Psychosocial Adjustment To Aphasia and Quality of Life Issues Flashcards by Haley Thompson

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~Could be even more    
   debilitating than  
   neurobehavioral aspects
~Clinicians need to consider 
   patients as whole  human 
   beings not focus narrowly ion 
   the language disorder.

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“Fundamental link with ____ is altered profoundly.”

other human beings and with his or her own sense of personhood

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Clinicians need to consider patients as ___ not focus narrowly on the ____.

~whole human beings

~language disorder.

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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

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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.

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Aphasic people do not ___ as well as before becoming ill and all their other ____ are impaired in ____ as well.

~talk
~communicative acts
~varying degrees

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In addition they are likely to be
more ________
than before they got sick.

irritable, scared, depressed, and distractible

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Despite these changes….they

are often _____

unchanged at the core.

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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

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Process of Grief-

Elizabeth Kubler-Ross Steps of Grief (1969):

Denial
Anger
Bargaining
Depression
Acceptance

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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

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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.

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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.

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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

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Code-Müller Protocol

~Developed over time
~How psychosocial adjustment
impacts aphasia recovery
~Five components

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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 scale ```

Stroke 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 communication ```

Measuring 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 QCL ```

Life 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) ```