ImPACT: a multifaceted implementation for conversation partner training in aphasia in Dutch rehabilitation settings.

PURPOSE: Exploration of the clinical uptake of a novel conversation partner training (CPT) programme in aphasia in 10 Dutch rehabilitation facilities and identification of its perceived facilitators and barriers in service providers, and the evaluation of the implementation methods used. METHOD: Ten rehabilitation centres took part in a multifaceted implementation of CPT over 13 months. Each centre selected two speech and language therapists to act as knowledge brokers whose role was to raise awareness of CPT in the team and to facilitate getting partners of people with aphasia into the programme. The implementation was evaluated using analysis of recruitment data and questionnaires, supplemented by consensus data and scrutiny of implementation plans. RESULTS: Successful implementation was described as (1) four dyads included during the intervention period, (2) two more dyads included after the intervention period, before the end of the study, and (3) inclusion of the Partners of Aphasic clients Conversation Training (PACT) programme in a description of the logistics of local stroke care (stroke care pathway). Seven centres were successful in reaching the target inclusion of six dyads in total. Only one centre had care pathways in place. From a recruitment pool of 504 dyads, 41 dyads were recruited and 34 partners completed the implementation study of the PACT. Observed facilitators included the motivation to engage partners in the rehabilitation process and the perceived added value of PACT. The perceived barriers focused on time limitations within current systems to discuss the consequences of PACT with relevant professionals and to establish allocated time for this training within existing care routines. CONCLUSIONS: The motivation of professionals to involve partners in the rehabilitation process assisted with the introduction of PACT in practice. The main barrier was time, linked to the requirement to think through integration of this innovation within existing care. Longer term evaluation would ascertain how centres sustain uptake without support. Implications for Rehabilitation The integration of a new treatment method that reaches beyond the boundaries of one group of professionals needs to be facilitated by providing time to all team members involved to discuss and think through the consequences of that approach for clinical decision making within the care trajectory of a client and his/her significant other. Partners of people with aphasia need to be properly informed about the collaborative nature of communication with a view to the longer term adjustment to living with someone with aphasia.

'Now it is about me having to learn something .' Partners' experiences with a Dutch conversation partner training programme (PACT).

BACKGROUND: The increase in the number of reported conversation partner programmes for conversation partners of people with aphasia demonstrates increased awareness of partner needs and the positive effect of trained partners on the communicative abilities of the person with aphasia. Predominantly small-scale studies describe the effectiveness of conversation partner training (CPT) and how partners perceive this training. The view of partners on this service commission remains largely unknown. AIMS: To explore the experiences of partners of people with aphasia with a CPT programme when it was newly introduced into rehabilitation settings. METHODS & PROCEDURES: Seventeen partners of people with aphasia were interviewed using a semi-structured format about their experience with Partners of Aphasic Clients Conversation Training (PACT). Transcribed interviews were analysed using qualitative content analysis. OUTCOMES & RESULTS: Four categories representative of the practical nature and individual tailoring of PACT were identified: engaging with PACT; learning from PACT; reflecting on behaviour and emotions; and experiences with earlier speech and language therapy (SLT). Two themes were identified cutting across all categories: the nature of communication is difficult to grasp; and balancing roles as partner, carer and client. CONCLUSIONS & IMPLICATIONS: Partners appreciated the training programme once their initial lack of awareness of the interactive nature of communication had been addressed. SLTs need to be clear about the collaborative nature of conversations and what can be offered within the rehabilitation trajectory to address conversation alongside language training.

Rehabilitation targeted at everyday communication: can we change the talk of people with aphasia and their significant others within conversation?

OBJECTIVE: To investigate whether aphasia therapy can change the talk of speakers with aphasia and/or their significant others within conversation. DESIGN: Small number of intervention studies targeting conversations involving speakers with aphasia are reviewed. All are single case studies. SETTING: Key assessment in the studies was an audio or video recording of 1 or more conversations between the dyad, usually made in the home setting. Intervention in these studies took place in the participants' home or another setting, such as a therapy room. PARTICIPANTS: In all of the studies reviewed, the participants consisted of a person with aphasia (PWA) and a significant other, usually the PWA's spouse. INTERVENTIONS: In all studies, therapy took the form of a behavioral intervention involving the provision of feedback to the significant other and/or PWA on their conversational behaviors uncovered by a conversation analysis assessment. Handouts, transcripts, discussion, and video feedback were used. Suggestions to permit participants to cope better with the effects of aphasia within conversation were given, and opportunities for practicing these strategies within conversation were provided. MAIN OUTCOME MEASURES: Postintervention, 1 or more conversations involving the PWA and significant other were recorded in the same manner as the preintervention. Conversations were analyzed in relation to changes in the behaviors targeted in intervention, such as those involved in topic initiation or repair of linguistic errors. RESULTS: Each of the studies reviewed presented evidence that the talk of people with aphasia and/or their significant others can be changed in conversation. In some studies the evidence is primarily qualitative, in the form of observed changes to conversational behaviors postintervention. Some studies produce stronger evidence by combining qualitative and quantitative analyses of change. CONCLUSIONS: There is evidence that intervention targeting conversations involving an aphasic speaker can achieve change. Future studies should move beyond single case designs, include more robust, quantifiable evidence of change, and provide evidence of maintenance of change.

MAAS (Multi-axial Aphasia System): realistic goal setting in aphasia rehabilitation.

Treatment success in aphasia is influenced by various factors. Clinical decisions, including patient selection and decisions on frequency and content, are often guided by a clinician's implicit opinions. The Multi-axial Aphasia System (MAAS) was developed to structure linguistic, somatic, neuropsychological, psychosocial and socio-economic information on five separate axes, enabling an explicit and interdisciplinary process of clinical decision-making. The objectives of this study were to investigate the potentialities of MAAS in predicting the outcome of cognitive-linguistic treatment. A group of 58 aphasic patients were investigated prospectively. All received cognitive-linguistic treatment during a randomized, controlled study on the efficacy of lexical semantic treatment. An interdisciplinary aphasia team rated the pretreatment MAAS profiles of all patients. The team was blinded for treatment allocation and outcome. A multiple linear regression analysis was performed with the posttreatment verbal communication score as the variable to be predicted and the overall MAAS rating, age and type of treatment as predictor variables. In a second multiple regression analysis, the ratings for each of the five MAAS axes were used as candidate predictors. The team's overall rating contributed significantly to the prediction of verbal communicative ability after linguistic treatment. Of the five MAAS axes, the neuropsychological axis contributed to the prediction. An interdisciplinary approach to aphasia assessment may contribute to realistic goal setting in aphasia rehabilitation. The results of this study stress the importance of neuropsychological assessment of aphasic patients before treatment.

A computerised communication aid in severe aphasia: an exploratory study.

PURPOSE: To investigate the efficacy of TouchSpeak (TS), a handheld computerised communication aid for aphasia. METHOD: A pre-post one-group design was used with a referred sample of 34 patients with a severe aphasia and a need for alternative and augmentative communication (AAC). The participants were trained to use TS in two self-chosen communicative situations. The ability to navigate the hierarchical vocabulary and overall communicative ability were assessed. Participants rated their communicative success with and without TS. Three years after completion of the training, participants were interviewed about their present use of TS. RESULTS: In total, 76% used TS outside the clinic in two trained communicative situations. Overall communicative ability improved, as tested in untrained scenarios. Quality of communication with TS was rated higher than without TS. Fifty per cent obtained their own TS after the training and after 3 years 6% still used TS. CONCLUSIONS: Aphasic communication can be supported effectively by TS. Patients with a severe aphasia are able to master a hierarchical computerised vocabulary and to use it in daily life for specific communicative situations. In addition, TS may also have a generalised effect on overall communicative ability. For most patients, the supportive role of TS is temporary.