Translating stepped psychological care to aphasia rehabilitation

Abstract

Stroke rehabilitation needs more psychological services to address mood changes and depression after aphasia. An evidence-practice gap exists that can be minimised through implementation of stepped psychological care-an evidence-based framework offering multidisciplinary intervention after stroke. However, stepped psychological care has not been adapted for the communication disability associated with aphasia. Further, there is a lack of research exploring the perspectives of key stakeholders in managing depression after post-stroke aphasia. The overarching aim of this research was to describe the evidence-practice gap in managing mood changes and depression after post-stroke aphasia. Chapter one of this thesis comprises: an introduction, including a review of the literature, the aims of the thesis, and an overview of the methodology and the thesis structure. The thesis then reports on three research studies investigating the management of mood changes and depression after poststroke aphasia: 1) a systematic review of rehabilitation interventions to prevent and treat depression after post-stroke aphasia; 2) a description, from the perspective of stroke health professionals, of: a) current practice; and b) the identification of barriers and facilitators to implementing stepped psychological care to clinical practice; and 3) a description, from the perspective of people with aphasia, of: a) experiences of mood changes, depression and current practice; and b) preferences within a stepped psychological care approach. Study 1 systematically reviewed the research evidence for rehabilitation interventions to prevent and treat depression after post-stroke aphasia. It followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. A total of 45 studies were eligible for inclusion. It is not clear which interventions may prevent depression. A range of interventions that may enhance mood or treat mild depression after post-stroke aphasia were identified and described within the stepped psychological care framework. Study 2 described, from the perspectives of stroke health professionals: a) current practice for the management of depression after post-stroke aphasia; and b) the barriers and facilitators to implementing stepped psychological care for depression after post-stroke aphasia. Thirty-nine stroke health professionals participated in qualitative focus groups. Five focus groups within acute, rehabilitation and community settings were divided into two parts: 1) a discussion about current practice; and 2) information provision about the stepped psychological care framework, followed by a discussion of the barriers and facilitators to implementing this framework to clinical practice. Four core components of current practice were derived from an interpretive description analysis: 1)

How do speech and language therapists enact aphasia psychosocial support in Ireland? A cross‐sectional online survey informed by normalization process theory

“…The types of contextual integration barriers identified in our survey such as gaps in mental health service availability, communication access problems, and a lack of clarity on referral processes, mirrored those described in the UK (all aetiologies) and Australia (post‐stroke aphasia) despite differences in their health systems (Northcott et al., 2017; Sekhon et al., 2015). A need for leadership, resourcing, and support at the health organization level, was also highlighted by Baker and colleagues in Australia (Baker et al., 2021; Baker, 2018).…”

“…This included speech and language therapy, mental healthcare and opportunities for meaningful social participation. In responding to the informational, emotional and relational needs of persons living with aphasia, and facilitating access to other health and social services, including mental health, speech and language therapists (SLTs) play a key role in supporting psychosocial well‐being (Manning et al., 2019; Kagan and LeBlanc, 2002; Baker, 2018; Sekhon et al., 2015; Volkmer et al., 2023a). In recent years, an integrated model of psychological care, stepped care, has been developed and examined initially in the context of stroke (Kneebone, 2016) and then in post‐stroke aphasia (Baker, 2018).…”

“…In responding to the informational, emotional and relational needs of persons living with aphasia, and facilitating access to other health and social services, including mental health, speech and language therapists (SLTs) play a key role in supporting psychosocial well‐being (Manning et al., 2019; Kagan and LeBlanc, 2002; Baker, 2018; Sekhon et al., 2015; Volkmer et al., 2023a). In recent years, an integrated model of psychological care, stepped care, has been developed and examined initially in the context of stroke (Kneebone, 2016) and then in post‐stroke aphasia (Baker, 2018). Aphasia‐adapted stepped psychological care is a coordinated and interdisciplinary framework of support that is tailored to individual needs in terms of level of specialism and intensity (Baker, 2018; Baker et al., 2017, 2021).…”

“…In recent years, an integrated model of psychological care, stepped care, has been developed and examined initially in the context of stroke (Kneebone, 2016) and then in post‐stroke aphasia (Baker, 2018). Aphasia‐adapted stepped psychological care is a coordinated and interdisciplinary framework of support that is tailored to individual needs in terms of level of specialism and intensity (Baker, 2018; Baker et al., 2017, 2021). For example, levels 1–2 include routine screening, assessment, communication partner training, goal‐setting, narrative therapy, psychosocial support, information provision and monitoring.…”