Blog Archives

Amelioration, regeneration, acquiescent and discordant: an exploration of narrative types and metaphor use in people with aphasia

Aphasia is an acquired communication impairment that affects a person’s ability to use and understand language. The aim of this study was to explore the narrative types and metaphors expressed by people with aphasia, to enhance insight into this experience. A qualitative narrative approach using videoed semi-structured interviews was undertaken with 11 people with aphasia. The transcribed data were analysed for underlying narratives and metaphors. Four types of narratives, labelled amelioration, regeneration, acquiescent and discordant, along with 13 conceptual metaphors used by persons with aphasia to convey their stroke experiences were identified. Metaphors specific to aphasia included aphasia as a thief, aphasia as a barrier, aphasia as a gift and aphasia as enlightenment. These findings facilitate understanding of the experience of aphasia and highlight the different narratives that may be used by the individual to make sense of and respond to their aphasia.

from Disability & Society

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What people with aphasia want: Their goals according to the ICF

Conclusions: People with aphasia in this study were able to articulate a wide range of goals post-stroke that encompassed all of the ICF components but had a particular focus on the Activity and Participation components.

from Aphasiology

Language differences in qualitative research: is meaning lost in translation?

This article discusses challenges of language differences in qualitative research, when participants and the main researcher have the same non-English native language and the non-English data lead to an English publication. Challenges of translation are discussed from the perspective that interpretation of meaning is the core of qualitative research. As translation is also an interpretive act, meaning may get lost in the translation process. Recommendations are suggested, aiming to contribute to the best possible representation and understanding of the interpreted experiences of the participants and thereby to the validity of qualitative research.

from European Journal of Ageing

My Speech Problem, Your Listening Problem, and My Frustration: The Experience of Living With Childhood Speech Impairment

Conclusion: Successful communication is dependent on the skills of speakers and listeners. Intervention with children who experience speech impairment needs to reflect this reciprocity by supporting both the speaker and the listener and by addressing the frustration they experience.

from Language, Speech and Hearing Services in Schools

Disentangling the social threads within a communicative environment: a cacophonous tale of alternative and augmentative communication (AAC)

Alternative and augmentative communication (AAC) technology is being increasingly recognised as an important means of fostering the literacy of students with significant disabilities. However, the coordinated use of AAC technology continues to challenge professionals, families and users leading to dissonant meanings and fragmented use. This paper is an attempt to inquire into, and disentangle some of, the social threads that made up the communicative environment of one first-grade student with significant disabilities – Trevor – for whom augmentative communication technology was procured. The ethnographic study reported in this paper documents the conflicting meanings of access and participation that surfaced among the multiple participants under whose guidance Trevor was required to use AAC. The paper discloses the assumptions implicit in these practices and in the conceptions of literacy enacted by different professionals. The paper notes the significance of these issues for Trevor’s narrative construction of himself and concludes with implications for practitioners.

from the European Journal of Special Needs Education

The evidence for a life-coaching approach to aphasia

Conclusions: The assumptions behind the life-coaching approach are well supported by the narratives of people living with aphasia. Even if the life-coaching approach is not adopted wholeheartedly by the profession, the principles of positive psychology and the life goal perspective appear highly relevant to living successfully with aphasia.

from Aphasiology

Critical Tensions in Talk About Brain Injury

This article presents an introduction to some potential applications of a critical discourse perspective to the field of traumatic brain injury. Critical Discourse Analysis (CDA) examines spoken and written texts as a means to understand the two-way relationship between discourse and cultural context. CDA is particularly interested in how language use reflects and creates power relationships between those involved in the communication. In order to illustrate this perspective, this paper discusses a purposively selected set of written texts about brain injury from a range of institutional contexts: a scholarly journal article, a submission to government from an advocacy group, the home web page of a support group, a newspaper article from the general media, and personal letters written by people with traumatic brain injury. The analysis involved investigation of key linguistic features reflecting the experiential, interpersonal and textual aspects of these texts. Three main lines of tension between competing discourses emerged from an examination. Tension emerged within each text between medical vs. lay terminology, and this was seen as reflecting the widespread power of the scientific paradigm. Tension was apparent between problem talk vs. positive talk. Talk about the problems associated with brain injury forms an essential component when seeking support, and yet talk about positive outcomes forms an essential component when describing the rehabilitation journey. There were also competing discourses in terms of the focus of the talk, between person centredness vs. other centredness. The methodology of CDA is proposed as a tool for reflective clinical practice at both an individual and professional level, as it provides a systematic means to examine health professionals’ interactions and promotes the development of a critical understanding of the cultural ideologies and institutions in which practice is located.

from the Australian Academic Press

Aphasia Therapists’ Stories of Ending the Therapeutic Relationship

This article uses the medium of clinicians’ comments and stories to explore their perceptions of therapeutic relationships and how these relationships come to a close at discharge from aphasia therapy. These narratives are drawn from a qualitative, grounded theory study carried out in South Australia and Northern Territory involving semi-structured interviews with 30 speech pathologists. The stories reported here shed light on the complexities of negotiating boundaries and endings to therapeutic relationships. Interviewees discussed the special nature of their relationships with their clients with aphasia, professional distance, and dependence. Exploration of these narratives is timely because of the increasing emphasis on person-centeredness in rehabilitation, shared decision making, and authentic relationships. This work is important to encourage refl ective practice and greater insight into both speech pathologists’ professional identities and their therapeutic relationships.

from Topics in Stroke Rehabilitation

Barriers to Teaching Non-speaking Learners with Intellectual Disabilities and their Impact on the Provision of Augmentative and Alternative Communication

The purpose of this investigation was to gain an understanding of the challenges of teaching non-speaking learners with intellectual disabilities and the scope of augmentative and alternative communication (AAC) used in primary school settings in Gaborone, Botswana. A qualitative interview methodology was used to investigate the experiences of 11 special educators working with non-speaking learners with intellectual disabilities. Participants of the study revealed that teaching non-speaking students with intellectual disabilities is challenging. The study further showed that AAC systems were not widely used in Botswana, and that teachers lacked knowledge and skills. Nevertheless, the participants recognised the importance of AAC in enhancing the functional communication skills of the non-speaking learners with intellectual disabilities. Based on the findings recommendations are made to pave the way forward.

from the International Journal of Disability, Development and Education

Qualitative study of the therapeutic relationship in speech and language therapy: perspectives of adults with acquired communication and swallowing disorders

Background: Considerations of the negotiated therapeutic relationship in speech and language therapy are somewhat scarce, with specific therapeutic factors generally framed from psycholinguistic, behavioural, or neurological perspectives.

Aims: To explore the therapeutic relationship in speech and language therapy, focusing on the personal meanings and experiences of adult clients with acquired communication and swallowing disorders.

Methods & Procedures: The study was qualitative, using methods from Grounded theory to analyse eleven interviews with adults who had acquired disorders of communication or swallowing, as they described their perceptions of speech and language therapy and therapists. Five males and six females with a mean age of 62 years, ranging from 25 to 87 years, with varied communication disorders, were interviewed.

Outcomes & Results: A preliminary theoretical framework explains how speech and language therapists supported alienated, demoralized or confused clients with therapeutic qualities, such as Being Understanding, Being Gracious, Being Erudite and Being Inspiring; and with therapeutic actions, such as Being Confident, Being Soothing, Being Practical and Being Empowering. These categories provided a basis for the researcher to construct a substantive theory of restorative poise which characterized the attitudinal and behavioural characteristics of an ideal speech and language therapist from the perspective of the client.

Conclusions & Implications: Participants were aware of the components of a therapeutic relationship and valued these as essential to their own personal understanding of positive outcomes in speech and language therapy. Therefore, specific types of attitudes and actions that constitute the speech and language therapist’s contributions to the therapeutic relationship seemed to provide catalytic conditions for successful working together in therapy; and consequently, may have a bearing on effective practice and treatment efficacy.

from the International Journal of Language and Communication Disorders

A qualitative longitudinal case study of a daughter’s adaptation process to her father’s aphasia and stroke

Conclusions: The results indicate that the experience of a daughter was an evolving process, involving negative and more positive consequences. The process of adaptation was influenced by the particular life situation of this participant, her perception of stresses, and the types of strategies she employed. These results show that children may be stressed by many changes associated with a stroke, such as communication limitations. When possible, adult children should be included in the rehabilitation process since they provide skills, abilities, and affection in caring for their parent with aphasia. These may contribute to the reduction of overall stress related to a family’s adaptation to the consequences of aphasia and stroke.

from Aphasiology

How do people with aphasia view their discharge from therapy?

Conclusions: Despite the individual circumstances of each person’s account, a common finding was uncertainty and confusion surrounding discharge. Clients were not always sure why therapy ended. They rarely discussed it with their therapists in much depth and often felt unable to question their therapists’ decisions. This paper argues that such findings reflect the disempowered position of our clients with aphasia and that a more open, shared process of decision making would not only be more satisfactory for all parties but also demonstrate better outcomes of therapy itself.

from Aphasiology

Breaking the connection: Why is it so difficult to talk about discharge with our clients with aphasia?

This paper, drawn from a study into experiences of treatment termination in chronic aphasia, discusses why communication, between speech-language pathologists and clients with aphasia, breaks down so frequently during discharge negotiations. Considering our role as communication experts and our awareness of the barriers faced by people with aphasia in sharing decisions about their care, this is a concern. Eight general reasons for communication breakdown are discussed: the presence of aphasia; inadequate explanations or shared understandings of therapy in general; discharge reflecting other aspects of professional-client communication; discharge as “bad news”; discharge and the limits to negotiation; discharge as an unclear phenomenon; discharge documentation; and discharge evaluation. These reasons are illustrated by several real stories gathered from in-depth interviews with 30 speech-language pathologists, 21 people with aphasia and 16 family members. This paper aims to help speech-language pathologists reflect on how they break the connection, so important in therapy, between themselves and their clients with aphasia at discharge and how this is communicated. This issue is important, not only because of the centrality of communication to our work, but also because it has implications for the overall success of therapy and for our clients’ wellbeing.

from the International Journal of Speech-Language Pathology