Sue Sherratt

Background: Humour is considered as an integral aspect of interpersonal communication and is said to explain success in group and social situations. Directly elicited or spontaneously occurring humour has only relatively recently been investigated in therapeutic encounters with people with aphasia (PWA), mainly in one-to-one treatment sessions. In social participation groups for PWA, the focus is on increasing communicative effectiveness in conversation and on the adjustment to living with aphasia. Therefore, solidarity and supportive relationships are of particular importance and spontaneously occurring humour may facilitate social interaction. Aims: The aim of this study was to explore spontaneously occurring, conversationally based humour during interaction in social participation aphasia groups in terms of its functions, modalities, and initiators. Method: Ten sessions of a long-standing social participation aphasia group were video-recorded over a one-year period. The group consisted of 8–10 PWA (6 females and 4 males) who varied in aphasia severity, age (range 47–82 years) and time post onset (range 18–204 months) and two student clinicians (in each block) and two experienced aphasia clinicians. In this qualitative analysis of video-recorded group sessions, instances of humour were identified and subsequently categorised according to the functions they served within the group process. The modalities used to express humour and the initiators of the humorous events were also determined. Results: Six functions of humour were identified. Humour served to reinforce solidarity and togetherness and self-depredating humour was often used to manage identity. Humour was used as a face-saving strategy to cope with the difficulties associated with aphasia and communication. If disagreements occurred or complaints were voiced, humour acted as a means of mitigating or deflecting issues. Humour could also be used to avoid or redirect offensive, inappropriate or embarrassing topics. Finally, some group members used humour to increase their likeability by emphasising appealing personal qualities. Both verbal and non-verbal modalities were used to express humour, regardless of aphasia severity. The instances of humour were more frequently initiated by the group members than by the clinicians. Discussion and conclusion: Social participation aphasia groups are often permeated by humour; it is particularly relevant to PWA regardless of severity in promoting well-being, encouraging interaction, coping with the difficulties of aphasia, and discovering new ways of communicating. This study has shown that humour has a special part to play in providing individuals with aphasia the opportunity to participate in group conversation and to establish and maintain relationships, and also in demonstrating the success of therapy groups.

Purpose: Communicative access to participate in daily life is of paramount importance to individuals with communication disorders such as aphasia. Access to the courts may present additional hurdles due to inaccessible legal information and resources, lack of awareness of legal issues, high costs, and the communication disabilities involved in testifying and giving evidence. To address these challenges, this study aims to determine the issues faced by people with aphasia (PWA) accessing the court system in the United States as victims, plaintiffs, or defendants. Method: Using the LexisNexis and Google Scholar case law databases, a systematic review of all U.S. court cases (1915–2021) documenting aphasia/dysphasia revealed 1,926 case reports. After elimination for exclusion criteria, 389 were analyzed using data software to identify types of cases, description and assessment of aphasia, health professionals, and accommodations provided. To facilitate access to this large amount of data, quantitative descriptive statistics are provided and exemplified with quotes. Results: Analysis revealed the continued confusion and inaccuracy surrounding the terms “aphasia/dysphasia,” the lack of knowledge about these deficits both generally and within the justice system, and the absence of involvement of speech-language pathologists. Assessments of PWA were usually conducted by psychologists or medical professionals, and accommodations to allow greater participation for PWA were rarely permitted. Conclusions: PWA are at continued risk of being unable to access and participate in the justice system. The speech-language pathology scope of practice means that we have no choice but to raise awareness of access to court for PWA and to advocate for the role of speech-language pathologists within the health and legal professions in assessing, supporting, and developing strategies to facilitate PWA to be more equitable members of society and equal participants in the justice system. Three practical strategies to facilitate their more equitable participation in the court system are detailed. Supplemental Material: https://doi.org/10.23641/asha.21561255

BackgroundThe emerging global issue of climate change has large‐scale effects on health and well‐being, including communication disorders. The broad range of the speech and language therapy profession's scope of practice incorporates prevention, advocacy and equality in service delivery. These act as a springboard for involvement in climate change and health.AimsThis is an appeal to speech and language therapists (SLTs) to focus and take action on this issue and its considerable effects on communication and swallowing disorders.Methods & ProceduresThis article discusses the importance of taking a public health position on prevention and equality of services to manage environmental determinants of communication and swallowing disorders. It also describes the extent to which climate change affects these disorders and exacerbates the inequality of healthcare services in low‐ and middle‐income countries.Main ContributionFive strategies are provided for action on fulfilling therapists’ roles in reducing the incidence, development and exacerbation of climate‐related communication and swallowing disorders, as well as the role of SLTs in acting as advocates. The case is made for expanding the scope of services to focus on prevention and service equality so as to best meet the needs of the wider community.Conclusions & ImplicationsDespite other challenges currently facing SLTs, climate change and its increasing effects on communication disorders and dysphagia is difficult to ignore. SLTs owe it to their clients, the wider community, low‐ and middle‐income countries, the economy, and the future to take action.What this paper addsWhat is already known on the subject Multiple studies published in peer‐reviewed scientific journals show that climate change is extremely likely to be due to human activities. The global effects will be higher temperatures, changes in precipitation, more droughts and heatwaves, stronger and more intense hurricanes, and a rising sea level which directly threaten the health of entire populations. Other health professions are beginning to take climate change into account in training and practice.What this paper adds to existing knowledge Many disorders of communication and swallowing are caused or exacerbated by the effects of climate change. Increasing temperatures, extremes of precipitation, population displacement and air pollution contribute to cardiovascular and cerebrovascular events, respiratory disease, malnutrition, premature birth, air‐ and water‐borne diseases, and mental illness. These may affect the communication and swallowing abilities across the lifespan, but particularly those of children and older adults.What are the potential or actual clinical implications of this work? SLTs’ roles in prevention, advocacy and education act as a starting point for involvement in climate change and health. Three practical strategies for action include educating SLTs and other health professionals on climate change and its effects on communication and swallowing, promoting awareness with clients and their families, and gathering and disseminating reliable data.

BackgroundThe emerging global issue of climate change has large‐scale effects on health and well‐being, including communication disorders. The broad range of the speech and language therapy profession's scope of practice incorporates prevention, advocacy and equality in service delivery. These act as a springboard for involvement in climate change and health.AimsThis is an appeal to speech and language therapists (SLTs) to focus and take action on this issue and its considerable effects on communication and swallowing disorders.Methods & ProceduresThis article discusses the importance of taking a public health position on prevention and equality of services to manage environmental determinants of communication and swallowing disorders. It also describes the extent to which climate change affects these disorders and exacerbates the inequality of healthcare services in low‐ and middle‐income countries.Main ContributionFive strategies are provided for action on fulfilling therapist...

Background: Humour is considered as an integral aspect of interpersonal communication and is said to explain success in group and social situations. Directly elicited or spontaneously occurring humour has only relatively recently been investigated in therapeutic encounters with people with aphasia (PWA), mainly in one-to-one treatment sessions. In social participation groups for PWA, the focus is on increasing communicative effectiveness in conversation and on the adjustment to living with aphasia. Therefore, solidarity and supportive relationships are of particular importance and spontaneously occurring humour may facilitate social interaction. Aims: The aim of this study was to explore spontaneously occurring, conversationally based humour during interaction in social participation aphasia groups in terms of its functions, modalities, and initiators. Method: Ten sessions of a long-standing social participation aphasia group were video-recorded over a one-year period. The group consisted of 8–10 PWA (6 females and 4 males) who varied in aphasia severity, age (range 47–82 years) and time post onset (range 18–204 months) and two student clinicians (in each block) and two experienced aphasia clinicians. In this qualitative analysis of video-recorded group sessions, instances of humour were identified and subsequently categorised according to the functions they served within the group process. The modalities used to express humour and the initiators of the humorous events were also determined. Results: Six functions of humour were identified. Humour served to reinforce solidarity and togetherness and self-depredating humour was often used to manage identity. Humour was used as a face-saving strategy to cope with the difficulties associated with aphasia and communication. If disagreements occurred or complaints were voiced, humour acted as a means of mitigating or deflecting issues. Humour could also be used to avoid or redirect offensive, inappropriate or embarrassing topics. Finally, some group members used humour to increase their likeability by emphasising appealing personal qualities. Both verbal and non-verbal modalities were used to express humour, regardless of aphasia severity. The instances of humour were more frequently initiated by the group members than by the clinicians. Discussion and conclusion: Social participation aphasia groups are often permeated by humour; it is particularly relevant to PWA regardless of severity in promoting well-being, encouraging interaction, coping with the difficulties of aphasia, and discovering new ways of communicating. This study has shown that humour has a special part to play in providing individuals with aphasia the opportunity to participate in group conversation and to establish and maintain relationships, and also in demonstrating the success of therapy groups.

BackgroundKnowledge of the discourse performance of non‐brain‐damaged individuals is critical not only for its differentiation from disordered expression but also for more accurate models of ageing and communication. The effect of ageing and cognitive skills on the cohesive adequacy of discourse has, until now, presented a confusing and ambiguous picture.AimsTo examine comprehensively the effects of both age and cognitive skills on the discourse cohesion of 32 non‐brain‐damaged males divided into four age groups.Methods & ProceduresA large body of narrative and procedural samples (394 samples) was elicited from the participants. Their cognitive skills were determined using three tests, whilst their discourse cohesion was analyzed and correlated with the cognitive test results.Outcomes & ResultsThis extensive investigation of ageing effects on discourse cohesion and their relationship to cognitive behaviour did not provide neat generalizable results. It showed that ageing significant...

Purpose: This article proposes that providing solutions to ethical dilemmas and, if necessary, disclosing breaches of care are critical to speech-language pathologists’ ethical behaviour and professional responsibilities. They are also pivotal to incorporating person-centred-care into our clinical practice. Method: Evidence is reviewed regarding the nature of breaches of care in speech-language pathology, disclosure of these breaches and the training and resources that are currently available. The significance of either disclosing or not disclosing breaches of care is also discussed. Results: Although the profession already has an armory of resources for tackling ethical dilemmas, innovative and ongoing ethical education is needed to deal with the increasingly complex situations that arise in the current healthcare climate. Within the workplace, appropriate arenas for discussion and avenues for disclosure would minimize the need for disclosure of breaches of care. Conclusions: In some circumstances, disclosing breaches of care may be necessary if the safety or care of our clients is being negatively affected and person-centred care is being jeopardised. Such disclosures can be used as a feedback mechanism to improve our effectiveness as clinicians, enable us to enhance the quality of care for our clients and ensure the future health of our profession.

The professional bodies that accredit degrees in our faculty require students to complete periods of work experience. Recent initiatives to promote work integrated learning (WIL) provided an opportunity to explore students' experiences of these placements. We administered an electronic survey comprising quantitative and openended questions. Key findings from the open-ended questions are presented here. Students reported both positive and negative aspects of their placements. Most considered the experience to be valuable and one that complemented their studies. They felt that the placements enhanced their understanding of their chosen careers and improved their career prospects. Students also outlined difficulties in obtaining information on WIL and in securing placements. Maintaining a balance between university and work requirements, and the requirements and expectations of the realworld work place were problematic for some students. As well as confirming the important benefits...

ABSTRACT Background In 2015, researchers called for the preferred use of the term “aphasia” and the elimination of the term “dysphasia”. They determined that speech-language pathologists, researchers and consumer organizations prefer the term “aphasia”. However, individuals with aphasia, their family members and friends are faced with a probably unknown disorder and may rely on the internet to provide the information they need. Aims To determine the frequency and use of the terms “aphasia” and “dysphasia” on publicly accessible websites. Method Using the Google search engine, three searches (general, news and Google Scholar) were conducted for the terms “aphasia” and “dysphasia” for the year 2019. Results A survey of the terms “aphasia” and “dysphasia” in 2019 reveals a reduced frequency of the latter term in general searches, news and accessible scholarly publications. However, the term continues to be used inconsistently and inaccurately. In general searches, a layperson had only around 50% chance of obtaining a correct explanation of dysphasia as a language disorder. In news items, only around one-third correctly identified dysphasia as a language disorder. Conclusions Although the use of the term “dysphasia” has reduced compared to “aphasia” in internet searches, confusion and inaccuracy surrounding the meaning of these two terms persists. There is still a need for greater advocacy and awareness raising regarding accurate terminology amongst the wider society and the professional community. Only by doing this, can everyone affected by aphasia gain relevant and appropriate healthcare, support and opportunities.

ABSTRACT 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.

To remain competitive and relevant it is necessary for organizations to undergo constant change, yet two-thirds of all organizational change initiatives fail. This paper proposes the novel application of an Adult Mentoring Model which has been revised and extended to address this issue. The Adult Mentoring Model aims to create an environment that is both challenging and supportive for the effective mentoring of an individual. This paper proposes to extend this model by introducing a number of strategically aligned components that can deliver organizational change. The challenges are provided by the following four linked hierarchically-applied components: the case for change; key performance indicators and targets; data collection and reporting; and performance management and governance. To balance these challenges the following four components provide support during change: business process redesign; knowledge management; training and development; and reward and recognition. Maintaining a balance between sufficient support and adequate challenge provides a valuable structural framework for implementing organizational change. This paper's revised mentoring model potentially provides a more practical and flexible solution to deliver successful change.

A healthcare organization, like any organization, faces the inevitability of change. However, healthcare in the developed world is required to meet increasing demands for, and complexity of, services; together with enhanced consumer expectations and challenging primary healthcare systems. Over the last two decades, governments have been attempting to address these challenges largely through strategies of major health system reform. However, there remains considerable debate over the most effective model for supporting organizational change in healthcare settings. This review considers the main change models adopted in healthcare organizations and aims to identify key enablers and barriers to successfully implementing change in these settings. The findings of the review are then used as the basis for identifying and developing an appropriate model to support change in healthcare organizations. It is argued that a mentoring model of organizational change responds to many of the complex situational barriers to healthcare reform and builds on key enablers of change in these settings. This model particularly develops key skills in management and communication through a balance of tension and support activities. The mentoring model offers an easy to use and scalable tool which supports and guides management, communication and engagement throughout the change process.

This chapter aims to provide novice clinicians a broad overview of therapy for aphasia. The first part of the chapter establishes the overarching context of therapy - the who, what, when, and why of therapy. This discussion shows that there are many different therapy approaches. Each approach should be guided by a strong rationale. A good clinicial can provide a strong rationale for the approach taken with each and every client. The rationale not only integrates the needs of the client but also the research literature and the therapist's experience and constraints. When all three sources of practice knowledge are integrated, evidence-based practice is realized. The second part of the chapter provides more detail about therapy, in particular the process of therapy. This is illustrated in the final section by a case study of therapy for a person with aphasia.

Purpose: The environment plays a key role in determining the health of populations, and climate change is considered to be the greatest threat to human health in the 21st century. However, despite extensive research on its increasing effects on health in general, extremely limited attention has been paid to its impact on communication and swallowing disorders (CSDs). This is surprising considering the substantial effect that the environment and climate change (air pollution, infectious diseases, and extreme weather events) have on these disorders. Method: This tutorial is written by a speech-language pathologist and audiologist to provide education and resources on the ramifications of climate change for the professions. It also offers strategies for speech-language pathologists and audiologists (SLPAs) to use and to incorporate into their practice. Results and Conclusions: The effects of climate change on the incidence, development, and exacerbation of CSDs, such as aphasia, develo...

Purpose: This article proposes that providing solutions to ethical dilemmas and, if necessary, disclosing breaches of care are critical to speech-language pathologists’ ethical behaviour and professional responsibilities. They are also pivotal to incorporating person-centred-care into our clinical practice.
Method: Evidence is reviewed regarding the nature of breaches of care in speech-language pathology, disclosure of these breaches and the training and resources that are currently available. The significance of either disclosing or not disclosing breaches of care is also discussed.
Results: Although the profession already has an armory of resources for tackling ethical dilemmas, innovative and ongoing ethical education is needed to deal with the increasingly complex situations that arise in the current healthcare climate. Within the workplace, appropriate arenas for discussion and avenues for disclosure would minimize the need for disclosure of breaches of care.
Conclusions: In some circumstances, disclosing breaches of care may be necessary if the safety or care of our clients is being negatively affected and person-centred care is being jeopardised. Such disclosures can be used as a feedback mechanism to improve our effectiveness as clinicians, enable us to enhance the quality of care for our clients and ensure the future health of our profession.