity of the person with aphasia. [ABSTRACT FROM AUTHOR]