Deborah Hersh

Background: There have been numerous calls for rehabilitation professionals to involve patients or clients in decisions about the goals of therapy. And yet collaborative goal setting in rehabilitation remains uncommon and is particularly difficult to achieve for people with aphasia.Aims: This discussion paper describes a new framework for conceptualising and structuring collaborative goal setting in aphasia rehabilitation. The framework has

... It is a relatively consistent finding in the literature on discharge from stroke rehabilitation that the process is not well communicated or shared between rehabilitation professionals and clients (Cameron, Tsoi, & Marsella, 2008; Ellis-Hill et al., in press ... Case example: Grace. ...

ABSTRACT This paper discusses the nature of ethics in research, challenges that may arise in obtaining ethics approval, and conducting ethical research in speech pathology. The paper begins with an overview of principles of ethics and discusses how these apply in the research context. The paper then considers who needs to agree to research and ways of obtaining such agreement through the processes of informed consent. Challenges and some solutions to obtaining informed consent from people with communication impairments are discussed and illustrated. The impact of legislation on the conduct of ethical research is considered. Procedures for obtaining approval for the conduct of research from ethics committees are outlined. The paper concludes with practical references and resources to assist clinicians prepare and conduct ethical research.

ABSTRACT This article reports on the attitudes towards aphasia therapy of 21 people with aphasia and 16 carers, mainly spouses. The research draws on a doctoral study that examined clients' and clinicians' experiences of aphasia treatment termination. This paper develops ten key themes to explore how clients looked back on their experiences of therapy. (author abstract)

This article reports on the attitudes towards aphasia therapy of 21 people with aphasia and 16 carers, mainly spouses. The research draws on a doctoral study that examined clients' and clinicians' experiences of aphasia treatment termination. This paper develops ten key themes to explore how clients looked back on their experiences of therapy. (author abstract)

The ending of therapy is a crucial time for speech-language pathologists and can impact on their sense of achievement and satisfaction. Drawing on literature from psychotherapy, social work and rehabilitation as well as from the area of aphasia therapy, this paper explores how speech-language pathologists juggle the tensions of coping with real versus ideal endings, of managing the building of close therapeutic relationships which then have to be broken, and of balancing a respect for client autonomy while retaining control over caseloads and fair allocation of resources. I suggest that the way in which therapy finishes reflects a merger of how clinicians manage these tensions. Clinicians may benefit from a greater recognition of what they do and feel at discharge, not only to further reflective practice, but also to encourage more sensitive involvement with both clients and students.

In this theoretical paper, we argue that the adoption of the social model to aphasia rehabilitation within group settings changes the metaphorical location of the boundaries between clinicians and clients. Despite a growing literature on group work for aphasia and social model applications for people with chronic aphasia, there has been almost no attention paid to how professional boundaries are negotiated. This paper reviews how this issue is dealt with within professional codes of ethics and what is written more broadly on professional boundaries, and then uses a number of real case examples to encourage further discussion and awareness of this important issue in aphasia rehabilitation within group settings.

Abstract Purpose: Limited research exists on acquired communication disorders (ACD) in Aboriginal Australians despite their high rates of stroke. Their uptake of rehabilitation services is low, and little information is available on functional consequences for this population. This pilot study explored consequences of ACD for Aboriginal Australians after stroke, including their experiences of services received. Method: Semi-structured interviews were collected with 13 Aboriginal people with ACD, and family members, in Perth. Ages ranged from 30 to 78 years and time post stroke from 0.5 to 29 years. A qualitative, thematic analysis of interview transcripts was undertaken. Results: The key themes which emerged were "getting on with life", coping with change, independence/interdependence, the importance of communication for maintaining family and community connection, role and identity issues and viewing the stroke consequences within the broader context of co-morbidities. Conclusions: While similar life disruptions were found to those previously reported in the general stroke population, this study highlighted differences, which reflect the particular context of ACD for Aboriginal people and which need to be considered when planning future services. While implications are limited due to small numbers, the findings emphasise the importance of a holistic approach, and integration of communication treatments into community-led social activities. Implications for Rehabilitation Aboriginal Australians frequently experience a range of concurrent and complex co-morbidities and demanding social or family circumstances at the same time as coping with communication disorders post-stroke. A holistic approach to post stroke rehabilitation may be appropriate with services that accommodate communication disorders, delivered in collaboration with Aboriginal organisations, emphasising positive attitudes and reintegration into community as fully as possible. Communication and yarning are important for maintaining family and community connection and identity, and family and community context should be incorporated into all assessment and treatment activities.

ABSTRACT This paper discusses the nature of ethics in research, challenges that may arise in obtaining ethics approval, and conducting ethical research in speech pathology. The paper begins with an overview of principles of ethics and discusses how these apply in the research context. The paper then considers who needs to agree to research and ways of obtaining such agreement through the processes of informed consent. Challenges and some solutions to obtaining informed consent from people with communication impairments are discussed and illustrated. The impact of legislation on the conduct of ethical research is considered. Procedures for obtaining approval for the conduct of research from ethics committees are outlined. The paper concludes with practical references and resources to assist clinicians prepare and conduct ethical research.

Total laryngectomy (TL), a life-preserving surgery, results in profound physical and communication changes for the individual. Physical and psychosocial adjustment to a TL is complex, and quality-of-life (QoL) measures have provided useful knowledge to assist clinical management. However, many tools were developed without considering the perspectives of people who have experienced TL. To improve understanding of the phenomena of living with TL, a qualitative study was conducted which explored the views and experiences of seven men and five women from a range of ages, geographical locations, and social situations who had undergone a TL. Data were collected through in-depth, semi-structured interviews, journals, and field notes, and analysed using a constructivist grounded theory approach and symbolic interactionism. The emergent concept was identifying with the altered self after TL as reflected in dynamic multi-level changes (physical, communication, and psycho-emotional) continuous...

ABSTRACT Hersh, D., Worrall, L., O’Halloran, R., Brown, K., Grohn, B. & Rodriguez, A. (2013). Assess for Success: Evidence for therapeutic assessment. In: N. Simmons-Mackie, J. King & D. Beukelman (Eds.) Supporting Communication for Adults with Acute and Chronic Aphasia. Brookes Publishing. (pp. 145-164).

Goal-setting is considered an essential part of rehabilitation practice and integral to person-centredness. However, people with aphasia are not always satisfied with goal-setting, and speech-language pathologists are concerned about the appropriateness of therapy. Furthermore, family members are often excluded from goal-setting, despite the impact aphasia has on them. The actual goals set by clinicians for clients with aphasia and their family members have not yet been investigated. This study aimed to examine the goals that clinicians set for their clients with aphasia and their family members. Data from in-depth interviews with 34 speech-language pathologists describing 84 goal-setting experiences with people with aphasia were coded into superordinate goals for both groups. Clinicians expressed a wide range of goals for people with aphasia and their family members, relating to communication, coping and participation factors, and education. In addition, evaluation was considered a goal for the clients. There were clients for whom no goals were set, particularly for family members, due to a lack of/limited contact. The goals described broadly addressed all aspects of the International Classification of Functioning, Disability and Health (ICF) and reflected the use of both functional and impairment-based therapeutic approaches; they also emphasize the importance of providing goal-setting options for the family members of these clients.

Purpose. Little is known about the needs of Indigenous Australian adults with acquired communication disorders (ACD) following stroke or brain injury and how these needs are met by speech-language pathology (SLP) services. In order for the profession to respond to the challenges of providing culturally appropriate, well-tailored and accessible services, more information on current practice and SLPs' concerns and attitudes is required. Method. This paper reports on a national survey with completed responses from 112 SLPs, who worked with adult neurological populations, about their levels of contact with Indigenous clients, cultural competency training and potential sources of support. Results. Of the total respondents, 63 SLPs reported clinical contact with Indigenous clients and they also answered questions on their assessment, intervention and discharge practices; liaison with family; and involvement with Aboriginal Health Professionals and interpreters. This group reported ins...

This article uses the medium of clinicians' comments and stories to explore their perceptions of therapeutic relationships and how these relationships come to a close at discharge from aphasia therapy. These narratives are drawn from a qualitative, grounded theory study carried out in South Australia and Northern Territory involving semi-structured interviews with 30 speech pathologists. The stories reported here shed light on the complexities of negotiating boundaries and endings to therapeutic relationships. Interviewees discussed the special nature of their relationships with their clients with aphasia, professional distance, and dependence. Exploration of these narratives is timely because of the increasing emphasis on person-centeredness in rehabilitation, shared decision making, and authentic relationships. This work is important to encourage reflective practice and greater insight into both speech pathologists' professional identities and their therapeutic relationships.