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Worksheet about problem solving Copy of a worksheet concerning problem solving that Maria used to express her thoughts, feelings, and assessments during the intervention. The unbolded text was written by Maria. The quotes were translated from Norwegian to English by the authors.
Source publication
Telling stories is essential to the continuous process of creating meaning and to self-understanding. Persons with aphasia are vulnerable to psychosocial problems by their limited ability to talk and interact with others. This single-case study illustrates how a young woman with aphasia and a trained nurse interacted to coconstruct stories within t...
Contexts in source publication
Context 1
... gradually wrote down more about her reflections prior to the encounters. Figure 5 shows a worksheet concerning problem solving that was written by Maria six and a half months after stroke onset. The statements that Maria wrote on the worksheet, illustrated in Figure 5, reflected how the stroke disrupted her life and brought her into a new situation in which she had to adjust and find her new role. ...
Context 2
... 5 shows a worksheet concerning problem solving that was written by Maria six and a half months after stroke onset. The statements that Maria wrote on the worksheet, illustrated in Figure 5, reflected how the stroke disrupted her life and brought her into a new situation in which she had to adjust and find her new role. Maria's retrospective assessment of the methodological approach of working to coconstruct stories was reflected in the follow-up interview: I think the "booklet" was very good. ...
Citations
... Within the LPAA movement, the recognition of the importance of supporting identity has become more prevalent (Shadden, 2005;Shadden et al., 2008;Simmons-Mackie, 2018;Simmons-Mackie & Elman, 2011). Additionally, researchers working in the LPAA framework (Chapey et al., 2000) are beginning to recognize the value of supported storytelling for people with aphasia (Bronken et al., 2012;Corsten et al., 2015;Strong et al., 2018;Strong & Sather, 2023). ...
Purpose
Researchers working in the Life Participation Approach to Aphasia (LPAA) framework are beginning to recognize the value of supportive co-constructed storytelling for people with aphasia. Supported storytelling facilitates identity reconstruction that is part of rehabilitation as defined in the LPAA and the Living with Aphasia: Framework for Outcome Measurement. This clinical focus article reviews the therapeutic value of using co-constructed storytelling in clinical practice and describes how this was done in the My Story Project, Aphasia! This Is Our World, and Aphasia-Friendly Reading. These projects used co-constructed storytelling in intervention with people with aphasia in university and support group settings. Three case examples are presented, including sample therapy goals and documentation. Co-constructed person-centered storytelling has been used in clinical projects and has been shown to have immense value in rehabilitation for improving quality of life for people with aphasia.
Conclusions
Co-constructed stories can provide a powerful opportunity for targeting life participation, identity, and environmental factors, while simultaneously targeting language. Clinicians are encouraged to consider incorporating the use of co-constructed person-centered storytelling in clinical practice. Guidance is offered for preparing for storytelling intervention sessions and documenting these sessions as billable, skilled services.
... People with aphasia are at a disadvantage when participating in this social, meaning-making experience of storytelling due to their reduced language capacity-a necessary tool in storytelling (Shadden et al., 2008). Interest in how the process of creating stories relates to identity renegotiation and improved HRQOL is growing within aphasia research (Bronken et al., 2012;Corsten et al., 2015;Strong et al., 2018). ...
... Of interest to this study is that storytelling interventions targeting identity renegotiation (e.g. Bronken et al., 2012;Corsten et al., 2015;Strong et al., 2018) have been identified as a Level 1 intervention to support mood and reduce depression in people living with aphasia post-stroke. ...
... Persons with endometrioses appreciated that the sessions focused on personal needs and preferences, 'It has been very different I have gotten more in-depth answers and much deeper talks'; additionally, they appreciated the change of focus 'about me as a person not just the disease' [13]. Others emphasised that when sharing their newly gained person-specific knowledge with a HCP, they experienced that the HCP contributed with their understanding and provided disease-specific knowledge on disease, treatment and symptoms targeting their needs [7,13,43,45,47,49,53]. In continuation of this, some highlighted that this exchange of knowledge increased their own knowledge of disease-related behaviour [13,50]. ...
... Several experienced that GSD sessions enabled the parties to 'get acquainted', which generated trust [45,53], confidence, understanding and partnership [39,53,54]. Some persons with T2DM described being seen and heard in an unjudging way, in contrast to what they usually had experienced [49]. ...
... Several experienced that GSD sessions enabled the parties to 'get acquainted', which generated trust [45,53], confidence, understanding and partnership [39,53,54]. Some persons with T2DM described being seen and heard in an unjudging way, in contrast to what they usually had experienced [49]. ...
Aim
To review the evidence of the existing literature on the impact of guided self-determination across methodologies in different healthcare settings.
Methods
An integrated five-stage review.
Results
Forty-five eligible papers were included. Guided self-determination was applied in full- or small-scale, or combined with another intervention or approach in different healthcare settings handling, for example diabetes, stroke survivorship, schizophrenia, attention-deficit hyperactivity disorder and medical disorder, gynaecological and breast cancer, endometriosis, persons with chronic pain, persons in haemodialysis and intensive care survivors. The included studies covered 12 randomised trials, 26 qualitative and seven papers of different methodology. A statistically significant effect was found in three trials. Six main themes describe the qualitative findings across papers on patients: (1) Guided self-determination reduces disease-related loneliness, (2) Insight enables integration of life and disease, (3) Reflection sheets—appreciated but challenging tool to prompt insights and person-specific knowledge, (4) New person-specific knowledge enables person-centred support, (5) Feeling seen and believed in a new and trusted relationship and (6) Exchange of knowledge enables the development of life skills. Four themes describe the healthcare professionals' experience: (1) Change of usual practice—a decision from above, (2) A new role—unlearning previous behaviour and need for support, (3) Reflection sheets as facilitators and barriers and (4) Discovering the benefits of changing to a person-centred approach.
Conclusion
Overall, guided self-determination proved to have a great impact on patient important outcomes and was useful and well-accepted by the majority of patients and healthcare professionals. Albeit guided self-determination is not a ‘one size fits all’ method. Continuous training and supervision of professionals are a necessary mean when implementing guided self-determination to enhance adoption and sustainability in clinical practice.
... The storytelling approach has the potential to activate people with aphasia, because most interpersonal contacts are based on conversations and sharing stories. The use of photographic images in storytelling as a basis for developing communication in patients with aphasia significantly improves the participants' psychological wellbeing and recovery [12][13][14]. Applications offering this kind of interaction may be a potential solution to the problems from which people with expressive aphasia suffer. Storytelling applications most often allow for the building of visual stories based on photos or videos taken by the user, which can additionally be described with text, symbols, etc., and then shared with others [15]. ...
Aphasia is a partial or total loss of the ability to articulate ideas or comprehend spoken language, resulting from brain damage, in a person whose language skills were previously normal. Our goal was to find out how a storytelling app can help people with aphasia to communicate and share daily experiences. For this purpose, the Aphasia Create app was created for tablets, along with Aphastory for the Google Glass device. These applications facilitate social participation and enhance quality of life by using visual storytelling forms composed of photos, drawings, icons, etc., that can be saved and shared. We performed usability tests (supervised by a neuropsychologist) on six participants with aphasia who were able to communicate. Our work contributes (1) evidence that the functions implemented in the Aphasia Create tablet app suit the needs of target users, but older people are often not familiar with tactile devices, (2) reports that the Google Glass device may be problematic for persons with right-hand paresis, and (3) a characterization of the design guidelines for apps for aphasics. Both applications can be used to work with people with aphasia, and can be further developed. Aphasic centers, in which the apps were presented, expressed interest in using them to work with patients. The Aphasia Create app won the Enactus Poland National Competition in 2015.
... Most of them found the dialogues meaningful and felt that the IP listening to their illness stories helped them to reflect upon their new situation and communicate their resources, fears and worries. These findings also concur with some of our previous feasibility studies, which have highlighted patients' need for continual support and the possibility to talk to a trusted professional about threats to well-being following a stroke [12,25,39,40]. Some also found that participation in the dialogues had a positive impact on their family relationships [38]. ...
Background
Persons with stroke are susceptible to psychosocial problems, and express disappointment at how health care professionals fail to meet their psychosocial needs following discharge to home. The responsibility of nurses and occupational therapists in stroke rehabilitation is to assist the persons and their families during the recovery and adjustment process. A home-based dialogical intervention aiming to enhance psychosocial support was therefore developed and tested in a randomized controlled trial. This study is a part of the process evaluation conducted alongside the trial. The aim was to explore the nurses’ and occupational therapists’ experiences of conducting the intervention.
Methods
Eighteen nurses and four occupational therapists participated in six focus groups to explore their experiences when providing the intervention. The themes discussed in the focus groups were the aspects that facilitated the delivering of the intervention and the challenges they encountered during the study period. The interviews were analysed using qualitative content analysis.
Results
The analysis generated two themes. The theme Developing a supportive relationship to facilitate the adjustment process following stroke had two subthemes: Getting personally involved and Handling challenges. This theme reveals how the nurses and occupational therapists experienced their relationship with the persons with stroke and potential threats which challenged them while conducting the intervention. The theme Developing professional skills in providing psychosocial support had two subthemes: Becoming confident in conducting dialogues and Integrating psychosocial topics. This theme reveals the aspects that the nurses and occupational therapists perceived as facilitating the development of their professional skills in conducting the dialogues.
Conclusion
Delivering the psychosocial intervention was perceived as deeply meaningful and increased the nurses’ and occupational therapists’ understanding of how to support stroke survivors to live with the consequences of stroke. However, balancing the professional and the personal relationship was challenging. A basic educational programme, training, supervision and having dedicated time were crucial elements to instil confidence in professionals conducting theme-based dialogues to promote post-stroke psychosocial well-being. Individual clinical experience and knowledge of stroke care were considering important to enable professionals to integrate psychosocial rehabilitation into community health care.
Trial registration
ClinicalTrials.gov, NCT 02338869, registered 10/04/2014.
... It can invite conversation, collaboration, creativity, and problem solving, and can serve as a vehicle for the communication and meaningful self-expression (Baker, 2015). The activity of TSW, in which the client is encouraged to share stories with the help of a facilitating professional, can act as a tool for assisting persons struggling to regain coherence and meaning in the psychosocial sequelae that often accompanies chronic and progressive medical conditions (Bronken et al., 2012). ...
Background
Therapeutic songwriting (TSW) is an activity used with people who have neurological and psychological conditions. TSW can act as a tool for assisting people with primary progressive aphasia (PPA) struggling to regain coherence and meaning amidst the psychosocial sequelae that often accompanies this chronic, progressive medical condition. With help from a facilitating clinician, TSW addresses issues of building and maintaining interpersonal relationships in the face of considerable language challenges.
Aim
This study explored how two different forms of TSW were perceived by a participant with PPA in terms of the quality and meaningfulness of the activity, and as a modality for conducting communication therapy.
Methods & Procedures
The participant was a 64-year-old woman with the logopenic variant of PPA. She participated in 13 therapy sessions designed to increase her successful use of conversational repair strategies while engaged in TSW using two different techniques: Song Parody Technique (SPT) and modified song Collage Technique (SCT). The participant’s perceptions were measured using the Meaningfulness of Songwriting Scale and a Songwriting Satisfaction and Enjoyment scale. A modified version of the ASHA Quality of Communication Life (ASHA QCL) was administered (pre and post) to measure the extent the participant believed TSW impacted her quality of communication life. The use of spontaneous repair strategies (word finding and picture board) during TSW tasks was tallied from recorded sessions.
Outcomes & Results
The participant found both forms of TSW meaningful. She enjoyed the activity and indicated creating the two songs was satisfying. She preferred the SPT over the modified SCT. When compared to pre-ASHA QCL measures, the participant felt it “easier to communicate” and to “stay in touch with family/friends”. She rated herself higher in terms of feeling “included”, “seeing the funny things in life”, “trying when people didn’t understand her”, and was more “confident in her ability to communicate”. The use of conversation repair increased from 20% to 80% of the opportunities during TSW.
Conclusions
Given the risk for psychosocial sequelae that often accompanies PPA, TSW was identified as an authentic, meaningful activity that created connectedness, while working on communication repairs during therapy. Even in the face of declining linguistic and cognitive abilities, TSW provided an opportunity for enriched social interaction, self-expression, motivation, confidence, and enhanced quality of communication. TSW addressed the importance of maintaining relationships in a manner that supported individualized choice and dignity for the participant.
... Enhancing the ease or fluency of the interaction (using linguistic, visual or auditory cues) may evoke greater self-disclosure from clients (Alter & Oppenheimer, 2009). The use of co-construction or joint production strategies are paramount for clinicians to facilitate conversational and narrative collaboration and ultimately success (Oelschlaeger & Damico, 1998;Strong et al., 2018); these strategies have been beneficial to the psychological well-being and communicative competence of individuals with aphasia (Bronken et al., 2012;Simmons-Mackie & Damico, 2007). Furthermore, co-constructing stories may act as an important resource for coping, problem solving, engendering hope and renegotiating identity (Bronken et al., 2012;Strong et al., 2018). ...
... The use of co-construction or joint production strategies are paramount for clinicians to facilitate conversational and narrative collaboration and ultimately success (Oelschlaeger & Damico, 1998;Strong et al., 2018); these strategies have been beneficial to the psychological well-being and communicative competence of individuals with aphasia (Bronken et al., 2012;Simmons-Mackie & Damico, 2007). Furthermore, co-constructing stories may act as an important resource for coping, problem solving, engendering hope and renegotiating identity (Bronken et al., 2012;Strong et al., 2018). ...
... However, PWAs may not have "the necessary tools for reframing the story and for renegotiating self" (Shadden et al., 2008, p. 139). Therefore PWAs need the opportunity for storytelling and support in producing self-disclosure narratives (Bronken et al., 2012;Hinckley, 2010). In a recent study, Corsten et al. (2013) reported that a biographic-narrative intervention resulted in a significant improvement in health-related quality of life (particularly in the psychosocial category) and mood in PWAs. ...
Background
Notable positive change arising from the struggle with a major crisis (known as posttraumatic growth – PTG) has been reported following war, accidents and life-threatening illnesses. Whilst negative changes following aphasia are well-documented, positive changes, such as PTG, have not been sufficiently explored.
Aims
To determine whether people with aphasia can experience PTG throughout their first year post-stroke both quantitatively (Posttraumatic Growth Inventory) and qualitatively (video-taped open-ended interviews).
Methods & Procedures
Thirteen people with a first incidence of aphasia were assessed at four points in the first year, using a prospective longitudinal cohort study design.
Outcomes & Results
On the PTG Inventory, there were no significant differences in the mean total score nor in the five posttraumatic growth domains at each stage, although there was a trend to greater growth over time, particularly in relationships, appreciation of life and personal growth. Reflective comments reinforce this evidence and indicate the importance of post-aphasia relationships, enhanced positive traits, a greater appreciation of life and a changed sense of what is important.
Conclusions
It is apparent that some participants can experience PTG and are redefining themselves positively. Strategies to promote the development of PTG in parallel with other therapeutic tools are detailed.
... Additionally, increased confidence in talking was found as a benefit. A case study of one of the participants with aphasia and the nurse who provided intervention within the Bronken, Kirkevold, Martinsen, Wyller, et al. (2012) study highlighted the benefits of a partnership in story co-construction to support the recovery process (Bronken, Kirkevold, Martinsen, & Kvigne, 2012). Additionally, dedicated and guided time to talk about psychosocial issues over time was necessary to meet the needs of persons with aphasia. ...
... McAdams's (2008a) life story definition was adapted to life with aphasia for a story framework of "Who I was before my stroke and aphasia," "My stroke and aphasia," "Who I am today," and "My future goals." Additional influences were the importance of the co-constructive partnership in telling a story for persons with aphasia (Bronken, Kirkevold, Martinsen, Wyller, et al., 2012;Bronken, Kirkevold, Martinsen, & Kvigne, 2012) balanced by the caution to ensure that ownership of the story, while supported by the clinician, belongs to the client (Corsten et al., 2014). The inclusion of primarily individual sessions to the protocol was influenced by GDS (Bronken, Kirkevold, Martinsen, Wyller, et al., 2012;Bronken, Kirkevold, Martinsen, & Kvigne, 2012) and BN (Corsten et al., 2014). ...
... Additional influences were the importance of the co-constructive partnership in telling a story for persons with aphasia (Bronken, Kirkevold, Martinsen, Wyller, et al., 2012;Bronken, Kirkevold, Martinsen, & Kvigne, 2012) balanced by the caution to ensure that ownership of the story, while supported by the clinician, belongs to the client (Corsten et al., 2014). The inclusion of primarily individual sessions to the protocol was influenced by GDS (Bronken, Kirkevold, Martinsen, Wyller, et al., 2012;Bronken, Kirkevold, Martinsen, & Kvigne, 2012) and BN (Corsten et al., 2014). Literature on GAB (Birren & Deutchman, 1991) and other group interventions (Keegan, 2013;Richman & Hartman, 2013) inspired one group session. ...
Purpose
This clinical focus article provides an overview of the relationship between narrative, identity, and social co-construction for persons with aphasia and of narrative treatment approaches targeting identity renegotiation. The intent is to provide speech-language pathologists (SLPs) with background on how these key concepts fit within the Life Participation Approach to Aphasia and to empower them to consider engaging in personal narrative co-construction with their clients. The idea of narrative identity is supported by the Living with Aphasia: Framework for Outcome Measurement, particularly within the Personal domain. A focus on identity through the co-construction of small and big stories can help SLPs prioritize supporting those living with aphasia in moving on with aphasia as part of their story. Emphasis is placed upon the interaction and relationship between the SLP and the client as critical to the social reconstruction and validation of identity through support of shared personal narratives. The PULSE framework is introduced as a foundation for supporting narrative and identity in clinical work with individuals living with aphasia. Evidence-based life story–focused interventions are reviewed.
Conclusion
Stories are powerful tools in moving life forward post stroke and aphasia. Supporting the development of personal narratives that allow identity reconstruction falls within the scope of Life Participation Approach to Aphasia and the Living with Aphasia: Framework for Outcome Measurement. SLPs are well suited to support identity renegotiation in persons with aphasia through narrative construction.
... For them, self-disclosure may be difficult or nearly impossible and thus the nature of the aphasic disorder may deprive survivors of the "healing conversation" (Jaffe 1981 cited by Mackenzie, 1993) and rob them of a fundamental tool in their recovery (Shadden & Hagstrom, 2007). Facilitating and supporting narrative production using co-construction and supported conversation for individuals with aphasia has been beneficial (Bronken, Kirkevold, Martinsen, & Kvigne, 2012); reconstructing narratives within a group environment may be particularly effective as clients listen to each others' narratives as examples of identity reconstruction. ...
Background
Negative changes following aphasia have been widely documented whilst positive changes have not been well explored. Posttraumatic growth may be relevant to individuals with aphasia; however, without intact language skills, it may be difficult to ascertain.
Aims
This study aimed to determine if people with aphasia offered unsolicited revelations of posttraumatic growth in academic and self-written reports.
Methods
A systematised search of the literature found direct quotes of people’s experience of aphasia. These were qualitatively analysed and the results described within each of the five domains of posttraumatic growth (personal strength, new possibilities, relating to others, appreciation of life, and spiritual change).
Results
The analysis showed that that some people with aphasia do experience posttraumatic growth and demonstrates how posttraumatic growth can be facilitated under each of the five domains.
Conclusions
The results of this study open up new directions for research and may provide clinicians with a framework to support people with aphasia in finding the gains amongst the losses associated with aphasia.
... Since identity is a product of social relationships (Berger & Luckmann, 1966) constructed through communication, "it follows that [identity] may be harmed by having aphasia" (Blom Johansson, 2012, p. 20). For instance, Shadden (2005) described aphasia as "identity theft", and Bronken, Kirkevold, Martinsen, and Kari (2012) gave voice to a participant who described her post-stroke self as a "broken mirror". Several researchers (e.g., Boles & Lewis, 2004;Corsten, Konradi, Schimpf, Hardering, & Keilmann, 2014;Hinckley, 2006;Horton, 2007;Shadden, 2005), not least within the A-FROM framework (Kagan et al., 2008), have emphasised the importance of including identity issues in aphasia rehabilitation. ...
... They navigate the dilemmas by constantly, both online and offline, negotiating what to include in their stories of self. Thus, this study adds knowledge to the hitherto "limited understanding of the impact of the loss of the communication tool on narrative self" (Shadden et al., 2008, p. 11) and complexity to previous studies about aphasia and identity (e.g., Bronken et al., 2012;Shadden, 2005) by including online aspects. ...
Background: Self-identity construction through “stories of self” is highly relevant for people with aphasia, not only because the onset entails a “biographical disruption” but also since their ability to keep their “stories of self” going is reduced. Three dilemmas (constancy/change, sameness/difference and agency/dependency) are known to be central to identity. In a digitalised society like Sweden, self-identity construction, including the navigation of these dilemmas, takes place both online and offline. Nevertheless, research combining aphasia, identity and online issues is scarce.
Aim: This qualitative study aims, in terms identity dilemmas, to investigate self-identity construction in working-age persons living with post-stroke aphasia in a digitalised society (i.e. Sweden). Are the dilemmas relevant to the participants, and if so, how do they navigate them online and offline?
Methods and Procedures: Nine individuals (three men and six women, aged 24–54 at onset) with mild or moderate post-stroke aphasia participated. The data comprises nine individual audio-recorded interviews and 1,581 screenshots from online observations. Qualitative analyses were performed (vertically and horizontally), combining inductive and deductive approaches.
Outcomes and Results: All three dilemmas are relevant to the participants. They construct their self-identity as both the same as they were pre-stroke and changed. They are both the same and different in relation to other stroke survivors (with or without aphasia), i.e. both “disabled” and “normal”. They display both dependency and agency. Thus, they navigate the dilemmas by constantly negotiating what to include in their stories of self. In addition, telling one story of self offline does not imply telling the same story online.
Conclusion: The dilemmas are intertwined and highly relevant to the participants. Offline and online settings evoke different ways for them to navigate the dilemmas. Increased awareness of the possible struggle with self-identity dilemmas in people with aphasia, and the possible difference between their online and offline self-identities, should be of value to family members, clinicians and researchers. Further research based on a larger sample is suggested.
