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Mood problems are common after stroke, and screening is recommended. Training may support staff knowledge and implementation of screening, but the feasibility of training programmes in the Australian healthcare system has not been formally established. This study aimed to assess the feasibility of a mood screening training for a multidisciplinary team (MDT) of stroke clinicians working in a post-acute inpatient rehabilitation service. Twelve staff from a rehabilitation service at a major hospital in Sydney, Australia participated in a 3-h interactive training session. The feasibility of running the course, assessment of knowledge gained via a consolidation exercise and quiz and acceptability of the training were assessed via focus groups. The in-person modality of the training hindered recruitment and assessment of participants’ knowledge, though the actual measures themselves appeared appropriate. Nine participants provided feedback in two focus groups. Thematic analysis identified positive reactions to the training. However, low self-efficacy persisted and organisational/socio-cultural barriers to implementation emerged. Following training, the medical officers of the MDT had successfully implemented routine screening. Overall, the training appeared acceptable and to foster knowledge in staff. However, limitations to recruitment and administering evaluations were identified. The development of flexible online training may improve future evaluations of screening training programmes/pathways.

Speech-language pathologists (SLPs) utilize counseling to support the psychological wellbeing of people with post-stroke aphasia, however, SLPs receive variable, usually limited, counseling education. Counseling education may be effective in improving SLPs' knowledge, skills, and confidence in counseling in post-stroke aphasia.We aimed to evaluate the feasibility and preliminary efficacy of a novel online counseling education program for SLPs working with people with post-stroke aphasia.Our study was a Phase II, two-arm pilot randomized controlled trial with a waitlist control. Participants (n = 49) were stratified by previous counseling training (≥1 day) and co-work with psychologists when addressing psychological wellbeing in post-stroke aphasia, and randomized to either the education program or waitlist control arm. We developed an education program (7-hours self-directed learning; 3-hour online workshop) for the trial. Feasibility outcomes included SLP recruitment, workshop attendance, and participant attrition at follow-up. Participants' counseling self-efficacy and self-rated competency were assessed pre- and post-program (primary endpoint) and at 5-week follow-up.Forty-four (90%) participants attended the workshop with forty-one (84%) participants completing the trial. There was a significant interaction (large effect size) between time and group supporting a positive effect of the program on counseling self-efficacy,The demonstrated feasibility and preliminary efficacy of this online counseling program warrant a future definitive trial.

Speech-language pathology practice guidelines recommend competency in counselling to support psychological adjustment and well-being in people with communication disability. However, there is limit...

Introduction: Stroke patients with aphasia are often excluded from person-centred goal setting as part of their clinical care, despite a recommendation for person-centred goal setting in national c...

Background: Stroke patients with aphasia and their caregivers have higher incidence of depression than those without aphasia. Aims: To determine whether a tailored intervention program (Action Success Knowledge; ASK) led to better mood and quality of life (QoL) outcomes than an attention control with a 12 month end point at cluster and individual participant level. Methods: A multi-site, pragmatic, two-level single blind cluster randomized controlled trial compared ASK to an attention control (secondary stroke prevention program). Ten metropolitan and 10 non-metropolitan health regions were randomized. People with aphasia and caregivers were recruited within 6 months post-stroke who scored ≤12 on the Stroke Aphasic Depression Questionnaire Hospital Version-10 at screening. Each arm received manualised intervention over 6-8 weeks followed by monthly telephone calls. Blinded assessments of QoL and depression were taken at 12 months post-onset. Results: Twenty clusters (health regions) were randomised. Trained speech pathologists screened 1744 people with aphasia and 373 participants consented to intervention (n=231 people with aphasia and 142 family members). The attrition rate after consent was 26% with 86 and 85 participants with aphasia in the ASK arm and attention control arm respectively receiving intervention. Of those 171 who did receive treatment, only 41 met the prescribed minimum dose. Multilevel mixed effects modelling under the intention to treat protocol showed a significant difference on the Stroke and Aphasia Questionnaire-21 (SADQ-21 N=122, 17 clusters) in favour of the attention control (β: −2.74, 95% CI: −4.76, −0.73, p=0.008). Individual data analysis using a minimal detectable change score for the SADQ-21 showed the difference was not meaningful. Conclusion: ASK showed no benefit over attention control in improving mood and preventing depression in people with aphasia or their family members. Funding acknowledgement: National Health and Medical Research grant APP1060673 Trial registration: Australian Clinical Trials ACTRN12614000979651

Objectives This study investigated clinician experience of patient use of metaphors in chronic pain communication. Methods Interviews were conducted with eighteen Australian clinicians working with chronic pain patients, age range 26–64 years (M=46.6), 50% female, experience working in chronic pain ranging from 2 to 27 years (M=11.16). Results Thematic Analysis yielded four key themes: Metaphor as communicative tool, Metaphor as clue, Metaphor as obstacle, and Metaphor use in treatment. Clinicians identified metaphor as an important tool for patients to communicate their pain experience, whilst acknowledging that it could at times be unhelpful to patients. Metaphor was seen to contain useful information for clinicians and possess utility in assessment and treatment. Conclusions Metaphors play a significant role in chronic pain consultations, enabling clinician insight into pain type, psychopathology, and patient pain understanding. Metaphor in treatment phases may be underutilised. Clinicians should encourage patient metaphor use in chronic pain communication.

Anxiety is common after stroke and more prevalent in survivors with aphasia. Relaxation is an effective first-line therapy. The current study aimed to obtain the perspectives of stroke survivors with aphasia to inform the development of an accessible, technology-based, relaxation intervention.Qualitative co-design methods were used with twelve people with aphasia after stroke. The "Kalmer" Relaxation treatment package materials were iteratively based on participants' experiences and preferences; barriers and facilitators to treatment compliance were explored. Participants were also asked to consider how the intervention might be evaluated in a research trial.A thematic analysis highlighted the importance and need for the development of an appropriate and inclusive relaxation product, to be implemented by health professionals early post-stroke. Several behavioural strategies to improve treatment adherence were recommended. Participants had varying perspectives on clinically meaningful treatment outcomes.Overall, a co-designed accessible relaxation product was viewed as a necessary component of usual stroke care. Acceptability and feasibility and preliminary efficacy of the "Kalmer" intervention should be trialled in future studies. IMPLICATIONS FOR REHABILITATIONCo-designing psychological interventions for people with aphasia after stroke is needed to meet the needs of this at-risk population.Technology-based relaxation interventions to manage anxiety after stroke are viewed positively by people with aphasia and deemed acceptable and feasible.Clinical trials of these co-designed relaxation interventions are required before recommending integration into routine practice.

Virtual reality (VR) lends itself to communication rehabilitation by creating safe, replicable, and authentic simulated environments in which users learn and practice communication skills. The aim of this research was to obtain the views of health professionals and technology specialists on the design characteristics and usability of a prototype VR application for communication rehabilitation.Nine professionals from different health and technology disciplines participated in an online focus group or individual online interview to evaluate the application and use of the VR prototype. Data sources were analysed using a content thematic analysis.Four main themes relating to VR design and implementation in rehabilitation were identified: (i) designing rehabilitation-focused virtual worlds; (ii) understanding and using VR hardware; (iii) making room for VR in rehabilitation and training; and (iv) implementing VR will not replace the health professional's role.Health professionals and technology specialists engaged in co-design while evaluating the VR prototype. They identified software features requiring careful consideration to ensure improved usability, client safety, and success in communication rehabilitation outcomes. Continuing inclusive co-design, engaging health professionals, clients with communication disability, and their families will be essential to creating useable VR applications and integrating these successfully into rehabilitation. Implications for rehabilitationHealth and technology professionals, along with clients, are integral to the co-design of new VR technology applications.Design of VR applications needs to consider the client's communication, physical, cognitive, sensory, psychosocial, and emotional needs for greater usability of these programs.Realism and authenticity of interactions, characters, and environments are considered important factors to allow users to be fully immersed in virtual simulations to enhance rehabilitation.

BACKGROUND: Rates of stroke in people of working age are increasing. Returning to work (RTW) after stroke is a key rehabilitation aspiration for younger stroke survivors. A pilot community-based Stay at Work Initiative (SAWI) was developed and delivered from March 2017 to December 2019. SAWI used a co-ordination based approach, covering rehabilitation and vocational recovery to support RTW in younger stroke survivors. OBJECTIVE: The aim of the study was to conduct a feasibility evaluation of SAWI. METHODS: A mixed methods approach was taken considering quantitative and qualitative data. Quantitative data included employment, mood, anxiety and fatigue outcomes at time of engagement with the service and at 6-months post-stroke. Qualitative data was collected on a sub-sample of SAWI clients who volunteered to participate in a semi-structured interview. RESULTS: Overall, there were 93 referrals to SAWI, with 42 clients completing an initial service meeting. Average working hours pre-stroke were high (mean 46.9, SD 22.0, range 5–100 hours/week). By 6 months post stroke, 71% (n = 29 of 41) of SAWI clients were working. For those with 6-month questionnaire information (n = 19), there was a significant reduction in cognitive fatigue, overall fatigue levels, and perceived impact of stroke on employment (medium effect sizes of r = 0.36, 0.34 and 0.40 respectively). No significant difference was seen on measures of mood or anxiety from pre- to post-intervention. Qualitative interviews with six SAWI participants highlighted the importance of personalised support that addresses individual needs during the RTW journey. CONCLUSIONS: A significant number of eligible participants referred to SAWI can engage with the service. RTW is able to be assessed as are potential predictor variables. Seventy one percent of participants had RTW at 6 months post-stroke. Mood, self-efficacy, adjustment, and fatigue likely impact RTW. Qualitative interviews identified that SAWI’s personalised support, tailored to individual need, was valued.

Background In 2022, an estimated 1.105 billion people used smart wearables and 31 million used Fitbit devices worldwide. Although there is growing evidence for the use of smart wearables to benefit physical health, more research is required on the feasibility of using these devices for mental health and well-being. In studies focusing on emotion recognition, emotions are often inferred and dependent on external cues, which may not be representative of true emotional states. Objective The aim of this study was to evaluate the feasibility and acceptability of using consumer-grade activity trackers for apps in the remote mental health monitoring of older aged people. Methods Older adults were recruited using criterion sampling. Participants were provided an activity tracker (Fitbit Alta HR) and completed weekly online questionnaires, including the Geriatric Depression Scale, for 4 weeks. Before and after the study period, semistructured qualitative interviews were conducted to provide insight into the acceptance and feasibility of performing the protocol over a 4-week period. Interview transcripts were analyzed using a hybrid inductive-deductive thematic analysis. Results In total, 12 participants enrolled in the study, and 9 returned for interviews after the study period. Participants had positive attitudes toward being remotely monitored, with 78% (7/9) of participants experiencing no inconvenience throughout the study period. Moreover, 67% (6/9) were interested in trialing our prototype when it is implemented. Participants stated they would feel more comfortable if mental well-being was being monitored by carers remotely. Conclusions Fitbit-like devices were an unobtrusive and convenient tool to collect physiological user data. Future research should integrate physiological user inputs to differentiate and predict depressive tendencies in users.

People with communication disability after stroke need interventions to optimise healthcare communication and rehabilitation outcomes. Current evidence syntheses do not adequately inform the management of communication disability during the first 90 days post-stroke. To explore the scope of literature for the management of communication disability in the first 90 days after stroke. A scoping review was conducted using a systematic keyword search of six databases. A descriptive synthesis was generated using communication-related domains related to the biopsychosocial framework of the International Classification of Functioning, Disability, and Health (ICF). A total of 129 studies met eligibility criteria. Aphasia was the most frequently addressed communication disability after stroke (76/129 studies) with a paucity of evidence investigating other acquired neurogenic communication impairments. Management predominantly focused on communication-related: body functions and structures (62 studies) (e.g., linguistic-behavioural therapies), followed by environmental factors (39 studies) (e.g., communication partner training/support); activities and participation (15 studies) (e.g., augmentative and alternative communication); and personal factors (13 studies) (e.g., assessment of depression after aphasia). A coordinated, integrated approach to developing and testing acute and subacute interventions for all communication disabilities across all communication-related domains is required.IMPLICATIONS FOR REHABILITATIONInterdisciplinary stroke clinicians need to manage communication disabilities in the first 90 days after stroke to optimise healthcare communication and rehabilitation outcomes.There is some evidence to guide clinicians in aphasia management but less in other disabilities of speech and cognitive functioning.Most interventions to inform clinical practice address communication-related body functions and structures (e.g., linguistic and speech therapies). Clinicians need to address all domains and more evidence is needed to address environmental factors (e.g., communication support); activities and participation (e.g., person-centred goal setting); and personal factors (e.g., psychological care). Interdisciplinary stroke clinicians need to manage communication disabilities in the first 90 days after stroke to optimise healthcare communication and rehabilitation outcomes. There is some evidence to guide clinicians in aphasia management but less in other disabilities of speech and cognitive functioning. Most interventions to inform clinical practice address communication-related body functions and structures (e.g., linguistic and speech therapies). Clinicians need to address all domains and more evidence is needed to address environmental factors (e.g., communication support); activities and participation (e.g., person-centred goal setting); and personal factors (e.g., psychological care).

This study evaluated the feasibility of the Fearless Me! program, an online cognitive behavioral therapy (CBT) program for children with intellectual disability (ID) and anxiety.Twenty-one adolescents with mild to moderate ID participated in ten sessions of the therapist-assisted Fearless Me! program, combining face-to-face group sessions and an online component. A case series design was adopted to assess anxiety symptoms at baseline, throughout intervention, and postintervention. Feasibility of the measures, intervention, and trial design were considered.The measures were appropriate and sensitive to changes in anxiety, whereas the need for attention to factors influencing parent's completion of them was identified. Reliable Change Index and visual analyses of results indicated reductions in anxiety, particularly for older adolescents with heightened levels of anxiety at baseline.This is one of the first CBT programs for adolescents with ID, and provides preliminary evidence of adapted CBT as a feasible treatment.

BACKGROUND Depression affects approximately 60% of people with aphasia 1 year post stroke and is associated with disability, lower quality of life, and mortality. Web-delivered mental health (e-mental health) programs are effective, convenient, and cost-effective for the general population and thus are increasingly used in the management of depression. However, it is unknown if such services are applicable and communicatively accessible to people with poststroke aphasia. OBJECTIVE The aim of this study was to identify freely available e-mental health programs for depression and determine their applicability and accessibility for people with poststroke aphasia. METHODS A Web-based search was conducted to identify and review freely available e-mental health programs for depression. These programs were then evaluated in terms of their (1) general features via a general evaluation tool, (2) communicative accessibility for people with aphasia via an aphasia-specific communicative accessibility evaluation tool, and (3) empirical evidence for the general population and stroke survivors with and without aphasia. The program that met the most general evaluation criteria and aphasia-specific communicative accessibility evaluation criteria was then trialed by a small subgroup of people with poststroke aphasia. RESULTS A total of 8 programs were identified. Of these, 4 had published evidence in support of their efficacy for use within the general population. However, no empirical evidence was identified that specifically supported any programs’ use for stroke survivors with or without aphasia. One evidence-based program scored at least 80% (16/19 and 16/20, respectively) on both the general and aphasia-specific communicative accessibility evaluation tools and was subject to a preliminary trial by 3 people with poststroke aphasia. During this trial, participants were either unable to independently use the program or gave it low usability scores on a post-trial satisfaction survey. On this basis, further evaluation was considered unwarranted. CONCLUSIONS Despite fulfilling majority of the general evaluation and aphasia-specific evaluation criteria, the highest rated program was still found to be unsuitable for people with poststroke aphasia. Thus, e-mental health programs require substantial redevelopment if they are likely to be useful to people with poststroke aphasia.

Trainees of the Surrey PsychD (Clinical Psychology) programme were surveyed to identify if the courses module on older people – The Psychology of Later Life met the guidelines on training recommended by PSIGE. It was confirmed the course met the recommendations.

Assessment established high levels of anxiety, depression, cognitive impairment and low confidence in activities of daily living (ADLs) in a service mainly utilised by older people. Staff identified the need for support in managing challenging behaviour and assessing decision making capacity.

This paper considers findings with respect to the frequency with which cognitive impairment occurs in physician led community hospital rehabilitation service settings for older people. Particularly in light of the relevant National Service Framework this has implications for staffing, staff training and liaison psychiatry access with respect to these services.

Background/Aim Memory problems are frequently reported in people with multiple sclerosis (MS). These can be debilitating and affect individuals and their families. This subgroup analysis focused on the effectiveness of memory rehabilitation in patients with MS. Methods Data were extracted from a single-blind randomised controlled trial, the ReMiND trial, which also included participants with traumatic brain injury and stroke. Participants were randomly allocated to compensation or restitution treatment programmes, or a self-help control. The programmes were manual-based and comprised two individual sessions and ten group sessions. Outcome measures included assessments of memory, mood and activities of daily living. A total of 39 patients with MS participated in this study (ten males (26%), 29 females (74%); mean±SD age: 48.3±10.8 years). Results Comparison of groups showed no significant effect of treatment on memory, but there were significant differences between compensation and restitution on self-report symptoms of emotional distress at both five- (p=0.04) and seven-month (p=0.05) follow-up sessions. The compensation group showed less distress than the restitution group. Conclusions Individuals with MS who received compensation memory rehabilitation reported significantly less emotional distress than those who received restitution. Further research is needed to explore why self-reported memory problems did not differ between groups.

This article describes the development of a stroke support group for stroke survivors and carers based on user consultation.

This paper provides a brief overview of a symposium on stroke presented at the 26th PSIGE Annual Conference held at the University of Sussex in July, 2006. The principal conclusion from the discussion, arising from the papers presented, was that psychologists should be taking a broader (more holistic, systemic) approach to post-stroke adjustment.