Purpose The purpose of this article is to describe aphasia-friendly modification for occupational therapy assessments and home programs aimed at addressing upper extremity impairments for people post stroke. Method This article examines a case study example from a larger study (Wallace, Donoso Brown, Saylor, & Lapp, 2018 ) that implemented aphasia-friendly material modifications into an occupational therapy home program. The participant was a 74-year-old man who survived a left hemisphere cerebrovascular attack 6 years prior to the study. The participant experienced upper extremity hemiparesis and aphasia post stroke and was appropriate for an occupational therapy home exercise program with aphasia-friendly modifications to facilitate comprehension of the home program. Aphasia-friendly modifications (e.g., gestures and visual aids) were made to assessments to support comprehension and participation. To support reading comprehension deficits during completion of the home program, the program materials had aphasia-friendly modifications, such as modified text, supportive images, and reduced cognitive load of exercises. Finally, research team members used supported conversational techniques during all study procedures. Results At the end of the home program, an interview with the participant revealed several outcomes regarding the home program and the aphasia-friendly modifications. The participant reported pictures and reduced text to be beneficial in understanding the instructions. He also indicated that he enjoyed completing the exercises independently (i.e., outside of a therapy office). The participant's motor function demonstrated changes in a positive direction, although not greater than the minimally detectable change for performance-based measures. Conclusions Aphasia-friendly modifications (e.g., modifying text, adding supportive images, and using gestures) were found to be supportive of participation in assessments for and creation of an upper extremity home program. Speech-language pathologists can support the participation of people with aphasia through interprofessional collaboration and consideration of environmental adaptations.
Purpose Accessing auditory and written material simultaneously benefits people with aphasia; however, the extent of benefit as well as people's preferences and experiences may vary given different auditory presentation rates. This study's purpose was to determine how 3 text-to-speech rates affect comprehension when adults with aphasia access newspaper articles through combined modalities. Secondary aims included exploring time spent reviewing written texts after speech output cessation, rate preference, preference consistency, and participant rationales for preferences. Method Twenty-five adults with aphasia read and listened to passages presented at slow (113 words per minute [wpm]), medium (154 wpm), and fast (200 wpm) rates. Participants answered comprehension questions, selected most and least preferred rates following the 1st and 3rd experimental sessions and after receiving performance feedback, and explained rate preferences and reading and listening strategies. Results Comprehension accuracy did not vary significantly across presentation rates, but reviewing time after cessation of auditory content did. Visual data inspection revealed that, in particular, participants with substantial extra reviewing time took longer given fast than medium or slow presentation. Regardless of exposure amount or receipt of performance feedback, participants most preferred the medium rate and least preferred the fast rate; rationales centered on reading and listening synchronization, benefits to comprehension, and perceived normality of speaking rate. Conclusion As a group, people with aphasia most preferred and were most efficient given a text-to-speech rate around 150 wpm when processing dual modality content; individual differences existed, however, and mandate attention to personal preferences and processing strengths.
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