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Norma Paquin

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A-FROM

A-FROM in Action at the Aphasia Institute

Aura Kagan, Ph.D.

Learning Outcomes:

As a result of this activity, the reader will be able to (1) situate the work of aphasia centers within an outcome-driven framework for intervention that is grounded in the World Health Organization’s International Classification of Functioning, Disability and Health; (2) use key Living with Aphasia: Framework for Outcome Measurement (A-FROM) principles to broaden thinking about intervention and outcome; and (3) adapt illustrative A-FROM examples to his or her own setting.

Norma

A-FROM

A-FROM in Action at the Aphasia Institute

Aura Kagan, Ph.D.

Abstract

Aphasia centers are in an excellent position to contribute to the broad definition of health by the World Health Organization: the ability to live life to its full potential. An expansion of this definition by the World Health Organization International Classification of Functioning, Disability and Health (ICF) forms the basis for a user-friendly and ICF-compatible framework for planning interventions that ensure maximum real-life outcome and impact for people with aphasia and their families. This article describes Living with Aphasia: Framework for Outcome Measurement and its practical application to aphasia centers in the areas of direct service, outcome measurement, and advocacy and awareness. Examples will be drawn from the Aphasia Institute in Toronto. A case will be made for all aphasia centers to use the ICF or an adaptation of it to further the work of this sector and strengthen its credibility.

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Communication Aid for Capacity Evaluation (CACE)

The Aphasia Institute is pleased to offer you the Communication Aid for Capacity Evaluation – CACE

Alexandra Carling-Rowland, Ph.D., developed and tested CACE, a communicatively accessible capacity evaluation process to help health care professionals determine whether or not people living with communication barriers have the capacity to decide where they shall live. CACE is designed to be used with individuals who need help to understand information and to express themselves. CACE can be used with people living with aphasia, speech disorders or hearing loss and with those who speak English as an acquired language.

The Aphasia Institute has partnered with Alexandra to publish CACE. We strongly recommend you watch the CACE training video and read the manual before you first administer CACE.

Click here for the entire CACE package or click each individual item, as follows:

  • CACE Manual
  • CACE
  • CACE Evaluator’s Version – it is recommended that you print this version in colour
  • CACE Communication Cards
  • CACE Response Form and Rights Information
  • CACE Addendums
  • CACE Training Video (38 min.)

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MSC/MPC

Measure of Skill in Supported Conversation/ Measure of Level of Participation in Conversation (for partner with aphasia)

The MSC and MPC are two complementary measures designed to capture elements of conversation between adults with aphasia and their speaking conversation partners. The MSC provides an index of the conversation partner’s skill in providing conversational support. The MPC provides an index of the level of participation in conversation by the person with aphasia. The article A Set of Observational Measures for Rating Support and Participation in Conversation Between Adults with Aphasia and Their Conversation Partners presents the background to the development of the MSC/MPC, and includes preliminary psychometric evaluation.

Please click here to access the measures.

Kagan, A., Winckel, J., Black, S., Duchan, J. F., Simmons-Mackie, N., & Square, P. (2004). A set of observational measures for rating support and participation in conversation between adults with aphasia and their conversation partners. Topics in Stroke Rehabilitation, 11(1), 67-83.

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CAMS

Developed with funding from the Ontario Ministry of Health and Long-Term Care, via the Ontario Stroke Network, the Communicative Access Measures for Stroke (CAMS) is a set of simple and practical measures, which may be useful in developing heath equity plans, accreditation planning, service quality improvement initiatives and continuing education needs assessments related to stroke care in various healthcare settings. The measures include three questionnaires for evaluating status and satisfaction with communicative access in stroke care:

  • CAMS1 Policies and Procedures
  • CAMS2 Frontline Practice
  • CAMS3 Patient Satisfaction

This tool will be in helpful in developing health equity plans, accreditation planning, service quality improvement, and continuing education needs for stroke survivors in various health care settings.

CAMS will be ready in Winter 2015.

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ALA

Assessment for Living With Aphasia (ALA)

Developed with funding from the Ontario Ministry of Health and Long-Term Care, via the Ontario Stroke Network, this comprehensive assessment package provides tools to better assess the impact of aphasia and identify the factors that affect the quality of life and exacerbate or reduce disability.

Benefits of the Assessment

  • Provides quantitative and qualitative data from the perspective of the person living with aphasia
  • Uses pictographic approach which allows for participation across a full range of severity
  • Based on Living with Aphasia: Framework for Outcome Measurement A-FROM
  • In line with World Health Organization’s ICF
  • Psychometrically sound: demonstrated reliability and validity (n=101)
  • Captures real-life issues for planning and evaluating aphasia treatment and making funding decisions

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On-line – Self-Directed Learning

Helpful Materials

When communicating with a person with aphasia, keep some of the following materials on hand to help enable conversation and comprehension:

  • Blank paper to present one or two pictured items or words at a time.
  • Markers or pencils – the bolder or larger the writing, the better to see so use a thick black marker. For those with aphasia, writing with a pencil is easier. Make sure to place the pencil and paper right in front of him/her.
  • Cut out window, created from construction paper – use this to frame one picture at a time.
    Paper and flashcards – whether letter-sized or small sheets, flashcard can be used to write keywords (e.g., TOOTHBRUSH) or to introduce or change a topic.

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On-line – Self-Directed Learning

How to Use Communication Techniques

The fundamental thing to remember when working with someone with aphasia is to be natural. Use communication techniques when breakdowns occur, gradually layering when needed. Overusing communication techniques can also cause incomprehension if the person with aphasia feels you’re being patronizing. Watch the cues from the person with aphasia closely and follow the path that seems to be getting the most response. And remember – everyone experiences communication challenges from time to time, even the most skilled communication partners.

Those with severe aphasia will likely need more extensive support to absorb messages both in and out so use as many communication techniques that appear to be helping.

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On-line – Self-Directed Learning

Revealing Competence

There are communication techniques that can help ease the exchange of information and feelings between the conversation partner and the person with aphasia. The key is ensuring messages are taken IN, OUT and VERIFIED by the person with aphasia.

Getting the message IN is a matter of modifying the way you converse to ensure you are being understood by the person with aphasia. Some methods to try include:

  • Using short, simple sentences and an expressive voice.
  • Using gestures when conversing.
  • Writing keywords or main ideas down – e.g., PAIN in large or bold print.
  • Using pictures and focusing on one at a time.
  • Eliminating distraction – noises, other people, or multiple visual materials.
  • Observing the person’s facial expression, eye gaze, body posture or gestures to determine level of comprehension.

Getting the message OUT might be a bigger challenge for someone with aphasia. To help them express their thoughts to you, try:

  • Asking yes or no questions.
  • Asking one question at a time.
  • Asking him/her to gesture, point to objects or pictures, or write key words, such as “Can you show me…”
  • Giving him/her sufficient time to respond.
  • Asking fixed choice questions such as, “Do you want water or coffee?”
  • Phrasing yes or no questions from general to specific.

Verifying the message is important to making the person with aphasia feel understood and valued. Summarize slowly and clearly by saying, “So let me make sure I understand” and using the following methods:

  • Adding gestures or written key words.
  • Repeating the person’s message.
  • Expanding on what you think the person might be trying to say.
  • Recapping the conversation if it was a long one.

Norma

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