The perspectives of South African speech- language therapists on the implementation of augmentative and alternative communication for persons with post-stroke aphasia

Abstract

Background: It is necessary to advance the integration of augmentative and alternative communication (AAC) into rehabilitation plans to improve communication and social participation outcomes for persons with post-stroke aphasia. Although research studies have demonstrated AAC’s positive outcomes for this population, AAC is not always implemented. The incorporation of AAC into aphasia rehabilitation by South African speech-language therapists (SLTs) is currently not well-understood. Accordingly, the purpose of this phenomenological study is to explore SLTs' perspectives on the implementation of AAC for persons with post-stroke aphasia with a specific focus on the: (i) current AAC practice; (ii) influencing factors; and (iii) success and relevance of AAC interventions. Methods: A qualitative phenomenological design was used to study the perspectives of 10 SLTs who had at least 10 years of experience working with persons with aphasia post-stroke using open-ended interview questions. The interview data was transcribed and analysed thematically, using a six-phase process (Fereday & Muir-Cochrane, 2006). A combination of inductive and deductive analysis was used. Synthesised member checking was employed to increase trustworthiness. Results: The three a-priori themes aligned to the interview questions were identified in the data. In terms of current practice, nine participants reported that AAC was applicable and that they implemented AAC for all persons with post-stroke aphasia. Participants reported using a combination of unaided, low-tech, high-tech and partner-supported interventions. All participants reported on factors that influence the successful implementation of AAC, including factors related to: (1) the person with aphasia; (2) the AAC system; (3) the communication partner; (4) the therapist; (5) the physical and social environment; (6) the service organisation; (7) policy; and (8) scientific evidence. Participants provided descriptions of the success and relevance of AAC for persons with post-stroke aphasia. Some reported poor generalisation, but nine of the 10 maintained that AAC was relevant for this population. According to the data, the primary facilitators of successful generalisation included sustained practice and a communication-accessible environment through communication partner support. A fourth theme was inductively identified, namely the definition of AAC. This theme emerged as some participants highlighted the importance of the definition of AAC and indicated some misconceptions and disagreements about the definition amongst SLTs, other healthcare providers (HCPs), funders, and policymakers. Conclusions: The finding that all the participants implemented AAC with some of their clients with post-stroke aphasia is positive and aligns with the current evidence and best practice recommendations. It was evident that AAC implementation is complex, and therapists make conscious choices regarding the implementation considering various factors corresponding to previous literature. Despite barriers to implementation, most participants still had a positive view of AAC and actively worked to circumvent barriers to implementation. The data reflected the vital role of partners in communication interactions. Participants' comments about the definition of AAC highlighted the need to view AAC in the broad sense to ensure optimal outcomes for persons with post-stroke aphasia.