The public awareness of aphasia: an international survey

Community responses to persons with aphasia participating in CoActive therapeutic theatre: A pilot study

BACKGROUND

Persons with aphasia (PWA) experience a number of communicative and social-emotional challenges. Reported experiences of PWA include but are not limited to, being misunderstood, isolated, frustrated, and infantilised.

AIMS

The aim of this pilot study, involving a Life Participation Approach to Aphasia (LPAA), conducted over the course of 2 years, was to understand community perceptions of aphasia while PWA engaged in an interprofessional treatment program involving speech and drama therapy.

METHODS & PROCEDURES

The interprofessional treatment program involved PWA participating in a therapeutic theatre program using the CoActive Therapeutic Theater (CoATT) while also receiving speech-language therapy. Each year, the PWA performed a different, original therapeutic theatre production for a public audience, at the culmination of their interprofessional treatment program. In this paper, we share data obtained from perspectives of audience members who witnessed the theatre production and aphasia education during the first year of the study and friends and family of PWA who participated in the therapeutic theatre process during the second year of the study.

OUTCOMES & RESULTS

Responses from audience members who participated in aphasia education and witnessed the therapeutic theatre performance by the PWA during the first year, indicated an increased knowledge of aphasia. Friends and family members of PWA who witnessed their loved ones engaging in the CoATT process through interprofessional treatment, in the second year, reported that their loved ones benefited from the CoATT process, which was distinct from other therapeutic processes to their knowledge and that they were impacted by watching their loved one perform.

CONCLUSIONS & IMPLICATIONS

These initial findings create footing towards understanding impact of therapeutic theatre in combination with speech-language therapy in the lives of PWA. They help us to obtain an initial appreciation of how therapeutic theatre and aphasia education help connect PWA and their community.

WHAT THIS PAPER ADDS

What is already known on this subject Caregivers and communities at large play a significant role in and substantially impact the recovery of their loved ones (Dalemans et al., 2010; Grawburget et al., 2013; Kniepmann & Cupler, 2014) with aphasia. However, existing research suggests that persons with aphasia (PWA) are often misunderstood, isolated and infantilised by their communities. What this paper adds to existing knowledge The findings of our study reveal that friends, families and extended communities of PWA gain a positive and deep understanding of challenges experienced by PWA through therapeutic theatre supported by speech language therapy, based in a new CoActive Therapeutic Theatre (CoATT) model. This PWA community also agrees that therapeutic theatre in combination with speech-language therapy provides confidence and camaraderie between PWAs and strengthen connection between all constituencies. These results support the need for interprofessional intervention within the framework of a Life Participation Approach to Aphasia (LPAA). What are the potential or actual clinical implications of this work? Treatment paradigms that bring PWAs in contact with their communities using an LPAA approach can increase confidence and social engagement for PWAs potentially leading to better outcomes for their individual speech-language therapy as well as create means of educating communities about PWA, and their stories.

The effect of an aphasia ID card on the processing of language produced by a speaker with nonfluent aphasia

INTRODUCTION

We tested whether aphasia self-disclosure via an aphasia ID card impacts (1) how non-aphasic listeners initially process language produced by a speaker with aphasia and (2) learning of the speaker's error patterns over time.

METHODS

In this eye-tracking experiment, 27 young adults followed instructions recorded by a speaker with nonfluent aphasia while viewing a target picture and a distractor. The Card group (n = 14) was shown a simulated aphasia ID card for the speaker and the No Card group (n = 13) was not. The task was divided into Pre-Observation and Post-Observation blocks. Between blocks, participants observed the speaker making semantic paraphasias. Eye-tracking analyses compared the time course of target advantage (reflecting competition from the distractor picture) and workspace advantage (reflecting attention to task) between groups and blocks.

RESULTS

Pre-Observation, the Card group had a higher target advantage than the No Card group in the post-response window (i.e., after participants had responded), indicating sustained attention to the speaker's language. Across blocks, there was evidence that the Card group (but not the No Card group) learned that the speaker makes semantic paraphasias.

CONCLUSIONS

Aphasia ID cards impacted listeners' processing of language produced by a speaker with nonfluent aphasia. Increased patience and attentiveness may underlie both the Card group's sustained attention to the speaker as well as learning of the speaker's error patterns. Further research should address whether these changes impact communication success between PWA and new conversation partners.

The Implications of Public Awareness and Knowledge of Aphasia around the World

Background:

The services provided and the financial support for research into a health condition is influenced by public awareness of a health condition. There has been a wide range of surveys of the public's and health professional's awareness of aphasia throughout the world to gauge levels of awareness. Findings confirm that awareness of aphasia is universally lower than comparable conditions.

Objective:

To provide a review of international public and health workers' awareness and knowledge of aphasia.

Materials and Methods:

A narrative review examining known telephone, internet and face-to-face surveys of aphasia to determine international levels of awareness, knowledge and attempts to raise the awareness of aphasia.

Results:

Awareness is internationally low and actual knowledge is even lower: 1%-66% for awareness and 5%-17% for actual knowledge. While higher than the public, levels of awareness and knowledge are also low among health professionals. A range of demographic variables, like age, sex and socio-economic status, are significantly associated with levels of awareness. People who have some awareness or knowledge of aphasia have gained it from the media or personal and professional contact with aphasia.

Discussion and Conclusion:

Awareness and knowledge of aphasia are low when compared to other communication disorders and comparable neurological conditions, for example, Parkinson's disease. The implications of results for service provision, research funding and awareness-raising programmes are reviewed and further suggestions for awareness-raising are discussed.

Revisiting the public awareness of aphasia in Exeter: 16 years on

Background: Surveys of awareness of aphasia have been conducted worldwide. There has been no survey of change in awareness in one place over time. A survey in Exeter, UK in 2001 found awareness of aphasia was strikingly low. The aim of this study was to conduct a repeat survey using the same methods in the same city 16 years later to examine changes in awareness and knowledge. Method: We surveyed 167 shoppers in Exeter examining awareness and knowledge of aphasia. Awareness of stroke, stuttering, dyslexia and autism were examined for comparison. Demographic information was collected. Result: Thirty-four percent had heard of aphasia and 5% had some basic knowledge. Awareness of aphasia had improved significantly from 2001 to 2017, but basic knowledge had not. Awareness was higher in professional groups, such as lawyers and academics, and healthcare workers and in those who knew someone with aphasia. Awareness, but not knowledge, was higher in older respondents. Awareness of aphasia was significantly lower than awareness of all other conditions. Conclusion: We found a significant increase in awareness of aphasia in Exeter since 2001, but not knowledge. The implications of ongoing low levels of aphasia awareness, like inadequate funding and difficulty integrating into an ill-informed society, are discussed.

Extending knowledge of the public awareness of aphasia in the Balkans: Serbia and Montenegro

PURPOSE

Public awareness of aphasia has been surveyed in a number of countries revealing that it is universally low. We report results of surveys in the Balkan countries Serbia and Montenegro and compare results with data from Croatia and Slovenia.

METHODS

Convenience surveys of the general public were conducted in public places like shopping centers/malls and parks in Serbia (N = 400) and Montenegro (N = 500) using an adapted version of the public awareness of aphasia survey questionnaire. Respondents were asked whether they have heard of aphasia and tested with questions about aphasia. Information on gender, age, occupation and education was recorded.

OUTCOMES

Twelve percent (Serbia) and 11% (Montenegro) had heard of aphasia, but just 4% (Serbia) and 3.2% (Montenegro) had a basic knowledge of aphasia. Age, gender and occupation interacted variably with awareness. Between 16% (Slovenia) and 60% (Croatia) said they had heard of aphasia (10.5% overall mean for the four countries) and basic knowledge of aphasia across the four countries ranged between 3.2 and 7%.

CONCLUSIONS

Levels of awareness of aphasia in the Balkans are low and variably associated with age, gender, socio-economic and educational levels. Respondents with some knowledge of aphasia gained it through personal or professional interaction with aphasia or the media. The data provide a basis for awareness raising in Balkan countries to reduce stigmatization, improve community access and understanding. Implications for rehabilitation Awareness of aphasia is low universally, even among healthcare workers. Low public awareness of a condition, like aphasia, results in under-funded research and service provision. In order to raise public awareness of aphasia we need to know how many members of the general public know about it. Improvements in public awareness could positively affect funding, the quality of services, and the public understanding and acceptance of individuals with aphasia in the community. Improving awareness of aphasia in those who come into contact with aphasic people, like healthcare workers, could significantly improve the healthcare experience of people with aphasia and their families.

International patterns of the public awareness of aphasia

BACKGROUND

It has been suggested that public awareness of aphasia is vital for extending services, research support, social inclusion and targeted raising of awareness. Earlier studies show that knowledge of aphasia varies across a range of variables, but is very low compared with other conditions.

AIMS

To report a series of surveys of public awareness of aphasia from six countries, the largest study conducted this far.

METHODS & PROCEDURES

Surveys were conducted in Argentina (N = 800), Canada (N = 831), Croatia (N = 400), Greece (N = 800), Norway (N = 251) and Slovenia (N = 400) using the same methodology requesting information on age, sex and occupation, asking whether respondents had heard of aphasia and where they had heard of it. Respondents were tested on their levels of knowledge of aphasia.

OUTCOMES & RESULTS

Results revealed low levels of awareness of aphasia in countries surveyed with marked variability that appeared to interact with occupation, country, age and sex. We surveyed 3483 respondents (mean age = 43.16; SD = 17.68). Between 60% (Croatia) and 16% (Slovenia) said they had heard of aphasia (37.1% overall), but those with actual knowledge ranged from 13.9% (Norway) to 1.0% (Argentina). The combined mean of those with basic knowledge was 9.2%. Those who had heard of aphasia were younger; and females had higher levels of awareness. We also found associations between socio-economic status and awareness. Those working in health, social and educational spheres had the highest levels. Respondents mainly heard about aphasia through the media and work or personal contact with aphasia.

CONCLUSIONS & IMPLICATIONS

Levels of awareness are low everywhere in absolute terms, and relative to the awareness of other conditions, with significant variability between countries, sex and socio-economic status. We examine how surveys can be utilized to plan ways to increase understanding and discuss the comparison of awareness of aphasia with other conditions.

Raising public awareness of aphasia in southern Ontario, Canada: A survey

PURPOSE

Despite the relatively high prevalence of aphasia, research indicates that, world-wide, public awareness of aphasia is lacking. Of the surveys that have been conducted internationally, none has studied the Canadian public's awareness of aphasia. The purpose of the present survey was to assess public awareness and basic knowledge of aphasia of individuals in southern Ontario, Canada.

METHOD

Using the same questionnaire that has been used in other countries, face-to-face surveys were conducted in public places (e.g. parks) at various locations in southern Ontario. Respondents were asked questions pertaining to their awareness and knowledge of aphasia. The number of surveys retained for analysis was 831. In addition to an evaluation of public awareness and knowledge of aphasia, the potential influences of age, gender, and occupation were analysed. For those who had heard of aphasia, questions were asked to determine how or where they had heard of aphasia.

RESULT

Consistent with the literature, overall public awareness and basic knowledge of aphasia in southern Ontario was found to be limited. The factors of age, gender and occupation were found to influence the results.

CONCLUSION

This investigation supports the need for better promotion of aphasia awareness to the public in southern Ontario and, by extension, in Canada.

Aphasia rehabilitation in Australia: Current practices, challenges and future directions

This study reports on current aphasia rehabilitation practices of speech-language pathologists in Australia. A 30-item web-based survey targeted approaches to aphasia rehabilitation, education, discharge, follow-up practices, counselling, interventions to improve communication access, community aphasia support services, and challenges to practice. One hundred and eighty-eight surveys were completed representing ~33% of the potential target population, with 58.5% urban and 41.5% rural participants across all states and territories. Respondents reported embracing a wide variety of approaches to aphasia rehabilitation; however, significant challenges in providing aphasia management in acute and residential care were identified. Low levels of knowledge and confidence were reported for both culturally and linguistically diverse clients and discourse approaches. Group and intensive services were under-utilized and clinicians reported inflexible funding models as major barriers to implementation. Few clinicians work directly in the community to improve communicative access for people with aphasia. Despite the chronic nature of aphasia, follow-up practices are limited and client re-entry to services is restricted. Counselling is a high frequency practice in aphasia rehabilitation, but clinicians report being under-prepared for the role. Respondents repeatedly cited lack of resources (time, space, materials) as a major challenge to effective service provision. Collective advocacy is required to achieve system level changes.

The confidence of speech-language pathology students regarding communicating with people with aphasia

BACKGROUND

Aphasia is an acquired language disorder that can present a significant barrier to patient involvement in healthcare decisions. Speech-language pathologists (SLPs) are viewed as experts in the field of communication. However, many SLP students do not receive practical training in techniques to communicate with people with aphasia (PWA) until they encounter PWA during clinical education placements.

METHODS

This study investigated the confidence and knowledge of SLP students in communicating with PWA prior to clinical placements using a customised questionnaire. Confidence in communicating with people with aphasia was assessed using a 100-point visual analogue scale. Linear, and logistic, regressions were used to examine the association between confidence and age, as well as confidence and course type (graduate-entry masters or undergraduate), respectively. Knowledge of strategies to assist communication with PWA was examined by asking respondents to list specific strategies that could assist communication with PWA.

RESULTS

SLP students were not confident with the prospect of communicating with PWA; reporting a median 29-points (inter-quartile range 17-47) on the visual analogue confidence scale. Only, four (8.2%) of respondents rated their confidence greater than 55 (out of 100). Regression analyses indicated no relationship existed between confidence and students' age (p = 0.31, r-squared = 0.02), or confidence and course type (p = 0.22, pseudo r-squared = 0.03). Students displayed limited knowledge about communication strategies. Thematic analysis of strategies revealed four overarching themes; Physical, Verbal Communication, Visual Information and Environmental Changes. While most students identified potential use of resources (such as images and written information), fewer students identified strategies to alter their verbal communication (such as reduced speech rate).

CONCLUSIONS

SLP students who had received aphasia related theoretical coursework, but not commenced clinical placements with PWA, were not confident in their ability to communicate with PWA. Students may benefit from an educational intervention or curriculum modification to incorporate practical training in effective strategies to communicate with PWA, before they encounter PWA in clinical settings. Ensuring students have confidence and knowledge of potential communication strategies to assist communication with PWA may allow them to focus their learning experiences in more specific clinical domains, such as clinical reasoning, rather than building foundation interpersonal communication skills.

Aphasia--the hidden disability

Aphasia is an acquired language disorder due to brain damage and which may include difficulty in producing or comprehending spoken or written language. Stroke is the commonest cause and each year 50,000 new patients develop aphasia. People with aphasia differ in their speech output and in their fluency. Some people communicate reasonably well, while others have very limited powers of expression. This review will describe the neurology of speech and aphasia, and will focus on the role of the speech and language therapist in dealing with people with aphasia.

CLINICAL RELEVANCE

Dentists and their staff should be aware that after a stroke some people are unable to talk or have limited powers of expression. Comprehension might be impaired and people with aphasia may be unable to grasp some common language, such as appointment letters and patient information.