Self-efficacy and resilience in severe aphasia - an exploratory cross-sectional study of two psychosocial factors and their relation to functional communication.

PURPOSE: Self-efficacy and resilience are important for various aspects of rehabilitation outcome after stroke. However, little is known about how these factors are affected and related to communication outcome in stroke survivors with aphasia. The purpose was to investigate self-efficacy and resilience, and associations to language and functional communication, in people with severe post-stroke aphasia. MATERIALS AND METHODS: 37 participants with severe aphasia rated their self-efficacy and resilience, using adapted versions of the existing instruments DLSES and CD-RISC. In addition, linguistic ability, executive function and functional communication were assessed. RESULTS: Participants rated their self-efficacy and resilience as expected based on reports in the literature; somewhat lower than general populations and at similar levels as clinical populations. There were no association between self-efficacy, resilience and linguistic ability. In the sample as a whole, there were no associations between self-efficacy, resilience and functional communication. However, when results were stratified by executive function, associations emerged in the group with stronger executive function. CONCLUSIONS: People with severe aphasia have decreased self-efficacy and resilience compared to general populations, but not necessarily in proportion to their language impairment. Among participants with relatively spared executive functions there were indications of an association between self-efficacy, resilience and functional communication.

The constructs self-efficacy and resilience are related to several outcomes after stroke.Self-efficacy and resilience can be assessed in many people with severe aphasia, provided that materials and administration procedure are adequately adapted.There are indications of an association between functional communication and self-efficacy and resilience.Integrating activities to increase self-efficacy and resilience in aphasia rehabilitation may be beneficial to treatment outcomes regarding functional communication.

What do people respond to when rating executive function? - a cognitive interviewing investigation of BRIEF-A informant ratings in severe aphasia.

PURPOSE: Executive dysfunction is common in persons with severe aphasia. Assessing these functions in this population is challenging. Informant ratings, such as the BRIEF-A, might be a useful alternative to neuropsychological tests. However, research has shown weak relationships between tests and ratings. The aim of this study was to understand how significant others of people with severe aphasia interpret and respond to questions about executive function in the informant report version of BRIEF-A. METHODS: Eleven significant others were interviewed about a subset of the BRIEF-A items, using cognitive interviewing. Interviews were subjected to thematic analysis. RESULTS: There was variation in the interpretation of the items of BRIEF-A which frequently corrupted the items' relation to what it was intended to measure. Further, informants wavered between considering the person with aphasias' ability or actual performance and many had lowered their expectations. The language problems caused by the aphasia affected the validity of some items. CONCLUSIONS: The quantitative results of BRIEF-A informant ratings should be interpreted with caution, since it is unclear to what extent the responses represent executive function. The use of informant ratings does not solve the problem with aphasia being a confounding factor in assessment of executive function.IMPLICATIONS FOR REHABILITATIONAssessing executive function in people with severe aphasia is important but challenging.Quantitative results of informant ratings of executive function, such as BRIEF-A, in this population should be interpreted with caution, since it is unclear to what extent the ratings represent executive function.Using informant ratings does not solve the problem of the aphasia being a confounding factor, since the aphasia impacts on the validity of some of the items.

Swallowing dysfunction in patients hospitalised due to a COPD exacerbation.

OBJECTIVES: This cross-sectional study aimed to investigate the prevalence of self-reported and clinically screened swallowing dysfunction (dysphagia) in COPD patients with severe exacerbations and to identify any associated factors. Findings were then compared to a control group. METHODS: Participants included 30 patients hospitalised due to a COPD exacerbation. The control group consisted of 30 adults hospitalised with acute cardiac symptoms. Data were derived from spirometry, the 150 mL timed water swallow test, a cookie swallow test and a dyspnoea questionnaire (modified Medical Research Council (mMRC)). Scores from the 10-item Eating Assessment Tool (EAT-10) were calculated to assess patient perception of swallowing dysfunction. RESULTS: Self-reported swallowing dysfunction and clinical signs thereof were more common in COPD patients than in the control group (67% versus 23% and 80% versus 37%, respectively; p≤0.001). Clinical signs of swallowing dysfunction in the group with acute exacerbation of COPD were associated with self-reported swallowing dysfunction (p=0.02) and xerostomia (p=0.04). Dyspnoea (mMRC ≥2) was more common among the COPD patients (90% versus 47%, p<0.001). There was a significant negative correlation between lung function and self-reported dysphagia (r=-0.39, p=0.03), but not between lung function and clinically screened dysphagia (r=-0.23, p=0.21). CONCLUSION: COPD patients hospitalised with an acute exacerbation experienced significantly more self-reported and clinically screened swallowing dysfunction compared to a control group of patients with cardiac symptoms. Both patient groups experienced dyspnoea, but it was twice as common in the group with acute exacerbation of COPD. Both groups also experienced xerostomia.

Caregivers', teachers', and assistants' use and learning of partner strategies in communication using high-tech speech-generating devices with children with severe cerebral palsy.

Communication with speech generating devices (SGDs) with children with severe physical, communicative and cognitive impairments, such as children with cerebral palsy (CP), can be difficult. Use of partner strategies facilitates the communication and instructional approaches such as feedback and role play facilitate communication partners' learning in how to use partner strategies. To describe communication partners' use and learning about partner strategies in SGD-mediated communication with children with severe CP. Questionnaires (n = 65) were sent to caregivers (n = 30), teachers (n = 17), and teaching or personal assistants (n = 18) of children with severe CP. Response rate was 80%. To ask open-ended questions was the most frequently used partner strategy and aided augmented input the least frequently used partner strategy. Most commonly, participants learned partner strategies from speech and language pathologists (SLPs) who used verbal instructions when teaching partner strategies but seldom or never feedback, role play or video examples. Communication partners' learning about partner strategies in SGD-mediated communication is inadequate and needs to be improved. SLPs, who are the main prescribers of SGDs and responsible for training and support in using them, should consider using instructional approaches when teaching communication partners about partner strategies in communication with an SGD.

Measuring executive function in people with severe aphasia: Comparing neuropsychological tests and informant ratings.

BACKGROUND: Knowledge about patients' executive function is important in the rehabilitation of language and communication in stroke patients with aphasia. Due to linguistic demands, most neuropsychological tests are unsuitable for this population, and it might seem appealing to use informant report of executive function as a substitute. OBJECTIVE: To investigate the relationships between scores on a neuropsychological test and informant ratings of executive function, as well as between the informant ratings and the functional communication ability, in people with severe aphasia after stroke. METHODS: Thirty-eight people with severe aphasia and their significant others participated. Executive function was tested with parts of the neuropsychological screening instrument CLQT and rated by significant others (informants) using BRIEF-A. Functional communication was assessed with a standardised test and rated by significant others. RESULTS: Results revealed few correlations between CLQT and BRIEF-A. There was no correlation between informant ratings on BRIEF-A and scores on the measures of functional communication. CONCLUSIONS: Informant ratings of executive function do not measure the same construct as, and cannot be used as a substitute for, standardised neuropsychological tests. Informant ratings of executive function do not seem to provide information that is relevant to the understanding of functional communication in people with severe aphasia.

Subjective swallowing symptoms and related risk factors in COPD.

OBJECTIVES: This study aimed to investigate the prevalence of subjective (i.e. self-reported) swallowing symptoms in a large cohort of patients with stable chronic obstructive pulmonary disease (COPD) and to identify potential related risk factors. METHODS: A total of 571 patients with COPD, investigated in a stable phase, participated in this multicentre study (335 females, 236 males; mean age: 68.6 years (sd 7.7)). Data were derived from spirometry, a questionnaire and a 30-metre walking test. RESULTS: In total, 33% (n=186) patients reported at least some degree of swallowing problem. The most frequently reported symptom was food lodging in the throat (23%). A significant relationship was found between swallowing symptoms and dyspnoea, assessed as modified Medical Research Council (mMRC) ≥2 compared with <2 (46% versus 22%; p<0.001) and health-related quality of life, assessed as the COPD Assessment Test (CAT) ≥10 (40% versus 19%; p<0.001). Swallowing problems were also related to lower physical capacity (p=0.02) but not to lung function (p>0.28). CONCLUSION: Subjective swallowing symptoms seem to be a common problem in patients with stable COPD. This problem is seen in all stages of the disease, but is more common in symptomatic patients and in patients with lower physical capacity.

Speech and language pathologists' perceptions and practises of communication partner training to support children's communication with high-tech speech generating devices.

Purpose: This study examined speech and language pathologists' (SLPs') perceptions and practices of communication partner training with high-tech speech generating devices (SGDs). Method: Fifteen SLPs were recruited throughout Sweden. The SLPs answered a study-specific questionnaire on communication partner training in relation to communication partners to children with severe cerebral palsy and intellectual disability. The results were analysed with descriptive statistics (closed-ended questions, responses on Likert scales) and content analysis (open-ended question) using ICF-CY. Results: Twelve SLPs completed the survey. Half had no or one training session with communication partners in the last year. One-third never used documents for goal-setting. Half seldom or never taught communication partner strategies. Three quarters only used verbal instructions. The main obstacles were environmental factors. Conclusions: This study contributes valuable knowledge about high-tech SGD interventions targeting communication partners. The high-tech SGD intervention may benefit from goal-setting, extended number of training sessions and a range of instructional approaches. Implications for Rehabilitation Speech and language pathologist (SLPs) reported that children with severe cerebral palsy and intellectual disability (SSPI) can benefit from speech generating device (SGD) communication. Communication partner strategies and goal-setting supports the development of communication with SGD. SLPs seldom taught stakeholder communication partner strategies and instruments for goal-setting. Because stakeholders may vary in their way of learning SLPs need to use a variety of instructional approaches. SLPs used few instructional approaches, typically verbal information.

Prevalence of swallowing dysfunction screened in Swedish cohort of COPD patients.

BACKGROUND: COPD is a common problem associated with morbidity and mortality. COPD may also affect the dynamics and coordination of functions such as swallowing. A misdirected swallow may, in turn, result in the bolus entering the airway. A growing body of evidence suggests that a subgroup of people with COPD is prone to oropharyngeal dysphagia. The aim of this study was to evaluate swallowing dysfunction in patients with stable COPD and to determine the relation between signs and symptoms of swallowing dysfunction and lung function (forced expiratory volume in 1 second percent predicted). METHODS: Fifty-one patients with COPD in a stable phase participated in a questionnaire survey, swallowing tests, and spirometry. A post-bronchodilator ratio of the forced expiratory volume in 1 second/best of forced vital capacity and vital capacity <0.7 was used to define COPD. Swallowing function was assessed by a questionnaire and two swallowing tests (water and cookie swallow tests). RESULTS: Sixty-five percent of the patients reported subjective signs and symptoms of swallowing dysfunction in the questionnaire and 49% showed measurable ones in the swallowing tests. For the combined subjective and objective findings, 78% had a coexisting swallowing dysfunction. No significant difference was found between male and female patients. CONCLUSION: Swallowing function is affected in COPD patients with moderate to severe airflow limitation, and the signs and symptoms of this swallowing dysfunction were subjective, objective, or both.