Displays and claims of understanding in conversation by people with aphasia

Background: There is scope for additional research into the specific linguistic and sequential structures used in speech and language therapist (SLT)-led therapeutic conversations with people with aphasia (PWA). Whilst there is some evidence that SLTs use different conversational strategies than the partners of PWA, research to date has focussed mainly on measuring the effects of conversation-based therapies—not on analysing therapeutic conversations taking place between SLTs and PWA.

Aims: This paper presents an analysis of the use of oh-prefacing by some PWA during therapeutic supported conversations with SLTs.

Methods & Procedures: Normally occurring therapeutic conversations between SLTs and PWA after stroke were qualitatively analysed using Conversation Analysis. Interactions with five PWA were video-recorded, involving three different specialist stroke SLTs.

Outcomes & Results: The analysis revealed a difference in the way some PWA use turns that display understanding (e.g., oh right) versus those that continue the conversation, merely claiming understanding (e.g., right). This use of oh-prefacing is similar to that described in the literature on typical conversations. In our data, SLTs are shown to treat oh-prefaced turns differently from non-oh-prefaced turns, by pursuing the topic in the latter, and progressing on to a new topic in the former.

Conclusions: At least some PWA use oh-prefacing in the same way as non-language-impaired adults to display understanding of information versus merely claiming to understand. The SLTs in our data are shown to treat non-oh-prefaced turns as mere claims of understanding by providing the PWA with additional information, using supported conversation techniques, and pursuing additional same-topic talk, whereas oh-prefaced turns are treated as displays of understanding by being confirmed, and leading to changes of topic. This study is a first step in providing SLTs with a clearer understanding of the ways in which they are assessing the understanding of PWA, which may in turn help them better support non-therapy staff.     

Decision-making capacity in aphasia: SLT’s contribution in England

Background: Individuals’ right to be involved with decisions regarding their health and social care is the cornerstone for modern patient-centred care. Decision-making is a complex process that involves multiple cognitive and linguistic abilities. These are often challenging for people with aphasia (PWA). The Mental Capacity Act (MCA) Code of Practice (2007) recommends that speech and language therapists (SLTs) support capacity assessments for individuals with communication problems, such as PWA. To date, little is known regarding SLTs’ involvement in the UK for supporting decision-making and capacity assessment for PWA.

Aims: This research provides data to document when, how, and the extent to which SLTs are being used in capacity assessment for PWA in England. We also determined SLTs’ training and resource needs in capacity assessments, and their role in inter-professional training.

Methods & Procedures: 56 SLTs working with PWA from a wide range of clinical settings in England were recruited; they completed a secure questionnaire using the online survey tool Survey Monkey. The questionnaire collected information in the following areas: knowledge and awareness of the MCA; current involvement of SLTs in capacity assessments and decision-making; inter-professional understanding of SLTs roles in capacity assessments; and training needs of SLTs.

Outcomes & Results: The SLTs who participated in this survey indicated that they were not regularly involved to support capacity assessment for PWA. Moreover, they also reported that other professionals on the care team did not fully recognise or utilise their skills in supporting capacity assessment for PWA. Moreover, SLTs were not solicited to train professionals regarding communication difficulties in aphasia and its impact on capacity assessments. SLTs wanted profession-specific training to fulfil the role of supporting PWA in capacity assessments more effectively and reliably.

Conclusions: Healthcare professionals have an ethical duty to ensure that judgements of capacity are unbiased and accurate. SLTs have an important contribution to make but their skills and knowledge are not fully recognised or utilised. These findings highlight an important need to raise the profile of SLTs’ skills and expertise amongst professionals through education and/or inter-professional communications. This would enable SLTs to be regularly and effectively utilised in capacity assessments and decision-making for PWA.     

Top 10 research priorities relating to aphasia following stroke

Background: Pollock et al. (2014, Top 10 research priorities relating to life after stroke – Consensus from stroke survivors, caregivers, and health professionals, International Journal of Stroke, 9, 313–320) applied the James Lind Alliance methodology to derive the top 10 priorities for research relating to life after stroke. Many of the initial Treatment Uncertainties related to aphasia.

Aim: The current study uses these Treatment Uncertainties to derive the shared top 10 research priorities of people with aphasia (PWA), their carers and speech and language therapists (SLTs)

Methods & Procedures: Treatment Uncertainties relating to aphasia were identified from the 226 unique unanswered questions relating to life after stroke generated by Pollock et al. Using these 34 Treatment Uncertainties relating to aphasia, the last two stages of the JLA method (survey followed by consensus meeting) were carried out with PWA, their carers and SLTs. Participants ranked the top 10 priorities from the 34 given in the survey. Communication ramps were used with the PWA. The 16 highest ranked uncertainties were presented at the consensus meeting, where the final shared top 10 priorities were agreed, merging some statements and refining the wording in others.

Outcomes & Results: Participants included PWA with severely affected communication. The methodology produced consensus on a range of priorities including the best treatments and most effective service delivery, management of psychosocial issues, helping volunteers and carers, and research into treating severe forms of aphasia.

Conclusions: PWA are able to participate fully in research priority setting. These shared research priorities represent an excellent base for the development of clinically important research in aphasia, addressing issues which are of greatest importance to key stakeholders.     

Reliability and validity of the Korean version of the Communicative Activity Log (CAL)

Background: The ultimate goal of aphasia rehabilitation is to enhance communicative activities in people with aphasia (PWA) in order to increase their daily activities and social participation. The amount of communication and its quality largely vary according to language and cultural differences.

Aims: This study was designed to develop a Korean version of the Communicative Activity Log (CAL), and to verify its reliability and validity for PWA after stroke.

Methods & Procedures: A Korean version of the CAL (K-CAL) was developed through a cross-cultural adaptation process consisting of the following six steps: translation, reconciliation, back-translation, cognitive debriefing, feedback, and final reconciliation. Internal consistency, test–retest reliability, concurrent validity, and construct validity were used to verify its reliability and validity for PWA after stroke. A total of 50 PWA completed the K-CAL with the help of caregivers. All participants completed the K-CAL again 1 week later to measure test–retest reliability. Communication score on the Korean version of Stroke and Aphasia Quality of Life Scale-39 (K-SAQOL-39) was used to demonstrate concurrent validity. Severity of aphasia assessed by Korean version of the Frenchay Aphasia Screening Test (K-FAST) was used to determine construct validity of the K-CAL.

Outcomes & Results: Among the 50 PWA, 20 had cerebral infarction and 30 had brain haemorrhage. Mean duration after onset of aphasia was 47.96 ± 62.01 months. Mean communication scores on the K-SAQOL-39 and K-FAST were 2.63 ± 0.97 and 12.69 ± 9.78 points, respectively. K-CAL demonstrated high internal consistency (Cronbach’s α = .987) and test–retest reliability (r = .915, p < .001). Correlation between K-CAL and communication score on the K-SAQOL-39 revealed a high concurrent validity (r = .915, p < .001). Correlation between K-CAL and K-FAST also showed a high construct validity (r = .882, p < .001).

Conclusions: A K-CAL was successfully developed through a cross-cultural adaptation process. Our results suggested that K-CAL had high reliability and validity for assessing communicative behaviour of Korean PWA after stroke.     

Sensitivity to change and responsiveness of the Stroke and Aphasia Quality-of-Life Scale (SAQOL) in a Singapore stroke population

Background: The health-related quality of life (HRQoL) of people with aphasia (PWA) in Singapore is unknown.

Aims: To compare outcomes between stroke survivors with and without aphasia in Singapore and examine the sensitivity and responsiveness to change of the Stroke and Aphasia QOL Scale (SAQOL-39g) and its Singapore (Mandarin) variant, SAQOL-CSg.

Methods & Procedures: A longitudinal cohort study was conducted with stroke survivors with and without aphasia. Participants underwent a series of questionnaires at 3 and 12 months post-stroke including SAQOL-39g/SAQOL-CSg, Barthel Index, Modified Rankin Scale (MRS), Mini Mental State Examination, Frontal Assessment Battery, Center for Epidemiologic Studies Depression Scale and the EQ-5D. The following data analyses were conducted: comparison of stroke outcomes between participants with and without aphasia, computation of floor and ceiling effects, calculation of effect sizes (ESs) to determine sensitivity to change and estimation of minimally important differences (MIDs) for examining responsiveness.

Outcomes & Results: A total of 78 participants (29.5% female, 29.5% PWA, mean age 64.1 years) completed all the assessments on both occasions. At 12 months post-stroke, PWA had higher levels of disability on the MRS (Mann–Whitney U = 294.5, p < 0.01) and reported significantly lower quality of life on the SAQOL-39g/SAQOL-CSg (U = 349, p < 0.01) and the EQ-5D index (U = 447, p < 0.05). In terms of sensitivity to change, the SAQOL-39g/SAQOL- 35CSg showed a small degree of improvement for the entire sample (ES, r = 0.22) but change was only significant for participants without aphasia. MID estimates for improvement were 0.21 on the SAQOL-39g/SAQOL-CSg and 0.17 on the EQ-5D index.

Conclusions: PWA reported poorer HRQoL even when physical function was comparable. SAQOL-39g/SAQOL-CSg was found to have adequate sensitivity to change (i.e., reflect at least small change) up to 12 months post-stroke. MID estimates of the SAQOL-39g/SAQOL-CSg may assist in the interpretation of changes in scores in the clinical setting.     

Role of cognitive control in language deficits in different types of aphasia

ABSTRACT

Background: Although studies show that different facets of cognitive control are impaired in persons with aphasia (PWA), the question how they impact language abilities in different types of aphasia remains open.

Aims: Following the hypothesis that diminished attention contributes to language impairments in aphasia, we predicted that both fluent and non-fluent PWA would perform worse than neurologically intact individuals on verbal and non-verbal cognitive control tasks. Also, testing the view that linguistic disturbances in fluent and non-fluent PWA dissociate, we predicted differential relationships in performance on cognitive control tasks and language impairment.

Methods & Procedures: Fluent PWA (N = 17) and non-fluent PWA (N = 14) were compared to unimpaired speakers (N = 21) on the non-verbal Flanker task tapping domain-general cognitive control, and Stroop task measuring verbal cognitive control, as well as subtests from the Russian version of the Birmingham Cognitive Screen, namely the Auditory Control task tapping verbal cognitive control and the Rule Finding task measuring domain-general cognitive control. All PWA completed picture naming and language comprehension tasks.

Outcomes & Results: All PWA were more impaired on the Stroop and Auditory Control tasks, with no impairment on the non-verbal Flanker task compared to the controls. Non-fluent PWA also performed significantly worse on the Rule Finding that requires forming and updating non-verbal relational representations. Differences between aphasia groups were found on the Auditory Control task only, where non-fluent PWA were more vulnerable to task demands. Correlation analyses found that verbal and non-verbal cognitive control performance was correlated for the non-fluent group, whereas only correlations between verbal cognitive control tasks were significant for the fluent group. For all PWA, non-verbal cognitive control indexed by Flanker interference scores was related to language comprehension, whereas verbal cognitive control was related to picture naming. However, non-verbal relational reasoning as indexed by the Rule Finding task was significantly related to language comprehension in the non-fluent group only.

Conclusions: All PWA had diminished verbal cognitive control. Non-fluent PWA demonstrated higher vulnerability to domain-general cognitive control deficits compared to fluent PWA. Performance on verbal and non-verbal cognitive control tasks significantly overlapped in the non-fluent group only. Both groups recruited non-verbal cognitive control during language comprehension and verbal cognitive control during picture naming. Only non-fluent PWA relied on domain-general relational reasoning during language comprehension. These findings reinforce the importance of cognitive assessment in aphasia.     

Profession-specific training on decision-making and capacity assessment in aphasia for speech-language therapy students

ABSTRACT

Background: Speech and Language Therapists (SLTs) play a vital role in supporting people with aphasia to communicate. Recent studies have shown that despite SLTs’ expertise, skills, and knowledge to support people with aphasias’ communication needs; they are not regularly involved in the decision-making and capacity (DMC) assessments for people with aphasia. Literature suggests three key contributors to this under-involvement: (1) SLTs do not feel they understand their role in a DMC assessment, (2) they do not feel there is enough profession-specific training, and (3) they feel members of the multidisciplinary team do not fully understand their role and responsibilities to involve them in the process.

Aims: This research reports the development of a profession-specific DMC training programme for SLT trainees, and its implementation to document change in their confidence, knowledge and understanding of the DMC process in people with aphasia.

Methods & Procedures: Thirty-nine SLT students attended a two-hour DMC training session conducted in three phases: pre-training questionnaire, the training programme, and the post-training questionnaire. Topics in the training programme included: the knowledge and tenets of the Mental Capacity Act (MCA); DMC for people with aphasia, focusing specifically on the barriers faced by people with aphasia and professionals; the SLTs’ role within a multidisciplinary team regarding DMC assessments; and resources available for facilitating DMC assessments. The change in participants score from pre- to post-training questionnaire was taken as a measure of efficacy of the training programme.

Outcomes & Results: Following training there was a significant increase in the confidence levels of SLT students in terms of ability to complete capacity assessments and train others in their role within a capacity assessment. Participants also had a better understanding of the MCA and an increased knowledge of resources available to support people with aphasia in these assessments. These results demonstrate a crucial need for profession-specific training, which has implications for inter-professional education.

Conclusions: The findings highlight the effectiveness of a short training session in increasing SLT trainees’ knowledge and confidence in DMC for aphasia, and improving their understanding of SLTs’ role and responsibilities. It is anticipated that this type of training will place SLTs in a better position for future clinical practice, reducing the risks currently present not only to patients, but also to staff themselves. We propose that similar training programmes should become mandatory for SLT trainees as part of their clinical training.     

From patients to teachers: the perspectives of trainers with aphasia in a UK Conversation Partner Scheme

Background: The importance of addressing the long-term needs of stroke survivors is emphasised in recent strategy and guideline documents, with community re-engagement and participation seen as particularly important. In recent years there has been a growing interest in stroke survivors with aphasia becoming involved as trainers in Conversation Partner Schemes (CPSs). There is little research into the experiences of people with aphasia being involved in or developing this “expert” role.

Aims: This study explored the experiences of aphasia trainers in a UK CPS in order to develop an understanding of how “aphasia expertise” was understood and whether participation addressed long-term issues implicit in living with aphasia.

Methods & Procedure: A qualitative approach was adopted involving semi-structured interviews with eight Conversation Partner Trainers, four males and four females, with a range of mild to severe aphasia. All except one trainer was of working age when they had their stroke. Interviews were transcribed and subject to thematic analysis.

Outcomes & Results: Three themes were produced through thematic analysis: Informal communication practice, Social re-engagement, and Interpersonal connections. Participants spoke about being motivated to improve their own and others’ communication skills, gaining a sense of purpose, achievement, and self-worth through their participation as a trainer. Deploying their expertise was seen as a way of “giving back”, addressing the effects of social isolation, and reconnecting to their previous self.

Conclusions: Becoming involved as a trainer in a CPS gave these participants an opportunity to feel they had a meaningful purpose. This has wider implications for trainers’ currently living with aphasia in regard to their sense of reclaiming, maintaining, and constructing their identity, and for future services for people with aphasia.     

Age and aphasia: a review of presence,type, recovery and clinical outcomes

Background: Each year approximately 100,000 stroke survivors are diagnosed with aphasia. Although stroke is associated with age, the relationship between age and aphasia is less clear.

Objectives: To complete a review of the literature to examine the relationship between age and: (a) presence or likelihood of aphasia after stroke, (b) aphasia type, (c) aphasia recovery patterns, and (d) aphasia clinical outcomes.

Data Sources: Articles were identified by a comprehensive search of “OneSearch,” PubMed, and individual journals: Aphasiology, Stroke and the Journal of Stroke and Cerebrovascular Diseases.

Study Selection: Inclusion criteria included: age and incidence of aphasia, likelihood of aphasia, aphasia recovery, and aphasia clinical outcome.

Data Extraction: Independent searches were completed by the authors. Each author independently assessed the full text of reports meeting inclusion criteria. Differences regarding study eligibility and need to proceed with data extraction were resolved by consensus.

Results: 1617 articles were identified during the initial search. Forty studies including 14,795 study participants were included in the review. The review generally demonstrated that: (a) stroke patients with aphasia are typically older than stroke with patients without aphasia and (b) aphasia type and age are associated as younger patients with aphasia are more likely to exhibit non-fluent or Broca’s type of aphasia. In contrast, studies examining aphasia recovery and aphasia clinical outcomes did not demonstrate a positive relationship between age and recovery or clinical outcomes.

Conclusions: Stroke is a condition of the elderly. However, age appears to only influence likelihood of aphasia and aphasia type.     

A pilot study examining the impact of aphasia camp participation on quality of life for people with aphasia

Objectives: For people with aphasia (PWA), attending an aphasia camp can result in increased confidence, social relationships, and greater participation in activities. Although much anecdotal evidence of the benefits of aphasia camps exists, systematic studies on outcomes from aphasia camp participation are lacking. The purpose of this pilot study was to examine the effect of attending the Alberta Aphasia Camp on quality of life for people with aphasia.

Methods: Nine PWA who attended the inaugural Alberta Aphasia Camp completed the Assessment for Living with Aphasia-2 before and after camp. A subset of their caregivers (n = 4) completed the Communicative Effectiveness Index, a rating scale evaluating their PWA’s communication, and were interviewed about their experiences and perceptions of camp participation.

Results: Significant changes were observed on total scores on the ALA-2, and in particular the Personal and Participation subtests. These improvements were corroborated by themes identified from interviews with caregivers.

Discussion: This study provides preliminary evidence that aphasia camp participation can result in improved outcomes for PWA across a range of domains. Aphasia camps provide a unique intervention for PWA and caregivers to experience therapeutic and recreational activities, respite and create social connections in a supported communication environment. Future studies should recruit a greater number of participants, employ control groups, and examine outcomes for caregivers.     

Forum

Background: Assessment of communication for people with communication problems following stroke should be socially valid; it should encompass activities relevant to the speaker's environment and the opinion of people within that environment. Potentially relevant opinions include those of the person with the communication problem and their close carers/companions. When compared to the evaluations of healthcare providers (here speech and language therapists) there may be differences between the professional and “non-professional” opinions, and also between the carers and service users. Differences may be due to levels of familiarity with the speaker, experience of their communication in different situations, differing perceptions of the impact of the problem, or potentially the ability of people with communication problems to engage with the assessment materials.

Aims: The study aimed to compare speakers', carers', and speech and language therapists' perspectives of stroke survivors' functional communication; to examine the effect of severity of aphasia on levels of agreement.

Methods &; Procedures: Participants were (a) 98 people who had communication problems (aphasia and/or dysarthria) following a stroke; (b) 56 of their carers; (c) speech and language therapists who were specialists in this field. Stroke survivors and carers rated communication on the parallel COAST and Carer COAST scales; SLTs rated a 10-minute videoed sample of conversation between the person with communication problems and an unfamiliar facilitative partner, using the aphasia/dysarthria activity scale of the Therapy Outcome Measure (TOM). Analysis included correlation, percent total and close agreement, and exploration of individual scale items.

Outcomes &; Results: Good agreement was shown between speakers and carers using the COAST and Carer COAST. Moderate agreement was shown between both these and the SLT TOM ratings. Severity affected level of agreement to some extent; there was a moderate negative correlation between stroke survivor–carer difference in ratings and the stroke survivor's score on the Frenchay Aphasia Screening Test.

Conclusions: Similarity in the stroke survivor and carer views was revealed by COAST and Carer COAST. However, both may differ from the opinion of the SLT. It is possible for assessment of functional communication to capture different perspectives that are each important and should not be expected to be identical. Therapists should focus on exploring the reasons for the different perceptions and working through the implications for their intervention.     

Preliminary psychometric analyses of two assessment measures quantifying communicative and social activities: the COMACT and SOCACT

Background: There is a need for clinical tools that capture the real-life impact of aphasia. This study reports on a psychometric investigation of two self-report tools: the Communicative Activities Checklist and the Social Activities Checklist (COMACT; SOCACT), which assess the dimensions of communication activity and social participation in aphasia.

Aims: (1) To investigate internal consistency (IC), convergent, and known validity of the COMACT and SOCACT and (2) to investigate the impact of personal contextual factors: gender, age, years in education, linguistic ability, and emotional health on communicative and social activities.

Methods & Procedures: Thirty participants with mild-moderate chronic aphasia (people with aphasia (PWA); mean age 71 years, mean time post onset 41 months, mean years in education 10.77) and 75 control neurologically healthy participants (NHP; mean age 74 years, mean years in education 13.18) completed the COMACT and SOCACT reporting how frequently they engaged in particular activities. The COMACT has 45 communication activities with subscales of Talking, Listening, Reading, and Writing. The SOCACT contains 20 social activities with subscales of Leisure, Informal, and Formal. IC was examined using Cronbach’s alpha (α). Correlations with published assessments, Western Aphasia Battery (WAB) and Communication Activities of Daily Living were computed for COMACT only. Multiple regression models were examined for differences in participant (PWA vs. NHP) performance on COMACT and SOCACT.

Outcomes & Results: Total COMACT IC was 0.83 (PWA) and 0.84 (NHP). Following deletion of four items, to further improve subscale ICs, total COMACT IC was 0.83 (PWA) and 0.86 (NHP). COMACT total score and WAB AQ were moderately correlated (r = 0.55). Total SOCACT IC was 0.58 (PWA) and 0.63 (NHP). Following single item deletion, total IC was 0.65 (PWA) and 0.64 (NHP). Statistical analysis revealed PWA, in comparison to NHP, participated in significantly fewer communication and social activities. Personal contextual factors impacted both groups differently; particular aspects were associated with communication activity (age and language severity) and social activity (age only). For NHP, ageing, emotional health and years in education were significant predictors of social and communication activity.

Conclusions: This study finds the COMACT to be a reliable, valid measure of communication activity. The SOCACT had “questionable” IC and requires further psychometric investigation. Both tools demonstrate known group validity. Relationships between impairment-level and personal contextual factors for communication activity and social participation are highlighted.     

What matters in semantic feature processing for persons with stroke-aphasia: Evidence from an auditory concept–feature verification task

Background: The relationship between object concept domains (living vs. nonliving) and their underlying feature structures is a frequent area of investigation regarding semantic processing in healthy individuals and some individuals with neuropsychological impairment resulting from herpes simplex encephalitis, semantic dementia, and Alzheimer’s disease. However, this relationship has been less well investigated in persons with stroke-aphasia (PWA), even though many treatments for anomia following stroke are predicated on the use of semantic feature cues.

Aims: As part of a larger investigation into the influence of semantic feature processing on naming for PWA, this study examined the ability of PWA to confirm the relations between object concepts and associated semantic features.

Methods & Procedures: Fifteen native English-speaking, right-handed individuals with post-stroke-aphasia responded yes or no via button press to feature verification questions designed to probe the relationships between concept domain and feature type and distinctiveness.

Outcomes & Results: PWA were more accurate and quicker to confirm concept–feature relationships when features contained function/action, rather than visual–perceptual information about concepts and when features were distinctive to concepts rather than shared. The truthfulness (i.e., veracity) of concept–feature pairings was demonstrated to differentially affect living versus nonliving concepts. Within domain, only nonliving concepts were verified more accurately and more quickly when pairings were true (rather than false). Between domains, true nonliving concept–feature pairings were more accurately and more quickly verified than true living concept–feature pairings. Also with respect to veracity, correlations were observed between aphasia severity and accuracy and speed of response to false concept–feature pairings.

Conclusions: Findings have implications for the way in which semantic processing is probed with PWA, as well as providing preliminary information regarding responsivity of PWA to differing types of semantic information for living versus nonliving concepts. The fact that PWA demonstrated disproportionate difficulty responding to certain types of semantic information also suggests preliminary implications for the utility of different types of semantic cues in semantically based treatments for word retrieval impairment.     

Language and iconic gesture use in procedural discourse by speakers with aphasia

Background: Conveying instructions is an everyday use of language, and gestures are likely to be a key feature of this. Although co-speech iconic gestures are tightly integrated with language, and people with aphasia (PWA) produce procedural discourses impaired at a linguistic level, no previous studies have investigated how PWA use co-speech iconic gestures in these contexts.

Aims: This study investigated how PWA communicated meaning using gesture and language in procedural discourses, compared with neurologically healthy people (NHP). We aimed to identify the relative relationship of gesture and speech, in the context of impaired language, both overall and in individual events.

Methods & Procedures: Twenty-nine PWA and 29 NHP produced two procedural discourses. The structure and semantic content of language of the whole discourses were analysed through predicate argument structure and spatial motor terms, and gestures were analysed for frequency and semantic form. Gesture and language were analysed in two key events, to determine the relative information presented in each modality.

Outcomes & Results: PWA and NHP used similar frequencies and forms of gestures, although PWA used syntactically simpler language and fewer spatial words. This meant, overall, relatively more information was present in PWA gesture. This finding was also reflected in the key events, where PWA used gestures conveying rich semantic information alongside semantically impoverished language more often than NHP.

Conclusions: PWA gestures, containing semantic information omitted from the concurrent speech, may help listeners with meaning when language is impaired. This finding indicates gesture should be included in clinical assessments of meaning-making.     

Validation of the Italian version of the American Speech-Language and Hearing Association—Functional Assessment of Communication Skills for adults (I-ASHA-FACS)

Background: Impairment of communicative-linguistic and cognitive functions is common after stroke and traumatic brain injury (TBI). While assessment of language function is usually performed in clinical practice, standardised assessment of pragmatic, functional, and communicative competences is less common, even though suggested by many recent national and international guidelines. The “American Speech-Language and Hearing Association—Functional Assessment of Communication Skills for adults” (ASHA-FACS) is a measure of communication disability that investigates functional communication. It has been translated and adapted into Italian in 2001, but psychometric properties of Italian version of ASHA-FACS (I-ASHA-FACS) have not yet been investigated.

Aims: To investigate psychometric properties of the I-ASHA-FACS scale and provide normative data.

Methods & Procedures: Participants included 100 healthy adult persons without neurological disorders nor communicative-cognitive deficits and 80 post-acute outpatients with aphasia following stroke (n = 60) or TBI (n = 20). Mini Mental State Examination (MMSE) was used to exclude control participants with cognitive decline (MMSE > 24). I-ASHA-FACS was completed for all participants. All patients were also assessed with Functional Independent Measure (FIM) and either Aachener Aphasie Test (AAT) for persons with aphasia due to stroke or Levels of Cognitive Functions scale (LCF) for TBI persons. I-ASHA-FACS internal consistency, inter- and intra-rater reliability and construct validity were calculated; normative data were also calculated for healthy controls stratified by age and education. Cronbach’s alpha was used for internal consistency analysis. Spearman’s test was used to correlate I-ASHA-FACS and FIM, AAT, and LCF scores.

Outcomes & Results: I-ASHA-FACS showed good internal consistency (α > .84) and strong intra- and inter-rater reliability (r > .97 and >.89). All healthy persons showed very high level of functional communication abilities in all domains of communication independence (higher than 6, on a 7-point scale) and all qualitative dimensions scores (higher than 4, on a 5-point scale). Correlations between I-ASHA-FACS scores and FIM were strong in aphasic persons, particularly in problem solving (r > .71) and comprehension (r > .73) subscales. Correlations between I-ASHA-FACS and AAT were generally from moderate to strong (r values ranging from r = .31 to r = .81), and particularly strong in spontaneous speech subtest (r > .70). Correlations between I-ASHA-FACS and LCF did not reach statistical significance.

Conclusions: I-ASHA-FACS shows good internal consistency, strong intra- and inter-rater reliability and satisfactory validity. The application of I-ASHA-FACS to the Italian population of patients with communicative deficits due to aphasia or TBI is recommended.     

Aphasia blog talk: How does stroke and aphasia affect the carer and their relationship with the person with aphasia?

Background: Carers of stroke survivors with aphasia are at risk of experiencing negative bio-psychosocial consequences and reduced quality of life. So far, in aphasia studies, this has mainly been explored through qualitative interviews and questionnaires. Unsolicited first-person narratives in the form of blogs offer a novel and rich source of data to examine how stroke and aphasia affect the carer and their relationship with the person with aphasia.

Aims: This study explored how carers of people with aphasia perceive their roles and responsibilities; it also examined the consequences of carrying out these carer roles and duties, in terms of both the carer’s own well-being and their relationship with the person with aphasia; furthermore, it investigated facilitative factors in their adaptation to the carer role.

Methods & Procedures: Publically available blogs written by carers of aphasic stroke survivors, which included information on how stroke and aphasia affect the carer and their relationship with the person with aphasia, were analysed using the Framework Method.

Outcomes & Results: The search resulted in nine carer blogs. The number of posts per blog ranged from 13 to 241. For blogs containing over 90 posts, the first and last 30 relevant posts were collected and analysed. New roles and extra responsibilities identified by participants included having to act as therapists, nurses, counsellors, and administrators and carrying out tasks usually assigned to the other person in the relationship. The extra tasks and duties impacted on the carers’ quality of life and their relationship with the person with aphasia in negative ways, such as leading to physical and mental exhaustion, health issues, feeling lonely, and resentful of their circumstances; however, participants also identified positive changes such as new closeness, new appreciation of life, and pride in achievements. A variety of strategies emerged from the data that helped carers adjust to their new roles. Strategies included positive reframing, allocating time to oneself, and seeking support from family and friends. The activity of blogging was also mentioned as having beneficial effects on the carers’ well-being.

Conclusions: The study provides further evidence for the specific challenges faced by carers of people with stroke and aphasia; it thus confirms the importance of addressing carer related needs in intervention and considering psychosocial well-being for both the carer and the person with aphasia.