Strategies for managing the social determinants of health in people with aphasia

Stroke care in the UK was significantly affected by the COVID-19 pandemic, with many services switching to telehealth. Post-pandemic, a UK survey of speech and language therapists (SLTs) working with people with aphasia (PWA) showed the vast majority planned to continue to use telehealth alongside in-person intervention. Telehealth is considered a cost-effective and feasible method of service delivery; however, there is limited evidence to support its use in the assessment of people with post-stroke aphasia. To investigate what barriers and facilitators SLTs experience when administering telehealth assessments to PWA and to explore SLTs' perspectives on what makes for a positive patient experience. Focus groups (dyadic/triadic) were conducted via videoconferencing. Transcripts were analysed using framework analysis. Inclusion criteria for participants were SLTs working in the UK with PWA, with experience of using telehealth assessment. A total of 14 SLTs participated across six groups. Seven themes were identified: assessment; technology; factors specific to PWA; factors specific to family, carers and their environment; factors specific to SLTs; benefits of telehealth assessment; and what telehealth would look like in an ideal world. Facilitators to telehealth assessment included good internet connectivity, access to a helper, adapted assessments, preparation and training PWA to use telehealth platforms. Barriers included reduced control over the environment, having a cognitive impairment, aphasia severity, low beliefs in competence using technology and challenges with managing the emotional needs of PWA during telehealth assessment. A strong therapeutic relationship, offering choice and flexibility in assessment administration, promoted a positive patient experience. This study provides new insights into the current use of telehealth assessment with PWA by SLTs in the UK. Barriers and facilitators identified can support the implementation of telehealth assessment in SLT services. Providing a positive patient experience when using telehealth assessment is important to SLTs, with patient choice a key factor. Further research is indicated to increase the range of standardized assessments for telehealth assessment and investigate the efficacy of a hybrid model approach to service delivery. What is already known on the subject There is emerging evidence for the use of telehealth assessment as a feasible and appropriate means of service delivery for SLTs. However, little is known about SLTs' experience of delivering telehealth assessments to PWA. What this paper adds to existing knowledge This study identified both the facilitators and barriers experienced by SLTs when using telehealth assessment with PWA. Practical advice and considerations for telehealth administration are provided. What are the potential or actual clinical implications of this work? Resources are required for the implementation of SLT telehealth assessments, particularly in training for both PWA and SLTs, assessments designed for telehealth and accessible telehealth platforms. A hybrid approach to assessment could be beneficial for both PWA and clinicians, retaining the advantages with the acknowledgement that telehealth may not be suitable for all.

ABSTRACTBackground: Individuals’ right to be involved with decisions regarding their health and social care is the cornerstone for modern patient-centred care. Decision-making is a complex process that involves multiple cognitive and linguistic abilities. These are often challenging for people with aphasia (PWA). The Mental Capacity Act (MCA) Code of Practice (2007) recommends that speech and language therapists (SLTs) support capacity assessments for individuals with communication problems, such as PWA. To date, little is known regarding SLTs’ involvement in the UK for supporting decision-making and capacity assessment for PWA.Aims: This research provides data to document when, how, and the extent to which SLTs are being used in capacity assessment for PWA in England. We also determined SLTs’ training and resource needs in capacity assessments, and their role in inter-professional training.Methods & Procedures: 56 SLTs working with PWA from a wide range of clinical settings in England were recruited; they completed a secure questionnaire using the online survey tool Survey Monkey. The questionnaire collected information in the following areas: knowledge and awareness of the MCA; current involvement of SLTs in capacity assessments and decision-making; inter-professional understanding of SLTs roles in capacity assessments; and training needs of SLTs.Outcomes & Results: The SLTs who participated in this survey indicated that they were not regularly involved to support capacity assessment for PWA. Moreover, they also reported that other professionals on the care team did not fully recognise or utilise their skills in supporting capacity assessment for PWA. Moreover, SLTs were not solicited to train professionals regarding communication difficulties in aphasia and its impact on capacity assessments. SLTs wanted profession-specific training to fulfil the role of supporting PWA in capacity assessments more effectively and reliably.Conclusions: Healthcare professionals have an ethical duty to ensure that judgements of capacity are unbiased and accurate. SLTs have an important contribution to make but their skills and knowledge are not fully recognised or utilised. These findings highlight an important need to raise the profile of SLTs’ skills and expertise amongst professionals through education and/or inter-professional communications. This would enable SLTs to be regularly and effectively utilised in capacity assessments and decision-making for PWA.

There is a wide agreement that family and friends of people with aphasia (PWA) can play a crucial role in the rehabilitation of interpersonal communication. Therefore, speech and language therapists (SLTs) should include family and friends in the process of therapy. However, little has been said about the role of caregivers of severely disabled PWA in the rehabilitation of communication functions. To examine how caregivers of severely disabled PWA perceive their relationship and communication with PWA, how they facilitate communication with PWA, and whether the caregiver's personality and emotional intelligence modify the abovementioned processes. The study involved 123 caregivers of severely disabled stroke survivors with aphasia. Participants took part in a structured interview based on a structured interview guide created for the purpose of this study. The standardized psychological questionnaires NEO Five-Factor Inventory (NEO-FFI) and Schutte Emotional Intelligence Scale (SEIS) were used. The caregiver's positive attitude towards the PWA correlated with the active facilitation of communication. The personality traits of caregivers and their level of emotional intelligence were associated with the tendency to use certain techniques to facilitate communication with PWA. Caregivers' positive attitude towards PWA is beneficial for the rehabilitation of communicative functions. Personality traits and emotional intelligence could modify the caregiver's strategy of coping with aphasia-related challenges and should be taken into consideration when providing support. What this paper adds What is already known on the subject Interpersonal communication must by definition involve at least two people. Therefore, there are a lot of approaches in SLT where support is given not only to the PWA but also to the communication partners. The most important group is significant others, which is usually understood as family members and friends. There is an increasing recognition that SLTs should include them in therapy. What this paper adds to existing knowledge For those PWA who need constant care, caregivers may have a significant influence on the quality of communication. Their positive attitude towards PWA corresponds with more active facilitation of communication and can make rehabilitation more efficacious. Caregivers should be educated on the cognitive and behavioural aspects of aphasia and encouraged to look actively for a PWA's positive characteristics. Caregivers' personality traits play a role in facilitating communication. For example, caregivers with high agreeableness are more likely to enjoy providing care, while those with higher conscientiousness declare using more techniques to facilitate communication with the PWA. What are the potential or actual clinical implications of this work? Caregivers' personality traits play a role in caring. Their positive attitude towards PWA corresponds to more active facilitation of communication, which can lead to more effective rehabilitation. This should be taken into account when training caregivers. Training programmes should include cognitive and behavioural aspects of aphasia as well as emphasize the need to maximize the PWA's abilities.

Background: There is scope for additional research into the specific linguistic and sequential structures used in speech and language therapist (SLT)-led therapeutic conversations with people with aphasia (PWA). Whilst there is some evidence that SLTs use different conversational strategies than the partners of PWA, research to date has focussed mainly on measuring the effects of conversation-based therapies—not on analysing therapeutic conversations taking place between SLTs and PWA.Aims: This paper presents an analysis of the use of oh-prefacing by some PWA during therapeutic supported conversations with SLTs.Methods & Procedures: Normally occurring therapeutic conversations between SLTs and PWA after stroke were qualitatively analysed using Conversation Analysis. Interactions with five PWA were video-recorded, involving three different specialist stroke SLTs.Outcomes & Results: The analysis revealed a difference in the way some PWA use turns that display understanding (e.g., oh right) versus those that continue the conversation, merely claiming understanding (e.g., right). This use of oh-prefacing is similar to that described in the literature on typical conversations. In our data, SLTs are shown to treat oh-prefaced turns differently from non-oh-prefaced turns, by pursuing the topic in the latter, and progressing on to a new topic in the former.Conclusions: At least some PWA use oh-prefacing in the same way as non-language-impaired adults to display understanding of information versus merely claiming to understand. The SLTs in our data are shown to treat non-oh-prefaced turns as mere claims of understanding by providing the PWA with additional information, using supported conversation techniques, and pursuing additional same-topic talk, whereas oh-prefaced turns are treated as displays of understanding by being confirmed, and leading to changes of topic. This study is a first step in providing SLTs with a clearer understanding of the ways in which they are assessing the understanding of PWA, which may in turn help them better support non-therapy staff.

Background: Addressing the long-term consequences of stroke is a top 10 research priority, and understanding the views of different stakeholders is essential in designing appropriate patient-centred multidisciplinary rehabilitation.Aims: This study reports on the perspectives of 38 individuals who live with or work with aphasia: people with aphasia (PWA), family members (FM) and friends, and speech and language therapists (SLTs), about its consequences in the daily lives of PWA.Method & Resources: In total, 14 PWA, 14 FM and 10 SLTs participated in the study. All participants were interviewed about the consequences of stroke and aphasia. Small focus groups were used with some participants. In-depth semi-structured interviews were used with other participants. Interviews were carried out in groups or individually in order to accommodate severe aphasic impairments or respondents with fewer years of education. Interviews were video or audio-recorded. Verbal and non-verbal communication was transcribed and analysed qualitatively using content analysis. Data was coded and mapped onto the ICF framework.Outcomes & Results: All three groups reported consequences in Body Functions and Body Structures, primarily in Mental Functions (Specific Mental Functions and Global Mental Functions) and Neuromusculoskeletal and Movement-Related Functions. Within Specific Mental Functions, PWA emphasised Expression of Oral Language, whereas FM and SLTs emphasised Emotional Functions. Within Global Mental Functions, PWA and FM emphasised Energy and Drive Functions, whereas SLTs emphasised Temperament and Personality Functions. Some consequences were shared between PWA and SLTs (Sensory Functions and Pain, and Functions of the Digestive, Metabolic and Endocrine Systems), whilst others were specific to SLTs alone (Voice and Speech Functions, and Cardiovascular, Haematological, Immunological and Respiratory Systems). All three groups reported consequences in Activities and Participation in Major Life Areas; Community, Social and Civic Life; Interpersonal Interactions and Relationships; Communication; and Mobility. Some consequences were shared by PWA and FM (Domestic Life), and others by FM and SLT (Self Care). Consequences in General Tasks and Demands were only described by SLTs and in Learning and Applying Knowledge by PWA. Both PWA and FM reported a general Loss of Autonomy.Conclusions: PWA, FM and SLTs reported a considerable range of stroke and aphasia consequences in the daily life of those who live with it. They were concerned to different degrees with language, physical and emotional changes, and impact on communication, mobility, self-care, relationships, leisure and work. Professionals’ practices in Portugal need to be changed in order to consider these findings.

Background The law is leading a cultural shift away from medical paternalism towards shared decision-making with patients. A person’s ability to make decisions about their care and treatment is regulated through mental capacity law in the UK. A verbal interview is used to judge a person’s capacity. People with aphasia (PwA) may retain the cognitive ability to make decisions but have difficulty understanding information and expressing their wishes. PwA are at risk of having their capacity status misidentified without the support of skilled communication partners such as Speech and Language Therapists (SLTs). Currently, little is known about the SLTs’ role in capacity assessment for PwA in the UK. Aims This research aimed to explore UK SLTs’ experience of mental capacity assessment in PwA, focusing on the principal challenges and facilitators and the role SLTs play in the assessment process and within the multidisciplinary team (MDT). Methods A qualitative approach was taken using semi-structured interviews to explore SLTs’ perspectives. 13 interviews were conducted with SLTs from England and Scotland. Data were analysed thematically. Results Participants reported that facilitators were routine decision types, patients without complex co-morbidities, availability of time, close collaborative teams where the role of the SLT was valued, and trust existed in the relationship with the PwA and their carers. Challenges to the process were infrequent decision types, patients with complex cognitive/communication impairments, lack of time, conflict with carers and the MDT, and lack of access to team support. SLTs inhabited a variety of roles in the process of mental capacity assessment. They were morally motivated to adopt supportive roles but were equivocal towards adopting assessor roles. Across the data set an ambiguous interpretation of terminology, processes and level of specialisation required emerged. Conclusion SLTs’ play a unique role in supporting PwA to exercise their right to autonomy. This study is the first to explore SLTs’ experience of mental capacity assessment across different UK jurisdictions. SLTs’ confidence in their role in capacity assessment is growing although the complexity of the process continues to present challenges. Broader training in legal and conceptual aspects of mental capacity would support a clearer understanding of assessment procedures and facilitate SLTs to promote their role more broadly with their colleagues.

Background Clinicians such as speech-language pathologists (SLPs) and neuropsychologists play a central role in the rehabilitation process of people with aphasia (PWA). Some studies, mostly from the Global North, have reported training, assessment, and treatment practices, as well as facilitators and barriers faced by clinicians working with PWA. However, less is known about these topics from the perspectives of clinicians working with PWA in the Global South. Understanding clinical practices in these countries can help to identify gaps in aphasia rehabilitation services and guide tailored implementation strategies to improve aphasia care in the Global South. This pilot study aims to contribute to this broader understanding by focusing on the experiences and perspectives of clinicians working with PWA in Colombia. Aims The current pilot study had three aims, to: 1) describe the aphasia training received and the training needs perceived by SLPs and neuropsychologists working with PWA in Colombia; 2) report the assessment and treatment practices used when working with PWA in Colombia; and 3) outline the main facilitators and barriers to providing rehabilitation services to PWA in Colombia Methods and Procedures Five SLPs and five neuropsychologists working with PWA in Colombia participated in this study. In-depth interviews were conducted to explore participants’ training, assessment, treatment practices, and perceived facilitators and barriers to aphasia care. A thematic analysis was employed to identify key themes emerging from the interviews Outcomes and Results Eleven key themes emerged from the thematic analysis. These themes were organized into four groups: training characteristics and resources, usual clinical practice characteristics in aphasia, facilitators of clinical practice, and barriers to clinical practice. Overall, clinicians perceived aphasia training to be insufficient. Perceived barriers included a lack of assessments and treatments adapted to the Colombian context, and Spanish-speaking patients. There were also barriers associated with the Colombian healthcare system, where some administrative processes hindered access and continuous rehabilitation services for PWA. Facilitators included some features of the universal healthcare system in Colombia and the ample number of qualified clinicians who could potentially work with aphasia. Conclusions Our findings underscore the need to expand aphasia research in the Global South. Describing the training, assessment, and treatment practices, as well as systemic facilitators and barriers perceived by clinicians working with PWA in Colombia, is the first step toward understanding what implementation targets and strategies could meaningfully improve aphasia care in the country

Advancing ERP-based tools for language monitoring in chronic aphasia: psychometric and clinical utility of the word-level N400.

ABSTRACTBackgroundAphasia, a communication disorder mainly resulting from stroke, poses challenges to the meaningful interactions between healthcare professionals and people with aphasia (PWA). Little is known about the knowledge and skills of Cypriot healthcare professionals when interacting with PWA in clinical settings. This study explores the knowledge and skills of Cypriot healthcare professionals in communicating with PWA.MethodA total of 245 Greek‐speaking Cypriot healthcare professionals completed the Greek version of the Health Professionals and Aphasia Questionnaire (HPAQ). Participants’ knowledge and skills were assessed in five categories: Knowledge, Skills, Behaviour and Emotions, Practice, and Environment. Demographic data were analysed through linear regression and ANOVA to identify predictors of HPAQ scores.ResultsParticipants’ mean HPAQ score was 94.57 (SD = 28.1). Higher educational levels (master's degree) and the Speech and Language Therapy profession significantly predicted higher HPAQ scores. Moderate frequency of interaction with PWA (1–20 times/week) was also associated with improved knowledge of aphasia and better communication skills when interacting with PWA.ConclusionSpeech and Language Therapists exhibited higher competency in interacting with PWA compared to other healthcare professionals, highlighting their specialised training. The findings emphasise the importance of education, experience, and interaction frequency in enhancing healthcare professionals' ability to communicate effectively with PWA in clinical settings. To address identified gaps, targeted interventions, such as Communication Partner Training, are recommended to improve communication strategies and patient outcomes in Cypriot healthcare settings.WHAT THIS PAPER ADDSWhat is already known on this subjectAphasia, which affects 40% of stroke survivors in the acute phase, profoundly impacts communication abilities, leading to longer hospital stays, increased healthcare needs, and higher rates of disability. Many healthcare professionals lack the training, strategies, and resources required to effectively communicate with people with aphasia (PWA), limiting PWA's participation in decision‐making and negatively impacting the quality of care. In Cyprus, there is an urgent need to evaluate and enhance healthcare professionals' competencies in supporting PWA, highlighting the importance of communication training programs in improving care quality and patient outcomes.What this paper adds to the existing knowledgeThis research highlights the critical need for accessible training programs at all educational levels to ensure equitable standards of stroke care in Cyprus. Moderate interaction with PWA plays a pivotal role in improving healthcare professionals' communication skills, emphasising the importance of balanced and sustainable contact opportunities that foster professional development while minimising the risk of burnout. The findings also reveal that professional experience alone does not enhance communication outcomes unless accompanied by purposeful training and meaningful interaction with PWA. The study underscores the need for targeted communication training for healthcare professionals to improve interdisciplinary collaboration and patient care outcomes.What are the potential or actual clinical implications of this work?The clinical implications are as follows (a) there is a critical need to implement Communication Partner Training programs in Cypriot healthcare settings to address knowledge and skills gaps among non‐speech language therapy (SLT) healthcare professionals; (b) communication training programs can create more inclusive clinical environments, enabling PWA to actively participate in healthcare decisions and rehabilitation planning; (c) training interventions should be tailored to different professional groups and educational levels, with introductory‐level modules for non‐SLT professionals and advanced modules for SLTs; (d) communication training has the potential to improve the quality of care, patient satisfaction, and rehabilitation outcomes for PWA; (e) these actions will provide a basis for developing scalable and targeted communication training solutions to meet diverse healthcare needs in Cyprus.

Introduction Aphasia is a communicative disorder prevalent in about one-third of stroke survivors. People with aphasia (PWA) typically require lifelong healthcare support and frequent consultations with various health professionals (HP) who must be well-prepared to adapt their communication to effectively communicate with them. This study aims to analyse the communication strategies used by Portuguese HP, namely nurses, physiotherapists, occupational therapists, speech and language therapists, and other professionals in contact with PWA, as well as senior health professional students (SHPS) of these professions, when communicating with PWA. Methods & Procedures A cross-sectional mixed-methods convergent design, incorporating a self-developed survey with both quantitative and qualitative strands was conducted. The content validity of the questionnaire was ensured by an expert panel, based on individual agreement with its items. Seven HP (3 speech and language therapists, 2 physiotherapists, 1 physician, 1 neuropsychologist) were part of this expert panel. The Content Validity Index (CVI) was calculated, and a value of > 0.90 was obtained for all its items. The questionnaire developed, which includes both quantitative and qualitative sections, was completed online by HP/SHPS. HP/SHPS who underwent training in Portugal and have/had contact with PWA were included. Quantitative analysis was performed using Microsoft Excel (2013 version). Open-ended questions were analyzed using deductive content analysis. Results HP/SHPS (N = 223) reported using mostly verbal strategies (e.g. Ask PWA to explain in an alternative way, time to respond, slow down speech rate, yes/no questions, rephrase/clarify) and visual strategies (e.g. writing, drawing, pictures, augmentative and alternative communication) when communicating with PWA. The same strategies are reportedly for different purposes (improving PWA expression and comprehension and revealing PWA competence). Conclusions HP/SHPS, independently of their professional background, tended to use the same strategies for different purposes, which may indicate a lack of knowledge about PWAs’ competencies and limitations, as well as the best strategies to facilitate communication with them. Given the increasing aging of the Portuguese population and the estimated number of PWA, more information in this area is recommended, particularly by integrating these topics into the formal training of HP and/or offering additional training throughout their careers.

BackgroundAphasia is an acquired language disorder that can present a significant barrier to patient involvement in healthcare decisions. Speech-language pathologists (SLPs) are viewed as experts in the field of communication. However, many SLP students do not receive practical training in techniques to communicate with people with aphasia (PWA) until they encounter PWA during clinical education placements.MethodsThis study investigated the confidence and knowledge of SLP students in communicating with PWA prior to clinical placements using a customised questionnaire. Confidence in communicating with people with aphasia was assessed using a 100-point visual analogue scale. Linear, and logistic, regressions were used to examine the association between confidence and age, as well as confidence and course type (graduate-entry masters or undergraduate), respectively. Knowledge of strategies to assist communication with PWA was examined by asking respondents to list specific strategies that could assist communication with PWA.ResultsSLP students were not confident with the prospect of communicating with PWA; reporting a median 29-points (inter-quartile range 17–47) on the visual analogue confidence scale. Only, four (8.2%) of respondents rated their confidence greater than 55 (out of 100). Regression analyses indicated no relationship existed between confidence and students‘ age (p = 0.31, r-squared = 0.02), or confidence and course type (p = 0.22, pseudo r-squared = 0.03). Students displayed limited knowledge about communication strategies. Thematic analysis of strategies revealed four overarching themes; Physical, Verbal Communication, Visual Information and Environmental Changes. While most students identified potential use of resources (such as images and written information), fewer students identified strategies to alter their verbal communication (such as reduced speech rate).ConclusionsSLP students who had received aphasia related theoretical coursework, but not commenced clinical placements with PWA, were not confident in their ability to communicate with PWA. Students may benefit from an educational intervention or curriculum modification to incorporate practical training in effective strategies to communicate with PWA, before they encounter PWA in clinical settings. Ensuring students have confidence and knowledge of potential communication strategies to assist communication with PWA may allow them to focus their learning experiences in more specific clinical domains, such as clinical reasoning, rather than building foundation interpersonal communication skills.

Research has found that people with aphasia (PWA) may experience psychosocial benefits from participating in communication partner training (CPT). It is unknown whether similar benefits are found if components of the CPT are delivered via telepractice. This pilot study aimed to explore PWAs’ perceptions of: (a) their communication confidence and self-esteem after communicating with speech-language pathology (SLP) students via telepractice as part of a CPT programme; (b) whether it is important for SLP students to converse with PWA; and (c) the suitability of using telepractice to facilitate these conversations. Five adults with aphasia participated. A single group, pre-test post-test design was utilised. Standardised measures were used to capture changes in the participants’ self-reported communication confidence and self-esteem. A verbal questionnaire was used to obtain participants’ perceptions of the programme. Post-CPT, a significant decrease occurred on one confidence item. Non-significant improvement was noted on other items. All five participants believed it was important for SLP students to converse with PWA. Content analysis of the participants’ responses revealed two categories: (a) aphasia being a chronic communication difficulty and (b) conversing with PWA can be scary and different from conversing with adults without aphasia. Four out of five participants thought that telepractice was suitable for conversing with students. Results suggest that PWA may experience psychosocial benefits from conversing with students via telepractice. Confirmation of these findings from a larger scale study would have implications not only for PWA, but also for SLPs providing clinical services to PWA and for educators of SLP students.

ABSTRACTBackground: Speech-language pathologists (SLPs) have begun to incorporate telepractice methods into clinical service delivery and online intervention for aphasia is recognised as an appropriate alternative to face-to-face services. However, little is known about the SLP experience of telepractice with no known study exploring the provision of aphasia group therapy online. The purpose of this study was to describe the experience of SLPs who provided the online aphasia group therapy, Telerehabilitation Group Aphasia Intervention and Networking (TeleGAIN), to people with aphasia (PWA) and their perceptions regarding the outcomes of intervention and feasibility of implementation into clinical practice.Aims: The aim of this study was to describe the experience of SLPs who provide TeleGAIN to people with aphasia including the perceived outcomes of the intervention and treatment procedures.Methods & Procedures: Three SLPs with experience in aphasia rehabilitation delivered at least one 12 week block of TeleGAIN – an aphasia group intervention purposefully developed for delivery via telepractice. Prior to TeleGAIN, SLPs were trained in using the technology required and the goals, activities, and constructs of TeleGAIN. The goals of TeleGAIN for PWA were to 1) create opportunities for communicative success, 2) share personal life history, and 3) provide support for living successfully with aphasia through networking with others. The SLPs provided this intervention to 21 PWA across six groups. Following completion of all treatment blocks, each SLP participated in a semi-structured interview exploring their perceptions of TeleGAIN and the potential for implementation. Interviews were analysed using qualitative content analysis and key categories were identified.Outcomes & Results: SLPs enjoyed providing the online aphasia group therapy TeleGAIN, and considered the intervention to be feasible and worthwhile. SLPs developed a range of strategies to manage the barriers to implementing the online group successfully and promoted those factors that facilitated more efficient and effective group sessions. In addition, benefits for individuals with aphasia, SLPs and SLP services were recognised despite challenges with technology and group dynamics experienced during TeleGAIN.Conclusions: The results from this study suggested that although SLPs may take time to improve their skills and confidence in telepractice, they were successfully able to provide online group aphasia therapy to PWA. The experience of the SLPs in this study suggested that commonly cited barriers to telepractice such as rapport building and technology issues were able to be overcome. SLPs perceived that TeleGAIN offered PWA many communication and psychosocial benefits and may improve SLP service provision. Findings support investigation of the implementation of TeleGAIN into clinical services.

Communication partner training (CPT) has been used to support communication partners to interact successfully with people with aphasia (PWA). Through successful CPT interaction PWA's accessibility to healthcare is notably improved. The present study sought to build on prior studies by investigating the experiences of individuals with aphasia and healthcare providers to ascertain what they deemed to be beneficial from CPT and what could be refined or improved, dependent on the setting and skill set of those participating. To gain an understanding of the experiences of PWA involved in the provision of CPT to health professional (HP) students. Also to investigate the experiences of HP students who participated in the CPT programme. Eight PWA and 77 HP students who had completed a CPT programme participated in a focus group/semi-structured interview (PWA) and feedback session (HP students) moderated by two speech-language pathologists (SLPs). These sessions were recorded (audio and video), transcribed verbatim, including non-verbal communication, and analyzed using qualitative content analysis. Overall, the study sought to understand experiences of the training. Both the PWA and HP students reported positive experiences of CPT. PWA discussed their perception that CPT improved HPs and HP students' understanding and interactions conversing with them and emphasized the need for training and education for all health related professions. HP students enjoyed the opportunity to experience interacting with PWA, without being 'assessed' and felt it consolidated their learning based on lecture content. Inclusive and accessible healthcare is paramount to ensure the engagement of patients and providers. Based on the experiences and feedback of the participants in this current study, CPT offers a salient and practical training method with potential to improve practice. Participants perceived CPT to be beneficial and validated the need for the training to support PWA accessing healthcare.

Background: People with aphasia (PWA) may have difficulty accessing information in their environment, including the hospital setting. Prior research has recommended the use of aphasia-friendly text-formatting principles, including using graphics when providing information to PWA. There is limited research into the impact of using such principles for hospital menus. Aims: To evaluate the impact of an aphasia-friendly menu with assistance from a Speech Pathology Therapy Assistant (SPTA) compared with usual hospital menus in PWA on 1) oral intake, 2) self-reported involvement and 3) ease in meal ordering and 4) meal preference. The secondary aim was to investigate the feasibility of implementing the aphasia-friendly menu by exploring staff and caregiver experiences regarding the perceived barriers and facilitators to its implementation, along with time required to assist PWA to order meals. Methods and procedures: This embedded mixed-methods design study was piloted at two hospitals in Queensland, Australia. Hospital inpatients with aphasia due to non-progressive neurological damage, their caregivers and SPTAs participated. Each day PWA received either the 1) aphasia-friendly menu: professional photos of menu items on an iPad with SPTA support, or 2) usual hospital menus provided in random order for up to 15 days during their inpatient stay. Each day, oral intake was measured and PWA rated their perceived involvement and ease with ordering from the menu provided on a 10-point Likert scale. SPTAs recorded time assisted using the menus and reported barriers and facilitators to the use of the menus daily. At the completion of the pilot, the PWA’s preferred menu type was recorded, SPTAs participated in a focus group and caregivers completed a questionnaire. Outcomes and results: There was no significant difference in oral intake between menu types. PWA rated the aphasia-friendly menu more favourably for involvement (p = 0.004) and ease (p = 0.015) when ordering. Nineteen out of 20 PWA who provided a response preferred the aphasia-friendly menu (p = 4 × 10−5). SPTA comments were analysed using qualitative content analysis and outlined their perceived barriers and facilitators to the use of aphasia-friendly menus, experience with usual menus and recommendations for future directions. Meal ordering was approximately 4.4 minutes longer with PWA using the aphasia-friendly menus. Conclusions: The aphasia-friendly menu was positively perceived by PWA, caregivers and SPTAs and may be a viable and preferred option for PWA when ordering food in hospitals. Staff are encouraged to consider the contextual barriers and facilitators identified in the pilot, prior to implementation of such aphasia-friendly menus.