Introduction: Research has suggested a relationship between living alone and risks to physical and mental health, wellbeing, and longevity. However, little attention has been given to how living alone interacts with aphasia and how it impacts on participation, mood, and quality of life.

Aim: The aim of the study was to explore and describe the experiences of people with aphasia who live alone to understand participation, loneliness, and aloneness for people with chronic aphasia.

Methods: Following ethics approval, five people with aphasia participated in two semi-structured, in-depth interviews. The initial interview explored living alone with aphasia, and the second interview included sharing an artefact (e.g., photo, drawing, written note etc.) that held significance related to living alone with aphasia. Interviews, using supported communication, were recorded and transcribed verbatim with data analysed through interpretative phenomenological analysis.

Results: Four key themes encompassed meaning-making about living alone; managing day-to-day activities; relationships; and participation. There were a range of artefacts chosen reflecting strategies and outlook on life with aphasia.

Conclusion: Living alone risked compounding feelings of isolation, particularly for those with more severe aphasia. However, even in this small sample reactions and experiences were diverse. They varied with level of aphasia, social circumstances, time, and life stage. Staying connected was particularly important but there was a distinction between living alone and feeling lonely. This research has significance for how clinicians reflect on the implications of living alone and respond by supporting social connection and participation through their intervention.


Keywords: aphasia, aloneness, loneliness, qualitative

Submission statement: Little attention has been given to how living alone interacts with aphasia and how it impacts on participation, mood, and quality of life. This presentation promotes reflection on the diversity of client experiences and highlights the need for tailored responses to minimise isolation and support opportunities for social connection.

Introduction: Student-led aphasia book clubs provide a valued experience for people with aphasia. Previous research has substantiated the benefits of aphasia book clubs within a Life Participation Approach to Aphasia. Traditionally, aphasia book clubs however, have been designed by expert facilitators such as speech pathologists. Limited partnership has occurred with people with aphasia and student speech pathology collaborators in the design.

Aim: Guided by the Medical Research Council MRC (UK) complex intervention development framework the aim of this study was to codesign a new student-led book club for a university service.

Methods: The codesign involved three stakeholder groups: people with aphasia, speech pathology educators, and speech pathology students. A literature review was conducted to inform development. The intervention development identified critical components of the service (what, where, when, how, and why). The composition, number, and length of each codesign workshops was flexible and dependent on the collaborators’ needs. Evidence-based approaches to supporting inclusion of people with aphasia was used, e.g., supported communication techniques and provision of accessible written formats/documents.

Results: The codesign process is ongoing and will be concluded in 2023. Results of the codesign process will be reported against complex intervention development guidelines, codesign guidelines, and intervention descriptions (TIDieR). In line with the conference this project will reflect on aphasia book club practices– respect the voices of key stakeholders – and respond to those voices in the book club design.

Conclusions: The codesign process will result in a manual, resources to support the book club, and student clinical education workbook.

Introduction/or rationale
There are large evidence-practice gaps in Australian aphasia services. Implementation efforts are required to address these gaps, focussed on high-priority practice areas. Priority areas should recognise and respond to consumer and stakeholder preferences and needs, however these are currently unknown.

Aim(s)
We sought to identify implementation priorities for Australian aphasia services from the perspectives of consumers (people with aphasia and family members) and speech pathologists.

Methods
The research team firstly identified 23 best practice recommendations with strong evidence or reported as being important to consumers. Then two iterative online surveys were conducted, followed by an online facilitated workshop. Survey 1: participants ranked the importance of all recommendations and selected implementation priorities. Survey 2: participants ranked the relative importance and feasibility of 10 shortlisted recommendations. Rankings were analysed using a graph theory-based voting system. Workshop: Discussions were facilitated and priority implementation were identified through anonymous voting.

Results
A total of 108 participants took part (survey 1: 26 consumers and 82 clinicians; survey 2: 17 consumers and 49 clinicians). The workshop was attended by five consumers and seven clinicians. Three priority recommendations for implementation were identified: assessment by a speech pathologist; offering tailored information; and provision of therapy for all people with aphasia.

Conclusions
We have identified the top priority recommendations for implementation in aphasia care through engaging with people with aphasia, their families and clinicians. Clinicians should respond to these priorities to improve outcomes for people with aphasia. A national implementation toolkit will be developed to facilitate this process.

Keywords - implementation, evidence-based practice, aphasia, consumer involvement

Submission Statement: Our research responds to the evidence based practice gap in aphasia services and respects the preferences and needs of consumers by including their voices in this process.

Comparing acute hospital outcomes for people with post-stroke aphasia who require an interpreter.

Introduction: People with communication differences are known to have poorer hospital outcomes than their peers. This is demonstrated for people with aphasia and for people from culturally and linguistically diverse (CALD) backgrounds. It remains unknown whether being a CALD person who also has aphasia results in exacerbation of these poorer outcomes.

Aim: To investigate the association between requiring an interpreter, and the provision of evidence-based care and patient outcomes for people with aphasia in acute care after stroke.

Methods: We compared cross-sectional, observational data collected in the Stroke Foundation National Audit of Acute Services (2017–2021). Descriptive statistics, chi-square tests and regression models were used to compare outcomes and care by interpreter status. Models were adjusted for sex, stroke type, and severity factors.

Results: 3122 people with aphasia were identified from 126 participating hospitals: 6% required an interpreter. When compared to people with aphasia who did not require an interpreter, people requiring an interpreter had a length of stay 2 days longer (p=0.003), were less likely to be independent on discharge (OR 0.54, 95% CI 0.33,0.89), and were less likely to have their mood assessed (OR 0.495, 95% CI 0.32, 0.76).

Conclusions: Differences exist in management and outcomes for people with aphasia who require an interpreter. Further research is required to explore their needs, the practice needs of their clinicians, and the systems underpinning their clinical pathways.


Keywords: Aphasia, CALD, stroke, hospital

Submission Statement: This work reflects on current stroke practice for CALD people with aphasia, and provides direction to respond to discrepancies in care for culturally and linguistically diverse people in order to ensure equity in day to day practice.

Introduction: Individuals with non-traumatic subarachnoid haemorrhage (SAH) are often excluded from studies of stroke populations due to differing pathophysiology and treatment pathways. Thus, aphasia presentation in the non-traumatic SAH population is potentially under-represented within existing research evidence.
Aims: This review aims to systematically investigate the available research literature related to aphasia presentations following non-traumatic SAH.
Methods: Five databases were systematically searched with terms related to ‘aphasia’ and ‘subarachnoid haemorrhage’. Studies were included if aphasia was attributed to non-traumatic SAH or its associated complications, and where at least one language assessment measure used determined the presence or absence of aphasia. Study quality was evaluated using the Mixed Methods Appraisal Tool (MMAT).
Results: Following deduplication, 2726 articles were identified for title and abstract screening. Full text screening for 162 articles occurred, with 18 articles selected for inclusion. Aphasia incidence ranged from 5 to 24%, and was influenced by assessment measure, timing of assessment, subgroup studied, and definition of aphasia. Many studies excluded participants with poorer clinical outcome, intracerebral complications, or severe aphasia. Few studies used comprehensive language assessment measures to examine across language domains.
Conclusions: Aphasia presentation is highly heterogenous following non-traumatic SAH. Future research using comprehensive language assessments at multiple time points post onset is required to better understand aphasia presentation and management needs for this population.

Keywords: subarachnoid haemorrhage; aphasia; systematic review; stroke; language

Submission statement: The findings from this review call on speech pathologists to reflect on their current practice with individuals following subarachnoid haemorrhage and encourage them to respond to the need for routine, timely assessment and management of aphasia in this population.

Introduction:
Despite evidence-based guidelines for both stroke and aphasia, little is known about whether the presence of aphasia influences stroke care in Australian hospitals.

Aim:
To investigate whether the presence of aphasia is associated with differences in quality of care and outcomes post stroke in the Australian hospital setting.

Methods:
This was an analysis of pooled data from the Australian Stroke Foundation National Audit conducted in 2017, 2019 and 2021. Processes of care included the Acute Stroke Clinical Care Standard indicators. Outcomes included in-hospital complications, independence at discharge and discharge destination. Descriptive statistics and logistic regression were used to examine associations between aphasia status, processes of care, and stroke outcomes (adjusted for age, gender, stroke type, prior function and severity).

Results:
There were 3,122/11,613 (26.9%) audited patients with aphasia (51% Male; median age 78 years). Patients with aphasia were more likely to be assessed by speech pathology (93% versus 89%), but less likely to have their mood assessed (23% versus 30%). Patients with aphasia were more likely to experience one or more in-hospital complication (aOR 1.61 95%CI 1.45, 1.78), less likely be independent at discharge (aOR 0.43 95%CI 0.37, 0.48) or be discharged home (aOR 0.58 95%CI 0.52, 0.64), but more likely to access inpatient rehabilitation (aOR 1.27 95%CI 1.13, 1.42).

Conclusion:
People with aphasia received poorer quality of care and had worse outcomes after stroke. There is a need to consider equity of service provision and for further research examining the quality of stroke care for people with aphasia.

Keywords:
Aphasia, Stroke, Quality, Outcomes, Processes of care, Service delivery

Submission Statement:
Information regarding stroke quality of care and outcomes for people with aphasia is required in order to reflect on current performance, respond to identified inequities, and ultimately improve stroke care for people with aphasia.

Background
Twitter is a popular social media platform enabling communication, connection, and engagement. To date, there is little research to guide rehabilitation professionals in supporting people with aphasia who wish to participate in Twitter communities.

Aim
To analyse a year-long corpus of tweets sent by people with aphasia to understand (a) more about their use of Twitter for online communication and connection, and (b) the content and discourse of their tweets.

Method
This Twitter hashtag study involved collecting tweets tagged with aphasia-related hashtags. Each week for 12 months in 2021, the second author used the Twitter search bar and NCapture to collect tweets which were imported into NVivo and exported into Excel for qualitative and quantitative analysis.

Results
In total, 28,884 tweets tagged with aphasia-related hashtags were collected; of these 908 tweets were sent by 106 Twitter users identifying as people with aphasia (n=625 tweets) and 50 Twitter users identifying as family members of people with aphasia (n=283 tweets). Content and discourse analysis revealed that the tweets were sent to (i) raise awareness about aphasia, (ii) share personal experiences, (iii) communicate with other people with aphasia, and (iv) share resources, inspiration and advice on living with aphasia.

Conclusion
Twitter enables some people with aphasia and their families to connect and share their views on several topics which could affirm living successfully with aphasia and increase access to information. Speech pathologists should identify if clients wish to use Twitter for these purposes and build goals into rehabilitation plans that enable their engagement.

Keywords: Aphasia, social media, Twitter

Statement
A rich analysis of 12-months of social media engagement by people with aphasia provides a foundation to understand how people with aphasia publicly discuss and understand their communication disability and its impacts. The connections and contents represented show a key stakeholder perspective of aphasia to which clinicians must respond

Introduction / Rationale
Intensive Comprehensive Aphasia Programs (ICAPs) are an emerging service delivery model; however, further stakeholder engagement in the design of these models is required. The Comprehensive, High-dose Aphasia Treatment (CHAT) program is the first modified-ICAP to be implemented within a clinical service in Australia. A greater understanding of participants’ experience of intensive aphasia therapy and their perspectives on this service delivery model is important for future service planning.
Aims
This study aims to explore participants’ experience and satisfaction with the CHAT program, when delivered as part of the speech pathology service in the Surgical Treatment and Rehabilitation Service.
Methods
Twenty-two adults with post-stroke aphasia (>1-month post-stroke) participated in the CHAT program in 2021. A mixed-methodology survey was administered to participants on completion of therapy. Satisfaction ratings for program elements were obtained using a 5-point Likert scale and open-ended questions. Analysis of survey results included content analysis and descriptive statistics.
Results
Participants reported high satisfaction with the CHAT program (mean = 4.74, SD = 0.45) and perceived improvements in their communication ability and confidence. Reported benefits of the service delivery model included the shared experience of the cohort design and the personalisation of treatment. Participants identified logistical challenges attending intensive therapy and the need for ongoing aphasia services and support beyond the completion of CHAT.
Conclusions
This novel service delivery model was well-received by participants, with high consumer satisfaction. As aphasia is a chronic disorder; further consideration of the long-term management of aphasia, beyond intensive services, is required.


Aphasia, Therapy, Intensive Comprehensive Aphasia Program (ICAP).


This abstract explores participants’ reflections and experience of a novel service delivery model for aphasia rehabilitation, the CHAT program. This data will be used to respond to and inform ongoing iterations of the intervention as it is implemented in the speech pathology service at the Surgical, Treatment and Rehabilitation Service.