No abstract

Clinicians must often contend with ethical issues that arise during rehabilitation. When a patient has right hemisphere damage (RHD), these concerns may be exacerbated because of the presence of cognitive deficits. In this article, we focus on the ethical principle of respect for autonomy, which raises issues relevant to patients with RHD who have impaired executive control functions. Respect for autonomy involves respecting others in terms of their decision-making and subsequent actions. Disagreements may occur between members of the rehabilitation team, the patient, and family about the decisions that the patient makes. Clinicians may have concerns about the patient's capacity to make informed decisions. Indeed, in some cases, because the patient is “talking,” the verbal skills may mask the impairments in underlying cognitive processes. We provide two case examples of patients with RHD with sufficient language skills to express their choices, but cognitive deficits that affect their decision-making abilities. We use a clinical decision-making model adapted from Jonsen et al to discuss the cases. In both cases, the rehabilitation team strives to balance what they deem to be in the best interest of the patient while continuing to respect the patient's autonomy.

Purpose In today's digital world, text messaging is one of the most widely used ways that people stay connected. Although it is reported that people with aphasia experience difficulties with texting, little information is available about how they actually do text. This study reports texting behaviors, such as the number and type of messages sent and contacts individuals with aphasia have. The relationships between texting behaviors and aphasia severity, including writing impairments, and social connectedness are explored. Method Twenty participants were sampled from an ongoing randomized clinical trial investigating an electronic writing treatment for aphasia (Clinical Trials Identifier: NCT03773419). Participants provided consent for researchers to view and analyze texts sent and received over a 7-day period immediately prior to the assessment. Participants' text messages were recorded, transcribed verbatim, and coded. Results Over the 7-day period, the number of contacts with whom participants texted ranged from one to 18. The mean number of text messages exchanged was 40.3 ( SD = 48.24), with participants sending an average of 15.4 ( SD = 23.45) texts and receiving an average of 24.9 ( SD = 29.44) texts. Participants varied in the types of texts sent; some had a larger proportion of initiated texts, while others drafted more responses, either simple or elaborative in nature. There was no correlation between the total number of texting exchanges and the Western Aphasia Battery–Revised Aphasia Quotient ( r s = .13, p = . 29) or the Western Aphasia Battery–Revised Writing subtest ( r s = .05, p = .42). There was also no correlation between the total number of texting exchanges and scores on measures of social connectedness. Conclusions Texting behaviors of individuals with aphasia are widely variable. Demographics, severity of aphasia and writing, and social connectedness may not predict texting behaviors. Therefore, it is clinically important to explore the unique texting abilities and preferences of each individual to meet their communication and social participation goals. Supplemental Material https://doi.org/10.23641/asha.14669664