Communication Partner Strategies to Support Aphasia Tyler Buchholz 10/13/2012 [email protected]

Introduction

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Bachelor’s of Arts in Speech Communication: Concentration in SLHS (Metro State; 05/2011) Internships at Metro State o Assistive Technology Partners (ATP), UCD Physical Medicine and Rehabilitation – Research Assistant o Denver Speech and Language – SLP Private Practice

Graduate Student Clinician at University of Colorado Boulder (08/2011-Present)

Forming a research question

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Choosing a topic and initiating a research project in graduate school Initial Thesis Ideas: o Acquired neurogenic communication disorders o Family education and counseling o Group therapy format with peer support

Thesis Background Title: Evaluation of an Aphasia Communication Skills Workshop for Significant Others

Background: o o

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Aphasia: acquired language disorder Therapy approaches can vary depending on one’s viewpoint of aphasia:  Something to treat? Overcome? Live with? Consider aphasia’s effects on relationships:  Everyday communication contexts WHO-ICF model considers the following areas regarding disability:  Impairment, Activity, Participation, and Wellness

Study Design

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Single-Subject Design o o

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Multiple baseline assessment 4 dyads of participants (n=8)  Significant Others/Caregivers (SO/Cs)  Person with Aphasia (PWA)

Independent Variable o Participation in communication skills workshops  1-2 hours, 1x/week, for 4 weeks  Curriculum based on previous literature and needs assessment (i.e. interview and survey data)

Study Design

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Communication skills curriculum  Broad topics

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Learning about aphasia as a foundation to learning communication skills. Communication skills and their ability to increase comprehension and expression. Being an effective communication partner for a person who has aphasia.

 Communication skills/strategies

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Face-to-Face attention; Asking closed-ended questions; Gesture and speech; Speaking slowly, simply, clearly; Encouraging communication and self corrections; Carefully filling in words that he or she has difficulty with; and Verbal, Visual, and Tactile Cues

 Resources

Study Design

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Dependent Variables o

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Symptomatology and Quality of Life  Care-Related Quality of Life Instrument (CarerQoL): caregiver burden measures with a valuation component – SO/C survey  Quality of Communication Life Scale (QLS): impact of impairment on socialization and activities, confidence and selfconcept, and roles and responsibilities – PWA survey Social Significance and Social Validity  Communicative Effectiveness Index (CETI): success in functional communicative ability – SO/C rating of PWA  Communication Skills Diary (CSD): self-reported use and perceived effectiveness of functional communication enhancement skills - SO/C survey  Knowledge of Aphasia Exam (KAE): knowledge of the disorder of aphasia - SO/C survey  Conversation Analysis (CA): interactions between dyads to assess Interactional and Transactional functions of discourse.

Preliminary Results

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Symptomatology and Quality of Life o

CarerQoL Results:  Responses indicated less frequency to the statement “I have ____ relational problems with the care receiver” 2 SO/Cs (1 & 4) o QLS Results: 3/4 PWA (1, 2, & 4) increased overall average from baseline; 1/4 decreased  Responses with more agreement were found in the following statements: “People include me in conversations” (PWA 2, 3, & 4) “I speak for myself” (PWA 2 & 3) “It’s easy for me to communicate (2 & 3 PWA)

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Preliminary Results Social Significance and Social validity o

CETI Results: 4/4 SO/C overall average from baseline increased  Responses with more agreement were found with the following communication situations: “Giving “yes” & “no” answers appropriately” (4/4 SO/Cs) “Communicating his/her emotions” (4/4 SO/Cs) “Indicating he/she understands what is being said to him/her” (SO/Cs 1, 3, & 4) o KAE Results: no significant changes, although 4/4 SO/Cs responded with high baseline scores o CSD Results: data is currently being analyzed; results indicate variability across all 4 dyads (ex. SO/C 4 showed an increase in finding “Face-to-Face Attention” to be helpful in supporting communication, while other SO/Cs showed variable responses) o CA Results: data is currently being analyzed; qualitative differences noted in communication breakdown repair strategies

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Participant Feedback & Future Directions

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Intervention Feedback o o o

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“I particularly found it helpful since there are no caregiver support groups available in my area” “The workshop made me more aware of my own communication techniques and how to improve them” “It was helpful to relate to others in the workshop and compare our problems and/or successes”

Future Directions o o o

Presentation of findings at local stroke support groups Revise curriculum based on results and feedback Complete thesis with proposed curriculum for communication skills training

Other Projects

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“Social Stories™: Strengthening Academic Skills for Students with Asperger Syndrome” (Smithwick & Buchholz, 2012) “Pathways: A Family-Centered, Culturally-Responsive Approach to Transdisciplinary Assessment” (Moore et al., 2011)

References • •

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Avent, J., Glista, S., Wallace, S., Jackson, J., Nishioka, J., & Yip, W. (2005). Family information needs about aphasia. Aphasiology, 19(35), 365-375. doi: 10.1080/02687030444000813

Draper, B., Bowring, G., Thompson, C., Van Heyst, J., Conroy, P., & Thompson, J. (2007). Stress in caregivers of aphasic stroke patients: a randomized controlled trial. Clinical Rehabilitation, 21(2), 122-130. doi: 10.1177/0269215506071251

Hinckley, J. J., & Packard, M. E. W. (2001). Family education seminars and social functioning of adults with chronic aphasia. Journal of Communication Disorders, 34(3), 241-254. doi: 10.1016/s0021-9924(01)00049-1 Kazdin, A. (2011). Single-case research designs: Methods for clinical and applied settings (2nd ed). New York, NY: Oxford University Press, Inc.

Le Dorze, G., Croteau, C., Brassard, C., & Michallet, B. (1999). Research considerations guiding interventions for families affected by aphasia. Aphasiology, 13(12), 922-927. Moss, B., Parr, S., Byng, S., & Petheram, B. (2004). 'Pick me up and not a down down, up up’: how are the identities of people with aphasia represented in aphasia, stroke and disability websites? Disability & Society, 19(7), 753-768. doi: 10.1080/0968759042000284222

Schulz, R., O'Brien, A., Czaja, S., Ory, M., Norris, R., Martire, L. M., Belle, S., Burgio, L., Gitlin, L., Coon, D., Burns, R., GalagherTompson, D., & Stevens, A. (2002). Dementia caregiver intervention research: In search of clinical significance. Gerontologist, 42(5), 589602.

Simmons-Mackie, N., Raymer, A., Armstrong, E., Holland, A., & Cherney, L. R. (2010). Communication Partner Training in Aphasia: A Systematic Review. Archives of Physical Medicine and Rehabilitation, 91(12), 1814-1837. doi: 10.1016/j.apmr.2010.08.026