A comparison of client and therapist goals for people with aphasia: A qualitative exploratory study

Rohde, Alexia; Townley-O'Neill, Kerry; Trendall, Karine; Worrall, Linda; Cornwell, Petrea

doi:10.1080/02687038.2012.706799

Cited by 33 publications

(22 citation statements)

References 47 publications

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“…This desire for additional information in the acute phase correlates with the premise of Laver et al (2010) (Leach, Cornwell, Fleming, & Haines, 2010), whereas the goals of people with aphasia are spread across the spectrum of the ICF, with most goals linked to activities and participation . This finding of discrepancy in perspectives is supported by other research from Australia and Scotland, which suggests that while commonality exists, the views of people with aphasia do not necessarily coincide with those of aphasia practitioners in relation to service provision (Law et al, 2010;Rohde, Townley-O'Neill, Trendall, Worrall, & Cornwell, 2012).…”

Section: What Do People With Aphasia Want In the Acute Hospital Setting?supporting

confidence: 49%

“Communication is taking a back seat”: An exploration of aphasia management in acute hospital settings

Foster¹

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While in the past the focus of speech pathologists working in the acute hospital setting has been service provision to people with communication disorders and their families, their primary role is now in dysphagia. In the limited literature regarding aphasia management in acute hospital settings, there is a lack of consistency regarding the type and amount of intervention being provided to people with aphasia; however, there is consensus that current practice is inconsistent with bestpractice recommendations. Given that aphasia intervention has been identified as being central to improved communicative outcomes, an increased capacity to effectively communicate healthcare needs, a decrease in hospital negative events, and an increased sense of satisfaction for people with aphasia, this is of concern. Little is known about the reasons underlying this evidence-practice gap.The overall aim of this thesis was to provide an understanding of current acute aphasia management practice and the factors that influence it. Specifically, the research aimed to: (a) provide an in-depth understanding of the current aphasia management pathway in the acute hospital setting; (b) explore acute speech-language pathologists' conceptualisation, experiences, and perceptions of post-stroke aphasia management, and provide a greater understanding of the factors that influence their practice; and, (c) understand the factors that influence acute aphasia management from the perspectives of speech pathologists, people with aphasia, and their close others, through a cultural lens.In order to address the research aims, the empirical aspects of this research were conducted in two Phases. Phase One, an interpretative phenomenological investigation, aimed to provide a deep understanding of aphasia management from the perspective of acute speech pathologists. Semistructured, in-depth interviews were undertaken with 15 Australian speech pathologists working with people with aphasia (one of which was later excluded resulting in a total n=14). Interviews were transcribed verbatim, and data were analysed using a thematic analysis. Key themes identified included: role perception; competing priorities; the de-prioritisation of aphasia; and, the sense of disempowerment experienced by speech pathologists as a result of their relationship with evidencebased practice for acute aphasia management. In addition, a qualitative content analysis was undertaken to describe the current aphasia management pathway. Grounded within the guiding construct, First contact with the profession, the findings represented the significant diversity in the ii pathways of care for people with aphasia and their families in the acute hospital setting. Overall, analysis revealed the complex, diverse, and multi-faceted nature of the phenomenon.Phase Two was designed based on the findings of Phase One. It examined the culture of acute aphasia management by speech pathologists in depth, through the use of focused ethnography in a single acute stroke unit. Three participant triads...

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Section: What Do People With Aphasia Want In the Acute Hospital Setting?supporting

confidence: 49%

“Communication is taking a back seat”: An exploration of aphasia management in acute hospital settings

Foster¹

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“…The goals of their patients with aphasia and family members were then compared to the goals of the speech-language pathologists, and tensions or differences between goals were identifi ed. Rohde et al 8 also compared therapist and client treatment goals to explore the similarities and differences in selected cases. In a study by Brown et al, 9 clinicians were interviewed as to what it means to live successfully with aphasia.…”

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confidence: 99%

Clinician Perspectives of an Intensive Comprehensive Aphasia Program

Babbitt

2013

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Background: Intensive comprehensive aphasia programs (ICAPs) have increased in number in recent years in the United States and abroad. Objective: To describe the experiences of clinicians working in an ICAP. Methods: A phenomenological approach was taken. Seven clinicians from 3 ICAPs were interviewed in person or on the phone. Their interviews were transcribed and coded for themes relating to their experiences. Results: Clinicians described 3 major themes. The fi rst theme related to the intensity component of the ICAP that allowed clinicians to provide in-depth treatment and gave them a different perspective with regard to providing treatment and the potential impact on the person with aphasia. The second theme of rewards for the clinicians included learning and support, seeing progress, and developing relationships with their clients and family members. Third, challenges were noted, including the time involved in learning new therapy techniques, patient characteristics such as chronicity of the aphasia, and the diffi culty of returning to work in typical clinical settings after having experienced an ICAP. Conclusions: Although there is a potential for bias with the small sample size, this pilot study gives insight into the clinician perspective of what makes working in an ICAP both worthwhile and challenging.

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“…Rohde et al also compared clinician and client treatment goals to explore the similarities and differences. 19 Through interviews, they found that clinicians focused more on impairment-based goals.…”

Section: Resultsmentioning

confidence: 99%

“…Other research has found that persons with aphasia have goals that align with the ICF. [18][19][20] An ICAP is structured to provide comprehensive care that addresses functional goals related to activity and participation. [18][19][20] Another model focuses specifically on aspects that contribute to living successfully with aphasia.…”

Section: Service Delivery For Aphasia Treatment In the United Statesmentioning

confidence: 99%

Outcomes of an Intensive Comprehensive Aphasia Program

Babbitt¹

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Intensive comprehensive aphasia programs (ICAP) have increased over the last decade in the US and abroad. The increase in the number of clinical programs has outpaced the research that is necessary to establish the efficacy and effectiveness of these specialized treatment programs. The ICAP model incorporates principles from neuroplasticity, that is, intensive treatment provides a platform for the massed practice and repetition required to change the brain. It also incorporates comprehensive treatment that addresses not only impairment-based language deficits but also personal goals related to participation.Programs which offer intensive comprehensive treatment can provide up to 120 hours of treatment over several weeks (e.g., six hours a day, five days a week for four weeks). ICAPs are different from other types of aphasia services which generally provide two to three hours of therapy a week. This thesis examined one ICAP in depth to describe the structure, process, and outcomes using Donabedian's model of health care evaluation. This thesis also described the experiences of the ICAP from the perspectives of the primary stakeholders.Study One (Chapter Two) was a retrospective quantitative study using behavioral measures from an existing database that documented the outcomes of participants with aphasia. It found that first-time participants improved significantly in impairment-and participationbased measures, demonstrating moderate to large effect sizes. Participant characteristics were examined to determine if improvements were related to age, time post-onset, or type and severity of aphasia. None of these factors had an impact on the amount of change measured. Given that some participants did not make significant gains on a primary outcome measure, the Western Aphasia Battery -Revised Aphasia Quotient (WAB-R AQ), Study Two (Chapter Three) examined whether participant characteristics at baseline could predict who would make significant gains on the WAB-R AQ. Age and months post-onset were significantly different between the responder and the non-responder groups. Those who showed most gains on average were younger and a longer time post-onset. A logistic regression was performed and results indicated that only age (younger participants) predicted who would respond to treatment. Time post-onset, type and severity of aphasia, naming, non-verbal cognition, and communication confidence did not show significance in a predictive model. Studies Three and Four were qualitative studies involving interviews with therapists (Chapter Four) and people with aphasia and their families (Chapter Five). Both studies were 3 conducted using a phenomenological approach which allowed for the interviewees to describe their experiences in a semi-structured interview. The clinicians described the intensity of the therapy, the rewards, and challenges of the program. Therapists also considered that the ICAP model of service delivery had several positive benefits for them, but acknowledged that the intensity of therapy was challe...

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A comparison of client and therapist goals for people with aphasia: A qualitative exploratory study

Cited by 33 publications

References 47 publications

“Communication is taking a back seat”: An exploration of aphasia management in acute hospital settings

“Communication is taking a back seat”: An exploration of aphasia management in acute hospital settings

Clinician Perspectives of an Intensive Comprehensive Aphasia Program

Outcomes of an Intensive Comprehensive Aphasia Program

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