Designing Occupational Therapy Home Programs for People With Aphasia: Aphasia-Friendly Modifications

Abstract

Purpose The purpose of this article is to describe aphasia-friendly modification for occupational therapy assessments and home programs aimed at addressing upper extremity impairments for people post stroke. Method This article examines a case study example from a larger study (Wallace, Donoso Brown, Saylor, & Lapp, 2018 ) that implemented aphasia-friendly material modifications into an occupational therapy home program. The participant was a 74-year-old man who survived a left hemisphere cerebrovascular attack 6 years prior to the study. The participant experienced upper extremity hemiparesis and aphasia post stroke and was appropriate for an occupational therapy home exercise program with aphasia-friendly modifications to facilitate comprehension of the home program. Aphasia-friendly modifications (e.g., gestures and visual aids) were made to assessments to support comprehension and participation. To support reading comprehension deficits during completion of the home program, the program materials had aphasia-friendly modifications, such as modified text, supportive images, and reduced cognitive load of exercises. Finally, research team members used supported conversational techniques during all study procedures. Results At the end of the home program, an interview with the participant revealed several outcomes regarding the home program and the aphasia-friendly modifications. The participant reported pictures and reduced text to be beneficial in understanding the instructions. He also indicated that he enjoyed completing the exercises independently (i.e., outside of a therapy office). The participant's motor function demonstrated changes in a positive direction, although not greater than the minimally detectable change for performance-based measures. Conclusions Aphasia-friendly modifications (e.g., modifying text, adding supportive images, and using gestures) were found to be supportive of participation in assessments for and creation of an upper extremity home program. Speech-language pathologists can support the participation of people with aphasia through interprofessional collaboration and consideration of environmental adaptations.

Cognitive and Linguistic Benefits of Aerobic Exercise: A State-of-the-Art Systematic Review of the Stroke Literature

“…There are methods to foster the participation of PWA in future exercise intervention research. Modifications to physical home exercise programs to reduce cognitive and language load such as simplifying syntax and vocabulary in instructional text, adding supportive images (personalized photographs of the participant performing each step may be particularly helpful), and using supportive communication techniques to maximize auditory comprehension and verbal expression have been used successfully to ensure program adherence in the context of aphasia ( 90 , 91 ). Indeed, Marsden et al ( 92 ) indicated that they had not used aphasia as an exclusionary criterion to assure that a broad spectrum of stroke survivors could participate and that they used “aphasia-friendly” [( 92 ), p. 341] written material and presentation when providing education about physical activity and other aspects (e.g., goal-setting, fatigue management) of their community-based group intervention for stroke survivors and their caregivers.…”

“…Nonetheless, Marsden et al did not specify how many of their participants had aphasia, did not describe the “aphasia-friendly” modifications within the education component of their intervention, nor indicate if during the physical activity training component of their intervention, staff members who were supervising the activity sessions utilized supportive communication techniques. In studies including PWA and/or individuals needing cognitive or language supports, modifications to protocol instructions and materials to reduce cognitive and language load should be clearly detailed ( 91 ).…”

The Importance of Aphasia Communication Groups

“…It is also important for members to share stories about life before the stroke [35]. Resources for total communication such as writing boards, notebooks, tables, communication books, aphasia friendly materials [36], and the Internet should be used to access information online [37].…”