Developing an evidence‐base for accessibility for people with aphasia

Background: Discrimination on the basis of disability is prohibited in many countries and therefore research on communication accessibility for people with aphasia has become a priority.

Aims: The aim of this paper is to summarise and discuss the results of a series of research studies, carried out in one Centre, into accessibility issues for people with aphasia, focusing on the accessibility of community environments and the accessibility of information.

Main Contribution: When asked about the accessibility of the community generally, people with aphasia reported both physical and societal barriers and facilitators, as well as barriers and facilitators related to other people. Many people with aphasia still do not receive written health information about aphasia and, when they do, the information is often written at a level too high for them to read. In terms of the accessibility of written information on websites about aphasia, high‐quality websites may not be easily accessible to people with aphasia. For accessible websites to be delivered, the involvement of people with aphasia is paramount.

Conclusions: There are three common themes emerging from this series of research studies. First, accessibility is an important and often emotive issue for people with aphasia. Second, people with aphasia are marginalised by a communicatively inaccessible society. Third, there is considerable diversity among people with aphasia about their perceptions of the barriers and facilitators to communication in the community.     

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.     

Improvement in psychological well-being of people with aphasia and their families: Evaluation of a community-based programme

Abstract

The York-Durham Aphasia Centre comprises a community-based programme for people with aphasia and their families. It offers long-term support and service at any time post-stroke or head injury. This evaluation focused on improvement in psychosocial well-being in the clients and their family members as a measure of programme effectiveness. Trained programme volunteers administered Ryff's Psychological Well-being Scale to 35 clients twice, at 6 months apart. Twelve family members also self-administered the scale twice. Voluuteers handled the administration well, and aphasic clients were able to complete the scale with little difficulty. Both clients and family members showed positive change in five of six dimensions of psychological well-being. This improvement in both groups may be related to the direct attention the programmes give to psychosocial well-being and communication, the overall environment of the centre, and the test administration itself. The positive change in these aphasic clients of varying ages and time post-stroke means that imporovement in psychological well-being is possible regardless of time post-stroke and age. There are important implications for health and social service system planning, and more specifically for programme planning for people with aphasia and their families.     

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.     

Factors that influence Australian speech-language pathologists’ self-reported uptake of aphasia rehabilitation recommendations from clinical practice guidelines

Background: There are clinical practice guidelines for speech-language pathologists’ aphasia management practices. However, reported adherence to aphasia guideline recommendations is variable. The barriers and facilitators to meeting aphasia management recommendations are not well understood. In order to develop theory-informed strategies to improve implementation of aphasia management practices, a better understanding of these barriers and facilitators is required.

Aims: This study aimed to describe barriers and facilitators to speech-language pathologists’ uptake and implementation of five prioritised recommended practices for aphasia management.

Methods & Procedures: An online survey sought information from Australian speech-language pathologists working with clients with aphasia. The survey focused on five practices including goal setting, information provision, constraint-induced language therapy, timing, and intensity of intervention. The Theoretical Domains Framework was used to design the survey, with several statements generated about factors influencing practice for each domain.

Outcomes & Results: Surveys were completed by 63 respondents. The theoretical domain “environmental context and resources” (e.g., “I have insufficient time to engage in…”) was the main perceived barrier for the majority of practices being investigated, whilst the theoretical domain “social/professional role and identity” (e.g., “It is part of my role with the multidisciplinary stroke team to engage in…”) was the main perceived implementation facilitator for all practices. The top three barriers and facilitators varied for each of the five recommended practices being investigated. Across clinical settings, there were commonalities and differences in the perceived barriers and facilitators to implementation. There was a significant correlation between self-reported uptake of all of the aphasia rehabilitation recommendations we investigated and participants’ total barrier scores. Total barrier scores were also significantly different between clinical settings in the area of goal setting, with acute settings having a higher number of reported barriers to goal setting than rehabilitation settings (p = 0.011).

Conclusions: Implementation interventions that seek to overcome the barriers of environmental context and resources (time, competing priorities and resources) are likely to have the most effect on aphasia best practice uptake. Encouraging behaviour change in the “social professional role and identity” domain by emphasising the role of the speech-language pathologist in aphasia rehabilitation within the multidisciplinary stroke team should further improve uptake of recommended practices. At a local level, departments or individual speech pathologists need to identify their own barriers and facilitators and choose effective implementation interventions using the Behaviour Change Wheel. Both strategies should help close the evidence-practice gap in aphasia rehabilitation.     

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.     

Association between incongruence about survivor function and outcomes among stroke survivors and family caregivers

Background: Stroke survivors and family caregivers often have incongruent appraisals of survivor cognitive, physical, and psychosocial function. Partner incongruence contributes to poor outcomes for survivors and caregivers.

Objectives: This study explored whether partner incongruence: (1) differs by function domain; (2) increases or decreases over time, and; (3) is associated with self-rated health, distress, stress, and depressive symptoms.

Methods: Structured surveys were administered to 32 survivors and caregivers at approximately 3 (enrollment) and 7 months (follow-up) post-stroke. Paired t-tests were used to examine partners’ ratings of survivor function at enrollment and follow-up, and changes in incongruence over time. Partial correlations were used to examine the association between incongruence at enrollment and outcomes at follow-up.

Results: Survivors consistently rated their own memory and thinking as significantly better than caregivers rated their memory and thinking. At follow-up, survivors rated their own communication as significantly better than caregivers rated their communication. Incongruence about survivor memory and thinking was associated with survivor distress, as well as caregiver distress, stress, and depressive symptoms. Incongruence about survivor ADLs was associated with caregiver stress and depressive symptoms. Incongruence about survivor social participation was associated with caregiver distress.

Conclusions: Findings from this study suggest that survivors and caregivers often have incongruent appraisals of survivor function, that incongruence does not improve naturally over time, and that incongruence may be detrimental for survivor and caregiver outcomes. Further research should be directed at the mitigation of incongruence and strategies to improve outcomes for both survivors and family caregivers.     

Challenges facing COS development for aphasia

ABSTRACT

Background: Difficulty in communicating (due to aphasia) can have serious consequences for patients in health care settings. Communication Partner Training is effective for improving communication between people with aphasia and health care professionals.

Aim and Objective: This study aims to evaluate the feasibility of developing and introducing a Communication Program which focuses on improving communication between nurses and persons with aphasia in a peripheral hospital setting.

Methods &; Procedures: A mixed-methods feasibility study was conducted with a pre-test post-test design in the quantitative part and two focus group discussions in the qualitative part. Nurses received training for communicating with persons with aphasia. In the pre-test and post-test, nurses filled in a questionnaire for barriers and facilitators and a feasibility questionnaire. Nurses’ attitudes towards the Communication Program were further explored in two focus group discussions.

Outcomes &; Results: Forty six nurses took part in the training sessions. Most nurses were satisfied about the Communication Program (24/30) and intended to continue using it (25/30). Almost all nurses saw positive effects for patients with aphasia (27/30), such as an increase in the ability to communicate. However, nurses reported that using the program was time consuming and that they still often experienced frustration when communicating with persons with aphasia.

Conclusions: Improving communication with persons with aphasia via the Communication Program seems feasible and valuable according to nurses. Nurses probably need more support during implementation of the Communication Program, mainly due to time barriers and the complexity of communicating with persons with aphasia. Further research should focus on revising the program, training health care professionals with different educational backgrounds, and assessing the implementation of this communication partner training in health care settings.     

Barriers and facilitators to using the CommFit™ smart phone app to measure talk time for people with aphasia

Background: The use of mobile technology in aphasia rehabilitation is an emerging area of research. CommFit? is a smart phone application which was developed according to aphasia-friendly guidelines to measure the talk time of people with aphasia. Presently, the ease-of-use of CommFit? for people with aphasia has not been investigated, and there is little research on the barriers and facilitators to using mobile technology for this population.

Aims: The aim of this study was to describe the barriers and facilitators experienced by people with aphasia while using CommFit?.

Methods &; Procedures: Twelve people with aphasia used the CommFit? system-app, iPhone and BlueTooth headset, to measure their talking time for 14 days. The Western Aphasia Battery-Revised Aphasia Quotient was used to determine aphasia severity. During the initial training session and data collection period, field notes were taken by researchers. At the end of the data-collection period, participants completed an ease-of-use rating scale and participated in semi-structured interviews on the barriers and facilitators to using the CommFit? system.

Outcomes &; Results: Field notes and data from semi-structured interviews identified eight barriers; physical and language impairments related to stroke, other physical barriers not related to stroke, time constraints, unfamiliarity with technology, social attitudes, design of the technology and technology malfunction. Facilitators included support from researchers, support from other people, app design and use of the manual. On the ease-of-use rating scale, steps involving the headset were rated as less usable than other steps involved in using the CommFit? system. However, all steps had mean scores indicating that they were “easy to use” or “very easy to use”. Spearman correlations indicated that there was no significant relationship between ease-of-use ratings and aphasia severity. However, there was a significant negative correlation between age and ease-of-use rating of “pairing the headset” (r = ?0.8173, p = 0.013).

Conclusions: The results of this study identified barriers to using mobile technology, many of which were not connected to the participants’ stroke-related impairments. It also identified several facilitators which should be capitalised on when using mobile technology with this population. Last, results indicated that the BlueTooth headset was not a highly usable component of the CommFit? system, especially for older users. This will be addressed in future research on the app.     

Evaluation of communication,life participation and psychological well‐being in chronic aphasia: The influence of group intervention

Background: The impact of change in communication, life participation, and psychological well‐being in aphasia is recognised but still not fully explored. Further, considerable scope exists to address these factors within the context of intervention. Innovative practices and group intervention are advocated for people with chronic aphasia but detail and evidence remains limited.

Aims: To explore the experience of aphasia within the context of communication, life participation and psychological well‐being and evaluate the outcomes of these phenomena in people with chronic aphasia following participation in a group intervention involving a social model approach.

Methods & Procedures: A group of seven people with chronic moderate aphasia were assessed on communication measures, by means of the Conversational Analysis Profile for People with Aphasia (CAPPA), and aspects of psychological well‐being, by means of The Hospital Anxiety and Depression Scale (HADS) and The Visual Analogue Self‐esteem Scale (VASES) pre, post, and at 3‐month follow‐up of a group intervention. The group involved a social model approach and the use of Total Communication to support conversation. Speech and language therapy and social care personnel, including an equality disability trainer, contributed to the group.

Outcomes & Results: Although variation in individual participants was demonstrated, results showed evidence of statistically significant beneficial change in conversation experiences (many of these related to life participation) and, to a lesser degree, beneficial change in conversation abilities. Additionally there were beneficial changes for some participants on psychological well‐being measures. Due to the small sample, participant variation, and (in the case of psychological well‐being measures) the lack of evidence of serious reduction in psychological well‐being at the outset, the results have to be evaluated with caution.

Conclusions: Appropriately planned group intervention can produce benefits in conversation, life participation, and psychological well‐being in chronic aphasia.     

Language deficits following dominant hemisphere tumour resection are significantly underestimated by syndrome-based aphasia assessments

ABSTRACT

Background: In assessing post-operative language impairment, clinical teams typically rely on “aphasia subtype” classifications, based on post-stroke patterns of impairment. However, this approach may significantly underestimate the prevalence of post-surgical language impairments due to the different pathophysiological mechanisms involved. There is a paucity of research in chronic post-surgical patients.

Aims: We investigated post-surgical language performance in the chronic phase.

Methods & Procedures: Using both the Western Aphasia battery Revised (WAB-R) and the Comprehensive Aphasia test (CAT), we assessed a range of language skills in 26 right-handed patients approximately 6–12 months after they underwent surgery to remove a primary tumour in their left cerebral hemisphere. Participants’ self-reports of their speech and language skills post-surgery were also collected.

Outcomes and Results: Following surgery, 77% of patients scored below normal cut-off on one or more language subtests of the CAT battery. This contrasted with only 27% on the WAB AQ. The CAT findings were supported by subjective data, with 58% of patients self-reporting post-surgical communication difficulty.

Conclusions: Our results show that current “aphasia subtype” testing is inadequate, and is likely to significantly underestimate chronic language deficits in this population. Alternative approaches to formal language assessment need to be used in this group of patients whose pattern of impairments is very different from that observed in post-stroke aphasia.     

Self-reported symptoms of anxiety and depression in chronic stroke patients with and without aphasia

Background: About half of the stroke population suffers from emotional difficulties, such as anxiety and depression post-stroke. Acquiring aphasia is seen to increase the risk of developing symptoms of emotional difficulties such as anxiety and depression.

Aims: The aim of the present study was to investigate self-reported emotional difficulties in chronic stroke patients with and without aphasia 1 year post-stroke. Further, we aimed to investigate the relationship between aphasia severity and self-reported symptoms of post-stroke depression and anxiety. We expected to find that patients with aphasia reported more symptoms of anxiety and depression than patients without aphasia. Furthermore, we expected to find that aphasia severity was associated with self-reported symptoms of anxiety and depression.

Methods & Procedures: The Norwegian Basic Aphasia Assessment (NBAA) was used to assess aphasia severity. The Hospital Anxiety and Depression Scale (HADS) was administered to all patients to assess self-reported symptoms of anxiety and depression. To investigate group differences we used the patients’ scores on the subscales communication, ability to carry out daily activities, and ability to participate in social/leisure activities from the Stroke Impact Scale (SIS), the modified Rankin Scale (mRS), and the Mini Mental State Examination (MMSE).

Outcomes & Results: There were no significant differences between the groups regarding self-reported symptoms of anxiety and depression. We found a significant correlation between aphasia severity and symptoms of depression, indicating that patients with more aphasic difficulties reported more symptoms of depression. Specifically, the subscale repetition and reading comprehension from the NBAA correlated with the HADS total score. Furthermore, we found significant correlations between the patients’ performance on reading comprehension, repetition, and reading out loud and the HADS depression subscale. There was a significant difference between the groups on the SIS communication scores and the patients’ scores on the MMSE, whereas the aphasia group had more self-reported communication difficulties and a lower level of cognitive functioning 1 year post-stroke. However, on the SIS daily activities the non-aphasia group scored significantly lower. Finally, the groups did not differ on functional disability as measured by the mRS at admission to the hospital.

Conclusions: Although there were no significant differences between the aphasic and non-aphasic groups as to the degree of self-reported symptoms of anxiety and depression, patients with aphasia reported symptoms of anxiety and depression that seemed to be associated with specific language problems, as the ability to repeat, and to read and comprehend words and sentences.     

Examining the feasibility and effectiveness of a culturally adapted participation-focused stroke self-management program in a day-rehabilitation setting: A randomized pilot study

ABSTRACT

Background: Stroke survivors find it difficult to participate in daily activities, despite their improvement throughout the rehabilitation process. Thus, it has been questioned whether day-rehabilitation services provide adequate preparation for participation and reintegration into the community. Self-management programs can improve survivors’ self-efficacy to manage their condition and participation. Improving Participation After Stroke Self-Management program (IPASS) is an occupational therapy-based group intervention developed in the United States, which has been effective in improving participation outcomes.

Objective: To evaluate the feasibility and effectiveness of the IPASS adapted for an Israeli population of individuals admitted to a day-rehabilitation center after stroke.

Methods: A single-center, randomized, assessor-blind study was conducted. Eligible participants were randomized to receive the IPASS (intervention group), in addition to standard individual therapy or standard care only (control group). Feasibility was based on attendance rate and a feedback questionnaire. Effectiveness was evaluated with the Functional Independence Measure (FIM), the Reintegration to Normal Living Index (RNLI) and self-efficacy questionnaires.

Results: Sixty participants were included, of which 39 completed baseline and post-intervention evaluations. The intervention group improved significantly in the FIM scores (p < .01), as compared to the control group (p > .05). Moderate effect sizes (≥0.35) were found for the FIM and RNLI, and large effect sizes (≥0.65) for two subcategories in the participation self-efficacy questionnaire.

Conclusions: The results support the feasibility of the adapted IPASS, and show a trend for positive effects in improving participation and self-efficacy in managing participation in home and community activities, for an Israeli post-stroke population.     

Sales assistants serving customers with traumatic brain injury

Background: General lack of awareness regarding neurogenic communication disorders generally, and cognitive communication disorders following a traumatic brain injury (TBI) specifically, has resulted in pervasive environmental and attitudinal barriers for these individuals. While collaborative communication partner training programmes have been advocated as a means to remove barriers and provide social supports to enhance participation, a dearth of published programmes is evident within the field of TBI specifically. Similarly within the corporate context, in spite of legislative changes and diversity awareness programmes for employees, few training programmes exist worldwide, and in South Africa particularly, that remove barriers between employees and customers with a communication disability, and with a TBI specifically. In order to address this, the current research targeted the retail supermarket environment as a context in which a significant number of everyday communicative exchanges take place.

Aims: The study examined the effects of a specialised once‐off training session on the confidence and knowledge of sales assistants in identifying barriers to, and facilitators of, sales interactions with customers with cognitive‐communication disorders following a TBI. To do this, a randomised controlled trial design was used.

Methods and Procedures: Two questionnaires were developed and administered on two different occasions to the experimental group pre and post training, as well as the control group, to determine the confidence and knowledge with which they identified barriers and facilitators during videotaped sales interactions. The training session was developed based on previously established principles of diversity awareness training. Training and its evaluation used original on‐site videotaped scenarios within small group discussion format.

Outcomes and Results: Inter‐ and‐intra group comparisons were analysed on the derived confidence and knowledge constructs from item analysis of the questionnaires. All results pointed consistently to the impact of the once‐off training session on experimental group participants, who also rated the training session highly.

Conclusions: The need for companies to expand their concept of customer service to include the customer with a disability is emphasised. Training programmes empowering their employees to interact with greater knowledge and confidence specifically with customers with a TBI will potentially facilitate deeper participation for both. The current research lays the groundwork for more in‐depth research that can be generalised beyond this specific population of individuals with a communication disorder.     

Insomnia and health-related quality of life in stroke

Abstract

Background:

Insomnia is a common complaint in stroke survivors. Insomnia after stroke is correlated with physical disability, dementia, anxiety, depression, and fatigue. However, the influence of insomnia following stroke on health-related quality of life (HRQoL) has not been investigated.

Objectives:

The current study aimed to examine the effect of insomnia on HRQoL in stroke survivors 3 months after their index stroke over and above confounding variables.

Method:

Three hundred and thirty-six patients were recruited from the acute stroke unit in a regional hospital in Hong Kong. Insomnia was ascertained by a single item on a locally validated, seven-item insomnia questionnaire. HRQoL was measured by the total score and the 12 domain scores of the Stroke Specific Quality of Life (SSQoL) scale. Demographic and clinical characteristics were obtained using the following scales: National Institutes of Health Stroke Scale (NIHSS), Barthel Index (BI), Mini-Mental State Examination (MMSE), and Geriatric Depression Scale (GDS).

Results:

Forty-four percent of stroke survivors reported experiencing insomnia in the past month; they were more likely to be female and to have a higher GDS score. The insomnia group had significantly lower overall SSQoL, energy and thinking scores after adjusting for sex, BI, and GDS scores.

Conclusion:

The findings show that stroke survivors who experienced insomnia had a reduced overall HRQoL and were impaired in the energy and thinking domains of HRQoL. Early screening for sleep disturbance would be beneficial to prevent later development of post-stroke insomnia. Pharmacological and non-pharmacological interventions are suggested to improve HRQoL in stroke patients with insomnia.     

Gavel Club for people with aphasia: communication confidence and quality of communication life

Background: Many factors that contribute to successful living with aphasia intersect with the benefits one can get from attending an aphasia group. Affiliated with Toastmasters International, Gavel Clubs (GCs) for people with aphasia (PWA) provide a range of communication activities that promote public speaking and leadership skills. The constructs of communication confidence and quality of communication life (QCL) were introduced over a decade ago but have not been widely investigated.

Aims: This study aims to investigate the association between weekly participation in GC public speaking activities for PWA and the constructs of QCL and communication confidence. In addition, the study aims to explore the association between the severity of aphasia, QCL and communication confidence.

Methods & Procedures: Eight members of a GC for PWA, who attended 31–33 weekly GC meetings per year between 2012 and 2016, participated in assessments of their QCL (using the ASHA Quality of Communication Life (ASHA QCL)), communication confidence (using the Communication Confidence Rating Scale for Aphasia (CCRSA)), and aphasia severity (using the Western Aphasia Battery-Revised (WAB-R)). A link was sought between severity of aphasia and the constructs of QCL and communication confidence.

Outcomes & Results: QCL improved significantly over four years of participation in the GC (Z = 2.103, n = 8, p = .035, r = .74). Communication confidence also improved significantly (Z = 1.973, p = .049, r = .70). No associations were found between the two scales or between the scales and severity of aphasia.

Conclusions: Weekly participation in GC group activities was associated with improved QCL, as measured by the ASHA QCL, and improved communication confidence as measured by the CCRSA. Decision-making (measured by the CCRSA) and the Roles and Responsibilities domain (in the ASHA QCL) also improved. More research is needed to verify these findings using a study design that includes a control group, to identify the links between the various psychosocial aspects at play in the life of PWA and to conceptualise how the gains achieved with GC participation can be applied more broadly to successful living with aphasia.