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To be fully prepared to work within an increasingly diverse society, CSD students need to learn more about oppression, racism, equity and inclusion in addition to learning about cultural differences. In this article, a model of Anti-Oppressive Practice (AOP) developed as an integral part of a CSD graduate education curriculum is presented. Rooted in theoretical models including Critical Race Theory and Critical Disability Theory, the AOP curriculum includes eight modules, with each module defining relevant language, introducing concrete action step strategies, and giving students opportunities to practice these steps. Topics include forms of bias, systemic racism, oppression, cultural competence and cultural humility, deficit vs. strength-based models, inclusion and ableism in CSD. Numerous examples of how AOP has been threaded throughout the CSD curriculum in academic and clinical courses are provided.

People post-stroke experience increased loneliness, compared to their healthy peers and loneliness may have increased during COVID due to social distancing. How social distancing affected loneliness among people after stroke is unknown. Bandura's self-efficacy theory suggests that self-efficacy may be a critical component affecting individuals' emotions, behaviors, attitudes, and interpretation of everyday situations. Additionally, previous studies indicate that self-efficacy is associated with both loneliness and social participation. This study investigates relationships among self-efficacy, social participation, and loneliness in people with stroke. Determine how social participation affects the relationship between self-efficacy and loneliness in people with stroke during the COVID-19 pandemic. 44 participants were community-dwelling individuals, ≥ 6 months post-stroke who participated in a 2-hour phone interview. A regression-based mediation analysis was conducted using these measures: Participation Strategies Self-Efficacy Scale, Activity Card Sort for social participation, and UCLA Loneliness Scale for loneliness. The total effect of self-efficacy on loneliness was significant (b = -0.36, p =.01). However, social participation fully mediated the relationship between self-efficacy and loneliness (indirect effect, b = -0.11, 95% CI [−0.24, −0.01]; direct effect, b = -0.25, 95% CI [−0.03, 0]). Self-efficacy is associated with both social participation and loneliness in people with stroke in this cross-sectional study. Mediation analysis findings suggest that interventions focused on increasing social participation may prevent or potentially alleviate loneliness in people with stroke who have low self-efficacy. [ABSTRACT FROM AUTHOR]

Background: Achieving activity participation goals is a key factor in quality of life (QOL) for people with aphasia (PWA), but expressing participation goals can be difficult for many of them. Proxy reports by caregivers may not accurately reflect the interests and participation goals of PWA, and discrepancies in these goals between PWA and their caregivers may affect QOL, based on the assumption that caregivers' awareness of their loved ones' unique participation goals may be important to increasing PWA activity participation. Aims: To examine everyday activities valued by PWA using the Life Interests and Values (LIV) Cards; to measure congruence between PWA and their caregivers on life participation goals; and to measure how congruence of PWA-caregiver participation goals related to QOL. Methods & Procedures: A convenience sample of 25 PWA completed the LIV Card assessment and the Stroke Aphasia Quality of Life Scale--39 to assess participation goals and QOL. Participation goals were also evaluated with respect to age, time post-onset and aphasia severity. A total of 12 caregivers were administered the LIV Cards to calculate agreement between PWA-proxy activity reports and the relationship between agreement and QOL. Outcomes & Results: PWA endorsed wanting to participate more in a wide range of activities, with common interests in walking/running, going to the beach and eating out, among others. PWA-caregiver activity agreement was fair to moderate with point-to-point agreement averaging 70%. However, no relationship between degree of congruence in PWA-proxy pairs and QOL was found. Conclusions & Implications: PWA have a variety of activity participation goals that can be integrated into intervention plans. Dependence on proxy respondents should be reduced as much as possible to support self-determination for PWA.

Objectives The present research examined associations between stroke and long-term trajectories of loneliness. Methods We conducted secondary analyses in 3 large representative panel studies of adults 50 years and older in the United States, Europe, and Israel: the English Longitudinal Study of Aging (ELSA; analytic N  = 14,992); the Survey of Health, Aging, and Retirement in Europe (SHARE; analytic N  = 103,782); and the Health and Retirement Study (HRS; analytic N  = 22,179). Within each sample, we used discontinuous growth curve modeling to estimate loneliness trajectories across adulthood and the impact of stroke on loneliness trajectories. Results Across all 3 samples, participants who experienced stroke reported higher levels of loneliness relative to participants who did not experience stroke. In ELSA and HRS (but not SHARE), loneliness levels were higher after stroke onset relative to before stroke onset. Discussion This research adds to a growing body of evidence demonstrating elevated loneliness among stroke survivors and highlights the need for interventions to increase social connectedness after stroke. [ABSTRACT FROM AUTHOR]

Previous research has reported that residual neurological impairment and emotional factors play a role in regaining successful participation post-stroke. The objective of this study was to investigate the mediating impact of anxiety on the association between residual neurological impairment and participation in survivors with and without post-stroke depressive symptoms. Participants (N = 79) were classified into 2 categories, those with post-stroke depressive symptoms (N = 40) and those without post-stroke depressive symptoms (N = 39). Variables measured in this study: residual neurological impairment (NIH Stroke Scale Score), participation (Reintegration to Normal Living Index), depressive symptoms (Patient Health Questionnaire-9), and trait anxiety (State-Trait Anxiety Inventory). A regression-based mediation analysis was conducted for each group of participants. The majority of participants had some level of anxiety. Residual neurological impairment predicted participation in stroke survivors both with (β = -.45, p =.003) and without (β = -.45, p =.004) post-stroke depressive symptoms. Anxiety mediated this relationship in participants with depressive symptoms (β = -.19, 95% CI = -.361 ∼ -.049), but not in participants without depressive symptoms (β = -.18, 95% CI = -.014 ∼.378). Depressive and anxious symptoms should both be addressed to best facilitate participation by stroke survivors. [ABSTRACT FROM AUTHOR]

Participation restrictions continue to be prevalent for community-dwelling stroke survivors. Research is needed to understand the associated post-stroke factors that limit or facilitate optimal participation and quality of life. To investigate emotional health, executive functioning (EF), and social support as predictors of participation restrictions post-stroke. Cross-sectional data collected from participants ≥ 6 months after mild stroke with and without aphasia (N = 114) were analyzed using three participation outcome measures: Reintegration to Normal Living Index (RNL), Activity Card Sort (ACS), and the Stroke Impact Scale (SIS) Version 2.0 Participation/Role Function domain. Predictor variables investigated were emotional health (SIS Emotion domain scores), EF (Delis Kaplan Executive Function System Trail Making Condition 4: DKEFS), social support (Medical Outcomes Study Social Support Survey: MOS-SSS), stroke severity (National Institutes of Health Stroke Scale: NIHSS), and education level. Using multiple regression, these predictors accounted for 26.4% to 40% of the variance for the three participation outcomes. Emotional health was a significant independent predictor across all three measures. Social support was a significant predictor of participation as measured on the RNL. Executive function was not a significant predictor of participation when controlling for the other predictor variables. Emotional health and social support should be considered as modifiable factors that could optimize meaningful participation and quality of life. [ABSTRACT FROM AUTHOR]

Communication abilities have been considered to be a key influential factor for social participation in persons with post-stroke aphasia. Previous literature has shown that social support is positively associated with social participation post-stroke. However, few studies have investigated if social support mediates the negative impact of communication difficulties on social participation in persons with aphasia and without aphasia after stroke. To investigate the mediation effect of social support on the association between communication abilities and social participation in persons with aphasia and without aphasia after stroke. A total of 116 participants who have had a stroke, including 60 persons with aphasia and 56 persons without aphasia, were enrolled. This study used a regression-based mediation analysis using Hayes's PROCESS macro (SPSS model 4). Measures included the Medical Outcomes Study (MOS) - Social Support Survey as the mediator (perceived social support), the Stroke Impact Scale 2.0 (SIS) communication domain as the independent variable, and the Activity Card Sort (ACS) social activity domain as the dependent variable (social participation). Two separate models were built for persons with aphasia and without aphasia. As post hoc analyses, the four domains of MOS social support (emotional/informational support, affectional support, positive social interaction, and tangible support) were included as a mediator in four individual models. Our results showed that there was no difference in social participation between persons with aphasia and without aphasia after stroke. Perceived social support (b=0.180, 95% CI=0.054~0.352), including emotional/informational support (b=0.182, 95% CI=0.552~0.359), affectionate support (b=0.138, 95% CI=0.020~0.316), and positive social interaction (b=0.178, 95% CI=0.035~0.357), fully mediates the association between communication abilities and social participation in persons with aphasia, but did not for persons without aphasia (p>0.05). The results indicate that perceived social support, specifically emotional/informational support, affectionate support, and positive social interaction, may be used as an intervention approach for improving social participation in persons with post-stroke aphasia. [ABSTRACT FROM AUTHOR]

Purpose: To explore whether individuals with aphasia exhibit differences in the M350, an electrophysiological marker of lexical activation, compared with healthy controls. Method: Seven people with aphasia, 9 age-matched controls, and 10 younger controls completed an auditory lexical decision task while cortical activity was recorded with magnetoencephalography. There were 2 stimulus conditions of interest: identity primed (i.e., a word preceded by itself) and semantic primed (i.e., a word preceded by a semantically related word). Latency and amplitude of the M350 response as well as reaction time were measured. Results: Consistent with the age-matched control group, the group with aphasia showed both identity and semantic priming behaviorally. In contrast to the control groups, the group with aphasia did not show either semantic or identity priming of the M350 response. This group also demonstrated longer M350 latencies than either control group. Furthermore, within this group, M350 latency was positively correlated with a measure of semantic impairment. Conclusions: These findings highlight the usefulness of temporally sensitive measures when studying aphasia and demonstrate that the latency of electrophysiological markers is of interest in this population. In particular, increased M350 latency appears to be indicative of a semantic processing impairment.

This study investigated the influence of apathy and positive social support on community reintegration after stroke. A prospective, correlational, cross-sectional design was used. 85 community dwelling participants with and without aphasia were included (≥ 18 years of age, first stroke, ≥ 6 months post-stroke). The Reintegration to Normal Living Index (RNL) measured poststroke participation. The Apathy Evaluation Scale (AES) and Positive Social Interaction domain of the Medical Outcomes Study Social Support Survey assessed apathy and social support respectively. NIH Stroke Scale measured residual neurological impairment. Apathy, social support, and stroke impairment together were strongly associated with the RNL and accounted for 51% of total variance in the RNL. The AES and NIHSS were independent predictors of the RNL, though positive social interaction failed to reach significance. Persons with and without apathy differed significantly on the RNL. Therefore, stroke rehabilitation should address apathy as a potential target for intervention. Future research should determine factors that mediate the relationship between poststroke apathy and community reintegration. [ABSTRACT FROM AUTHOR]

Participation in daily activities is the ultimate goal of stroke rehabilitation. Emotional factors have been considered as contributors to participation, but associations between emotional factors and participation post-stroke have not been fully explored. To investigate the extent to which emotional factors contribute to participation post-stroke. 73 participants were included. Three participation outcomes were used as dependent variables in three models: (1) Stroke Impact Scale (SIS) Participation/Role Function, (2) Activity Card Sort (ACS), and (3) Reintegration to Normal Living (RNL). Main independent variables were six emotional factors: SIS Emotion Function (General emotion), Visual Analog Mood Scale energetic and happy subscales, Patient Health Questionnaire-9 (Depression), State-Trait Anxiety Inventory-Trait Anxiety Scale, and Apathy Evaluation Scale. Covariates of stroke severity and social support were included. Model 1 showed stroke severity (β = −0.300) and depression (β = −0.268) were significant contributors to SIS Participation/Role Function (R2 = 0.368, p <.05). Model 2 indicated that happiness (β = 0.284) and apathy (β = −0.330) significantly contributed to ACS total activity retention (R2 = 0.247, p <.05). Model 3 revealed that anxiety (β = −0.348), apathy (β = −0.303), stroke severity (β = −0.184), and social support (β = 0.185) were significant contributors to RNL total score (R2 = 0.583, p <.05). Results suggested that emotional measures of apathy, depression, anxiety, and happiness, but not general emotion, were important contributors to participation post-stroke. These findings suggest that rehabilitation professionals should address individual emotional contributors to facilitate participation post-stroke. [ABSTRACT FROM AUTHOR]

This ICAP program is a collaboration between an institute of health professions and a rehabilitation hospital. It was a 6-week intensive treatment program for people with post-stroke aphasia designed to maximize recovery and return to activities. This retrospective study investigated outcomes of this program offered annually from 2015 to 2019. This is an analysis of existing data collected for other purposes. While conducting a therapeutic program for people with aphasia, data were not collected for the purpose of conducting research. The treatment components addressed the activity participation goals of 35 participants. Programming consisted of individual and group speech-language and occupational therapy, adaptive sports, swimming, music therapy, and a wellness mindfulness group.. Participants received a comprehensive evaluation and a treatment plan addressing their individual participation goals, delivered primarily by SLP and OT graduate students under faculty supervision. Pre- and post-treatment outcomes were measured within four WHO ICF domains: impairment, participation, environment, person. Each cohort consisted of seven or eight community-dwelling participants seen four days/week. Significant post-treatment changes were observed on measures within the impairment domain and on self-perception measures of participation, functional communication, and communication confidence. Subsequent analyses found a subset of 15 responders (WAB Aphasia Quotient change of ≥5) drove most significant effects seen on performance-based impairment measures, but that patient-reported self-perception measures showed significant changes in both responders and non-responders. Results support research indicating that short-term intensive, interprofessional comprehensive aphasia programs (ICAPs) are effective treatment options for people with moderate-to-severe aphasia. [ABSTRACT FROM AUTHOR]