Rationale: The study aimed to explore the practices of South African speech-language therapists in providing psychosocial care to people with aphasia. People with aphasia are at risk of adverse psychosocial disruptions and access to appropriate support may be particularly challenging for individuals with compromised communication abilities. The study was the first of its kind in the unique multilingual and multicultural context. By understanding current practices, direction for improved psychosocial care to people with aphasia, as well as support to speech-language therapists delivering this care may be provided. Method: A 20-item previously published online survey was completed by 56 South African speech-language therapists. Purposive sampling and snowball sampling were used to recruit participants for the study. A mixed-methods design was adopted. Descriptive and inferential statistics, as well as qualitative content analysis, were used. Results: Respondents recognised addressing psychosocial wellbeing to be very important. A variety of psychosocial approaches were used in practice. However, 67.9% of the sample felt ill-equipped to provide psychosocial care to people with aphasia. Further barriers included: time/caseload pressures (60.7%) and feeling out of their depth (48.2%). Enablers were access to more training opportunities (89.3%), adequate time (62.5%), and ongoing support from skilled professionals (55.4%). The majority of respondents also perceived mental health professionals to have limited expertise in working with people with aphasia, making onward referral challenging. Conclusions: Respondents aimed to support people with aphasia’s psychosocial wellbeing by working collaboratively, including family and setting person centred goals. However, many challenges to the provision of psychosocial care to people with aphasia were identified. In order to improve services, more training, role definition and interprofessional collaboration is required. / Dissertation (MA (Speech-Language Pathology))--University of Pretoria, 2021. / Speech-Language Pathology and Audiology / MA (Speech-Language Pathology) / Restricted

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The purpose of this study was to examine how length and location of speech pausing affects a listeners' perception of likability and communication effectiveness. Furthermore, the end goal of this study is to understand how to better assess atypical speech pause for persons with aphasia (PWA). Speech samples were collected from two neurotypical speakers over the age of 75. The speech samples were the recorded responses of picture description tasks found in the Western Aphasia Battery (WAB) and the Boston Diagnostic Aphasia Examination (BDAE). These speech samples were then modified to include artificial pauses located both within sentence and between sentence, as well as differing lengths of three seconds, five seconds, and seven seconds. Forty-one listeners (31 female, 8 male) were recruited to listen to the 28 speech samples. Using a visual analogy scale, listeners rated each sample on their perception of likability and communication effectiveness. Communication effectiveness and likability ratings were significantly higher for between-utterance pauses. Likewise, ratings were highest for the baseline (no pause) stimuli and decreased as pause length increased. Across all conditions, ratings for the male speaker were rated slightly greater than that of the female speaker. Results of this study provide preliminary evidence that longer speech pause, especially found within utterance, affect the likability and communication effectiveness of PWA. It is hoped that additional research regarding speech pause will be conducted to determine how best to assess speech pause in PWA.

Bakgrund: Nästan hälften av alla människor som drabbats av stroke får någon form av talhandikapp till följd som har stor påverkan på deras fortsatta livskvalitet. Varje år får ca 12 000 personer i Sverige afasi, vilket innebär avsaknad av en språklig funktion på grund av skador i hjärnan. Det är ovanligt med en total avsaknad av språk istället brukar det variera mellan att glömma bort ord, upprepningar, ha ett oförståeligt tal och felaktig grammatisk ordföljd. Sjuksköterskan har en stor roll i patientens rehabiliteringsprocess efter en stroke och kunskaper kring afasi och hur det påverkar individen och dess närstående är betydande för att kunna ge adekvat omvårdnad och ett bra bemötande. Syfte: Syftet med studien var att utifrån tidigare forskning beskriva hur afasi efter stroke påverkar vuxna personers sociala liv. Metod: En litteraturstudie som inkluderade tio artiklar varav åtta var kvalitativa och två var kvantitativa. Resultat: Resultatet visade att många afasipatienter upplevde svårigheter i kommunikationen med sina närstående och kände att både de och deras anhöriga behövde mer kunskap kring kommunikationsstrategier. Anhöriga spelade en viktig roll i rehabiliteringsprocessen och behövde göras delaktiga i ett tidigt skede för ett bättre resultat av rehabiliteringen. Graden av belastning hos närstående påverkades av hur den anhörige upplevde den afatiskes begränsningar och det var störst påfrestning för de som bodde ihop med den som drabbats av afasi. Vårdpersonal har möjligheten göra anhöriga delaktiga och och ge både den afatiske och dess närstående de instrument som krävs för att de ska kunna utveckla nya kommunikationsstrategier. Slutsatser: En bibehållen god relation med familj och vänner var en mycket viktig faktor för de afatiska personernas välbefinnande och dessa relationer bör stärkas bland annat genom större kunskaper om afasi med hjälp av vårdpersonal. / Background: Almost 50 percent of all people affected by stroke get some form of speech and language disability that will have a major impact on their continued quality of life. Every year about 12 000 people in Sweden are diagnosed with aphasia, which means the lack of a linguistic function due to damage of the brain. Total absence of language is rare, usually the severity varies between forgetting and repeating words, incomprehensible speech and incorrect grammar. The nurse has a major role in the patient's rehabilitation process after a stroke. Knowledge of aphasia and how it affects the individual and their relatives are important to provide adequate care and good treatment. Aim: The purpose of the study was to based on previous research describe how aphasia after stroke affects social life of adults persons. Method: Literature study that included ten articles, of which eight were qualitative and two was quantitative. Results: The results showed that many patients with aphasia experienced difficulties in communicating with their family and felt that both they and their families needed more knowledge about communication strategies. Family members played an important role in the rehabilitation process and needed to be involved at an early stage for better rehabilitation results. The degree of strain on the relative was influenced by how they experienced the new limitations of the person suffering from aphasia and it was hardest on those living with the relative suffering from aphasia. Nurses should make families involved and give both the person with aphasia and their relatives instruments required to enable them to develop new communication strategies. Conclusion: Maintaining a good relationship with family and friends was a very important factor for the aphasic person’s well-being and these relations should be strengthened through greater knowledge of aphasia with the help of medical professionals.

This study explored the acceptability of Relationship-Centered Communication Partner Training (RC-CPT) for couples impacted by aphasia. Three couples participated in the program across two sessions. Surveys were administered to assess outcome measures of their marital relationship and communication confidence before and after participation in RC-CPT. The quantitative findings were analyzed using descriptive statistics. Overall, participants generally maintained or experienced improvements in accessibility, responsiveness, engagement, conflict, conflict resolution, and communication within their marriage after participating in RC-CPT. Additionally, individuals with aphasia demonstrated enhanced communication confidence scores. During the third session, couples completed a semi-structured interview to share their experiences with the program. The interviews were transcribed orthographically and coded using reflexive codebook analysis. Reflexive codebook analysis of the semi-structured interviews revealed four prominent themes: (I) "Impact on Communication," (II) "Impact on Relationship," (III) "Impact on Psychosocial Well-Being," and (IV) "Feedback for Future Development". The convergence of the quantitative and qualitative data revealed that couples indicated positive changes in their communication, relationship, and psychosocial well-being. These findings suggest that RC-CPT has the potential to effectively address both communicative and psychosocial impacts of aphasia on couples. Moreover, this study highlights the promise of RC-CPT as a relationship-centered counseling tool, warranting further exploratory and experimental research.

While it is commonly understood by occupational therapy practitioners that collaborative goal setting leads to increased goal achievement (Sugavanam, Mead, Bulley, Donaghy, & van Wijck, 2013), the current literature shows that people with post stroke aphasia are not optimally involved in the collaborative goal setting process (Berg, Askim, Balandin, Armstrong, & By Rise, 2017; Berg, By Rise, Balandin, Armstrong, & Askim, 2016; Rohde, Townley-O’Neill, Trendall, Worrall, & Cornwell, 2012). This leads to reduced goal achievement (Sugavanam, Mead, Bulley, Donaghy, & van Wijck, 2013) and ultimately less leisure and social participation (Hilari, 2011; Eriksson, Aasnes, Tistad, Guidetti, & von Koch, 2012; Nätterlund, 2010). ClientCollab is a theory-based and evidence-driven online visual supplement to the Canadian Occupational Performance Measure (COPM), designed to reduce the cognitive and communication burdens of the COPM and assist the practitioner and client with aphasia in the goal setting process. ClientCollab is guided by research on reading and pictorial comprehension of people with aphasia as well as by the Universal Design of Learning (UDL) theory. The online program is available free of charge at www.clientcollab.net and is designed to be used in conjunction with the COPM to assist the occupational therapy practitioner and client in identifying occupational performance issues. The content of the program parallels the section and subsection breakdown of the COPM and is designed for use during step one of the COPM to assist in the identification of occupational performance issues. The objective of the program is to increase communication between client and practitioner during the goal setting process as well as to increase the number of goals developed with client input. ClientCollab is meant to act as a visual supplement to the goal setting section of the COPM, however it is not meant or able to fully replace the COPM, and must be used in conjunction with the paper or online version of the COPM. In conclusion, ClientCollab aims to decrease the cognitive and communication barriers limiting people with aphasia from completing the COPM in hopes of facilitating increased collaborative goal setting and ultimately increased goal achievement in this population.

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