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‘Living with Aphasia the Best Way I Can': A Feasibility Study Exploring Solution-Focused Brief Therapy for People with Aphasia

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      Abstract

      Objective: Post-stroke aphasia can profoundly affect a person's social and emotional well-being. This study explored the feasibility of solution-focused brief therapy as an accessible intervention and investigated its impact on participants' psychosocial well-being. Participants and Methods: This is a small-scale repeated-measures feasibility study. Participants received between 3 and 5 therapy sessions. They were assessed on psychosocial outcome measures before and after therapy and took part in post-therapy in-depth qualitative interviews. Three men and 2 women with chronic aphasia took part (age range: 40s-70s). Results: Participants found the therapy acceptable, and it was possible to adapt the approach so as to be communicatively accessible. Quantitative assessments showed encouraging trends in improved mood [pre-therapy General Health Questionnaire 12-item version (GHQ-12): mean (SD): 4.80 (4.60), median: 6; post-therapy GHQ-12: mean (SD): 2.00 (2.55), median: 1] and improved communicative participation [pre-therapy Communicative Participation Item Bank (CPIB): mean (SD): 7.80 (5.76), median: 7; post-therapy CPIB: mean (SD): 12.20 (4.44), median: 14]. Measures of social network and connectedness, however, remained stable. Themes emerging from the qualitative analysis included changes to mood, communicative participation, mobility, and everyday activities. Conclusions: This small-scale study suggests that solution-focused brief therapy is a promising approach to helping people with aphasia build positive change in their lives.

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      Most cited references 29

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      Natural history, predictors and outcomes of depression after stroke: systematic review and meta-analysis.

      Depression after stroke is a distressing problem that may be associated with other negative health outcomes. To estimate the natural history, predictors and outcomes of depression after stroke. Studies published up to 31 August 2011 were searched and reviewed according to accepted criteria. Out of 13 558 references initially found, 50 studies were included. Prevalence of depression was 29% (95% CI 25-32), and remains stable up to 10 years after stroke, with a cumulative incidence of 39-52% within 5 years of stroke. The rate of recovery from depression among patients depressed a few months after stroke ranged from 15 to 57% 1 year after stroke. Major predictors of depression are disability, depression pre-stroke, cognitive impairment, stroke severity and anxiety. Lower quality of life, mortality and disability are independent outcomes of depression after stroke. Interventions for depression and its potential outcomes are required.
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        Epidemiology of aphasia attributable to first ischemic stroke: incidence, severity, fluency, etiology, and thrombolysis.

        In a geographically defined population, we assessed incidence and determinants of aphasia attributable to first-ever ischemic stroke (FEIS). A 1-year prospective, population-based study among the permanent residents of the canton Basle City, Switzerland, was performed using multiple overlapping sources of information. Among 188,015 inhabitants, 269 patients had FEIS, of whom 80 (30%; 95% CI, 24 to 36) had aphasia. The overall incidence rate of aphasia attributable to FEIS amounted to 43 per 100,000 inhabitants (95% CI, 33 to 52). Aphasic stroke patients were older than nonaphasic patients. The risk of aphasia attributable to FEIS increased by 4% (95% CI, 1% to 7%), and after controlling for atrial fibrillation, by 3% (95% CI, 1% to 7%) with each year of patients' age. Gender had no effect on incidence, severity, or fluency of aphasia. Cardioembolism was more frequent in aphasic stroke patients than in nonaphasic ones (odds ratio [OR], 1.85; 95% CI, 1.07 to 3.20). Aphasic patients sought medical help earlier than nonaphasic stroke patients. Still, after controlling for stroke onset-assessment interval, aphasic stroke patients were more likely to receive thrombolysis than nonaphasics (OR, 3.5; 95% CI, 1.12 to 10.96). Annually, 43 of 100,000 inhabitants had aphasia resulting from first ischemic stroke. Advancing age and cardioembolism were associated with an increased risk for aphasia. Severity and fluency of aphasia were not affected by demographic variables.
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          Social isolation and outcomes post stroke.

          To assess the relationship between social isolation and stroke outcomes in a multiethnic cohort. As part of the Northern Manhattan Stroke Study, the authors prospectively followed a cohort of patients with stroke for 5 years. Baseline data including social isolation were collected. At follow-up, the authors documented outcome events as defined by the first occurrence of myocardial infarction (MI), stroke recurrence, or death. Cox hazard models were used to calculate the hazard ratio (HR, 95% CI) for prestroke predictors of post stroke outcomes. The authors followed 655 ischemic stroke cases for a mean of 5 years. The cohort was 55% women; 17% white, 27% African American, 54% Hispanic; mean age 69 +/- 12 years. There were 265 first outcome events. In univariate analysis, coronary artery disease (OR 1.3, 1.0 to 1.7), age > 70 years (OR 1.9, 1.5 to 2.5), atrial fibrillation (AF) (OR 1.8, 1.3 to 2.5), race-ethnicity (white vs Hispanic) (OR 1.7, 1.1 to 2.9), physical inactivity (OR 1.3, 1.1 to 2.6), help at home (OR 1.8, 1.4 to 2.4), and social isolation (OR 1.4, 1.2 to 1.6) were associated with increased risk of an outcome event. No association was seen for hypertension, diabetes, education, sex, insurance, occupation, marital status, or primary care physician. In the multivariable model controlling for age, AF (OR 1.9, 1.5 to 2.5), help at home (OR 1.5, 1.1 to 2.0), and social isolation (OR 1.4, 1.1 to 1.8) predicted outcome events. Prestroke social isolation is a predictor of outcome events post stroke. Lack of social support may contribute to poorer outcomes due to poor compliance, depression, and stress.
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            Author and article information

            Affiliations
            aDivision of Language and Communication Science, School of Health Sciences, City University London and bCentre for Mental Health Research, School of Health Sciences, City University London, and cSpeech and Language Therapy Department, Chelsea and Westminster Hospital, London, UK
            Journal
            FPL
            Folia Phoniatr Logop
            10.1159/issn.1021-7762
            Folia Phoniatrica et Logopaedica
            Folia Phoniatr Logop
            S. Karger AG (Basel, Switzerland karger@123456karger.com http://www.karger.com )
            978-3-318-05686-0
            978-3-318-05687-7
            1021-7762
            1421-9972
            January 2016
            21 January 2016
            : 67
            : 3
            : 156-167
            © 2016 S. Karger AG, Basel

            Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher or, in the case of photocopying, direct payment of a specified fee to the Copyright Clearance Center. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

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            Figures: 2, Tables: 1, References: 44, Pages: 12
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