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Creating a novel approach to discourse treatment through coproduction with people with aphasia and speech and language therapists
Aphasiology ( IF 2 ) Pub Date : 2021-07-03 , DOI: 10.1080/02687038.2021.1942775
M. Cruice 1 , S. Aujla 2 , J. Bannister , N. Botting 1 , M. Boyle 3 , N. Charles 4 , V. Dhaliwal , S. Grobler 5 , D. Hersh 6, 7 , J. Marshall 1 , S. Morris , M. Pritchard 1 , L. Scarth , R. Talbot 8 , L. Dipper 1
Affiliation  

ABSTRACT

Background

Although spoken discourse is an outcome prioritised by all stakeholders in aphasia rehabilitation, assessment and treatment of discourse are not routine clinical practice. The small evidence base, varied clinical expertise, multiple barriers in the workplace, and challenges for clients in understanding their altered language abilities all contribute to this situation. These factors need serious consideration when developing a new treatment. Involving intended stakeholders as partners in the development process is recommended. This assists with future implementation by ensuring assessment and treatment are practical, feasible, and acceptable to those who will deliver and undertake it.

Aims

This paper reports on the coproduction phase of the Linguistic Underpinnings of Narrative in Aphasia (LUNA) research project and describes the levels of partners’ involvement, the outcomes and impact of coproduction, and the factors that influenced it.

Methods and procedures

Four partners with aphasia and four speech and language therapists (SLTs) worked with academic team members across a 6-month period to create the LUNA assessment and treatment. Separate sessions were held with partners with aphasia (monthly) and SLTs (fortnightly). Coproduction methods included open discussion, the Someone Who Isn’t Me (SWIM) technique (thinking from others’ perspectives), low and high fidelity prototypes, flexible brainstorming, card sort, and active experimentation with assessment and treatment tasks. Verbal and written information was presented, shared and documented during each session in supportive formats, and each session summarised as accessible minutes.

Outcomes and Results

Partners contributed at consultation, cooperation, and co-learning levels during the coproduction phase. Outcomes included joined-up thinking across assessment-goal setting-treatment-desired outcomes; agreed decisions and content for assessment protocol and treatment manual; clarity on personalised, meaningful, and relevant treatment; therapeutic alliance operationalised in treatment manual; and more. Impacts included increased confidence, self-knowledge, pride, validation, peer support, networking, and benefits to SLTs’ services. Coproduction was positively influenced by consistent session structure and conduct, group dynamics, accessible communication methods, active task experimentation, and SWIM technique. Although the process was time and labour intensive, all partners considered this worthwhile.

Conclusions

LUNA has exemplified how an inclusive coproduction process can work well despite the language challenges of aphasia. Authors also believe that coproduction with intended users has resulted in products (assessment protocol, treatment manual) that are more practical, feasible, and acceptable to clinicians and clients than if designed by academics alone. This latter claim now needs testing on a wide scale.



中文翻译:

通过与失语症患者以及言语和语言治疗师共同创造一种新的话语治疗方法

摘要

背景

尽管口语话语是失语康复中所有利益相关者优先考虑的结果,但话语的评估和治疗并不是常规的临床实践。小的证据基础、不同的临床专业知识、工作场所的多重障碍以及客户在理解他们改变的语言能力方面面临的挑战都促成了这种情况。在开发新的治疗方法时,这些因素需要认真考虑。建议让预期的利益相关者作为合作伙伴参与开发过程。这有助于确保评估和治疗是实用的、可行的,并且对于那些将要交付和承担它的人来说是可以接受的,从而有助于未来的实施。

目标

本文报告了失语症叙事语言基础 (LUNA) 研究项目的联合生产阶段,并描述了合作伙伴的参与程度、联合生产的结果和影响以及影响它的因素。

方法和程序

四个失语症合作伙伴和四个言语和语言治疗师 (SLT) 与学术团队成员在 6 个月的时间里合作创建了 LUNA 评估和治疗。与失语症(每月一次)和 SLT(每两周一次)的合作伙伴举行了单独的会议。联合制作方法包括公开讨论、非我之人 (SWIM) 技术(从他人的角度思考)、低保真和高保真原型、灵活的头脑风暴、卡片分类以及评估和治疗任务的积极实验。口头和书面信息在每次会议期间都以支持性格式呈现、共享和记录,并且每次会议都总结为可访问的会议记录。

结果和结果

在联合制作阶段,合作伙伴在协商、合作和共同学习层面做出了贡献。结果包括跨评估-目标设定-治疗-期望结果的联合思考;评估方案和治疗手册的商定决定和内容;明确个性化、有意义和相关的治疗;治疗手册中实施的治疗联盟;和更多。影响包括增加信心、自我认识、自豪感、验证、同行支持、网络和对 SLT 服务的好处。共同生产受到一致的会话结构和行为、小组动态、可访问的沟通方法、主动任务实验和 SWIM 技术的积极影响。尽管这个过程耗时耗力,但所有合作伙伴都认为这是值得的。

结论

尽管存在失语症的语言挑战,LUNA 举例说明了包容性共同生产过程如何运作良好。作者还认为,与预期用户共同生产的产品(评估方案、治疗手册)比单独由学者设计的产品更实用、更可行、更能被临床医生和客户接受。后一种说法现在需要进行广泛的测试。

更新日期:2021-07-03
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