Social and emotional aspects

Question 1

What do people with aphasia experience changes in?

Answer 1

Abilities
Roles
Relationships
Community life

Question 2

Reactions of others

Answer 2

Reactions and attitudes are different from what they were pre-aphasia.

Attitudes and reactions of others can influence emotional state and recovery.

Question 3

feelings reported by PwA

Answer 3

Isolation
Loss Identity
Low self-esteem
Social Exclusion
Anger
Frustration
Guilt
Anxiety
Depression

Question 4

Aphasia doesn’t just affect the PwA- it’s a ______ _________.

Answer 4

Family Problem.

Question 5

Loss is experience by who?

Answer 5

PwA
Family
Friends

Question 6

What has been reported regarding family problems associated with aphasia?

Answer 6

Family of PwA from stroke have reported more emotional and psychological difficulties
than
families of people who had a stroke but didn’t get aphasia.

Question 7

Social life with aphasia

Answer 7

PwA have significantly fewer social contacts and activities than their peers

Friendships are particularly vulnerable- family tend to stay around but friends go away.

30% with chronic aphasia had no close friends.

Positive correlation between contact with friends and reported QoL- more contact, higher QoL

Question 8

Those with reduced social support are more likely to be __________.

Answer 8

depressed.

Question 9

What’s important to the PwA socially?

Answer 9

They feel isolated and want to be engaged.
They don’t care about number of activities- but their engagement in these activities
They feel burdensome to others and wish to function normally.
They want to know what’s going on, but getting info from convo can be really hard.
If they aren’t able to work they want to contribute to the community in other ways.
Often feel stigmatised and wish to be respected.

Question 10

Emotional Impact on PwA

Answer 10

Varies individually and changes over time.

Type and location of brain damage may influence reaction.

Question 11

Name individual influences on emotional impact

Answer 11

general health status
personality
resilience
motivation
age and stage of life
responsibilities
life experience

Question 12

What doesn’t affect emotional reaction?

Answer 12

The severity of aphasia- it is completely individual, someone may have mild aphasia and it has a massive impact on them.

Question 13

What is emotional reaction also affected by?

Answer 13

Family Response

Question 14

What tends to be gradual?

Answer 14

The realisation of the extent of disability and the implications for life are gradual for PwA and family.

Question 15

Common early reactions

Answer 15

Anxiety
Panic
Disbelief
Apathy
Apparent lack of concern
Denial

Question 16

What is a common early response that can be enouraged by others?

Answer 16

Denial- encouraged by others in attempt to reassure.

It’s important that we avoid false reassurance but still keep spirits up.

Question 17

Some PwA and family can be in ____ for a long time. what is our job?

Answer 17

Denial.

To make their expectations realistic.

Question 18

Name some later reactions

Answer 18

Sense of loss- realise extent of disability- lots of losses- role, dignity, self-confidence, physical abilities, appearence, employment etc.

Self-concept - sense of identity and self worth

Grief
this is a complex process of emotional and intellectual adjustment which allows a person to cope with their loss
DABDA grief Kubler Ross
Denial
Anger
Bargaining
Depression
Adaptation

Question 19

Adapting, accepting and coping.

Answer 19

“Philosophical Shift”-
Accept limitations and look beyond what’s no longer possible
Not thinking of normal as the only acceptable outcome
Placing aphasia in context- not being defined by it
Planning and looking forward to future events.
Living and functioning to full extent possible, resuming relationships and forming new ones.

Question 20

Family

Answer 20

Loss experienced by family too.

May undergo grief too :(

Question 21

Depression

prevalence

Answer 21

Depression is common

70% of people with aphasia had some level of depression 3 months post stroke

Question 22

Depression

influencing factors

Answer 22

Biological changes due to brain damage
Individual characteristics
Develops as a natural reaction to awareness of circumstances

Question 23

How id depression treated?

Answer 23

Medication

Important to make an onward referral.

Question 24

Assessing Mood

Answer 24

All should be screened for mood disturbance as early as appropriate .
If suspect issue make onward referral to GP.

Screening-
SAD-Q
Stroke Aphasic Depression Questionnaire
filled out by carer, based on observable behaviours e.g. crying, disturbed sleep.

Visual Analogue Mood Scale (VAMS)
specifically designed for people with communication difficulty for whom verbal measures would be unsuitable and unreliable.