Psychosocial Adjustment To Aphasia and Quality of Life Issues Flashcards
Limited __________ Available
Fundamental link with other human beings and with his or her own sense of personhood is…
Clinicians need to consider…
Information
altered profoudly
patients as whole human beings not focus narrowly ion the language disorder.
Generalized Problems
Either do not understand the term “aphasia” or never hear the word.
People usually have never heard the word “aphasia”
SLP/aphasiologist must educate patient and family
What is an aphasic person?
Aphasic people do not talk as well as before becoming ill and all their other communicative acts are impaired in varying degrees as well. In addition they are likely to be more irritable, scared, depressed, and distractible than before they got sick.
Despite these changes….they are often unchanged at the core.
Sarno (1993) Article Review
Loss of language negatively effects all aspects of a person’s life
Aphasia rehabilitation is more than just treating words
Social isolation and loneliness occur
Anger and frustration may further isolate
Process of Grief
Elizabeth Kubler-Ross Steps of Grief
Denial
Anger
Bargaining
Depression
Acceptance
Changes to Family Life:
Role in the family
Sudden /unexpected decrease in income
Increase in expenses
Spouse has burden alone
Changes in sexual relations
“No one to talk to”-feel that they are living alone
Goals of Treatment
Review of Rosenbek:
1) To assist people to regain as much communication as their brain damage allows and their need drive them to
2) To help them learn how to compensate for residual deficits
3) To help them learn to live in harmony with the differences between the way they were and the way they are.
Rosenbek, LaPointe, & Wertz…….
“The most important goal is…
is usually to prepare patients for a lifetime of aphasia.”
Some have little or no trouble adjusting.
Others never adjust despite the clinician’s best guidance.
Some (majority) adjust and are helped in that adjustment by things their clinicians do
Rehabilitation
Few studies: most by Chris Code, Muller, Sarno
Emphasize impact of depression, chorine anxiety social dysfunction on aphasia rehab.
Social rather than medical construct” Muller(1999).
Recommends including psychological adjustment into treatment plans: make treatment social rather than medical
Code-Muller Protocols:10-item overview
Code-Müller Protocol
Developed over time
How psychosocial adjustment impacts aphasia recovery
Five components
Evidence-Based Practice
Muller admits there is a lack of evidence-based approaches to managing psychosocial adjustment .
Need to establish a stronger core body of knowledge.
Code-Muller Treatment Process
Five components, provide guidelines for clinicians to develop broader programs:
Therapy Emotional adjustment Social factors Autonomy Work/vocation
What can a clinician do?
Rosenbek, LaPointe, & Wertz say: “Keep the patient successful.”
Begin by providing a realistic guess about the future, even if that future includes severe, persisting deficits.
Most are not destroyed by a poor prognosis but they can be irrevocably harmed by unrealistic promises.
Counsel about the value of life during and after treatment has ended.
Equally important for them to know that treatment’s goal is not normal communication but making the best use of what remains.
Rosenbek, LaPointe, & Wertz…
“We believe that aphasia is a human disorder that alters not only a person’s language but also a person’s life and relationship to others. We believe aphasia is often modifiable and that an appropriate therapy is one that takes into account all the deficits- linguistic, cognitive, behavioral, social, and familial.”
Adjustment
“If they were doing their best before, they will set about doing the best they can to adjust to their disability and to the treatments that are likely to accompany it.”
Clinicians should reinforce a patient’s personal strengths and support their natural processes.
They should treat aphasic people and not aphasia.
Know Your Limits
SLPs cannot give marriage, financial, sex counseling, psychotherapy, advice about work, driving, and retiring. REFER!
Lack essentials skills to do these things!
Treatment requires the ability to separate treatable from untreatable conditions:
Bad marriages may become worse with aphasia or better!
Bad financial planning, poor diet, alcoholism are out of our arena.
What is going to happen?
Trust in people’s ability to….
____ helps!
New clinicians:
Muller: _____ rather than a _____ approach will impose an enormous challenge to new clinicians.
survive and cope.
Time
sometimes have difficulty treating severe, ill, very stubborn, demented or confused patients.
social rather than medical
What we CAN do….
Speech Therapy is often more than activities.
It is counseling
It is education of the family, friends, peers and patient
It is standing and waiting
It is listening
It is providing a prognosis and helping people accept reality
It is referral to another more appropriate professional
It is periodic follow-up
Arguments for Group Therapy
Elman: “It must be recognized that aphasia is a disorder from which full recovery is unlikely in a number of cases. There is a need to provide continued rehabilitation as a means of maintaining continued recovery.”
Support groups: Can be directed or self-help groups, use volunteers or SLPs.
Alternative Therapies
Family therapy Art Therapy Vocational Rehabilitation Pet Therapy Garden Therapy
“Quality of Life”
What does this mean to you?
Ephemeral/difficult to quantify
Definition has changed since 1940s when it was first coined
Shifted in 1960s to personal values
1970s became used in medicine (“Health-related quality of life”
Healthcare not just to…
Not just treat or cure..
Healthcare’s purpose is to…
reduce severity or frequency of symptoms
specific problems (high blood pressure, aphasia, anxiety, etc.)
help the person resume a productive and rewarding daily life.
World Health Organization Definition of QOL
“…an individual’s perception of their position in life in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards, and concerns. It is a broad-ranging concept affected in a complex way by the person’s physical health, psychological state, personal beliefs, social relationships, and their relationship to salient features of their environment. This definition highlights the view that quality of life is subjective, includes both positive and negative facts of life and is multi-dimensional.”
Measurement
Rating scales/questionnaires:
Satisfaction with Life Scale (SWLS, Diener, Emmons, Larsen, & Griffin, 1985)
One of the earliest
Short & General: 5 statements, 7-point Likert Scale
Sickness Impact Profile (SIP; Gibson, Gilson, Bertner, et al. 1975; Bergner, Bobbitt, Carter, et al., 1981)
Also an early measurement
136 statements related to physical abilities and psychosocial activities
Takes about 30 minutes to administer
Sickness Impact Profile-68 (SIP-68; deBruin, Diederiks, deWitte, et al., 1994)
Shorter version
Six domains: Somatic autonomy, mobility, psychic autonomy and communication, social behavior, emotional stability, mobility range.
