Dr Lindsey Thiel

This dataset includes emails from forty two control participants ranging from 16 to 88 years of age (mean = 46) and 9 to 24 years of education (mean = 13). Three emails were produced by each participant (between 2011 and 2014), each within a time limit of three minutes. It is expected that this normative data will be useful for clinicians and researchers working with adults with acquired language disorders in assessing email writing.

Improving writing in people with aphasia could improve ability to communicate, reduce isolation and increase access to information. One area that has not been sufficiently explored is the effect of impairment based spelling therapies on functional writing. A multiple case study was conducted with eight participants with aphasia subsequent to stroke. This aimed to measure the effects of spelling therapy on functional writing and perception of disability.Participants engaged in 10 sessions of copy and recall spelling therapy. Outcome measures included spelling to dictation of trained and untrained words, written picture description, spelling accuracy within emails, a disability questionnaire and a writing frequency diary.All participants made significant gains on treated words and six demonstrated improvements to untreated words. Group analyses showed significant improvements to written picture description, but not email writing, writing frequency or perceptions of disability.These results show that small doses of writing therapy can lead to large gains in specific types of writing. These gains did not extend to improvements in frequency of writing in daily living, nor ecological measures of email writing. There is a need to develop bridging interventions between experimental tasks towards more multi-faceted and ecological everyday writing tasks. Implications for Rehabilitation Acquired dysgraphia can restrict people from participating in social, educational and professional life. This study has shown that copy and recall spelling therapies can improve the spelling of treated words, untreated words and written picture description in people with a range of types and severities of dysgraphia following stroke. The results of this study suggest that more specific additional training is required for other writing activities such as email writing.

Writing therapy studies have been predominantly uni-modal in nature; i.e., their central therapy task has typically been either writing to dictation or copying and recalling words. There has not yet been a study that has compared the effects of a uni-modal to a multi-modal writing therapy in terms of improvements to spelling accuracy. A multiple-case study with eight participants aimed to compare the effects of a uni-modal and a multi-modal therapy on the spelling accuracy of treated and untreated target words at immediate and follow-up assessment points. A cross-over design was used and within each therapy a matched set of words was targeted. These words and a matched control set were assessed before as well as immediately after each therapy and six weeks following therapy. The two approaches did not differ in their effects on spelling accuracy of treated or untreated items or degree of maintenance. All participants made significant improvements on treated and control items; however, not all improvements were maintained at follow-up. The findings suggested that multi-modal therapy did not have an advantage over uni-modal therapy for the participants in this study. Performance differences were instead driven by participant variables.

BACKGROUND: We explore the theoretical and methodological aspects of decolonising speech and language therapy (SLT) higher education in the United Kingdom. We begin by providing the background of the Rhodes Must Fall decolonisation movement and the engagement of South African SLTs in the decoloniality agenda. We then discuss the evolution of decoloniality in SLT, highlighting its focus on reimagining the relationships between participants, students, patients and the broader world. OBJECTIVE: The primary objective of this discussion is to fill a gap in professional literature regarding decoloniality in SLT education. While there is limited research in professional journals, social media platforms have witnessed discussions on decolonisation in SLT. This discussion aims to critically examine issues such as institutional racism, lack of belonging, inequitable services and limited diversity that currently affect the SLT profession, not just in the United Kingdom but globally. METHODS: The methods employed in this research involve the engagement of SLT academics in Critical conversations on decolonisation. These conversations draw on reflexivity and reflexive interpretation, allowing for a deeper understanding of the relationship between truth, reality, and the participants in SLT practice and education. The nature of these critical conversations is characterised by their chaotic, unscripted and fluid nature, which encourages the open discussion of sensitive topics related to race, gender, class and sexuality. DISCUSSION POINTS: We present our reflections as academics who participated in the critical conversations. We explore the discomfort experienced by an academic when engaging with decolonisation, acknowledging white privilege, and the need to address fear and an imposter syndrome. The second reflection focuses on the experiences of white academics in grappling with their complicity in a system that perpetuates racism and inequality. It highlights the need for self-reflection, acknowledging white privilege and working collaboratively with colleagues and students toward constructing a decolonised curriculum. Finally, we emphasise that while action is crucial, this should not undermine the potential of dialogue to change attitudes and pave the way for practical implementation. The paper concludes by emphasising the importance of combining dialogue with action and the need for a nuanced understanding of the complexities involved in decolonising SLT education. CONCLUSION: Overall, this paper provides a comprehensive overview of the background, objectives, methods and key reflections related to the decolonisation of SLT higher education in the United Kingdom. It highlights the challenges, discomfort and responsibilities faced by academics in addressing decoloniality and emphasizes the importance of ongoing critical conversations and collective action in effecting meaningful change. WHAT THIS PAPER ADDS: What is already known on this subject Prior to this paper, it was known that the decolonial turn in speech and language therapy (SLT) was a recent focus, building on a history of professional transformation in South Africa. However, there was limited literature on decoloniality in professional journals, with most discussions happening on social media platforms. This paper aims to contribute to the literature and provide a critical conversation on decolonising SLT education, via the United Kingdom. What this paper adds to existing knowledge This paper adds a critical conversation on decolonising SLT higher education. It explores theoretical and methodological aspects of decoloniality in the profession, addressing issues such as institutional racism, lack of sense of belonging, inequitable services and limited diversity. The paper highlights the discomfort experienced by academics in engaging with decolonisation and emphasizes the importance of reflection, collaboration and open dialogue for meaningful change. Notably we foreground deimperialisation (vs. decolonisation) as necessary for academics oriented in/with the Global North so that both processes enable each other. Deimperialisation is work that focuses the undoing of privilege exercised by academics in/with the Global North not only for localising their research and education agenda but checking their rite of passage into the lives of those in the Majority World. What are the potential or actual clinical implications of this work? The paper highlights the need for SLT practitioners and educators to critically examine their practices and curricula to ensure they are inclusive, decolonised and responsive to the diverse needs of communities. The discussions emphasise the importance of addressing institutional racism and promoting a sense of belonging for research participants, SLT students and patients. This paper offers insights and recommendations that can inform the development of more equitable and culturally responsive SLT services and education programmes.

BACKGROUND: Written communication has become an increasingly important part of everyday life in social, educational and professional spheres. The substantial increase in writing via the internet and mobile technologies provides both an opportunity for social engagement and distinct challenges for people with aphasia. Within the current literature there has been limited research into the lived experiences of people with aphasia of their writing difficulties and how these affect their ability to communicate. AIMS: This qualitative study aimed to explore the experiences of people with aphasia of living with language-related writing difficulties and the impact of these on their lives. METHODS & PROCEDURES: Eight people with post-stroke aphasia and writing difficulties took part in semi-structured interviews. The interviews were analysed using inductive reflexive thematic analysis. OUTCOMES & RESULTS: Two themes were found in the data. The first theme was a gradual and effortful improvement to writing: Participants described how writing had improved since their stroke due to strategies and support, but they still found writing to be difficult and frustrating and described many barriers to writing. The second theme was the importance of writing for fulfilling adult social roles: Participants found writing to be important for communicating with family, friends and organizations, but their participation in society and self-esteem and confidence were impacted by writing difficulties; reduced social roles meant reduced need for writing, but participants were still motivated to work towards writing goals. CONCLUSIONS & IMPLICATIONS: The findings demonstrate the emerging importance of writing skills for people with aphasia with respect to communication, well-being, participation and inclusion in society, and carrying out social roles. They provide an insight into the process of improvement, including the difficulties, facilitators and barriers. Implications for speech and language therapy assessment and management are discussed. WHAT THIS PAPER ADDS: What is already known on the subject People with aphasia have difficulties with writing that can affect their ability to communicate. A small body of qualitative research has provided insights into individuals' experiences of literacy difficulties. More research is needed to understand the writing experiences of people with aphasia to help design appropriate assessments and interventions. What this paper adds to existing knowledge Participants experienced gradual and effortful improvement since their stroke. They felt negative about aspects of their writing, including speed, accuracy and range of vocabulary. Writing was facilitated through assistive technologies, spelling practice and support from others; barriers included technology, lack of time, stroke-related symptoms and others' lack of awareness about aphasia. Participants considered writing skills to be important, particularly for communication, carrying out adult social roles and participating in society, and were therefore still working towards goals related to everyday writing activities. What are the potential or actual clinical implications of this work? This study suggests that speech and language therapy assessment should include interviewing participants about their activities, strengths, difficulties, facilitators and barriers in writing, and informal assessment of a range of functional writing tasks. Intervention should be tailored to the individual's needs. This should include meaningful activities that relate to functional everyday writing and, where appropriate, self-management, compensatory technologies and group approaches, while making use of existing strategies identified by the individual.

© 2014, © 2014 Taylor & Francis. Background: Acquired dysgraphia (impaired writing/spelling skills) can significantly restrict people from participating in social, professional, and educational life. Using writing in order to access the Internet via computers, tablets, and mobile phones has become an important part of everyday life for people of all ages. Improving writing in people with acquired dysgraphia could facilitate communication, reduce isolation, and increase access to information. Aims: This review evaluates the writing therapy literature in terms of its usefulness in guiding clinicians in training writing in adults with acquired dysgraphia generally, with specific reference to functional writing activities. The databases Web of Knowledge and Psychinfo were searched for studies evaluating writing therapies for participants with acquired dysgraphia following brain injury. Studies were categorised according to type of treatment (e.g., impairment-based or assistive technology training) and outcome measures (e.g., single words or sentences). Main Contribution: Sixty-two studies were found. Of these, 54 described impairment-based writing therapies targeting single words or sentences using either lexical or phonological therapies. A small body of 14 studies evaluated the use of assistive writing technologies either alone or in conjunction with an impairment-based therapy. Although all studies reported positive effects of some kind, only 28 measured the effects of therapy on functional or spontaneous writing and only 21 explicitly encouraged the transfer of writing skills to functional tasks. Conclusions: The writing therapy literature has a dominant tradition of using theoretically motivated treatments to improve single-word writing. It provides limited guidance to clinicians treating functional writing, especially in natural contexts. There may be a specific therapeutic role for assistive technologies which have been as yet largely unexplored in the literature. Furthermore, the cognitive requirements of effective use of assistive technology for dysgraphia warrant research in order to understand which people with dysgraphia may benefit from their use.

Despite the increasing significance of written communication, there is limited research into spelling therapy for adults with acquired dysgraphia. Existing studies have typically measured spelling accuracy as an outcome, although speed may also be important for functional writing. As spelling is relatively slow, effortful and prone to errors in people with dysgraphia, minimising errors within therapy could be a factor in therapy success. This within-participant case-series study investigated whether errorless and errorful therapies would differ in their effects on spelling speed and accuracy for four participants with acquired dysgraphia. Matched sets of words were treated with errorless or errorful therapy or left untreated. Results were collated one week and five weeks after therapy. Both therapy approaches were successful in improving spelling accuracy. For three participants, equivalent gains were demonstrated following errorless and errorful therapy. One participant made significantly greater improvements in spelling accuracy following errorless therapy. The effects were maintained five weeks later. There was no significant difference in post-therapy spelling speed between the two therapy conditions. The results of this study suggest that both errorful and errorless therapies can be effective methods with which to treat spelling in adults with acquired dysgraphia.

Background: Improving email writing in people with aphasia could enhance their ability to communicate, promote interaction and reduce isolation. Spelling therapies have been effective in improving single word writing. However, there has been limited evidence on how to achieve changes to everyday writing tasks such as email writing in people with aphasia. One potential area that has been largely unexplored in the literature is the potential use of assistive writing technologies, despite some initial evidence that assistive writing software use can lead to qualitative and quantitative improvements to spontaneous writing. Aims: This within-participants case series design study aimed to investigate the effects of using assistive writing software to improve email writing in participants with dysgraphia related to aphasia. Methods and Procedures: Eight participants worked through a hierarchy of writing tasks of increasing complexity within broad topic areas that incorporate the spheres of writing need of the participants: writing for domestic needs, writing for social needs and writing for business/ administrative needs. Through completing these tasks, participants had the opportunity to use the various functions of the software, such as predictive writing, word banks and text to speech. Therapy also included training and practice in basic computer and email skills to encourage increased independence. Outcome measures included email skills, keyboard skills, email writing and written picture description tasks and a perception of disability assessment. Outcomes & Results: Four of the eight participants showed statistically significant improvements to spelling accuracy within emails when using the software. On a group level there was a significant increase in word length with the software, while four participants showed noteworthy changes to the range of word classes used. Enhanced independence in email use and improvements in participants’ perceptions of their writing skills were also noted. Conclusions & Implications: This study provided some initial evidence that assistive writing technologies can support people with aphasia in email writing across a range of important performance parameters. However, more research is needed to measure the effects of these technologies on the writing of people with aphasia, and to determine the optimal compensatory mechanisms for specific people given the linguistic-strategic resources they bring to the task of email writing.

Background: Stroke survivors with aphasia experience a range of challenges during hospital-based stroke rehabilitation. These include limited rehabilitative activities and difficulties interacting with healthcare professionals. There has been limited exploration of the experience of stroke survivors with aphasia in how their time is spent supporting recovery in hospitals in the UK. Aims: This qualitative interview study aimed to answer the question: What are the perceptions and experiences of adult stroke survivors with aphasia on how time is spent supporting their recovery on a stroke rehabilitation unit? Methods & procedures: Six people with aphasia were interviewed prior to their discharge from a hospital-based subacute stroke unit. Participants were three men and three women, with an average age of 65 years, a range of aphasia severity, and an average 97-day length of stroke unit stay. Interviews were audio-recorded and transcribed. Transcriptions were analysed using reflexive Thematic Analysis. Results: Three main themes were found: The requirements showed how participants did not feel that their therapy was sufficient or sufficiently meaningful; The relationships demonstrated that stroke survivors felt supported by their family, stroke survivor peers, and staff, although staff inconsistency disrupted their rehabilitation; finally, The restrictions described how participants felt excluded from conversations and disempowered in decision-making. Conclusions: The findings show that stroke survivors with aphasia would be better supported in their recovery if they had more meaningful activities during their time on a stroke unit, more consistent staff support and more opportunities for collaborative decision-making.

Background Conversation partner schemes for people with aphasia (PWA) can promote communication and quality of life as well as support skill development for students. Initial evidence indicates online conversation partner formats are acceptable as an alternative to in‐person delivery. Aims To evaluate the experiences of PWA of an online conversation partner scheme during the global pandemic. Methods & Procedures This qualitative study captured the experiences of eight PWA through semi‐structured interviews. Reflexive thematic analysis was used to analyse the data and to create themes and subthemes, reflecting the experiences of the participants through the interpretation of the researchers. Outcomes & Results Two main themes were generated, each with subthemes. The first theme was Communicating and connecting online: ‘It was brilliant’ with subthemes: ‘It help me and I help them’: Mutual benefits, ‘Straight away I managed to speak’: Supported conversations, ‘We got to know each other’: Connecting, and ‘Nine out of ten, easy’: Convenient and easy. The second theme was Being me online: lacks ‘Je ne sais quoi’ with subthemes: ‘I like to shake hands’: Missing a human connection, ‘Show me, me self, myself, my broad Yorkshire coming out’: Restricted self‐expression, and ‘Wetherspoons, Wetherspoons’: Loss of the physical environment. Conclusions & Implications This study supports the existing evidence that online conversation partner schemes for PWA are successful. It contributes original ideas relating to the acceptability of technology, interaction and self‐expression online for PWA, and considers the benefits of combining both online and face‐to‐face communication and connection opportunities. WHAT THIS PAPER ADDS What is already known on the subject University conversation partner schemes have been shown to improve the communication skills and confidence of PWA and students. A small body of research has shown that online conversation partner schemes are feasible and can be a positive experience for some, but not all, PWA. What this paper adds to the existing knowledge Participants found that an online conversation partner scheme during the COVID‐19 pandemic gave them the opportunity to communicate and connect with students, and led to mutual benefits including enjoyment, improved communication skills, confidence and a sense of purpose. They were able to connect through supported conversations and found it convenient and easy to meet online. Despite these benefits, the participants felt that there was something missing in terms of the human connection, self‐expression and the physical environment. What are the potential or actual clinical implications of this work? This study suggests that online conversation partner schemes provide an opportunity for those who are restricted in their ability to meet face to face or would prefer the ease and comfort of staying in their own home. However, some people may face more barriers in meeting online due to limited experience, skills or support with technology, and may find it more difficult to communicate, build a connection and express themselves. Either using a combined approach of online and face‐to‐face interactions or providing a choice for PWA will ensure that they are still able to access the psychosocial benefits of participating in a conversation partner scheme.

Abstract

Stroke survivors with aphasia (SsWA) tend to experience high levels of anxiety and stress, leading to an increased risk of recurrent strokes. Mindfulness and/or relaxation that does not require language outputs could reduce psychosocial stress; however, these approaches work best if they consist of a range of techniques and are modified to suit the needs of SsWA. Using a mixed-methods approach, we examined the feasibility and acceptability of a set of tailored mindfulness and relaxation techniques for SsWA. Nine SsWA were recruited (six men and three women, median age = 51 years). Four relaxation and mindfulness techniques which had been tailored for SsWA were filmed into a DVD/YouTube video and were given to participants together with a practice diary for home practice once daily for 5 weeks. The participants joined focus group discussions and completed a feasibility scale 5 weeks later. The participants perceived these techniques as easy, user-friendly and acceptable for SsWA in general. Although practised less often than instructed, many participants reported benefits of regular practice. The perceived relevance of these techniques to the participants' own situations and the intention to continue varied. Future research could encourage the regular practice of self-help interventions by incorporating behavioural change techniques such as using prompts and cues.