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Azios JH, Lee JB, Sigur A, Archer B, Elman RJ. Online Aphasia Groups: Navigating Issues of Voice and Identity. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2024; 33:333-348. [PMID: 38085656 DOI: 10.1044/2023_ajslp-23-00186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
PURPOSE Participation in aphasia groups is associated with increased communication, reduced feelings of social isolation, and increased quality of life. Despite the growing popularity of online aphasia groups, little is known about how to manage conversation in this format. We examined online aphasia book club sessions to examine how the facilitator supported group members' participation in conversation. METHOD Interactional sociolinguistic discourse analysis was used to analyze the behaviors and actions of the facilitator and group members. Qualitative data for this study were drawn from four recorded online aphasia book club sessions held through a university's free aphasia clinic on the Zoom web-conferencing platform. RESULTS Sociolinguistic discourse analysis revealed strategic facilitator behaviors that served to (a) give members with varying levels of verbal language abilities voice, (b) foreground or background aspects of voice, and (c) minimize her own voice to promote interactional symmetry between herself and group members. CONCLUSIONS Identity formed the backdrop for facilitators' actions when leading online groups, guiding decisions about who got to talk, when, for how long, through what modality, and about what topics. A better understanding of the interactions that occur online, such as how to develop and protect the identities of group members, could equip facilitators with the tools necessary for facilitating positive, engaging aphasia therapy groups online.
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Marshall J, Devane N, Talbot R, Caute A, Cruice M, Hilari K, MacKenzie G, Maguire K, Patel A, Roper A, Wilson S. A randomised trial of social support group intervention for people with aphasia: A Novel application of virtual reality. PLoS One 2020; 15:e0239715. [PMID: 32970784 PMCID: PMC7514104 DOI: 10.1371/journal.pone.0239715] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 08/31/2020] [Indexed: 11/18/2022] Open
Abstract
About a third of strokes cause aphasia, or language loss, with profound consequences for the person's social participation and quality of life. These problems may be mitigated by group social support. But this intervention is not available to all individuals. This study investigated whether it is feasible to deliver group social support to people with aphasia via a multi-user, virtual reality platform. It also explored the indicative effects of intervention and the costs. Intervention aimed to promote wellbeing and communicative success. It enabled participants to form new social connections and share experiences of living with aphasia. It comprised 14 sessions delivered over 6 months and was led by community based co-ordinators and volunteers. Feasibility measures comprised: recruitment and retention rates, compliance with intervention and assessment of treatment fidelity. Effects of intervention were explored using a waitlist randomised controlled design, with outcome measures of wellbeing, communication, social connectedness and quality of life. Two intervention groups were randomised to an immediate condition and two were randomised to a delayed condition. The main analysis explored scores on the measures between two time points, between which those in the immediate condition had received intervention, but those in the delayed group had not (yet). A comprehensive approach to economic data collection ensured that all costs of treatment delivery were recorded. Feasibility findings showed that the recruitment target was met (N = 34) and 85.3% (29/34) of participants completed intervention. All groups ran the 14 sessions as planned, and participants attended a mean of 11.4 sessions (s.d. 2.8), which was 81.6% of the intended dose. Fidelity checking showed minimal drift from the manualised intervention. No significant change was observed on any of the outcome measures, although the study was not powered to detect these. Costs varied across the four groups, from £7,483 - £12,562 British Pounds Sterling ($10,972 - $18,419 US dollars), depending on travel costs, the relative contributions of volunteers and the number of hardware loans that were needed. The results suggest that a larger trial of remote group support, using virtual reality, would be merited. However the treatment content and regime, and the selection of outcome measures should be reviewed before conducting the trial. Trail registration: Study registered with ClinicalTrials.gov; Identifier: https://www.ncbi.nlm.nih.gov/NCT03115268.
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Affiliation(s)
- Jane Marshall
- Centre for Language and Communication Science Research, City, University of London, London, United Kingdom
| | - Niamh Devane
- Centre for Language and Communication Science Research, City, University of London, London, United Kingdom
| | - Richard Talbot
- Centre for Language and Communication Science Research, City, University of London, London, United Kingdom
| | - Anna Caute
- Centre for Language and Communication Science Research, City, University of London, London, United Kingdom
- School of Health and Social Care, University of Essex, Colchester, United Kingdom
| | - Madeline Cruice
- Centre for Language and Communication Science Research, City, University of London, London, United Kingdom
| | - Katerina Hilari
- Centre for Language and Communication Science Research, City, University of London, London, United Kingdom
| | - Gillian MacKenzie
- Centre for Language and Communication Science Research, City, University of London, London, United Kingdom
| | - Kimberley Maguire
- Centre for Language and Communication Science Research, City, University of London, London, United Kingdom
| | - Anita Patel
- Anita Patel Health Economics Consulting Ltd, Queen Mary University of London, London, United Kingdom
| | - Abi Roper
- Centre for Language and Communication Science Research, City, University of London, London, United Kingdom
| | - Stephanie Wilson
- Centre for Human Computer Interaction Design, City, University of London, London, United Kingdom
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Pitt R, Theodoros D, Hill AJ, Russell T. The development and feasibility of an online aphasia group intervention and networking program - TeleGAIN. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2019; 21:23-36. [PMID: 28868932 DOI: 10.1080/17549507.2017.1369567] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 05/31/2017] [Accepted: 08/16/2017] [Indexed: 06/07/2023]
Abstract
PURPOSE Aphasia group therapy offers many benefits, however people with aphasia report difficulty accessing groups and speech-language pathologists are faced with many challenges in providing aphasia group therapy. Telerehabilitation may offer an alternative service delivery option. An online aphasia group therapy program - Telerehabilitation Group Aphasia Intervention and Networking (TeleGAIN) - has been developed according to the guidelines of the Medical Research Council (MRC) framework for complex interventions. The purpose of this paper is to describe the development of TeleGAIN and the results of a pilot trial to determine feasibility and acceptability. METHOD The development of TeleGAIN was informed through literature reviews in relevant topic areas, consideration of expert opinion and application of the social cognitive theory. TeleGAIN was then modelled through a feasibility pilot trial with four people with aphasia. RESULT TeleGAIN appeared to be feasible and acceptable to participants and able to be implemented as planned. Participant satisfaction with treatment was high and results suggested some potential for improvements in language functioning and communication-related quality of life. CONCLUSION TeleGAIN appeared to be feasible and acceptable, however the study highlighted issues related to technology, clinical implementation and participant-specific factors that should be addressed prior to a larger trial.
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Affiliation(s)
- Rachelle Pitt
- a School of Health and Rehabilitation Sciences , University of Queensland , Queensland , Australia and
- b Centre for Research in Telerehabilitation , University of Queensland , Queensland , Australia
| | - Deborah Theodoros
- a School of Health and Rehabilitation Sciences , University of Queensland , Queensland , Australia and
- b Centre for Research in Telerehabilitation , University of Queensland , Queensland , Australia
| | - Anne J Hill
- a School of Health and Rehabilitation Sciences , University of Queensland , Queensland , Australia and
- b Centre for Research in Telerehabilitation , University of Queensland , Queensland , Australia
| | - Trevor Russell
- a School of Health and Rehabilitation Sciences , University of Queensland , Queensland , Australia and
- b Centre for Research in Telerehabilitation , University of Queensland , Queensland , Australia
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Gillespie A, Hald J. The paradox of helping: Contradictory effects of scaffolding people with aphasia to communicate. PLoS One 2017; 12:e0180708. [PMID: 28806409 PMCID: PMC5555562 DOI: 10.1371/journal.pone.0180708] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2016] [Accepted: 06/20/2017] [Indexed: 11/29/2022] Open
Abstract
When interacting with people with aphasia, communication partners use a range of subtle strategies to scaffold, or facilitate, expression and comprehension. The present article analyses the unintended effects of these ostensibly helpful acts. Twenty people with aphasia and their main communication partners (n = 40) living in the UK were video recorded engaging in a joint task. Three analyses reveal that: (1) scaffolding is widespread and mostly effective, (2) the conversations are dominated by communication partners, and (3) people with aphasia both request and resist help. We propose that scaffolding is inherently paradoxical because it has contradictory effects. While helping facilitates performing an action, and is thus enabling, it simultaneously implies an inability to perform the action independently, and thus it can simultaneously mark the recipient as disabled. Data are in British English.
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Affiliation(s)
- Alex Gillespie
- Department of Psychological and Behavioural Science, London School of Economics and Political Science, London, United Kingdom
- * E-mail:
| | - Julie Hald
- Department of Psychological and Behavioural Science, London School of Economics and Political Science, London, United Kingdom
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Gelech J, Bayly M, Desjardins M. Constructing robust selves after brain injury: positive identity work among members of a female self-help group. Neuropsychol Rehabil 2017; 29:456-476. [PMID: 28393594 DOI: 10.1080/09602011.2017.1308872] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Despite common experiences of identity damage, decline, and deterioration, many brain injury survivors succeed in reconstructing robust identities in the wake of injury. Yet, while this accomplishment greatly benefits survivors' quality of life, little is known about how positive identity work might be facilitated or enhanced in therapeutic institutions. Drawing on data from a women's self-help group, we argue that an egalitarian, reflective, strength-focused, and gender-segregated environment can provide female ABI (acquired brain injury) survivors with a fertile scene for identity enhancement and offer unique opportunities for collective identity development. Sociolinguistic interactional analysis revealed four types of positive identity work undertaken within the group: constructing competent selves; tempering the threat of loss and impairment; resisting infantilisation and delegitimisation; and asserting a collective gender identity. This identity work was facilitated by specific programme attributes and activities and contributed to the global project of decentring disability and destigmatising impairments and losses. We call for increased attention to identity issues in brain injury rehabilitation and argue that gender-segregated programming can provide a unique space for female survivors to construct empowering individual and collective identities after injury.
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Affiliation(s)
- Jan Gelech
- a Department of Psychology , University of Saskatchewan , Saskatoon , Canada
| | - Melanie Bayly
- a Department of Psychology , University of Saskatchewan , Saskatoon , Canada
| | - Michel Desjardins
- a Department of Psychology , University of Saskatchewan , Saskatoon , Canada
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Harmon TG, Jacks A, Haley KL, Faldowski RA. Listener Perceptions of Simulated Fluent Speech in Nonfluent Aphasia Aphasiology. APHASIOLOGY 2015; 30:922-942. [PMID: 34650319 PMCID: PMC8513757 DOI: 10.1080/02687038.2015.1077925] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND People with aphasia (PWA) are frequently perceived less favorably by listeners than their peers. These perceptions include incorrect assumptions that can prevent successful social interactions. While communication partner training has been shown to improve social outcomes related to the listener (see e.g., Kagan, Black, Duchan, Simmons-Mackie, & Square, 2001), changing the verbal output of PWA may also yield more favorable listener perceptions about the speech, speaker, and their own affective response. We investigated the effects of artificially altered fluency (i.e., simulated fluency) on listeners' subjective impressions. AIMS The purpose of the study was to (1) confirm that listeners perceive PWA less favorably than their neurologically healthy peers and (2) determine the effects of simulated fluency on listener perceptions about PWA. METHOD & PROCEDURES Thirty-eight listeners heard nine narrative monologue language samples from three conditions (i.e., speakers with nonfluent aphasia, simulated fluent samples from the same speakers, and neurologically healthy speakers). Listeners responded to a nine-item questionnaire that probed perceptions about speech output, speaker attributes, and listener feelings. OUTCOMES & RESULTS Listeners perceived PWA less favorably than their neurologically healthy peers. Simulated fluency yielded more positive listener perceptions for all questionnaire items except speech intelligibility, which was unchanged by simulated fluency. CONCLUSIONS Simulated fluency improved listener perceptions of PWA significantly, indicating that speech fluency may be a socially valid treatment target in aphasia. Beyond direct training of communication partners, changing the verbal output of aphasic speech can also yield more positive listener perceptions of PWA.
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Affiliation(s)
- Tyson G Harmon
- Division of Speech and Hearing Sciences, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Adam Jacks
- Division of Speech and Hearing Sciences, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Katarina L Haley
- Division of Speech and Hearing Sciences, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Richard A Faldowski
- Office of Research, Department of Allied Health Sciences, University of North Carolina at Chapel Hill, Chapel Hill, NC
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