Religiosity, Spirituality, Healthcare, and Aphasia Rehabilitation.

Awareness of the intersectionality of a person's religious and spiritual belief system with their mental and physical health is slowly being elevated within the Western healthcare system. There are many opportunities for better understanding and incorporation of religious and spiritual beliefs into aphasia rehabilitation. To extend the recognition of religion and spirituality's importance in healthcare to persons living with post-stroke aphasia while emphasizing the diversity of beliefs, the current article seeks to provide a brief overview of the global religions; explain the intersection of religion, spirituality, and health; review the existing literature in the area of aphasia and religion, spirituality, and spiritual care; discuss the clinical importance and implications of religion and spirituality; and finally, lay out a forward view of the direction this area of exploration may take within aphasiology.

The Intersectionality of Climate Change and Post-Stroke Aphasia.

Persons with communication disabilities including persons with post-stroke aphasia (PWAs) possess a vulnerability to climate change as a result of their communication impairments. The disproportionate effects of climate change are likely to exacerbate preexisting inequities in social determinants of health. Communication disability intersecting with other characteristics subject to discrimination (e.g., race, age, sex, income) may lead to inequities in climate-related adaptive capacity. This article echoes earlier concerns related to climate change and further educates healthcare professionals about the impact of climate change on the global human population, with particular consideration of PWAs. The aims of this article are the following: (1) to broaden the understanding of aphasiologists and clinicians caring for PWAs about climate change and the contributions of human activity (anthropogenic) to this crisis; (2) to describe climate change and its impact on health; (3) to detail the intersectionality of climate and health; (4) to explore climate change and its potential effects on PWAs; and (5) to offer hope through emissions reduction, adaptation, resilience, and immediate change.

Spirituality and Post-Stroke Aphasia Recovery.

The role of spirituality in post-stroke aphasia recovery has been ignored despite its potential contribution to positive health outcomes, particularly stroke recovery. The present study examines the spiritual experience of adults with aphasia in an effort to better understand the role of one's spirituality in the aphasia recovery process. Thirteen adults with aphasia completed a modified spirituality questionnaire and participated in semi-structured interviews. All participants considered themselves spiritual and reported improvements in communication during post-stroke recovery. Two themes related to spirituality that emerged from the interviews were (a) a greater power being in control of events and (b) a greater power as helper.

Perceived stress and depression in left and right hemisphere post-stroke patients.

Although it is well accepted that depression and stress are closely related in the general adult population, this link is less understood in post-stroke patients. Due to the high occurrence of depression in post-stroke patients it is important to look closely at this possible association. The current study explores perceived stress and depression in post-stroke patients. Nineteen left hemisphere (LH) stroke patients and 12 right hemisphere (RH) post-stroke patients were assessed for depression, perceived stress, and neurological functioning with the Stroke Aphasia Depression Questionnaire, the Perceived Stress Scale, and the Scandinavian Stroke Scale once per month for three months. Perceived stress and depressive symptoms were significantly correlated for both stroke groups. Neurological functioning was not correlated with either depressive symptoms or perceived stress in either stroke group. The perception of stress may be a more critical variable in developing post-stroke depression than neurological functioning is in stroke patients. Routine screening of perception of stress may need to occur in post-stroke patients to avoid development of depression.

An exploratory study of student, speech-language pathologist and emergency worker impressions of speakers with dysarthria.

PURPOSE: To explore the influence of listener profession on impressions of speakers with dysarthria with varying intelligibility using semantic differential scales. Method: Three listener groups (undergraduate students, emergency workers, speech-language pathologists (SLPs); n = 38) rated non-speech attributes of six adults with dysarthria that ranged from low to high speech intelligibility. Participants rated 22 bipolar adjective pairs and listening effort on visual analogue scales. Following factor analysis of the semantic differential scales, listener impression and effort ratings were compared across listening groups and speaker intelligibility. RESULT: Repeated measures ANOVA revealed that neither impressions nor effort ratings differed across listener groups. However, impressions significantly decreased and listening effort significantly increased with reduced intelligibility. Analysis of the semantic differential scale items revealed two factors (Capability, Personality) that predicted 52% of the variance. Listener impressions were significantly higher for Personality than Capability. Conclusion: Preliminary findings suggest that speakers with dysarthria with reduced intelligibility are at risk to be negatively judged, particularly on their physical and mental capability. This study demonstrates the promise of employing semantic differential scales to investigate listener impressions and therefore the daily communication experiences of speakers with dysarthria. SLPs should consider patient experience of negative impressions when designing treatment.

Depression in Poststroke Aphasia.

Purpose The aim of this tutorial is to provide speech-language pathologists with foundational knowledge of poststroke depression comorbidly occurring with aphasia. Given the negative effect of depression on functional outcomes and mortality, it is crucial that speech-language pathologists possess this knowledge in order to better advocate for and treat their patients. Method and Results Three areas of complementary expertise (speech-language pathology, psychology, and neurology) collaborated on this tutorial to address the following areas: (a) provide terminology associated with depression and related mood disorders, (b) describe the potential underlying pathophysiology of depression in the general population, (c) provide an overview of our existing understanding of comorbid poststroke depression and aphasia, and (d) summarize current assessment methods and interventions for poststroke depression in adults with aphasia. Conclusion Given the compounding impact aphasia and depression have on rehabilitation outcomes, it is imperative that speech-language pathologists understand terminology, assessment, and treatment practices for depression.

Stress and depression scales in aphasia: relation between the aphasia depression rating scale, stroke aphasia depression questionnaire-10, and the perceived stress scale.

BACKGROUND: Assessment and diagnosis of post-stroke depression (PSD) among patients with aphasia presents unique challenges. A gold standard assessment of PSD among this population has yet to be identified. OBJECTIVES: The first aim was to investigate the association between two depression scales developed for assessing depressive symptoms among patients with aphasia. The second aim was to evaluate the relation between these scales and a measure of perceived stress. METHOD: Twenty-five (16 male; 9 female) individuals with history of left hemisphere cerebrovascular accident (CVA) were assessed for depression and perceived stress using the Stroke Aphasic Depression Questionnaire-10 (SADQ-10), the Aphasia Depression Rating Scale (ADRS), and the Perceived Stress Scale (PSS). RESULTS: SADQ-10 and ADRS ratings were strongly correlated with each other (r = 0.708, p < 0.001). SADQ-10 ratings were strongly correlated with PSS ratings (r = 0.620, p = 0.003), while ADRS ratings were moderately correlated (r = 0.492, p = 0.027). Item analysis of each scale identified items which increased both inter-scale correlation and intra-scale consistency when excluded. CONCLUSIONS: The SADQ-10 and ADRS appear to be acceptable measures of depressive symptoms in aphasia patients. Measurements of perceived stress may also be an important factor in assessment of depressive symptoms.

Aphasia and the neuropsychobiology of stress.

Individuals with aphasia face significant challenges in their lives. These challenges stem from the difficulties caused by impaired language function. Impairment in the ability to successfully communicate could be a significant source of stress to individuals with aphasia. The purpose of the current paper is to present a review of the literature on the neuropsychobiology of stress and aphasia, give a contemporary conceptualization of stress (both neurobiological and psychological), offer a framework and directions for future investigations in stress and aphasia, and finally suggest clinical implications for this line of inquiry.

Acute stress reduces speech fluency.

People often report word-finding difficulties and other language disturbances when put in a stressful situation. There is, however, scant empirical evidence to support the claim that stress affects speech productivity. To address this issue, we measured speech and language variables during a stressful Trier Social Stress Test (TSST) as well as during a less stressful "placebo" TSST (Het et al., 2009). Compared to the non-stressful speech, participants showed higher word productivity during the TSST. By contrast, participants paused more during the stressful TSST, an effect that was especially pronounced in participants who produced a larger cortisol and heart rate response to the stressor. Findings support anecdotal evidence of stress-impaired speech production abilities.

Aphasia severity and salivary cortisol over time.

The current study explored the complicated interplay between aphasia and the stress biomarker, cortisol, in left-hemisphere (LH) and right-hemisphere (RH) stroke patients. Nineteen LH patients and 12 RH patients began the study between one to six months post stroke and were followed for three months. During this time, language skills were assessed monthly while afternoon salivary cortisol samples were collected biweekly. The LH and RH groups showed improvements in language test scores over the course of three months; however, only naming skills in the RH group appeared to be associated with afternoon salivary cortisol levels. Furthermore, contradicting previous reports regarding laterality and cortisol regulation in humans, the current study found that both LH patients and RH patients exhibited similar afternoon salivary cortisol levels across all time points.

Identifying behavioral measures of stress in individuals with aphasia.

PURPOSE: To develop valid indicators of stress in individuals with aphasia (IWA) by examining the relationship between certain language variables (error frequency [EF] and word productivity [WP]) and cortisol reactivity. METHOD: Fourteen IWA and 10 controls participated in a speaking task. Salivary cortisol was collected pre- and posttask. WP and EF were calculated from the language sample elicited during the speaking task. RESULTS: As expected, IWA had less WP and a higher EF than did control participants, and these effects were related to aphasia severity. Cortisol reactivity of IWA was moderately associated with WP, such that those with higher WP showed greater cortisol reactivity. The control group did not demonstrate this relation. Neither group demonstrated a relation between salivary cortisol reactivity and EF. CONCLUSION: WP in individuals with aphasia holds potential as a behavioral index of stress in this population.