A Qualitative Exploration of Communication Impairment following Stroke

Cochrane, Sophie and Murray, Craig (2022) A Qualitative Exploration of Communication Impairment following Stroke. PhD thesis, Lancaster University.

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Abstract

Section one presents a systematic literature review exploring the barriers and facilitators to accessing rehabilitation interventions for stroke survivors with communication impairments. Four databases were systematically searched, and 16 papers were reviewed using a meta-ethnographic approach. Findings highlight the importance of collaborative multi-disciplinary team (MDT) working across disciplines within services where training for all professionals is prioritised and expertise are shared. Stroke survivors with communication impairments are at risk of being excluded from or feeling unable to engage with rehabilitation interventions without this approach to care. In particular, the psychosocial wellbeing of these patients was often not prioritised or identified as a concern within rehabilitation. Clinical implications are discussed. Section two details an empirical exploration of the lived experiences of stroke survivors who have dysarthria in relation to their personal and social identity. Seven participants engaged in remote semi-structured interviews and data was analysed utilising interpretative phenomenological analysis (IPA). Four themes were identified: (1) a sense of distance and disconnection from other people; (2) navigating the reactions of others; (3) changes in self-perception; and (4) adjusting and coming to terms with dysarthria. Findings indicate that dysarthric stroke survivors can experience several challenges which impact upon how they feel about themselves. However, for many of the participants, they experienced a shift in their level of acceptance of their altered speech over time, finding ways to come to terms with it. Clinical implications are discussed, particularly relating to the role of clinical psychology within stroke rehabilitation. Section three includes a critical appraisal, which highlights some of the practical, methodological, and ethical issues encountered during the development of the empirical paper. The paper also provides some reflections and insights into the process of undertaking an IPA investigation within this field, particularly with individuals who have communication impairments following stroke.