Guiding principles for printed education materials: design preferences of people with aphasia

The objectives of this study were to obtain the preferences of people with aphasia for the design of stroke and aphasia printed education materials (PEMs) and to compare these preferences with recommendations in the literature for developing written information for other populations. A face-to-face quantitative questionnaire was completed with 40 adults with aphasia post-stroke. The questionnaire explored preferences for: (1) the representation of numbers, (2) font size and type, (3) line spacing, (4) document length, and (5) graphic type. Most preferences (62.4%, n = 146) were for numbers expressed as figures rather than words. The largest proportion of participants selected 14 point (28.2%, n = 11) and Verdana ref (33.3%, n = 13) as the easiest font size and type to read, and a preference for 1.5 line spacing (41.0%, n = 16) was identified. Preference for document length was not related to the participant's reading ability or aphasia severity. Most participants (95.0%, n = 38) considered graphics to be helpful, with photographs more frequently reported as a helpful graphic type. The identified preferences support many of the formatting recommendations found within the literature. This research provides guiding principles for developing PEMs in preferred formats for people with aphasia.

Third-Party Disability in Spouses of Older People With Hearing Impairment

Hearing impairment is the most common communication disability in older people. The wide-ranging impact of hearing impairment means that not only does the person with hearing impairment experience the consequences, but his or her frequent communication partners do also. In this article, the authors discuss the impact of hearing impairment in older people on spouses with normal hearing using the conceptualization of “third-party disability” created by members of the World Health Organization (WHO, 2001, p. 251). Results of a series of studies conducted by the authors demonstrate that spouses experience a range of activity limitations and participation restrictions due to their partner’s hearing impairment, including a variety of stresses involving lifestyle changes, communication difficulties, and emotional consequences. In this article, the authors highlight the important role of family-centered intervention in audiologic rehabilitation for older adults and emphasize the need to increase inclusion of spouses and significant others in the rehabilitation process.

Aphasia friendly written health information: content and design characteristics

People with aphasia need communicatively accessible written health information. Healthcare providers require knowledge of how to develop printed education materials (PEMs) in formats that people with aphasia prefer and can read. This study aimed to explore formatting characteristics considered to be barriers and facilitators to reading PEMs. Semi-structured in-depth interviews were conducted with 40 adults with aphasia who were selected using maximum variation sampling across aphasia severity, reading ability, and time post-stroke. Participants were shown stroke and aphasia PEMs obtained from the recruiting stroke services, asked to rank them from most liked to least liked, and comment on factors that made the PEMs easier and harder to read. The majority of participants ranked the aphasia friendly stroke (56.4%, n = 22) and aphasia (87.2%, n = 34) PEMs as most liked. Forty-five facilitator and 46 barrier codes were identified using qualitative content analysis and grouped into two categories; (1) content characteristics and (2) design characteristics. Findings support many of the recommendations found within the literature for developing best practice PEMs and accessible information for other patient groups. Routine consideration of the facilitators and barriers identified will contribute to making written information more accessible to people with aphasia.

Stakeholder opinion of functional communication activities following traumatic brain injury

PRIMARY OBJECTIVE

To establish a process whereby assessment of functional communication reflects the authentic communication of the target population. The major functional communication assessments available from the USA may not be as relevant to those who reside elsewhere, nor assessments developed primarily for persons who have had a stroke as relevant for traumatic brain injury rehabilitation.

RESEARCH DESIGN

The investigation used the Nominal Group Technique to elicit free opinion and support individuals who have compromised communication ability. A survey mailed out sampled a larger number of stakeholders to test out differences among groups.

METHODS AND PROCEDURES

Five stakeholder groups generated items and the survey determined relative 'importance'. The stakeholder groups in both studies comprised individuals with traumatic brain injury and their families, health professionals, third-party payers, employers, and Maori, the indigenous population of New Zealand.

MAIN OUTCOMES AND RESULTS

There was no statistically significant difference found between groups for 19 of the 31 items. Only half of the items explicitly appear on a well-known USA functional communication assessment.

CONCLUSIONS

The present study has implications for whether functional communication assessments are valid across cultures and the type of impairment.

The effect of hearing impairment on the vocal characteristics of older people

Measures of vocal intensity, frequency and harshness were compared for 19 hearing-impaired and 21 normal-hearing people over 60 years of age. Significantly greater comfortable intensity levels were found in the hearing-impaired group, but the other measures of frequency and harshness were not significantly different. A large proportion of the subjects in both groups reported a history of gastro-oesophageal reflux (GER), a condition associated with vocal fold pathology and hoarseness. Comparison of the GER and non-GER subjects on the measures of vocal function showed that the female GER speakers exhibited lower frequency on the vowel /u/ than the non-GER subjects. Clinicians need to be aware of the effect of highly prevalent disorders such as hearing impairment and GER on the voices of elderly speakers.

The evaluation of intervention programmes for communicatively impaired elderly people

A study is described which examined the efficacy of group intervention programmes using trained volunteers as agents of intervention with elderly nursing home residents with communication impairments. A series of intervention programmes, which consisted of six weekly sessions, was designed. Sessions were a combination of information giving, discussion and practical components where residents could practise newly acquired skills. Sessions covered a number of core components--the communication process, comprehension, expression and pragmatics, as well as information that was specific to the communication impairment. Volunteers were trained to administer the programme. Four groups of communicatively impaired elderly people were included in the study--a group of hearing-impaired residents, those with communication impairment subsequent to Parkinson's disease, those with communication impairment subsequent to cerebrovascular accident and those in varying stages of dementia. Results indicated that, although the residents studied responded very individually to the intervention strategies, with several subjects failing to demonstrate any gains in communicative competence from pre- to post-intervention, positive gains in communication skills and self-management of communicative impairment were observed for a number of subjects. Complicating factors such as general health and well-being are considered as uncontrollable variables in the measurement of performance in the elderly.

Speech perception in noise with BICROS hearing aids

The speech perception in noise abilities of 14 asymmetrically hearing-impaired subjects who had been fitted with Bilateral Contralateral routing of Signal (BICROS) hearing aids was evaluated. Speech tests were administered with subjects wearing both conventional monaural amplification and their own BICROS aids. Test procedures involved the use of sentence lists from the Speech Perception in Noise (SPIN) test and the Synthetic Sentence Identification (SSI) test, presented in a background of recorded four-talker babble. The performance of the subjects was found to be significantly better with the BICROS aids than with monaural amplification alone.

Progressive hearing loss in children with congenital cytomegalovirus

Case studies of five children with congenital cytomegalovirus (CMV) who were referred for audiological evaluation are presented. Significant deterioration of hearing was noted in all cases within the first 4 years of life. It is essential that neonates with congenital CMV be referred for hearing assessment and that the child's hearing be monitored on a long-term basis. Early intervention is vital for the speech and language development of the hearing-impaired child.