Stroke Rehabilitation Conference
Aphasia & Facilitating Communication post stroke Sheila Robinson, MSc BSc CertMRCSLT Senior Speech & Language Therapist, Cork University Hospital
Outline of Presentation – How do we communicate – Communication difficulties post stroke – What is aphasia? – Impact of aphasia on person, family, immediate environment, community
Dept. of Speech & Language Therapy, Cork University Hospital, Feb 2014
How do we Communicate? Listening & understanding Speaking Reading Writing Dept. of Speech & Language Therapy, Cork University Hospital, Feb 2014
How do we communicate But that’s not the whole story…
Intonation Gesture Facial expression Drawing Everyday technology (e.g. mobile phones, iPad) Use of augmentative/ alternative communication Dept. of Speech & Language Therapy, Cork University Hospital, Feb 2014
Communication Difficulties poststroke
Aphasia Apraxia Dysarthria Dyslexia Dysgraphia
Language vs. Speech! Dept. of Speech & Language Therapy, Cork University Hospital, Feb 2014
What is aphasia? Acquired impairment of language and the cognitive processes which underlie language, caused by focal brain damage
Dept. of Speech & Language Therapy, Cork University Hospital, Feb 2014
Aphasia – RECEPTIVE: difficulty understanding the incoming message (message in) – EXPRESSIVE: difficulty using language to get his/her message across (message out) – Frequently, Receptive and Expressive co-exist
Dept. of Speech & Language Therapy, Cork University Hospital, Feb 2014
Effects of Receptive Aphasia
Yes- No response may be inconsistent May respond appropriately to social language! May not be aware of his/her difficulties May only understand 1 piece information at a time May not understand long sentences/ commands May have difficulties with background noise, or with talking to more than 1 person
Dept. of Speech & Language Therapy, Cork University Hospital, Feb 2014
Effects of Expressive Aphasia May have minimal verbal output OR may have fluent output that doesn’t make sense! May say 1-2 words rather than a full sentence May get ‘stuck’ for words May be able to describe what he is talking about, even if he can’t find the right word Dept. of Speech & Language Therapy, Cork University Hospital, Feb 2014
Effects of aphasia in the hospital setting
Successfully negotiating the role of patient Giving a medical/diet history Ward rounds Understanding treatment options-medication, surgery… Following instructions in CT Carrying over strategies in Physiotherapy Buying something from the shop Knowing why the porter is there & where you’re going
Potential further complication of dysphagia! Dept. of Speech & Language Therapy, Cork University Hospital, Feb 2014
What is aphasia? Another way of looking at aphasia is ‘identity theft’; in order to reclaim identity person with aphasia must effectively interact with others (Dietz et al., 2012) Dept. of Speech & Language Therapy, Cork University Hospital, Feb 2014
What does aphasia feel like?
Dept. of Speech & Language Therapy, Cork University Hospital, Feb 2014
Effects of Communication Difficulties Impairment: loss or abnormality in body structure or of a physiological /psychological function. Activity: execution of a task or action by an individual. Participation: involvement in a life situation. (WHO, 2002) PLUS Environmental Factors! Dept. of Speech & Language Therapy, Cork University Hospital, Feb 2014
Effects of Communication Difficulties Impairment: Aphasia Activity: asking to go to toilet, filling out menu card, chatting with visitors, consenting to a procedure Participation: being a ‘patient’, decisionmaking re own health & care needs Dept. of Speech & Language Therapy, Cork University Hospital, Feb 2014
In their own words… ‘Before I had a stroke I used to go and have a talk good talk with someone- now I it’s not alright, well it is and it isn’t’ ‘C and I go to town often but I don’t go by myself…stops me going out...depends on how people know you’ (Cruice et al., 2010) Dept. of Speech & Language Therapy, Cork University Hospital, Feb 2014
What does aphasia feel like?
Sadness- grief reaction Frustration/anger Fear Pain Loneliness Effects for person themselves, family, relationship between the two Dept. of Speech & Language Therapy, Cork University Hospital, Feb 2014
Aphasia: affecting the whole family
Stress during acute stage & rehabilitation Concerns re how to communicate Research on the internet Protective towards parent ‘She could not skirt the reality of the permanence of his disability’ Loss of real conversations (Le Dorze, Tremblay & Croteau, 2009)
Dept. of Speech & Language Therapy, Cork University Hospital, Feb 2014
Aphasia over time Initial focus on coping with sudden change
Dealing with ongoing implications of aphasia
Effects of communication difficulties in hospital Situations where patients with aphasia unable to gain attention of nurse falls, incontinence, vomiting Poor information exchange Advocacy: importance of having spouse/ carer ‘I just need extra time to speak and my wife with me to get the detail’ ‘They’d come in and talk to him as if he could understand everything’ ( Hemsley et al., 2013)
Dept. of Speech & Language Therapy, Cork University Hospital, Feb 2014
Communication difficulties and adverse events Multiple planned & unplanned admissions since acquiring aphasia Inability to gain attention of nurse falls, vomiting, limb swelling, needing toilet Poor information exchange around transfer/discharge Inability to understand instructions after heart surgery Impact of dysphagia patient who was NPO being given contrast orally for procedure Patients expected to pass on information to spouses Dept. of Speech & Language Therapy, Cork University Hospital, Feb 2014
Philosophy of CUH SLT Department • Maximise individual’s ability to function communicatively in everyday life • Maximise decision-making ability • Promote psychological/emotional well-being • Promote independence and participation • Assist in the formation and maintenance of relationships
Dept. of Speech & Language Therapy, Cork University Hospital, Feb 2014
Living with aphasia
Dept. of Speech & Language Therapy, Cork University Hospital, Feb 2014
How do we think about outcomes? Individual’s input into goal setting Person with aphasia him/herself as most appropriate person to judge ‘meaningful’ life change Need to look at actual functioning in everyday life rather than capacity to perform tasks/ carry out activities (Kagan et al., 2008) Dept. of Speech & Language Therapy, Cork University Hospital, Feb 2014
Making communication easier on the ward
Dept. of Speech & Language Therapy, Cork University Hospital, Feb 2014
Barriers & Facilitators
Dept. of Speech & Language Therapy, Cork University Hospital, Feb 2014
The communication access triangle Interactions
Documents
Environments
Dept. of Speech & Language Therapy, Cork University Hospital, Feb 2014
Facilitating better interactions Communication partner training- family, staff in hospital, trained conversation partners in community Use of Total Communication
Dept. of Speech & Language Therapy, Cork University Hospital, Feb 2014
How do we communicate But that’s not the whole story… Intonation Gesture Facial expression Drawing Everyday technology (e.g. mobile phones, iPad) Use of augmentative/ alternative communication Dept. of Speech & Language Therapy, Cork University Hospital, Feb 2014
Total Communication
Dept. of Speech & Language Therapy, Cork University Hospital, Feb 2014
Dept. of Speech & Language Therapy, Cork University Hospital, Feb 2014
Use of Total Communication
Dept. of Speech & Language Therapy, Cork University Hospital, Feb 2014
Making documents aphasia friendly Picture based menus Stroke Rehab Unit aphasia friendly information folder
Dept. of Speech & Language Therapy, Cork University Hospital, Feb 2014
Negotiating the environment Symbols & signage Having what the person needs within reach- glasses, paper/pen etc Clear and uncluttered! Dept. of Speech & Language Therapy, Cork University Hospital, Feb 2014
Living with aphasia
Dept. of Speech & Language Therapy, Cork University Hospital, Feb 2014
Whose responsibility is aphasia?
Dept. of Speech & Language Therapy, Cork University Hospital, Feb 2014
Dept. of Speech & Language Therapy, Cork University Hospital, Feb 2014
Discussion & comments
Dept. of Speech & Language Therapy, Cork University Hospital, Feb 2014
