The Accessibility of Community Environments for Adults with Aphasia

1. The Accessibility of Community Environments for Adults with Aphasia What environmental factors support community participation? Facilitators Related to Other People • Physical Facilitators • Societal Facilitators Tami Howe, Linda Worrall, & Louise Hickson Communication Disability in Ageing Research Centre, School of Health & Rehabilitation Sciences • Introduction • The United Nations (UN) states: • “In all societies of the world there are still obstacles preventing persons with disabilities from exercising their rights and freedoms and making it difficult for them to participate fully in the activities of their societies. It is the responsibility of States to take appropriate action to remove such obstacles.”1 • ASHA Scope of Practice in Speech Pathology • states: • “Speech-language pathologists work to improve quality of life by reducing…environmental barriers of the individuals they serve.”2 • Many aphasiologists recommend identifying • and reducing barriers for clients with aphasia.3,4 • However, what are these barriers and what • facilitators are needed to overcome these barriers? • To date, most research in this area has been on • physical disorders. • Method • Participants • 25 adults with aphasia caused • by CVA living in community • sampled by maximum • variation sampling • Research Paradigm & Design • Interpretive paradigm with a qualitative • descriptive design5 • Method of Data Collection • Semi-structured in-depth interviews with topic • guide: • What places do you go to? • What is it like at these places? • What makes it harder at these places? • What makes it easier at these places? • What places have you stopped going to?/What • places would you like to go to?/What stops you? • Method of Data Analysis • Qualitative content analysis • Results • Examples of Barriers Related to Other People: • Lack of familiarity with other person: “If it was a new doctor,…I’d have to explain…just too hard” • Other people’s attitudes about them: “Stupid,” “Mentally deranged,” “Like a child,” “Drunk” • Examples of Physical Barriers: • Objects:“Every one of them (automated teller machines) are different…They’re really there just to …struffle (stifle).” • Visual aspects:“In the coffee shop…if there’s a lot of movement on the street… more difficult to concentrate on the conversation…Icould cope with anything like that(before the stroke).” • Examples of Societal Barriers: • Procedures: Use of recorded telephone messages in businesses: “Phoning, number 1, number 2, number 3. Hope someone says (hope an operator comes on)…” “If they don’t come…put the phone down and that’s…nothing.” • Examples of Facilitators Related to Other People: • Actions: “(Gets) information out of me so he (bus driver) could produce a ticket… by…asking questions (when she has difficulties finding words on the bus).” • Examples of Physical Facilitators: • Objects:“I think have the names (of movies) written up on them (on a list right at the movie ticket counter) would be much better…Then we could see it…We could say it. (If person had difficulties saying the words), well you you say, ‘Number 3.’” • Examples of Societal Facilitators: • Services:“Should have a speech therapist …(present when you are meeting) with your solicitor. They will make sure that…I am...laying out…the conversation how I want it…like an at atcavat (advocate).” • Procedures:“Since I’ve had them (the bank manager) put the word ‘stroke’ (on my banking computer file), it’s been easier. Much.” • Results (continued) • Some factors were identified • as both a facilitatorAND a • barrier (e.g. support of other • people) • Some participants reported • factors related to their physical • AND communicative difficulties • “Stairs without handrails (is a barrier)”- • “Balance is a problem with • aphasia too, isn’t it?” What environmental factors hinder community participation? Barriers Related to Other People • Physical Barriers • Societal Barriers • Conclusions • Wide range of barriers and • facilitators identified that • policy makers and clinicians • may need to consider • Different from some World • Health Organization • International Classification • of Functioning, Disability, • and Health6 (ICF) Environmental • Factor codes; Future versions of • ICF may need to incorporate • these factors • Data along with findings from a • participant observation study • will contribute to development • of an audit tool (e.g. for banks • and government departments) • Research Questions • What environmental factors are perceived by adults with aphasia to hinder participation of people with the communication disorder in the community? • What environmental factors are perceived by adults with aphasia to support participation of people with the communication disorder in the community? References 1United Nations (1993). Standard rules on the equalization of opportunities for persons with disabilities. Retrieved December 12/2003 from http://www.un.org/documents/ga/res/48/a48r096.htm; 2American Speech-Language-Hearing Association. (2001). Scope of practice in speech-language pathology. Rockville, MD: American-Speech-Language-Hearing Association; 3Byng, S., Pound,C., & Parr, S. (2000). Living with aphasia: A framework for therapy interventions. In I. Papathanasiou (Ed.), Acquired neurogenic communication disorders: A clinical perspective (pp.49-75). London: Whurr Publishers; 4Chapey, R., Duchan, J.F., Elman, R.J., Garcia, L.J., Kagan, A., Lyon, J.G., & Simmons-Mackie, N. (2001). Life participation approach to aphasia: A statement of values for the future. In R. Chapey (Ed.), Language intervention strategies in aphasia and related neurogenic communication disorders (4th ed., pp. 235-245). New York: Lippincott Williams & Wilkins; 5Sandelowski, M. (2000). Whatever happened to qualitative description? Research in Nursing and Health,23,334-340; 6World Health Organization. (2001). International classification of functioning, disability, and health: ICF. Geneva: World Health Organization. Acknowledgement: Queensland Government’sGrowing the Smart State: A Ph.D. Research Funding Program