Managing life in the first year after stroke: What do people with communication disorders want us to know?

How are our patients with post-stroke communication disorders really managing after discharge? What kinds of challenges are they facing? How can we better prepare them to adapt to these challenges after therapy is over? 

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Wray et al. interviewed 14 people with communication disorders after a stroke and 7 family members to learn about:

  1. how they adjusted to life after their strokes,

  2. what strategies they were using that were helpful, and

  3. what needs they still had in relation to the adjustment process.

All of the participants had their strokes less than a year before the interview.

The main findings are that people who survived strokes and their families are already doing a lot of work on their own to figure out how to adapt to life with a communication disorder. They often also feel lost and sometimes abandoned after discharge. This means we have the opportunity to use our therapy time to support families, ease the transition from therapy, and improve self-management after therapy. So what could this look like? 

  • Encouraging patients to test out different communication environments while they are still in therapy. You can help guide them in the “trial-and-error” process that they will be doing anyway. And by doing it under your support, patients may find it easier to keep testing their participation boundaries after discharge.

  • Identifying patients’ goals and the strategies they already have in place. Then, optimizing those strategies. The strategies people developed themselves were varied and personal such as choosing to laugh rather than feel embarrassed, wearing clothing that was likely to generate spontaneous conversation, or participating in certain routine activities with familiar people. 

  • Involving caregivers in therapy to the extent they are interested. The tension between independence and support was one of the themes that came up across participants. Let’s train caregivers to be confident in how to provide communication support while also helping families figure out how to balance independence and support in their daily lives.

We realize that none of this information is new. But, the interviews provide a beautiful portrait of what matters to people with communication disorders after stroke. The more we keep in mind what matters to our patients, the more meaningful and effective our therapy will be.

 

Wray, F., Clarke, D., & Forster, A. (2019). How do stroke survivors with communication difficulties manage life after stroke in the first year? A qualitative study. International Journal of Language & Communication Disorders. doi:10.1111/1460-6984.12487

Sparking conversation in aphasia groups: tips to keep them talking!

“This should be easy,” the graduate student thinks as they prepare to facilitate the aphasia conversation group. After all, they’ve been watching their clinical supervisor run the group for the past few weeks, and besides, it’s just a group of adults having a conversation. How hard could it be? The truth is, likely harder than it looks.

The good news is that it is the behaviors of the group facilitators that can directly contribute to engagement in aphasia conversation groups. The bad news is, group facilitators can also exhibit behaviors that cause people to disengage from conversation.  

In this study, behaviors of graduate student aphasia group facilitators were analyzed to determine which behaviors contributed to or detracted from a group’s success.  Results can be categorized into three themes:

  • The power of turns

  • Purpose and value system

  • Managing competing needs

Check out Table 2 for some great examples that fall under each of these themes!

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Among others, three main trends were noted:

First, the conversational turns taken by the facilitators influenced those that came after them (both positively and negatively).

TIP: Try moving the conversation forward by using open-ended questions and be sure to acknowledge communication turns by group members!

Secondly, the behaviors of the facilitators served to unintentionally undermine participants (causing disengagement) or, successfully minimize any existing power differential.

TIP: Create a group culture of support and encouragement early on (“foster group solidarity”)! This may be the only time your PWAs truly feel free to express themselves without judgment.

Finally, there was typically a greater focus on participants with more severe deficits, when ideally an equivalent amount of attention should be paid across all members of the group to ensure engagement across the board.

TIP: Be prepared in advance! This could include preparing multimodal communication strategies that can be used to support group members of all ability levels, so that focus isn’t spent here during the group.

Turns out it’s not quite as easy as it looks. In fact, facilitating a successful aphasia conversation group can actually be quite complex. Graduate students and novice clinicians alike will need formal training outlining the “do’s and don’ts” of managing a successful aphasia group.

Lee, J., Azios, J. (2019) Facilitator Behaviors Leading to Engagement and Disengagement in Aphasia Conversation Groups. American Journal of Speech Language Pathology. doi.org/10.1044/2019_AJSLP-CAC48-18-0220