Increasing opportunities for functional communication learning in post-stroke aphasia : an exploratory study of early supported discharge rehabilitation

• Main Author: Shiggins, Ciara
• Published: University of East Anglia 2017
• Subjects: 616.85
• Online Access: http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.709793

Aphasia is a communication disorder affecting all language modalities to varying degrees of severity, and impacting on the person’s overall quality of life, place in society and interpersonal relationships. Early post-stroke, healthcare professionals (HCPs) are often the main communication partners of people with aphasia (PWA), yet there are apparently few opportunities for communication practice in the course of rehabilitation. Practice is key to (re)learning, with other processes such as intensity, context, and the therapeutic alliance also shown to impact on outcomes of (re)learning. Currently, PWA in the UK receive stroke rehabilitation in a variety of care settings. Rehabilitation in the home through Early Supported Discharge (ESD) is the focus of this study. A systematic review using adapted Cochrane methodology examined how learning processes are reported in speech and language therapies for post-stroke aphasia with a functional outcome. The 34 included studies were reported with variable degrees of adherence to the Template for Intervention Description and Replication (TIDieR) checklist. More specific and comprehensive articulation of the learning processes entailed in rehabilitation and (re)learning is needed in such aphasia therapies. An exploratory study was conducted to understand how conditions for (re)learning are produced during routine rehabilitation for PWA in the ESD context. Observational and interview methods were used to collect data on perceptions and practices of routine rehabilitation with 10 PWA and 22 HCPs (observation study) and 9 PWA and 8 HCPs (interview study). Interview data were analysed using thematic analysis; observational data explored the structure and ecology of the rehabilitation session and how the interview themes were enacted in interactions. Interview and observation data were analysed and combined within an Activity-based Communication Analysis (ACA) approach. Opportunities to enhance (re)learning of functional communication during routine rehabilitation were identified, but not consistently realised. The home environment, rapport, emotions, the structure of sessions and HCP training all influence PWA’s (re)learning. These findings have clinical implications and warrant further research.