Abstract: Healthcare professionals may unintentionally cause harm for persons with aphasia and their family members. This presentation will describe the Living with Aphasia: Framework for Outcome Measurement (A-FROM) as it relates to the Life Participation Approach to Aphasia (LPAA). Examples of assessment and treatment techniques using LPAA principles will be provided.
Description: The maleficence principle in healthcare ethics involves the “do no harm” principle, which requires that healthcare providers weigh the risk that a particular course of action will hurt a patient against its potential to improve the patient’s condition. The condition of aphasia involves the loss of language due to stroke or other neurologic deficits and may additionally be accompanied by motor speech deficits such as apraxia and dysarthria and swallowing problems (dysphagia). These deficits produce broader difficulties with functional communication, such as difficulty conveying wants and needs to unimpaired communication partners during activities of daily living. At an even broader level, functional communication and swallowing deficits impact quality of life, leading to depression, social isolation, and loss of friendship.
The Living with Aphasia: Framework for Outcome Measurement (A-FROM) is adapted from the World Health Organization’s International Classification for Functioning (WHO-ICF) and describes four areas for the person living with aphasia that should be addressed as part of comprehensive, quality care: language/communication impairment, environment, personal factors, and life participation. Unfortunately, speech-language pathologists sometimes focus on the language impairment at the expense of the other three areas, such that more harm is caused rather than potentially improving the patient’s overall condition through addressing all four areas. For example, if a speech-language pathologist completes an impairment-based language assessment but does not address the patient’s personal factors (e.g., self-esteem, confidence), environment (e.g., communication partners), or life participation (e.g., learning about the condition of aphasia in the hospital), then the patient may experience more harm than help.
The Life Participation Approach to Aphasia (LPAA) is a person-centered approach to care. Rather than a prescribed set of assessment/therapy techniques, the LPAA provides a set of core values that promote targeting all four of the A-FROM factors such that the chief goal is the enhancement of life participation. Most people with aphasia have the potential to participate in interpersonal, social, informational, educational, and community activities when provided with appropriate communication supports and accommodations. By not providing these supports and accommodations, healthcare professionals may unintentionally cause harm for persons with aphasia and their family members.
In the early stages of recovery, persons with aphasia and their family members may deal with a sense of confusion regarding what happened and what to expect. The World Health Organization states that all patients have a right to receive factual, accurate, and easily-understood information regarding their health condition. Thus, patient and family education about the nature of stroke and aphasia should be a key component of health care within the acute stroke recovery period. Often times, it seems that dysphagia is the primary focus of the speech-language pathologist; however, patients should not be sent home without some understanding of their acquired condition (aphasia, dysphagia) and some means of communicating with others in their environment. Both persons with aphasia and their family members need to feel empowered in terms of their ability to communicate with each other, which results in increased motivation, compliance, satisfaction, and adjustment and decreased anxiety, fear, and confusion during the acute care phase of recovery and beyond. The LPAA attempts to address these challenges and avoid unintentionally causing harm to persons with aphasia.
This presentation will discuss LPAA-based approaches for assessing persons with aphasia and establishing treatment goals. Patient-centered goals for assessment and treatment will be identified, with the ultimate goal of providing more improvement and less harm for persons with aphasia and their loved ones.
Presentation Format & Methods: PowerPoint, interactive lecture involving some group discussion activities
Supporting Research: Reference 1: Divi, C., Koss, R., Schmaltz, S., Loeb, J. (2007). Language proficiency and adverse events in US hospitals: A pilot study. International Journal of Quality Health Care. 19(60), 67.
Supporting Research: Reference 2: Simmons-Mackie, N. (2018). Aphasia in North America. Moorsetown, NJ: Aphasia Access.
Supporting Research: Reference 3: Hilari, K., Northcott, S., Roy, P., Marshall, J., Wiggins, R.D., Chataway, J., Ames, D. (2010). Psychological distress after stroke and aphasia: The first six months. Clinical Rehabilitation, 24(2), 181-190.
Supporting Research: Reference 4: Blackstone, S. W., Beukelman, D. R., & Yorkston, K. M. (2015). Patient-provider communication: Roles for speech-language pathologists and other health care professionals. San Diego: Plural Publishing, Inc.
Supporting Research: Reference 5: O’Halloran, R., Grohn, B. & Worrall, L. (2012). Environmental factors that influence communication for patients with a communication disability in acute hospital stroke units: A qualitative metasynthesis. Archives of Physical Medicine and Rehabilitation, 93, S77-S85.
Learning Objectives:
Describe the Living with Aphasia: Framework for Outcome Measurement (A-FROM) and how it applies to an individual with aphasia.
List ways to increase motivation, compliance, satisfaction, and adjustment and decrease anxiety, fear, and confusion in persons with aphasia and their family members by using a Life Participation Approach to Aphasia (LPAA).
List possible ways to address the four A-FROM domains in speech-language assessment and therapy using the LPAA principles.