Search

BackgroundAimMethods & ProceduresOutcomes & ResultsConclusionsMaintaining therapy gains in the long term is necessary for therapy to be considered successful. Yet, this topic has received limited attention in aphasia rehabilitation research. Unfortunately, for some people with chronic aphasia, maintaining the gains achieved in therapy can be difficult and many experience reduced communicative functioning over time. Understanding the perspectives of speech-language pathologists (SLPs) on maintenance is vital. As key agents in aphasia therapy, their views are crucial for understanding current practice, identifying service gaps, and informing future research on the maintenance of therapy gains.The aim of this research was to explore speech-language pathologists’ perspectives on maintaining therapy gains in chronic aphasia and to understand their beliefs about the factors that influence the maintenance of gains made during aphasia rehabilitation.In-depth semi-structured interviews were conducted with seven SLPs who worked with people with chronic aphasia. Inductive thematic data analysis was used to identify themes.Six themes were identified, representing SLPs’ beliefs about maintenance and their perceptions of factors important for preserving therapy gains in aphasia rehabilitation. These were: 1) Ongoing communication activity; 2) Meaningful person-centred goals; 3) The challenge of translating functional goals to participation; 4) Individual capacity and resource availability; 5) Home support; and 6) Services. The results illustrate the complexity and interplay of factors that may both facilitate and hinder the maintenance of therapy gains.SLPs in this study believe that aphasia rehabilitation interventions should involve meaningful, personalised, enjoyable real-life experiences to optimise maintenance of therapy gains. Moreover, they believe that maintenance must be at the centre of aphasia rehabilitation research and clinical practice, requiring new models of care for chronic aphasia. These insights may provide direction for the development of future interventions and services to enhance long-term maintenance for people with chronic aphasia. [ABSTRACT FROM AUTHOR]

Introduction: Outcome measurement instruments (OMIs) are used to gauge the effects of treatment. In post‐stroke aphasia rehabilitation, benchmarks for meaningful change are needed to support the interpretation of patient outcomes. This study is part of a research programme to establish minimal important change (MIC) values (the smallest change above which patients perceive themselves as importantly changed) for core OMIs. As a first step in this process, the views of people with aphasia and clinicians were explored, and consensus was sought on a threshold for clinically meaningful change. Methods: Sequential mixed‐methods design was employed. Participants included people with post‐stroke aphasia and speech pathologists. People with aphasia were purposively sampled based on time post‐stroke, age and gender, whereas speech pathologists were sampled according to their work setting (hospital or community). Each participant attended a focus group followed by a consensus workshop with a survey component. Within the focus groups, experiences and methods for measuring meaningful change during aphasia recovery were explored. Qualitative data were transcribed and analysed using reflexive thematic analysis. In the consensus workshop, participants voted on thresholds for meaningful change in core outcome constructs of language, communication, emotional well‐being and quality of life, using a six‐point rating scale (much worse, slightly worse, no change, slightly improved, much improved and completely recovered). Consensus was defined a priori as 70% agreement. Voting results were reported using descriptive statistics. Results: Five people with aphasia (n = 4, > 6 months after stroke; n = 5, < 65 years; n = 3, males) and eight speech pathologists (n = 4, hospital setting; n = 4, community setting) participated in one of four focus groups (duration: 92–112 min). Four themes were identified describing meaningful change as follows: (1) different for every single person; (2) small continuous improvements; (3) measured by progress towards personally relevant goals; and (4) influenced by personal factors. 'Slightly improved' was agreed as the threshold of MIC on the anchor‐rating scale (75%–92%) within 6 months of stroke, whereas after 6 months there was a trend towards supporting 'much improved' (36%–66%). Conclusion: Our mixed‐methods research with people with aphasia and speech pathologists provides novel evidence to inform the definition of MIC in aphasia rehabilitation. Future research will aim to establish MIC values for core OMIs. Patient or Public Contribution: This work is the result of engagement between people with lived experience of post‐stroke aphasia, including people with aphasia, family members, clinicians and researchers. Engagement across the research cycle was sought to ensure that the research tasks were acceptable and easily understood by participants and that the outcomes of the study were relevant to the aphasia community. This engagement included the co‐development of a plain English summary of the results. Advisors were remunerated in accordance with Health Consumers Queensland guidelines. Interview guides for clinicians were piloted by speech pathologists working in aphasia rehabilitation. [ABSTRACT FROM AUTHOR]

Limited research informs management of cognitive-communication difficulties following traumatic brain injury (TBI) in older adulthood. The purpose of this study was to understand the characteristics and practice of speech-language pathologists (SLPs) working with people who sustained TBI at ≥55 years and more specifically their management of cognitive-communication difficulties with this population. This included assessment and treatment practices, resource needs, barriers to practice, and impact to service delivery from COVID-19 restrictions. A cross-sectional survey-based design with non-probability sampling of SLPs working in Australia with adults with TBI was utilised. Descriptive statistics and content analysis were used for analysis of survey data. Fifty responses were eligible for inclusion. Participants predominantly worked in inpatient rehabilitation (48%), acute (40%), and community settings (36%). Service delivery to adults who sustained TBI at ≥55 years commonly included cognitive-communication management. Assessment and treatment trends are described. Most SLPs (74%) perceived barriers to cognitive-communication management, often relating to time and funding, that existed prior to the COVID-19 pandemic. Pandemic restrictions presented additional challenges. Research relating to cognitive-communication difficulties following TBI in older adulthood is required to support evidence-based practice and inform services for older adults who sustain TBI. [ABSTRACT FROM AUTHOR]

Background: Communication partners (CPs) find it challenging to communicate with people with communication disorders post‐stroke. Stroke communication partner training (CPT) can enhance CPs' ability to support the communication and participation of people post‐stroke. While evidence for the efficacy of aphasia‐based CPT is strong, implementation in healthcare settings is unclear. Aims: To investigate Australian speech pathologists' current stroke CPT practices, factors influencing the implementation of CPT and how reported practice compares with the research evidence. Methods & Procedures: Speech pathologists in Australia who had worked with people post‐stroke were invited to complete a 99‐item online survey. The survey was informed by a comprehensive review of the literature review, the Template for Intervention Description and Replication (TIDieR) intervention taxonomy, and the theoretical domains framework. data were analyzed using descriptive statistics and content analysis. Outcomes & Results: A total of 122 clinicians were surveyed. Most participants reported providing CPT to treat a range of post‐stroke communication disorders. While 98.3% reported training familiar CPs, only 66.1% reported training unfamiliar CPs. Current stroke CPT practice is characterized by one to two < 1 h sessions of informal face‐to‐face education and skills training. Only 13.3% and 10.0% of participants used evidence‐based published programmes with unfamiliar and familiar CPs respectively. The main barriers included the perceived lack of behavioural regulation, skills, reinforcement, beliefs about consequences, positive social influences and resources. The main facilitators included clinicians' intentions to provide CPT, perception of CPT as part of their role and perceived compatibility of CPT with clinical practice. Conclusion & Implications: A significant evidence–practice gap exists. Research exploring the implementation of stroke CPT in healthcare settings, expanding evidence to support CPT for the range of post‐stroke communication disorders, developing freely accessible step‐by‐step CPT programmes that consider restrictions in current practice and providing explicit instructions of CPT best practice are warranted. A supportive workplace culture and freely accessible formal training opportunities are also needed. [ABSTRACT FROM AUTHOR]

Purpose: Many patients have difficulty communicating about their healthcare. At present there is no tool to identify these patients. This research investigated whether the Inpatient Functional Communication Interview Staff Questionnaire (IFCI SQ) could detect patients who have difficulty communicating their healthcare needs by investigating the sensitivity, specificity and internal consistency of the IFCI SQ. Method: Fifty patients and their nurses participated in this research. Every second consecutive admission on the general medical ward of a hospital was assessed for communication difficulty by a speech-language pathologist on the IFCI and screened for communication difficulty by a nurse using the IFCI SQ. Result: At a cut off score of <2, the IFCI SQ had a sensitivity of 95% and a specificity of 77% compared with the IFCI. The IFCI SQ is a useful test in identifying patients who have communication difficulty and is an extremely good test at ruling out patients who do not have communication difficulty. The internal consistency of the IFCI SQ was also high at 0.954. Conclusion: The IFCI SQ is a promising tool to detect patients in hospital with communication difficulty. Further research is required to explore the psychometric properties of the IFCI SQ in more detail. [ABSTRACT FROM PUBLISHER]

Understanding the impact of the environment on the participation of people with aphasia depends on one's perspective. A long-term perspective provides a unique insight into the myriad of ways in which the environment can influence the participation of people living with aphasia over decades. In this article, the authors present the real-life story of "Hank," who has lived with aphasia for more than 15 years. The authors consider how 2 different conceptual frameworks--the International Classification of Functioning, Disability and Health and the Social Determinants of Health--account for Hank's experience. The International Classification of Functioning, Disability and Health is useful to conceptualize the range of factors that influence living with aphasia at a particular point in time. In contrast, the Social Determinants of Health is useful to conceptualize the cumulative impact of living with aphasia on long-term health and well-being. Viewing aphasia as a social condition that impacts social determinants of health has potentially wide ranging implications for service design and delivery and the role of speech--language pathologists. [ABSTRACT FROM AUTHOR]

Background: Current service provision to people with aphasia in the acute hospital setting is reported to be inconsistent with best-practice recommendations. While speech pathologists (SPs) have been noted to express dissatisfaction with this, the underlying reasons for this evidence–practice gap are unclear. Change is required in order to move towards the provision of gold-standard aphasia management in acute hospitals. The voices of SPs working in this setting, and knowledge of their perceptions of the factors that influence their current practice, are essential in order to facilitate their capacity to act as agents for change. Aims: This research explored acute SPs’ conceptualisation, experiences, and perceptions of poststroke aphasia management, and provided a greater understanding of the factors that influence their practice. Methods & Procedures: A purposive, maximal variation technique was used to sample SPs. Semistructured in-depth interviews were conducted with 14 SP participants who work with people with acute poststroke aphasia. Inductive thematic analysis was used to analyse the results. Outcomes & Results: Analysis yielded five key themes. As a result of undertaking this research, insight was gained into (1) acute SPs’ perception of their role in relation to acute aphasia management; (2) the professional tension created by competing priorities; (3) the de-prioritisation of aphasia in relation to dysphagia management; (4) SPs’ beliefs about aphasia and their current aphasia management; and (5) their understanding of facilitators for acute aphasia management. Conclusions: This study elucidated the complex and multifaceted nature of the factors influencing SPs’ management of aphasia in the acute health care setting. Findings included the identification of modifiable factors—such as supportive practice environments, locus of control, and reflective practice—which facilitate evidence-based approaches to aphasia management in that acute hospital setting. [ABSTRACT FROM PUBLISHER]

Background An evidence-practice gap has been identified in current acute aphasia management practice, with the provision of services to people with aphasia in the acute hospital widely considered in the literature to be inconsistent with best-practice recommendations. The reasons for this evidence-practice gap are unclear; however, speech pathologists practising in this setting have articulated a sense of dissonance regarding their limited service provision to this population. A clearer understanding of why this evidence-practice gap exists is essential in order to support and promote evidence-based approaches to the care of people with aphasia in acute care settings. Aims To provide an understanding of speech pathologists' conceptualization of evidence-based practice for acute post-stroke aphasia, and its implementation. Methods & Procedures This study adopted a phenomenological approach, underpinned by a social constructivist paradigm. In-depth interviews were conducted with 14 Australian speech pathologists, recruited using a purposive sampling technique. An inductive thematic analysis of the data was undertaken. Outcomes & Results A single, overarching theme emerged from the data. Speech pathologists demonstrated a sense of disempowerment as a result of their relationship with evidence-based practice for acute aphasia management. Three subthemes contributed to this theme. The first described a restricted conceptualization of evidence-based practice. The second revealed speech pathologists' strained relationships with the research literature. The third elucidated a sense of professional unease over their perceived inability to enact evidence-based clinical recommendations, despite their desire to do so. Conclusions & Implications Speech pathologists identified a current knowledge-practice gap in their management of aphasia in acute hospital settings. Speech pathologists place significant emphasis on the research evidence; however, their engagement with the research is limited, in part because it is perceived to lack clinical utility. A sense of professional dissonance arises from the conflict between a desire to provide best practice and the perceived barriers to implementing evidence-based recommendations clinically, resulting in evidence-based practice becoming a disempowering concept for some. [ABSTRACT FROM AUTHOR]

There is a growing body of research that indicates that a person with a communication disability communicates and participates more effectively given a communicatively accessible environment. If this research is to be translated into practice then one needs to determine who will take on the role of creating communicatively accessible environments. This research adopted a qualitative methodology to explore the perceptions of speech-language pathologists about working to create communicatively accessible healthcare settings. Fifteen speech-language pathologists in three focus groups participated in this research. The focus group discussions were transcribed and analysed thematically. Thematic analysis indicated that speech-language pathologists believe there are four main benefits in creating communicatively accessible healthcare environments. These are Benefits for all people: Access for all, Benefits for healthcare administrators, Benefits for those wanting to improve communication with patients, and Benefits to the capacity to provide communicatively accessible environments. However, they believe these benefits can only be achieved if; The communication resources are available, Skilled, knowledgeable and supportive healthcare providers are available; and Systems are in place to support a whole-of-hospital approach. This research supports the development of a new role to improve the communicative accessibility of healthcare settings. [ABSTRACT FROM AUTHOR]

Background Communication and swallowing disorders are a common consequence of stroke. Clinical practice guidelines (CPGs) have been created to assist health professionals to put research evidence into clinical practice and can improve stroke care outcomes. However, CPGs are often not successfully implemented in clinical practice and research is needed to explore the factors that influence speech pathologists' implementation of stroke CPGs. This study aimed to describe speech pathologists' experiences and current use of guidelines, and to identify what factors influence speech pathologists' implementation of stroke CPGs. Methods Speech pathologists working in stroke rehabilitation who had used a stroke CPG were invited to complete a 39-item online survey. Content analysis and descriptive and inferential statistics were used to analyse the data. Results 320 participants from all states and territories of Australia were surveyed. Almost all speech pathologists had used a stroke CPG and had found the guideline "somewhat useful" or "very useful". Factors that speech pathologists perceived influenced CPG implementation included the: (a) guideline itself, (b) work environment, (c) aspects related to the speech pathologist themselves, (d) patient characteristics, and (e) types of implementation strategies provided. Conclusions There are many different factors that can influence speech pathologists' implementation of CPGs. The factors that influenced the implementation of CPGs can be understood in terms of knowledge creation and implementation frameworks. Speech pathologists should continue to adapt the stroke CPG to their local work environment and evaluate their use. To enhance guideline implementation, they may benefit from a combination of educational meetings and resources, outreach visits, support from senior colleagues, and audit and feedback strategies. [ABSTRACT FROM AUTHOR]

This paper describes a collaborative partnership between the Royal Talbot Rehabilitation Centre and La Trobe University to provide speech-language pathology students with a one-day experiential communication skills workshop. The workshop focused on the development of student knowledge, confidence and the communication skills required to effectively interact with adults with communication disabilities. The program, outcomes, challenges and future directions of the program are described. [ABSTRACT FROM AUTHOR]

Background: The role of speech pathologists working in the acute hospital setting has evolved away from service provision to people with aphasia and their families towards a stronger focus on dysphagia. Evidence-based practice (EBP) can be conceptualised as the integration of four streams of evidence: research-based clinical evidence, clinical expertise, patient preferences and values, and the practice context. EBP is an important tenet in current healthcare. However, it is not clear whether speech pathologists in the acute setting are using EBP to support their aphasia management. Not adopting evidence-based approaches to care has the potential to result in a negative impact on people with aphasia and their families, healthcare services, and speech pathologists, who experience a sense of dissonance related to their current service provision This paper explores acute aphasia management through an EBP lens in an attempt to better understand this dilemma. Aims: This paper applies the conceptual framework of EBP to acute aphasia management. An extensive, systematically conducted review of the international literature relating to health professionals was undertaken. The findings are presented as a narrative literature review. Main Contribution: This paper describes and evaluates how the different streams of research evidence, clinical expertise, patient preferences and values, and the practice context contribute to speech pathologists' management of acute aphasia. Further, the paper identifies current gaps in the literature and suggests a research agenda for the field. Conclusions: Little is known about how speech pathologists integrate and implement the different streams of evidence in EBP, and how these contribute to acute aphasia practice. Speech pathologists report that clinical guidelines containing low-level evidence are the main source of research information. Other sources of knowledge include colleagues, professional development events, and websites. Additional challenges to the management of people with aphasia in the acute hospital setting may be posed by the physical environment, the culture of the acute hospital setting, and the provision of leadership to support evidence-based approaches to care. The challenge of using a person-centred approach to care for people with aphasia is acknowledged. Further research exploring speech pathologists' perceptions of their role in acute aphasia management, the clinical decision-making process of speech pathologists in relation to acute aphasia management, and the experiences of people with aphasia and their families in the acute setting is required. This will allow for the design of patient-centred approaches to care, and enable the implementation of evidence-based acute aphasia management. [ABSTRACT FROM AUTHOR]

This commentary aims to extend the debate of the lead article authors (Wylie, McAllister, Davidson, and Marshall, 2013) by translating the nine recommendations of the World Report on Disability into a plan of action for the aphasia community. Solutions for the advancement of aphasia science and services are presented at international (macro), national (meso), and local (micro) levels. Implications for speech-language pathologists and aphasia service delivery are discussed. An overarching call to action is the need for speech-language pathologists to support a strong and vibrant aphasia community at all levels, so that the voices of people with aphasia can be heard. [ABSTRACT FROM AUTHOR]

Storytelling can be a powerful way to reflect on the ethical issues that emerge in clinical practice. This article uses two stories by speech-language pathologists to explore how notions of person-centered practice may influence speech-language pathology practice. Then these stories are examined in relation to definitions of person-centered practice and speech pathology code of ethics to discuss the ethical issues, challenges, and risks that these stories raise. Moving toward more person-centered ways of practicing will require speech-language pathologists to be open to the real lives of their clients with communication and swallowing disabilities. It may also require speech-language pathologists to be open to their own vulnerabilities as well. [ABSTRACT FROM AUTHOR]

Increasingly speech-language pathologists are considering the effects of a client's communication and/or swallowing disability on the client's day to day life. The activities and life situations that make up a person's everyday life are described in the Activities and Participation component of the World Health Organization's International Classification of Functioning, Disability and Health (ICF). This paper describes the Activities and Participation component of the ICF and how communication is currently represented in this component. This paper then explores the current debate between the concepts of activities and participation and how this can continue to inform and develop our understanding of communication activity and communication participation into the future. [ABSTRACT FROM AUTHOR]

A personal account of a speech pathologist’s experience of major depression and how her work and research in speech pathology provided a way for her to understand this illness. [ABSTRACT FROM AUTHOR]