Holistic Frameworks for Aphasia Management - PDF

Holistic frameworks for the management of aphasia & cognitive- communication disorders NNNS3033 Acquired Language & Communication Disorders 30 October 2024 By: Fatimah Hani Hassan  Cognitive Disorders...

Holistic frameworks for the management of aphasia & cognitive- communication disorders NNNS3033 Acquired Language & Communication Disorders 30 October 2024 By: Fatimah Hani Hassan  Cognitive Disorders Non-Cognitive Disorders Linguistic Non-Linguistic Motor Sensory Aphasia Cognitive- Apraxia Hearing loss communication Dysarthria Auditory disorder Dysphonia processing Dysfluency disorder 2  Conceptualization & Approaches Medical Unidimensional Multidimensional Cognitive/ Psychosocial Psycholinguistic Aphasia finds the mind struggling as it seeks ways to push a thought... Through a banged-up brain... I learned they belong to the province the mind, an area largely uncharted by humans, a vastness covering eternity, whose vistas pour out in endless time, a pulsating excitement willing us to taste, to drink, to absorb, to learn. - Helen Harlan Wulf, Aphasia, My World Alone (1973) 8/05/20XX CONFERENCE PRESENTATION 4 Contexts of Recovery Settings (clinical vs. non -clinical) Professional involvements (MDT vs. non -MDT) Recovery phases (acute, subacute vs. chronic) Sociocultural & socioeconomic contexts (internal vs. external) Family dynamics Distance 5 Which one is the best approach? Does it exist? Medical Unidimensional Multidimensional Cognitive/ Psychosocial Psycholinguistic Biopsychosocial model Psychological Biological Healthcare model Social Biopsychosocial (Engel, 1977) Biopsychosocial approach to aphasia intervention Medical Linguistic Biopsychosocial Cognitive Socioenvironmental The World Health Organization’s International Classification of Functioning, Disability and Health framework (ICF; World Health Organization, 2002)  WHO ICF Body Functions: Physiological functions Body Structures: Anatomical parts of the body Activity: Execution of a task or action Participation: Involvement in a life situation Contextual Factors: Physical, social and psychological make up (inside and outside of an individual) (World Health organization, 2002) ©2023 FATIMAH HANI HASSAN  Adaptation of WHO ICF, LPAA, and Disability Creation Process (DCP) Model (Noreau et al. 2002) 11 Re-engagement in life by broadening and refocusing clinical practice and research on the LPAA consequences of aphasia CORE VALUE 1 CORE VALUE 2 CORE VALUE 3 The explicit goal is the Everyone affected by aphasia is Success measures include enhancement of life entitled to service documented life-enhancement participation changes CORE VALUE 4 CORE VALUE 5 Both personal and Emphasis is on the availability environmental factors are of services as needed at all intervention targets stages of aphasia Disability Creation Process A conceptual model by the Quebec Committee on IDICH (WHO’s International Classification of Impairments, Disabilities, and Handicaps 1993) Impacts of disability on social experience, participation, and lifestyles (Noreau et al, 2002)  Adaptation of WHO ICF, LPAA, and Disability Creation Process (DCP) Model (Noreau et al. 2002) Participation in Life Situations = WHO ICF’s Activity-Participation + DCP’s Life Habits Personal Identity, Attitudes & Feelings emphasized > WHO ICF’s Personal Factors Severity of Aphasia = WHO ICF’s Body Functions component Communication & Language Environment = WHO’s Environmental Factors Life with Aphasia = Quality of life in living with aphasia 14 Possibilities & Priorities versus Problems & Limitations Prongs Comparisons between the frameworks WHO ICF A-FROM FOURC Body function and structure Severity of aphasia Skills + Abilities & intentional Activity Participation in life situations strategies Participation Environmental factors Communication & language Environmental support environments Personal factors Personal identity, attitudes & Motivation & confidence feelings Living with aphasia Communication goals 1. Choose goals 2. Create solution 3. Collaborative planning 4. Complete & continue  Model of cognitive-communication competence Multiple interrelated domains Major goals are related to communication competence (MacDonald, 2017) 8/03/20XX PITCH DECK 17 “Beginning with the end” (Kagan & Simmons-Mackie, 2007) What is the ultimate/end goal for the patient? Should focus on life participation across various stages Intervention should target all domains (impairment, participation, environmental and personal factors) at each stage of healthcare continuum Assessment should “gather data” in each domain of a model/framework relevant to the end goal  Adapted from: Aphasia Access – Intervention in LPAA Module A-FROM based assessment Considers: Considers: Confidence Conversations Self-esteem Relationships Identity Leisure activities Autonomy Community Optimism activities/involvement Considers: Things that act as a barrier to communication Considers: People in the environment Language activities (family, friends, acquaintances) to support specific ○ Knowledge roles ○ Attitudes Vocabulary for KEY ○ Skills in supporting interests communication Scripts for specific Physical environment activities Resources available Treatment Who? Where? When? What? Why? How? Who should receive intervention? According to, the LPAA Core Value 2 Everyone affected by aphasia is entitled to service Variations to the extent where individuals receive services (according to policies and norms)  Social Network Analysis (Simmons-Mackie, 2008) Best Parent- Friends in-law friend Spouse Neighbours Brother/ Individuals with acquired sister-in- Coworkers law communication disorders Children Other rehab SLP Siblings professionals Hired Parents caregivers Other health Physicians professionals Where should intervention begins and occurs?  When should treatment begins and occurs? AS EARLY AS POSSIBLE Godecke et al. (2014) - Very early rehab (started within 2 weeks; 1 hr/day) vs. usual care  LPAA Core Value 5: Availability of services at all stages of aphasia *evolution of severity of aphasia, needs, environmental and personal factors → optimization of treatment effects What intervention should be given? LPAA Core Value 1 – enhancing of life participation LPAA Core Value 4 –addressing personal and environmental factors Initial stage of recovery Communication needs ○ Understand medical management ○ Make decisions related to their care ○ Understand their conditions ○ Let others know about their pain, comfort, desires for certain things or people, concerns about their conditions and treatments Counsel and share information with families & caregivers ○ Initiate communication partner training Aphasia-friendly communication INCOG Recommendation for Cognitive-Communication and Social Cognition Rehabilitation (Togher et al., 2023) 2.0 Evaluation of variations in communication competence Individualized In-context training intervention Telerehabilitation Group therapy Augmentative and alternative communication (AAC) Culturally relevant Cultural competence training assessment and treatment for service providers 28 Evaluation of variations Individualized intervention in communication competence Reintegration to daily needs and Highly individualized participation Influenced by internal and Focus on communication external factors strategies and metacognitive Communication partners awareness Communication demands Coping strategies Environment Support confidence, identity Fatigue reformation, and self-esteem Sensory and motoric limitations Education for patient and Behavioural / emotional significant others variables Communication partner training 29  In-context training Group therapy Practicing skills in target Provide social space contexts (at home, at Goals remain individualized work/school, during social Homogenous versus events) heterogenous grouping of patients Monitoring of progress using goal attainment scaling AAC Telerehabilitation Severe communication disorders Research evidence post- With device VS without device COVID-19 Low tech VS high tech Increase access to services Pictures, symbols, icons, Poor evidence for alphabets etc. computerized treatment 30  Culturally relevant Culturally competence assessment and treatment training for service providers Consider language Diversifying experience dominance, proficiency, and Increasing awareness, preference knowledge, attitudes, and Communication style related beliefs to cultures and traditions Enhancing sensitivity Issues pertaining towards other cultures multilingualism and Modifying behaviours multiculturalism 31 C.A.P.E – The Treatment Essentials for Aphasia (Elman, 2021) C: Connecting people with aphasia A: Augmentative & alternative communication P: Partner training E: Education & resources C: Connecting People Aphasia is an isolating condition ○ Language barrier limits access to transactional and interactional role of language Some ways to connect people with aphasia: ○ Aphasia groups & programs ○ Formal visitation programs; informal meetings with past clients ○ Online options (e.g. Aphasia Recovery Connection (ARC) website, ARC Facebook - @aphasiaARC, Aphasia in Malaysia Facebook) ○ Aphasia conferences/camps A: AAC “low tech” options examples ○ individualized communication books ○ pen/paper ○ gestures/pantomime ○ yes/no in some format ○ writing, drawing ○ props (1-10 number line, maps, calendars, etc.) “High tech” examples ○ stored message retrieval/speech generating devices ○ visual scene programs ○ apps for smart devices TOTAL COMMUNICATION P: Partner Training A trained partner can be a “communication ramp” via the use of AAC tools and various communication strategies Aphasia Access Video Resource Page: ○ https://www.aphasiaaccess.org/videos Aphasia Institute – Supported Conversation™ eLearning Module E: Education & Resources What resources are available? ○ For the person with aphasia ○ For friends/family members ○ For people/businesses/individuals etc. in the community ○ For the general public Consider: ○ Making information “aphasia-friendly” Aphasia-friendly communication support UK Stroke Association (2012) Considerations for creating aphasia-friendly messages Content Sentence structure Word and sentence length Use of headings Fonts Colours Images Layout and spaces Uniformity × “Welcome to this conference. We are very glad to have you with us on this special occasion, and we hope you feel at home here.” ✔ “Welcome. We are glad you came.” Multimodal communication Use multiple communication modes ○ talking ○ writing ○ pictures ○ drawing ○ gestures ○ charades/acting Give time to people with aphasia to process input and give response Give MORE TIME… go slowly!!