Psychosocial Adjustment To Aphasia and Quality of Life Issues Flashcards
Limited info available
~Could be even more debilitating than neurobehavioral aspects ~Clinicians need to consider patients as whole human beings not focus narrowly ion the language disorder.
Limited info available
“Fundamental link with ____ is altered profoundly.”
other human beings and with his or her own sense of personhood
Limited info available
Clinicians need to consider patients as ___ not focus narrowly on the ____.
~whole human beings
~language disorder.
Generalized Problems
~Either do not understand the term “aphasia” or never heard 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.
Aphasic people do not ___ as well as before becoming ill and all their other ____ are impaired in ____ as well.
~talk
~communicative acts
~varying degrees
In addition they are likely to be
more ________
than before they got sick.
irritable, scared, depressed, and distractible
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 (1969):
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 usually to…”
~“The most important goal 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..
~___ rather than ____ construct” Muller(1999).
~Recommends..
~Code-Muller Protocols:
~impact of depression, chorine anxiety social dysfunction on aphasia rehab. ~Social rather than medical construct ~including psychological adjustment into treatment plans: make treatment social rather than medical ~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.”
Clinician’s job cont’d
Rosenbek, LaPointe, & Wertz say: “Keep the patient successful.”
~Begin by providing a…
~Most are not destroyed by…
~realistic guess about the future, even if that future includes severe, persisting deficits.
~a poor prognosis but they can be irrevocably harmed by unrealistic promises.
Clinician’s job cont’d
~Counsel about the…
~Equally important for them to know…
~value of life during and after treatment has ended.
~that treatment’s goal is not normal communication but making the best use of what remains.
Rosenbek, LaPointe, & Wertz…
We believe that…
“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
Quote..
“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.”
Adjustment
Clinicians should reinforce a patient’s…
They should treat ___and not ___
~personal strengths and support their natural processes.
~aphasic people
aphasia
Know Your Limits
SLPs cannot give ____advice about ____.
They should ___
~give marriage, financial, sex counseling, psychotherapy—work, driving, and retiring
REFER!
Know your limits
Lack …
Treatment requires the ability to separate treatable from untreatable conditions:
~essentials skills to do these things!
~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.
~survive and cope.
~Time helps!
~
What is going to happen? ~New clinicians: sometimes have difficulty treating... ~Muller: \_\_\_\_…will impose an enormous challenge to (new) clinicians.”
~severe, ill, very stubborn,
demented or confused patients.
~“social rather than a medical
approach
What we CAN do….
Speech Therapy is often more than activities-
~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 ____.
~There is a need to provide ______.”
~aphasia is a disorder from which full recovery is unlikely in a number of cases
~continued rehabilitation as a means of maintaining continued recovery.
Arguments for Group Therapy
Support groups: Can be ____, use____.
~directed or self-help groups
~volunteers or SLPs
Alternative Therapies
Family therapy Art Therapy Vocational Rehabilitation Pet Therapy Garden Therapy
Quality of Life
~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”
Broader Definition
~Healthcare not just to…
~Not just..
~Healthcare’s purpose is to help the person…
~reduce severity or frequency of symptoms
~treat or cure specific problems (high blood pressure, aphasia, anxiety, etc.
~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
-One of the earliest
-Short & General: 5
statements, 7-point Likert
Scale
~Sickness Impact Profile
-Also an early
measurement
-136 statements related
to physical abilities and
psychosocial activities
-Takes about 30 minutes
to administer
~Sickness Impact Profile-68
-Shorter version
-Six domains:Somatic
autonomy, mobility,
psychic autonomy and
communication, social
behavior, emotional
stability, mobility range.Specific to Aphasia (measurements)
`Stroke-adapted 30-item
Version of the Sickness
Impact Profile
-Shortened version of
SIP for stroke patients
-Eight domains: body
care and movement,
social interaction,
mobility, communication,
emotional behavior,
household management,
alertness, and
ambulation.
~Stroke-specific Quality of Life
Scale
-49-item scale assesses
QOL in 12 domains
-Rated on a 5-point
Likert scaleStroke QOL, cont.
~Stroke and Aphasia Quality of
Life Scale-56 (SAQOL56)
-49 items from SS-QOL
plus 7 items to increase
sensitivity to aphasia
-Weak statistical support so
they revised it to the….
~Stroke and Aphasia Quality of
Life Scale-39 (SAQOL-39)
-17 items related to
physical problems
-4 items related to energy
-11 items related to
psychosocial issues,
-7 items related to
communicationMeasuring Quality of Communicative Life
~Quality of Communication Life
Scale
-Designed for those with
significant language
impairments
-17 statements about
communicative QOL
-Short and simple
-Visual Analog Scale
-Appears to be a valid
measure of QCLLife Interest and Value Cards (LIV Cards)
~Developed to circumvent the '
language problems of people
with aphasia
~Allow them to choose goals for
rehabilitation
~95 cards in 4 different ADL
sets:
-Home and community (25
questions)
-Creative and relaxing
activities (25 questions)
-Physical activities (25
questions)
-Social Activities (20
questions)
