Podcasts about persp

Sukanka 35 metai, kai Lietuvos ir Baltarusijos pasienyje, Medininkų poste, Rygos sovietinės ypatingosios paskirties milicijos rinktinės (OMON‘o) smogikai užpuolė pasienio darbuotojus. Per išpuolį nušauti septyni muitinės, policijos ir pasienio pareigūnai. Vienas pareigūnas buvo sunkiai sužeistas.Precedento neturinčią migrantų bangą Seutoje, Ispanijos premjeras vadina tikslinga ataka. Dėl jos kaltinami prekeiviai žmonėmis.Šiandien viena karščiausių šios vasaros dienų – daugelyje šalies vietų temperatūra kils iki 30–33 laipsnių. Tačiau kartu su labai šilta oro mase iš pietvakarių gali atkeliauti ir Ispanijoje bei Prancūzijoje kilusių didelių miškų gaisrų dūmai bei nuo Sacharos dykumos pakilusios dulkės.Socialiniuose tinkluose verda diskusijos apie naktimis triukšmą keliančius modifikuotų automobilių ar motociklų vairuotojus. Įvairių miestų gyventojai skundžiasi, kad tokie, vasarą girdimi garsai neleidžia išsimiegoti ir tinkamai pailsėti ne tik vaikams, bet ir suaugusiems. Tuo metu sostinės policijos atstovas sako, kad triukšmadarius pagauna retai, o pasak automobilių entuziastų, atsiradus tinkamai infrastruktūrai – gyventojai galėtų miegoti ramiau.Legendinis Lietuvos futbolininkas ir treneris Valdas Ivanauskas šiandien švenčia 60-ies metų jubiliejų. LRT kalbintas futbolo specialistas sako, kad nieko nekeistų savo įspūdingoje karjeroje, tačiau pripažįsta, kad jo rūstus charakteris leido pasiekti užsibrėžtų tikslų.Ved. Andrius Kavaliauskas

Praėjo para nuo Japoniją sukrėtusio galingo žemės drebėjimo. Aukų skaičius išaugo iki 13-os. Dar apie 30 žmonių sužeista.Su LRT radijo bendradarbiu Japonijoje Andriumi Kleiva.

  Episode: 140 RAISING PPA assessment and treatment from the Ground Up: In Conversation with Jeanne Gallée     In this episode you will discover: · Assessment and Intervention Aren't Separate — Conversation itself can double as both. By listening closely and responding to what a client offers, in a "more art than science" way, clinicians gather meaningful data and provide support at the same time, rather than treating these as two distinct phases of care. · Rigid Testing Can Erase the Person Behind the Diagnosis — Traditional standardized assessments often serve the goals of an institution or research protocol more than the person being assessed. Frameworks like RAISE and the PACT scale shift the focus toward strengths, natural conversation, and what someone can still do, rather than repeatedly measuring decline. · PPA Needs Its Own Identity and Training Path — Because primary progressive aphasia sits uneasily between post-stroke aphasia care and traditional dementia care, clinicians often receive little formal training in it. A global survey found major gaps in education and confidence, underscoring the need for dedicated resources, like Dr. Gallée's PPA roadmap, built specifically for this population. Do you ever wish you could step back in time and undo the missteps and errors of the past? What if you had the opportunity to build something from the ground up? Certainly, knowing what you know now, you could begin in a better place. But of course, there's always pitfalls with new beginnings, even with the knowledge of lessons from the past. You could, however, make a positive impact on that new beginning. Welcome to the Aphasia Access Conversations podcast. I'm Jerry Hoepner, a professor from the University of Wisconsin Eau Claire, and co-facilitator of the Chippewa Valley Aphasia Camp, Blue Gold Brain Injury Group, Mayo Brain Injury Group, Young Persons Brain Injury Group, Brain In-Cog, and Thursday Night Poets. I'm also a member of the Aphasia Access Podcast Working Group. Aphasia Access strives to provide members with information, inspiration, and ideas about their aphasia care through a variety of educational resources. I'm privileged to introduce today's guest, Dr. Jeanne Gallée, who is a clinical scientist in the Department of Medicine at the University of Washington. Dr. Gallée is a licensed speech language pathologist practicing in the greater Washington state area. She completed her Bachelor of Arts in Cognitive and Linguistic Sciences at Wellesley College in 2016 and Doctor of Philosophy at Harvard University in Speech and Hearing Bioscience and Technology in 2021. She has been recognized as a Distinguished Early Career Professional by ASHA and a Distinguished Scholar by the Tavistock Trust for Aphasia. Her work is dedicated to improving assessment practices and functional outcomes for individuals living with aphasia and neurodegenerative conditions. Jerry Hoepner: Jeanne, it's really nice to see you again today, and to have this opportunity to have a conversation with you as a recent recipient of the Tavistock Scholar Program, and to talk about your work with individuals with primary progressive aphasia. So, thanks for being "on" today for the conversation. Jeanne Gallée: Thank you so much for having me, Jerry. I'm really honored to be here. Jerry Hoepner: Likewise, I'm really excited for this conversation, and as I just alluded to, I wanted to congratulate you on being awarded the first Tavistock Scholar with an emphasis doing work in primary progressive aphasia, and I thought maybe I could get your thoughts on being selected as a Tavistock Scholar. Jeanne Gallée: Thank you. It feels honestly incredibly remarkable in the sense that I think it represents a shift in how we're thinking about the separate diagnoses of progressive aphasia versus an aphasia that's due to an acute injury. And I'm really honored to be a part of that. I think there have been many discussions growing over the years, and I think we're seeing that shift in how we do think about addressing assessment and intervention and general care for people across the aphasia continuum. Jerry Hoepner: Agreed, I think there's been so much growth in the last five years in that area. I can remember at the outset of the pandemic, having discussions about "What do we do with people with primary progressive aphasia who were a part of our aphasia group? Should they be a part of our aphasia group? How do we pivot to that in an online context?" and it feels like we've come so far in our conversation about where primary progressive aphasia fits in in all of those different contexts. Jeanne Gallée: Right, I entirely agree, and I think the journey of my own work has already evolved in so many ways that I couldn't have imagined, like you say, five years ago I completed my doctoral work March 2021 and just seeing the phenomenal amounts of change that have really taken place since then has been incredible, and I feel very lucky to be part of that momentum right now. Jerry Hoepner: Absolutely, it's exciting to see these things move forward. And one of the differences that I see is primary progressive aphasia started out within the Life Participation Approach, just soundly from day one, as opposed to a lot of aphasia care, which has kind of evolved from this medical model, and how refreshing it is to see something built from the ground up. Done right, so to speak. I don't know if you have thoughts on that piece… Jeanne Gallée: No, I do. I think that's a really interesting point. I think I might be part of the camp that at times feels like progressive conditions get a little bit lost in the rehabilitation space, but I think you're absolutely right. I think the absence of pharmacological treatment, or a cure that has long standing effects for these progressive conditions has made rehabilitation specialists much more attuned to focusing on quality of life, life participation, maintaining autonomy, and so forth. So, I think I forget that perspective sometimes. Perhaps from the space that I work in, I tend to be in a more interdisciplinary environment where I feel on the opposite end. I'm often asked for justification for providing these types of services, and that fits in nicely with our previous discussion on how we do see that differentiation and how people with aphasia due to a progressive condition may be siloed from people who have the more quote unquote traditional aphasia symptoms. Jerry Hoepner: Yeah, that's a really good point. And you know, referring to those previous conversations we discussed that need for primary progressive aphasia to have a space of its own. It's tricky because it doesn't fit into post-stroke aphasia quite right, and it doesn't fit into the Alzheimer's and dementia world quite right. So, yeah, it's nice to see this developing in the Life Participation kind of context, really excited about Anna Volkmer's conference dedicated to primary progressive aphasia. Yeah, what an excellent point, that even though we feel like it's great to build it from the ground up, there's still people in that interdisciplinary context, who are very much looking at this, like,"Justify this. How is having conversations and doing activities with someone justifiable, as a, you know, as a skilled intervention?" Jeanne Gallée: Right. I think a lot of it comes back to misunderstandings about the scope of our profession. So, coming from the speech language pathology standpoint, we may have a perspective that other providers may not. And it's interesting, particularly when that confusion or disconnect happens in conditions that are communication led, where we see the symptoms primarily touching upon our ability to interact verbally or non-verbally to communicate. And it's fascinating, and I think speaking to that silo, we see PPA having been a relatively new and still considered very rare condition, but there's so much overlap with other conditions, right, in the kinds of symptoms that we see and there's so much where, as any speech pathologist with experience in acquired neurogenic communication disorders, we can see that we can apply our skill set, but again, likely due to the terminal nature of the condition, we end up seeing providers taking it a different route, or saying either there's only the pharmacological route, or we just let it lie or let it be as is, which we wouldn't do with any other condition. We wouldn't say that for someone with ALS. We would want to provide them the supports, even if they're temporary, to improve quality of life. So, it is an interesting, almost cultural phenomenon as well. I think. Jerry Hoepner: Yeah, that I think it's really fascinating, and I'm so glad you brought that up. It reminds me of kind of the phrase, the company we keep, right? It's easy to be amongst, you know, people who are in the [Life Participation Approach to Aphasia] LPPA world, who think the way that we think, and who do the way that we do. And I do a lot of work in the area of cognitive communication disorders with acquired brain injuries, and so forth, and there's been a remarkable shift in the last five years there as well towards a more Life Participation bio psychosocial approach, and some of the work that I've been passionate about for years has been more and more accepted. So you feel like when you're in that company of all of your people that everything's all good, but it also reminds me of something that my friend Natalie Douglas always says, which is that "We need to be out there amongst others who need to understand the importance of this kind of a perspective, and sharing that." And when you talked about those other professionals, I really didn't think about that until you said that. Right, really important to get them on the same page, and to help them understand why this is so important. Jeanne Gallée: Right? And I think that's where the conference that you mentioned, the first PPA only conference that's taking place this summer in London, is so special because one of the reasons why we were so motivated to have this type of a conference is that there wasn't really the space at the typical aphasiology conferences, and then the larger neurology-based conferences, or more broadly dementia-based conferences, also didn't quite feel like a home. I think, especially their studies of quality of life, in particular, we're really not seen as rigorous in those contexts. So, this conference, what's nice is that we have that uniting force of everyone being focused on PPA, but it's super interdisciplinary, and that I think will really promote some fantastic conversations. Jerry Hoepner: Wow, that's really encouraging and exciting to see that move forward. I'm not in the primary progressive aphasia world, although when we're at aphasia camp and things like that, certainly that's a part of my role. But as soon as I saw the call for papers come out, I'm, you know, texting and messaging all of my PPA folks to say, "Did you see this? This is great. Are you doing something?" It's very exciting. So, I'm excited to see where that moves in the future and to hear how things go this time around. That's great. Jeanne Gallée: Likewise, I'm really excited, and I do really believe it will lead to a whole future cascade of collaboration. Jerry Hoepner: Yeah, amazing. Well, before we delve into your amazing work, I've been reading your articles, and it's been just a pleasure to read it. I'm always impressed with how certain themes of importance can come across in different areas of our field, and it's been fun to see that. I wonder, because I'm looking at the list of collaborators, just some incredible collaborators on that list, in those papers, I'd love to hear a little bit about your mentorship, both in primary progressive aphasia and kind of thinking about the Life Participation quality of life kind of context as well. Jeanne Gallée: Yeah, I think in hindsight my mentorship experience seems more linear than it did in the moment. And I think it goes back to my original journey in my doctoral program. The program I was in, the Speech and Hearing Bioscience and Technology program at Harvard was a little bit different from others, where we didn't apply to work with a specific mentor, but truly just to get into the program. And they encouraged a pretty extensive shopping period to work with a variety of mentors to get a feel for topic area, mentorship style, and so traditionally first year students didn't even have any experiences, they just focused on the very time-intensive and rigorous coursework. I came in and started my first experience with Evelina Fedorenko at Massachusetts Institute of Technology, who had worked with an undergrad. And that I think from the get-go gave me a very holistic view. I think, of the ways in which we could think about language, and in particular, the language network. So, there I was working on MRI studies of what activations do we see in the language network. In response to linguistic stimuli. And we were working with undergrads at MIT who were all healthy between the ages of 18 through 30, and I just felt at a certain point that I had this growing interest towards thinking about what happens when something goes wrong. So when it's atypical processing of language. I first thought I might be interested in pediatric population, so I was all over the place, but through the partnership that my program had with the MGH Institute of Health Professionals, I ended up having this amazing opportunity to be mentored by Evelina Federenko, as well as Sophia Vallila Rohter at the Institute of Health Professions, as well as the Frontotemporal Disorders Unit at Mass General Hospital, through my actual clinical training. So I had this quite hefty consortium of mentors, and I think that has its own set of challenges, right? It's a little bit less mentor-directed and more on the student to say, "This is exactly what I want to work on." But I think that allowed me to build a network of experiences and mentors, and that just has bled into every experience I've had since then. I also think the pandemic, you brought that up before, had a huge role in this, and all of a sudden people were very, very open to virtual meetings and connections and wanted connection. I think everyone felt very stuck at home and wanted to find more people and to find meaning and Anna Volkmer and I had the opportunity to meet at the Academy of Aphasia in Macau in 2019. And honestly meeting her in our connection has been also one of those launching pads for me to really jump out into the world of international collaboration. So all that to say, I think a lot of chance encounters and just a lot of plunging into possible conversations head first has led to this phenomenal mentorship team. And a lot of people who I collaborate with now I see as my inadvertent mentors, and that includes Anna, that includes Maya Henry at UT Austin, Amy Mooney in Oregon, just people who have consistently volunteered their time to mentor me in ways in which I can only say I would have never expected. Jade Cartwright and I have had such a phenomenal collaboration over the past few years as well, where we just had the same interests, and Zoom allowing, we were able to build on those. Jerry Hoepner: That's really an amazing answer to that question. I love the term inadvertent mentors, because I just think that those are the best mentors, where you're as much a mentor to them as they are to you. And it's just this really reciprocal relationship, but it's also built on this organic, like passion and interest for the same kinds of topics. Where it's not forced and that's a really nice kind of look back on your entire process. I was also struck by the term "mentor shopping", or "mentor shopping period", whatever. And I think that's really great that you had an opportunity for that not to be so mentor-led, and I mean it clearly shows through when you talk about your clinical experience and how that was connected to your research experience, and kind of all used to create this amalgamation of who you are. I mean, it's clear in talking with you, it's clear in reading your work that you have that strong, multi prong kind of basis. It's not just research, it's not just this specific area of research, it's really broad and the clinical connection is there, so that makes a lot of sense when I hear you talk about that, for sure. Jeanne Gallée: Oh, thank you. Yeah, I think in hindsight, again, it seems more linear, and in the moment it sometimes felt a little wild, I will say, in terms of just wrangling what do I actually want to pursue, and how. And I'm still figuring that out. But I think this community of collaborators and mentors is truly what has kept me in the field and as well. Jerry Hoepner: Yeah, I think when you can connect with other people who are passionate about the work that you're doing. I can't imagine sitting at alone in my office doing a project, and I mean it's just so much more fun when you're doing it with other people. And other people who can expand the way that you think, which I'm sure everyone that you've mentioned on that list really does, when you can say, "Well, I think we should do it this way" and someone says, "Have you thought about…" and it just completely wrecks your world in a good way, "Like, oh my gosh, I didn't think about that, that's so exciting!" and then you just get into this back and forth. Yeah, very fun to hear about that. And again, it clearly shows through in the work that you do. In our previous conversations, you also mentioned this idea, and this again built on those clinical foundations that your initial mission was really to help develop interventions for people with primary progressive aphasia, and then you kind of got not off track, but inadvertently focused on working on assessments. You mentioned that there's just such a need, and this is so common in a lot of areas, but there's a need for more person-centered, ecologically valid strength-based assessment, and that the traditional measures just don't tell us enough. So, I'm really excited to talk about the work that you're doing on assessment, and how that brings us closer to what we need from an intervention standpoint, too. Jeanne Gallée: Yeah, so that really is at the heart of what has been my experience. Also, right from the get-go, we started talking about the differences, or the possible differentiation that the field has historically taken in thinking about post-stroke aphasia versus primary progressive aphasia. One of my first real PPA projects in my doctoral work was meant to be a naming treatment study for people living with PPA, and one of the roadblocks I kept hitting was also my mentors and reviewers telling me that I was trying to add too many things. And in that process I realized I don't think just using something that exists for post-stroke aphasia is going to be the best way to address the patients I'm seeing right now. And it's not because there's something wrong with that treatment. That treatment was not designed for these individuals. And that led to many more rabbit holes, and you know me really just feeling this existential crisis of "Well, why are we working on the stimuli that we are, and why are we asking questions about these ones?" And I have so much respect for the assessments that exist, and the individuals behind them, and the time they invested in making them. I am also of the belief that we can move forward and improve our processes. There are certain assessments that may be widely used and have so much again power behind them. You know, we have best associated certain assessments with characterizing a diagnosis, but what I ended up seeing in my placements and throughout my clinical work is that many assessments serve more of a mission of an institution or a research protocol than the person being assessed. And in the face of a person with a terminal condition who is using their precious time to serve you in that space, I just think it's so much more important, or that much more important, to really consider what is most functional for them. What will serve them? And how we, how can we give back to that person? And again, part of that emotion, I think, comes from having worked in many research-centered spaces, where someone might not get intervention afterwards, or they might not understand why they are participating in up to five hours of assessment, and I think that's where that passion for focusing on reprioritizing the patient or the client really came from. Jerry Hoepner: I think that attention to "what's in it for them", is really important and clearly based in kind of where your heart is at and where your clinical mindset is at. Because it's easy to go in and say, "Well, we need this data. We need all the data that we get." but to what end, right? Like, how is it going to help? And how is that going to give us any more information about how to help this person, then what they can't do, right? So, I appreciate that mindset a lot, you know. It makes me think, and this is a little off track, and we didn't talk about this question earlier, but what a shift it will be clinicians working with people with primary progressive aphasia, and how they'll be able to shift from using kind of the existing tools that were out there for other purposes to moving towards tools that are designed specifically for people with PPA, and maybe just a snapshot of your thoughts about that piece. Jeanne Gallée: So I think it's really important to know where the field comes from, the work in which it was grounded in. So, I think it, it makes sense to talk about standardized assessment scores. It makes sense to talk about, you know, the specific assessments that can help us quickly differentiate presentations or needs, right? So, using the symptom-led approach, can we identify specific behaviors really quickly in a standardized way? I think the issue comes in when we stop being dynamic in how we use them. It's very easy to use an assessment in a way that feels rote. It feels just like a test, and it's like you said, "just collecting data for the purpose of collecting data." And lose that aspect of humanity. And maybe I'm putting words in other clinicians' mouths, but especially when a certain condition is rare, like PPA is. You may not have very much experience with seeing someone with PPA, or any type of progressive condition, and feel really stuck and needing to be in the motivation of being really professional, sticking to a certain set of tests. "This feels right." Right, this is what someone told me to do. I can fill this out, and there's something very potentially vulnerable or scary about just going with your gut in those moments. And what Anna Volkmer and I have spoken about so often is just the power of having a conversation with someone, and seeing what you can learn from that conversation, not only about the person themselves, but their communication behaviors. And how you can get so much from that conversation, including the trust and comfort of the client in front of you. Jerry Hoepner: Absolutely, yeah. One of the things that I think about when you're talking about that is, in working with people with acquired brain injuries and traumatic brain injuries one of the things I've learned is they will tell you, or they will ask, right? They'll say, "What is this? "What kind of information is this giving you?" "Why do we have to do this stupid test?" And I think that's good. I think that's a mindset that we should have when we're thinking about all of the assessments that we do. Why are we doing this? Is this really necessary? And they're very willing to say, "If it's necessary, that's fine, I'll do it, but are you getting something from this that I'm not seeing?" Right, I love that question, and I think it speaks to what you just said, right? Like, there's so much information that we can gather from conversations, from our interactions with people, we should be thinking about getting that, and if we're doing something else, we should have a why directly following, yeah. Jeanne Gallée: Yes, the why is so important, and you're right. Sometimes we do just need to get certain information. I think for me, one of the most striking moments early on in my training was having small talk. You know, just conversation with a person with semantic variant primary progressive aphasia, and thinking, "Wow, this all feels quite typical. I'm curious about why they're here? What their testing will look like…" and then moving on to the Boston Naming Test and immediately seeing the challenges that came. That dichotomy is really helpful to have in those moments, but again, there's the argument of why are we asking about the name abacus, right? Why are we using that right now, and how does that represent how someone is performing functionally in their everyday life? Jerry Hoepner: Absolutely, yeah, totally. I agree. Can you share a little bit about the RAISE framework, which I really love, because it relates to the way that I think about assessment from the standpoint of counseling, like you build on relationships and connections. William Miller is famous for saying, "The last thing you should ever do at the beginning of a session is assessment." You're beginning of a relationship with someone, don't assess first thing. So, I love that piece, and then thinking about the pact, and I'll let you kind of expand those, but I'll let you unpack them – ha ha- but how that starts to move us towards intervention. Jeanne Gallée: Right. So the RAISE assessment framework was really built out of those conversations, and I guess realizations on my own part about that discomfort with the really rigid end that assessment can…I'll restate that. The rigidity that assessment can have, so again speaking to really, really standardized sets and rigid protocols of specific measures that someone uses, and like you said, having the experience of multiple research participants, as well as patients, asking "Why are we doing this? I know I'm not good at this. Why are we doing it again and again?" And in those moments, not feeling like I had the power to really justify exactly why we were doing everything, apart from, "Oh, this is important for the research study." Which it was, but just feeling like there was that aspect of humanity that was missing, and coming up with my own toolkit in those moments to fill in those blanks. So right after the completion of my PhD, Anna Volkmar and I started speaking a lot more about the power of conversational assessment. And then that led into conversations where we worked with Anne Whitworth, Deborah Hersh, and Jade Cartwright, where again, through the power of Zoom across all times. I was pregnant with my first, and meeting everyone usually at midnight my time. I already was nocturnal at that point!  Where we would just be discussing all of these issues, and what was amazing about this is that, particularly Anne and Deb come from more of the post-stroke aphasia world, and had these amazing principles grounded in those populations where Deborah Hersh had also really come forward with the concept of therapeutic assessment. So as you had said assessment and intervention shouldn't be separate, they belong together and coexist at all times if we're smart about it. And what we ended up doing, first informally and then formally through the more official Delphi process is coming up with a set of principles as a framework for assessment. So, to take a step away from, "Oh, it's just Lucy Goosey, we're having a conversation and chit chat." What we're actually promoting is a pretty structured set of principles to guide the ways in which we can cultivate assessment for individuals with PPA and their loved ones. Jerry Hoepner: Yeah, absolutely. I was kind of scanning on my computer, I was trying to think of the name. I love this name of the article, where it says, 'Please don't assess me to death, or something like that. Jeanne Gallée: Yes, yeah. Jerry Hoepner:  Yeah, and, and thinking about that whole entire process from beginning to end as a relationship, as you know, not discreetly assessment, not discreetly intervention, I think it's just really important. Can you talk a little bit about the PACT and kind of where that has moved things in terms of the assessment piece, but also kind of set a set up for intervention and what that looks like? Jeanne Gallée: Great, so the PACT the Progressive Aphasia Communication Toolkit kit builds off of what we put forth with the RAISE assessment framework. So with RAISE we promote that the relationship might be temporary, it might be a single interaction, or it might be long term, and we cultivate that through conversation and then the PACT is a set of scales that leverages that conversation, we take that natural or as natural as can be interaction and use it to come up with a concrete framework of communication strengths. So that might all sound very esoteric. To make that more concrete, there are four scales to the PACT. They're all clinician ratings, where the clinician is asked to look at a pre-recorded conversation that would occur naturally in a clinical or research context, and then on a scale from four to zero, rate the person speaking's strengths. So within the domains of speech and voice, as well as language and social pragmatics, as well as discourse, and the point or the purpose of that was to really anchor a person's communicative ability in one of these more natural environments with a provider. We collect so much phenomenal qualitative data, but at times it can feel challenging to quantify it and the hope with the PACT is that we can quantify our very real, possibly subjective evaluation of a person's communication at a certain moment in time. Jerry Hoepner: Yeah, and what I love about that, and you might have a slightly different thought about this, because you're deeper into it, but from an assessment standpoint, you can then do that all the way through. You can say, "Here's where they are this year, here's where they are next year, here's where they are the year after that, or you know, two years ago, or whatever your lens is at that point." You can do that without kind of this constant repeating of, "Okay, let's see how bad you are today compared to a year ago, or compared to two years ago." Just a very different mindset. And I love the focus on "What can you still do? What what's working? And how can we leverage what's working to really help you to actually communicate today?" As opposed to saying, "Oh boy, the ship is sinking." which is kind of the typical approach. Jeanne Gallée: Yes, that exactly what you're saying. The tendency tends to focus on what's no longer there. And while that might be helpful in clinical trials to characterize a person's performance diagnostically and the trajectory of a diagnosis over time. It really does not serve the person who goes home after the assessment, nor their loved ones to help them maintain that autonomy and quality of life, and also caregiver burden. And that is actually one of the points I really love about the PACT, is it builds on that RAISE aspect, that final tenant of evolution or adaptation over time. There's no repeat measure conflict here, where you know something might seem familiar. One of the unique parts of the PACT is that the clinician doesn't fill out the scale while they're talking to the person, they're really just recording them talking, so it is on the clinician side where, as often as they'd like to, they could implement the structured prompts of the PACT and then fill out the scale and see how performance might vary over time. They might see effects of context of the conversation, or the environment, or maybe the time of day, you know, phase of life, but it remains a way to use that really important information you gather through these conversations without recreating a testing environment frequently. Jerry Hoepner: I really love that framework. I think there's a lot of room for that to be used in other contexts as well. I just think it's really a wise way of thinking about it. I also, you just mentioned caregivers and caregiver burden in this context, and how does that fit into this entire RAISE framework, the PACT, and so forth. Jeanne Gallée: I think for both the RAISE assessment framework as well as the PACT the carers play an essential role in the sense that if they are available and present in the patient's life, then they are involved in the process. And so within the RAISE framework, the care partner is involved to provide feedback or to be given feedback, and in the PACT the same occurs, where if they are present at the time of the conversation, they are involved in the conversation. What I tend to do in the people I have piloted the PACT, I say come in as you would naturally, but then also take a step back. Let the person that with PPA that we're talking to take the lead, but I want you to interact as you would naturally. And then they're separately also asked to comment on the strengths that the person with PPA has. Their feedback is so integral because if they are present in a person's life, they play an essential role in promoting anything that we do work on in speech therapy. Jerry Hoepner: Absolutely, yeah, really well said. And I wanted to dig in, partly because I have envy of this figure, the roadmap figure for PPA, and I think it really sets up well for as we think about professionals out there too, like what's the roadmap, not just for the person and their partner, but what's the roadmap for clinicians, future clinicians, all of that. Maybe you can talk a little bit about that figure. Jeanne Gallée: I'd be delighted to. So, this was one of those, I would say classic for me moments where I had an idea and went to PowerPoint and started playing around with a visual of what I was thinking. The roadmap paper in no way is meant to be the only guide for how we can work with a person with PPA, but was really born out of discussions with Amy Mooney, as well as Zoe Ezzes, and Kristin Schafferr Mendez through the National Aphasia Association about the possible gaps in education or preparation a person might experience when first working with people living with PPA.  There are so many ways in which we could say, "Oh, just work on this exact task. Work on these.." and that can feel so lost and unanchored, unmoored moreover. And I wanted to provide the clinical toolkit that I've been using to help me think about my broader approach. So to not get lost in the weeds, but just generally think about what's my purpose here, what's my journey, and so at the center of this road that I created is the tenant of providing that person-centered care, like we aim to with the RAISE assessment framework, so really bringing it back to establishing that honest and holistic and person-centered relationship with your client and their care partners. And focusing on creating a journey that's unique to the client that I think can feel hard when there are so many unknowns with a condition like PPA, where you're always working with an interdisciplinary team. Which you may or may not have contact with. So the first part of this roadmap is really defining your role. Who are you as a professional, and what kinds of support can you provide, and part of defining your own role includes defining your role relative to the rest of the interdisciplinary team. How can you provide a different approach from the neurologist or the neuropsychologist who play vital but very different roles in a person's care journey? Part of that definition also includes advocating across professions, so a classic conundrum that people with communication-led disorders face is that they may not have certain challenges in other domains, but their communication results in a domino effect of difficulties. And so, as the speech language pathologist, coming up with ways in which you can provide supports to other providers or your client to improve their communication can be essential for that comprehensive care. That might include coming up with a communication notebook that has a single page related to specific questions or common topics when talking to the neurologist or the physical therapist or other providers. And then part of this roadmap includes referring out. So having the humility and confidence to say I can't help with this in the ways that you may need. I will either refer you to a specialist within our field or outside of our field to help with these specific aspects, and I think that's just responsible care. Jerry Hoepner: Absolutely. Really well described, and such a perfect. A segway to my next question. I always tell my students, assessment isn't just the first and last session that you're working with someone, and the same goes for intervention, right? It's not excluded from the beginning and the end, right? Like, you can't do intervention on day one, you can't do it on the last day, right? I think we kind of silo those things as well, you know, we assess and we intervene every day side by side. Can you share a little bit of your perspectives on this? And, and how that relates to kind of what we just talked about in terms of that roadmap? Jeanne Gallée: Yeah, I think part of the challenge with some of these concepts is that it's very helpful to have experience in working with individuals, whether it is through formal speech therapy or elsewhere, to feel comfort with the unknown. Because a lot of it relies on your ability to listen and to respond to what you notice. You may inadvertently put in assessment by asking follow-up questions to a point a person made when you were talking about their commute. Ad you may offer different technological supports or just visual supports to your client in that conversation in a way to build up supports to see, "Oh, do we see a difference in how they're responding to what I'm saying? And how I provide support? Or when I dial it back, do we see a completely different direction?" So, it is this beautiful, possibly more art than science approach of responding to what a person is giving you. And there are so many individual differences in all of us.  I always joke about how when I used to collect data on the picture description using both age match controls and people with PPA, I would almost burst out laughing when some of the controls provided responses, because I would get one to two sentences sometimes because see the difference in motivation. A person who does not have a communication concern, does not see the need to show exactly what they can do. And would benefit from some encouragement to show exactly how much they can say, whereas a person with PPA, who might have an Aphasia Quotient that recognizes their aphasia, might speak for five to 10 minutes to show exactly everything that they can accomplish. And so I think having that in your back pocket is really important when it comes to thinking about coming up with your recipe of all the ingredients of your assessment and intervention approach and counseling approach. So, I think that's where most of my work comes from, is that there is no one size fits all, but there are certain ingredients or components that we need to apply, and the exact ratios depend on the person you're working with. Jerry Hoepner: That is such a good description of dynamic assessment and intervention and how that I agree, probably more art than science. And that's hard for people who want a black and white answer, like "Step one…" but it's so true, and, and being effective in working in this context, that really moves us nicely into a recent paper that you did, those global perspectives on the management of PPA, and I was struck by the numbers here. Only 40% of respondents said that they had received training in primary progressive aphasia at their university, and they identified all of these needs, right, like online instruction, sample tools, and activity dealing with end of life care and trainings for end of life care. When you mentioned counseling, that totally relates to what we're up against in terms of counseling, right? No one feels confident or has very good self efficacy. Tey don't know if what you know the lines are, what part is theirs and what part is someone else. And I think just really important to like I said, lay out a roadmap and help people to understand what we were just talking about in terms of that art and science of how do you navigate this space when it has to be individualized for every person, and that can feel uncomfortable for a lot of people. So, I'd love to hear more of your thoughts on that, and kind of what you learned from that context. Jeanne Gallée: Yeah, so this research study. Was really an amazing endeavor on part of everyone who was involved. It felt like a grassroots effort to find the speech language pathologists around the world who aren't associated with a particular institution who do work with primary progressive aphasia. So of course it will never be a fully representative sample of every clinician who does so, but I do think we worked very hard to cast a wide net. So we used a snowball method. I contacted almost 40 institutions and governing bodies to find speech language pathologists who do have experience with PPA, because while more and more non-specialist providers will be seeing this patient population, we wanted to hear from the people who currently are in the field and creating their own expertise and toolkits to work with these individuals. So, what we found is that a lot of people are out on their own creating their own wheels, so to speak. And it just really led to that beautiful conclusion of now with the power of our globalization of education and sharing of resources, we can come up with a resource that's shared worldwide. Of course, there will be adaptations to fit different contexts, cultures, languages, but one of the issues has been that the systems of care for PPA have often relied upon very specific individuals. And that's reflected in the educational level. Even I was in the master's program between 2017 and 2019, I didn't hear about PPA formally in my coursework, and if it was mentioned we did not go into any of these aspects of specialized care. Part of that might have been because I didn't take very specific courses that then you know were optional or precluded, so I might have missed it, but I really didn't receive that education in the classroom. I received it through my clinical training, which I would argue is possibly even more valuable, right? You have that experiential training. But I think for clinicians who might want to transition in their careers, or you know, inadvertently in their place of work, are transitioning based on who shows up, that is a huge disservice. Jerry Hoepner: Yeah, agreed. And it's a complex issue, right, because I can remember actually teaching about this back before Tom [Sather] was in my department. I taught the aphasia class and the acquired cog class, and I was thinking, like, where do I talk about primary progressive aphasia? Do I talk about that in acquired com? Do I talk about that in aphasia? Do I do it in both? Where do I talk about end of life care, and like, how does that fit in, because that's, you know, at that point I was teaching dysphasia, too. Believe it or not, and I'm like, it's kind of there, it's kind of here, it's kind of, it's kind of in counseling, it's all right. So that makes it tricky to have kind of a uniform message when it's all over the place. And love to just get your thoughts on that too. Like, where do you put that stuff? Like, it's it's PPA, it's end of life care, it's aphasia, it's right, it's counseling, it's so many things at once. Jeanne Gallée: It is so many things at once, and I do think that speaks to the fact that it may well need its own class as part of progressive conditions. Jerry Hoepner: Yeah. Jeanne Gallée: But I do think a large part of what we share there is that understanding of we may also need to shift the identity of who we think about when we think about life care. And when we think about a progressive condition. Since a huge flavor, so to speak, of PPA is the fact that it is early onset, and especially with our cultural shifts, and you know, people starting families later in life. The face of a person with PPA looks very different from, at least in my childhood, of what looked like typical Alzheimer's disease dementia. And it's a younger, possibly more dynamic working person, possibly with little kids at home. And I think that's where that symptom-led approach has been most beneficial for my practice. Where we think about "What are you experiencing and how is it impacting your life?", rather than saying "This is the diagnosis, let's put you over here in this box." Jerry Hoepner: Yeah, the idea of putting it in a box and siloing things really resonates in this context, and I love what you said about identity, right? The identity - what we all have in our mind's eye when we think about end of life care is not the typical person with primary progressive aphasia. Like I can remember as an elementary school student visiting the nursing homes and singing to the residents and things like that, and this was not, this was not the group of people that we were thinking about in that context. Very, very different, and I just think that's a really good mindset shift to recognize how actually broad that is. I'm sure there's people listening to this who work in, you know, end of life pediatric care who want to slap me in the face right now, but right, we have such a different mindset when we're thinking about end of life care, and that reset that you just made super important. Jeanne Gallée: Yeah, yeah, and easier said than done, I think, As well as just seeing who shows up to the University of Washington support groups, and just the own perspectives that individuals bring there. But I think we can do it. I think, as a field, that will be the way in which we can become the best generalist provider, so to speak, where we take general principles of addressing symptoms or situations, and then apply those to diagnoses across the spectrum. Jerry Hoepner: Absolutely, really well said, and a great place to kind of wrap up our questions, but I want to give you the opportunity, are there points that you want to share before we kind of close our conversation? Things that we missed. Jeanne Gallée: I think the general thread throughout our conversation has just spoken to the power we do have as providers or researchers working with patients with primary progressive aphasia or related conditions, I think when we feel that our expertise in the newest theories or approaches might be lacking, we can always rely upon our empathy and full body listening, just to bring in elements that go across the lifespan, and that in of itself can lead to so many honest and transparent choices in our clinical care that can best serve our communities. I think we are much more empowered than we think we are. Jerry Hoepner: Absolutely, that's a really important thread through many places where clinicians feel uncomfortable. They've got it there and they just have to gain that confidence, and being empowered to step into those moments. Well said. Well, Jeanne it's been just a really fun conversation. I'm sure we could talk all afternoon, but I look forward to catching up to you at future conferences and things like that. It's been my pleasure to have this conversation. So, thank you for being a part of it. Jeanne Gallée: Right back at you, Jerry. Thank you so much. This has been a really fun conversation, and like you said, I hope to meet in person in the near future. Jerry Hoepner: Agreed. On behalf of Aphasia Access, thank you for listening to this episode of the Aphasia Access Conversations Podcast. For more information on Aphasia Access, and to access our growing library of materials, please go to www.aphasiaaccess.org. If you have an idea for a future podcast series or topic, email us at info at aphasia access.org Thanks again for your ongoing support of Aphasia Access.   Resources and Readings 1) The RAISE Assessment Framework: Gallée, J., Cartwright, J., Volkmer, A., Whitworth, A., & Hersh, D. (2023). "Please Don't Assess Him to Destruction": The R.A.I.S.E. Assessment Framework for Primary Progressive Aphasia. American journal of speech-language pathology, 32(2), 391–410. https://doi.org/10.1044/2022_AJSLP-22-00122  Gallée, J., Volkmer, A., Whitworth, A., Hersh, D., & Cartwright, J. (2024). Applications of the R.A.I.S.E. Assessment Framework to Support the Process of Assessment in Primary Progressive Aphasia. American journal of speech-language pathology, 33(5), 2280–2290. https://doi.org/10.1044/2024_AJSLP-24-00085 2) A roadmap for clinicians just starting to work with PPA: Gallée, J. (2023). A Roadmap to enhance care for people living with primary progressive Aphasia: What Can Be Done Now?. Perspectives of the ASHA Special Interest Groups, 8(5), 847-862. https://doi.org/10.1044/2023_PERSP-23-0002  3) Aspects of language functioning in early and late-onset Alzheimer's disease dementia: Gallée, J., Gibbons, L. E., Choi, S. E., Lee, M., Scollard, P., Trittschuh, E. H., Mez, J., Saykin, A. J., Foldi, N. S., Mukherjee, S., & Crane, P. K. (2025). Facets of language performance in early-onset and late-onset Alzheimer's disease dementia. Alzheimer's & dementia : the journal of the Alzheimer's Association, 21(9), e70705. https://doi.org/10.1002/alz.70705 4) The Progressive Aphasia Communication Toolkit (in production at Alzheimer's & Dementia, but here is the preprint): Gallée, J., Cartwright, J., Henry, M. L., Mooney, A. R., Stark, B. C., Volkmer, A., Dietz, A., Nakano, C., Battista, P., Beales, A., Beber, B. C., Cadório, I., Caldwell, M., Davies, K., Ezzes, Z., Gauch, M., Graney, T., Grobler, S., Haley, K. L., Hausmann, A., … Crane, P. K. (2025). The Progressive Aphasia Communication Toolkit (PACT): A Strengths-Based Approach to Multidomain Evaluation for Intervention. medRxiv : the preprint server for health sciences, 2025.11.25.25340904. https://doi.org/10.64898/2025.11.25.25340904 5) A global survey on SLP perspectives on the management of PPA: Gallée, J., Cartwright, J., Grasso, S., Jokel, R., Lavoie, M., McGowan, E., Pozzebon, M., Beber, B. C., Duboisdindien, G., Montagut, N., Norvik, M., Sugimoto, T., Townsend, R., Unger, N., Winsnes, I. E., & Volkmer, A. (2024). Global perspectives on the management of primary progressive aphasia. Scientific reports, 14(1), 19712. https://doi.org/10.1038/s41598-024-70156-5 6) Aspects of language functioning in early and late-onset Alzheimer's disease dementia: Gallée, J., Gibbons, L. E., Choi, S. E., Lee, M., Scollard, P., Trittschuh, E. H., Mez, J., Saykin, A. J., Foldi, N. S., Mukherjee, S., & Crane, P. K. (2025). Facets of language performance in early-onset and late-onset Alzheimer's disease dementia. Alzheimer's & dementia : the journal of the Alzheimer's Association, 21(9), e70705. https://doi.org/10.1002/alz.70705

Lietuvos prezidentas Gitanas Nausėda patvirtino užsienio žiniasklaidoje pasirodžiusią informaciją, kad Rusija planuoja provokacijas Lenkijoje ar Baltijos šalyse. Taip gali būti testuojama NATO vienybė. Anot Nausėdos, ši informacija yra pagrįsta žvalgybiniais duomenimis. Perspėjama apie galimus Rusijos smūgius kritinei infrastruktūrai. Pokalbis su buvusiu Lietuvos užsienio reikalų ministru Antanu Valioniu ir gynybos ekspertu, atsargos pulkininku Vaidotu Malinioniu.Ved. Andrius Kavaliauskas.

Demokratų sąjunga „Vardan Lietuvos“ į sveikatos apsaugos ministrus siūlo Liną Kukuraitį, į žemės ūkio – Kęstutį Mažeiką, o į energetikos – Luką Savicką. Šiandien šiuos kandidatus demokratų lyderis Virginijus Sinkevičius pristatė Prezidentui Gitanui Nausėdai.Ukraina surengė didžiausią dronų ataką ir žada 40 dienų intensyvią puolimo kampaniją. Kryme jau skelbiama nepaprastoji padėtis, daugėja pranešimų apie degalų stygių visoje Rusijoje.Prieš kelias dienas Kauno mečetės administracija feisbuke paskelbė įrašą, kuriuo pašo Kauno mečetės teritorijoje pernelyg atvirai nedemonstruoti intymaus fizinio artumo. Toks įrašas sukėlė didelę reakcijų bangą. Dalis visuomenės mano, kad musulmonų bendruomenė neturi teisės nurodinėti, kur galima laikytis už rankų ar bučiuotis.Istorinį rezultatą pasaulio čempionato atrankoje pademonstravusios Lietuvos futbolininkės jaučiasi neįvertintos ir metė akmenį į Lietuvos futbolo federacijos daržą. Šalies rinktinės lyderės smerkia vyrų ir moterų nacionalinių komandų premijų skirtumus, beda pirštu į nepakankamą rungtynių sklaidą ir tikisi pokyčių. Federacijos prezidentas Edgaras Stankevičius teigia spręsiantis premijų skirtumų klausimą, tačiau nesutinka, kad moterų rinktinės sąlygos prastos.Ved. Liepa Želnienė

Nuo metų pradžios Alytaus apskrityje kol kas neužregistruota nė vieno nuskendusio žmogaus. Tačiau prasidedant vasaros sezonui ugniagesiai gelbėtojai primena – vanduo neatleidžia klaidų, o daugelio nelaimių būtų galima išvengti.Apie didžiausias grėsmes prie vandens ir dažniausiai daromas klaidas FM99 laidoje „Pilietiškumo dėlionė“ kalbėjo Alytaus priešgaisrinės gelbėjimo tarnybos II komandos budinčios pamainos vadas Martynas Valaitis.

Prasidėjus vasaros sezonui Druskininkų ir Varėnos policijos pareigūnai džiaugiasi, kad didelių eismo nelaimių kol kas pavyko išvengti, tačiau ragina gyventojus neprarasti budrumo. FM99 laidoje „Ne tu vienas kelyje“ aptarta ne tik situacija keliuose, bet ir pastaruoju metu fiksuojami sukčiavimo, vagysčių bei viešosios tvarkos pažeidimų atvejai.

Paskutinė pavasario savaitė Alytaus ugniagesiams buvo darbinga. Gelbėtojams teko šalinti vėjo išverstus medžius, padėti medikams, vykti į eismo įvykius bei gesinti septynis gaisrus. Prasidėjus vasarai gyventojai raginami nepamiršti elementarių saugumo taisyklių, kurios gali padėti išvengti skaudžių nelaimių.

Prasidėjus vasarai Alytaus apskrities policijos pareigūnai ragina visus eismo dalyvius būti atsakingesnius. Pasak Alytaus apskrities vyriausiojo policijos komisariato Komunikacijos poskyrio vyriausiosios specialistės Eglės Kačinskienės, didžiausią nerimą šiuo metu kelia elektrinių paspirtukų vairuotojų daromi pažeidimai bei augantis eismo įvykių skaičius.

Prezidentas perspėja „kariaujančias šalis Europoje“Prezidentas Gitanas Nausėda griežtai perspėjo „kariaujančias šalis Europoje“ nenaudoti Lietuvos teritorijos bepiločių orlaivių antskrydžiams.Jungtinių Valstijų prezidentas Donaldas Trumpas išvyko į Pekiną. Amerikos prezidentas Kinijoje lankysis pirmą kartą per beveik dešimtmetį. Dviejų supergalių susitikime gali būti aptartas ne tik karas Irane, bet ir Ukrainoje, o Kinijos prezidentas gali siekti dešimtmečius nusistovėjusio Taivano status quo keitimo.Netyla diskusijos dėl viena po kitos įvykusių geležinkelio avarijų Lietuvoje. Kol vyksta incidento tyrimas, geležinkelio vadovai ir Vyriausybės atstovai Seime aiškinosi dėl incidentų.Seimo Kultūros komitetas svarsto LRT įstatymo pataisas, kurioms pastabų turi Venecijos komisija ir STT.Lietuva vėl pateko į Eurovizijos dainų konkurso finalą.Robotas humanoidas, vedantis kūno kultūros pamoką. Tai - ne filmo scenarijus, o netolima ateitis, sako mokslininkai. Tačiau tuo pačiu ramina - pedagogų robotai tikrai nepakeis, bet gali tapti rimtais jų pagalbininkais. Klaipėdos universiteto STEAM centras įsigijo tris robotus humanoidus, kurie bus naudojami ne tik moksleivių edukacijoms, bet ir pritaikant juos tapti mokytojų pagalbininkais.Ved. Andrius Kavaliauskas

Praėjęs savaitgalis Alytaus apskrityje buvo intensyvus tiek pareigūnams, tiek eismo dalyviams. Nors Dzūkijos regione vyko gausybė renginių, motociklininkų susibūrimų ir sporto varžybų, didesnių incidentų pavyko išvengti. Vis dėlto policijos suvestinėse netrūko pranešimų apie eismo įvykius, sukčiavimus bei smurto artimoje aplinkoje atvejus.

Pastarosiomis dienomis ugniagesiai gelbėtojai vis dažniau susiduria su išaugusiu gaisrų skaičiumi, kurį lemia ne tik gamtinės sąlygos, bet ir žmonių neatsargus elgesys. Minint šv. Florijono – ugniagesių globėjo – dieną, Alytaus priešgaisrinės gelbėjimo tarnybos atstovai atkreipia dėmesį į sudėtingą situaciją regione ir ragina gyventojus elgtis atsakingai.

  In this episode you will discover: Identity Is Shaped in Interaction — Narrative identity forms and reforms through relationships and stories shared with others — making connection a core ingredient of recovery, not a bonus Visual Methods Unlock What Words Cannot — Collage-making, photos, and art give people with aphasia a pathway into identity work that talk alone can't always reach. Identity Reconstruction Is a Long Game — People continue navigating complex, shifting identities for years after stroke. Our systems need to follow them farther into that journey, not stop too soon. Sit on Your Hands and Truly Listen — The most powerful thing you can offer is unhurried, attentive presence. Learning to wait and watch — rather than fill the silence — is a skill worth deliberately practicing. If you've ever felt like there's more to aphasia care than the therapy protocol in front of you, or wondered what identity-centered practice actually looks like in the real world, this conversation will give you both the framework and the practical insights you need. Welcome to the Aphasia Access Aphasia Conversations Podcast. I'm Katie Strong from Central Michigan University and a member of the Aphasia Access Podcast Working Group — a community dedicated to supporting better aphasia care. Rianne Brinkman is a speech-language pathologist and linguist from the Netherlands whose PhD project "Who Am I Now?" explores identity changes in people with aphasia through storytelling and creative arts-based approaches. Before her doctoral work — supported by the Dutch NWO Teacher Research Grant — she spent years as a clinician in rehabilitation and aphasia centers, and that deep clinical foundation shapes everything she brings to her research. She teaches in the Speech and Language Therapy program at Hanze University of Applied Sciences in Groningen and conducts her research at the University of Humanistic Studies in Utrecht. Today's conversation feels especially personal to me. Like Rianne, I came to doctoral work after years of established clinical practice, and my own research centers on narrative identity and aphasia through the My Story Project and the PULSE framework. So, when she sought me out at a conference in 2019, I recognized immediately that we were kindred spirits working toward the same questions from different corners of the world.   So, let's get into the conversation. Katie Strong: Well, before we dive into your work, I wanted to share something with our listeners. One of the things that drew me to this conversation is that we have a parallel story. We both came to do our PhDs after established clinical careers, and you're in the thick of that journey. I'd love to start with what made you decide to go back, and how did your clinical work shape what you wanted to pursue? Rianne Brinkman: I used to work in rehabilitation for a long time, and then I moved from one part of the Netherlands to another part, and there was not much work for me. So, I got the opportunity to help establish an aphasia center. And of course, if you look at the rehabilitation phase, that's far more deficit oriented, so that's very different than in the chronic phase, where an aphasia center comes into place. So, I really had to change my view of therapy. I had to establish a few groups on identity. I started reading on identity, on communicative participation, on how to do that in groups. So that's really where the interest came from. Katie Strong: I love hearing that. Sometimes as we go into a different phase or area of work, and it really re-shapes our thinking and how we engage with our clients or patients. Rianne Brinkman: Yeah, it does. And in those groups, I worked together a lot with creative therapists, and I learned so much from them, because then I realized that if you use narrative approaches, and you combine them with visual arts or arts therapy, that it can mean so much for somebody. They can get so many more means of expression. So, yeah, I learned a lot from that. Katie Strong: I love that! It is powerful. And I'm really looking forward to talking more about this. I was curious, you know, what the experience has been like from a clinician turned researcher, what you know, what's that actually been like for you? And has there been anything that surprised you most about the transition? Rianne Brinkman: I did not realize that much how much you yourself as a person influences the conversation with somebody with aphasia, you know that co-construction part. So that your identity aspects really influence how the conversation takes place and what somebody chooses to tell you or not. So that is really momentary, and so it's just a snapshot, really, when you do this. So, I became really aware of that. But also, your own norms and values and the way you listen and all those sorts of things. It's just a different way of doing therapy. And then you're doing it as research which is different. I think that's one thing, sometimes I'm a little bit too much the therapist, so I really have to be a researcher again, you know? So, you change between those roles.   Katie Strong: Yes, it is a shift, right? Rianne Brinkman: Yeah, exactly, exactly. Katie Strong: Yeah. And thinking about how those two roles are different or powerful, sometimes combined. Well, let's talk a little bit about the work that you're doing. And I want to acknowledge that what we're talking about today really all comes out of your doctoral journey, which is really remarkable. I thought we could first talk about your 2025 scoping review that really mapped the landscape of what we know about identity changes in aphasia, and it also laid the groundwork for everything that followed. Could you walk us through that narrative identity model that came out of the review?   Rianne Brinkman: Yeah. That was quite complex, because there's so much written about identity, and everybody defines it slightly in a different way, or uses different words. So, what we tried to do is really get a grip on that literature to see what was written on identity changes in aphasia, and what kind of theory was used. And what we saw was that everything is from a social constructionist perspective, really. But then there are many different philosophers and different authors that write about identity. So, what we tried to do was because, of course, Barbara Shadden, she's very foundational in this work. With her colleagues, she created the four domain interdisciplinary framework. So, we tried to use that in the model as one of the foundations. And then, of course, the work of Paul Ricoeur, who's a French philosopher who writes about that you only shape your identity through interaction with other people which gives meaning to the stories you share with other people. And the work of Bamberg, and he talks about dilemmatic spaces. So what it means, really, is that I think identity, you only shape in interaction, and we tried to visualize that in the model. So, there's an "I" part, and that's about you, the personal domains, and there's the "we" part, and that's about the social domains. We tried to visualize how those domains interact, including temporality, because you shape your identity in the here and now, but also through time. And then in the middle of the model, there's a head with interconnected gears, and that's where it all comes together. That's you at your identity, your narrative identity, a specific point in time. So that's the model in a nutshell. And then you've got, of course, all those personal domains, like your biography, agency and power, communicative abilities, your roles you fulfill in life. And then the social domains are, like your social situation, your cultural background, society and all of that works together, informing, shaping your identity. Katie Strong: It's powerful work, and it is complex. I appreciate the work that you led to be able to assimilate and give us this model for us to be really thinking about narrative identity in a way that takes all of those big thought leaders and helps it become more approachable to those of us that are interested in narrative identity as researchers, but also as clinicians. Rianne Brinkman: That's great. Thank you. Katie Strong: Thank you for that work. And then you have another recent paper. Congratulations, by the way! That paper just came out earlier this year in 2026 and I guess I should say to the listeners, we'll have both articles linked in the show notes, as well as some other resources that will be interesting to explore if you're into this topic. This 2026, article is really the first of its kind to look at identity in this early stage, six to eight weeks after admission to rehabilitation. So, I was hoping you could talk with us about who were these people and what were you doing together in these sessions? Rianne Brinkman: Yeah. So, it's the first session of a longitudinal study, so I'm following those people over two years. And so, there are 22 people with aphasia. Unfortunately, two of them couldn't continue as one of them, I couldn't organize the reflection session, and one of them, I just couldn't reach anyone. But the other 20 people are still in the study, which is really amazing! Katie Strong: That is really amazing! Rianne Brinkman : Yeah, that's really nice. They're all middle aged people who range in age from their 30s to their 60s until 67. They also have different severities of aphasia. Some people were still clinical inpatient, some of them already were outpatient. And then I tried to elicit their story with visual participatory methods in combination with the narrative approach. So those sessions are quite long, sometimes two and a half to three hours, so it's a lot of time. It's really nice to just sit with them and connect. During the first session I did collage making. I just took a lot of magazines with me and scissors and glue and everything, and then we just sat down. And then I just let them start leafing through those magazines and see what appealed to them, what kind of images, what kind of words, what it's reflected about them. And then they created their collage. And then, of course, you look at what kind of images do they choose, but also, how do they position them? How do they create their collage. Is there some kind of reason behind things? You discuss that, but also how do they get across what they do? You know, some people think for a long time and are hesitant to act. Some people start straight away. Some people tear the images. Some people cut them really neatly. So, everybody behaves in a different way, and that reflects something on your identity also. So, I always ask questions about that. And then when we finish the work, a proxy comes in and we reflect on the work of the person with the face yet together to get perspective. Katie Strong: That's really fantastic. So, you're, you're coming into either the hospital room or their home, is that where the work is done? Rianne Brinkman: Yeah, so usually the speech therapist, who's in charge books a room for me in the rehabilitation center. Or I just go to the homes of the people. Katie Strong: Well, I'm excited to talk about what you found out, but, but before we get into that, I just have to ask about the tattoo, because it's an integral part of this work. And it stopped me when I read it. And the title from the paper comes from the tattoo on one of your participants. So, could you talk to us about that?   Rianne Brinkman: Of course. There's one lady, and I was analyzing the session, because, of course, she will need to transcribe them. And then I saw her doing her hair in a ponytail, and I saw her arm, and I thought, "Oh, she's got a really nice tattoo there." So, I sent her a text, and I said, "What does that tattoo mean to you? What is it? "And then she told me that it was a tattoo that said, leave the thorn, enjoy the rose. And that's from a music play from Handel. And her father really enjoyed that. But her father passed away, so that tattoo was a memory tribute to her father, but also it reflects how she sees life, that you have to try to stay optimistic whatever happens. And I think that voice of positivity is a very important voice in all the stories of all the participants. Everybody said that. So, I thought, oh yeah. Even when something really bad happens, bad happens, people try to stay positive. So, it reflected a very important, yeah, result of the data, really. So, I thought, I'm going to make that the title. Katie Strong: It really is beautiful. So, so the rose bush. You develop this beautiful rose bush image to represent what you found across the participants. Walk us through that. And what does the rose bush capture about what identity looks like at that early stage of recovery? Rianne Brinkman: So, we used different methodology of analysis. So we listened to the voices that were reflected in the stories of people with aphasia, and then we realized that there are many contrapuntal voices, so it's very ambiguous. Really, very complex. So, we thought, we cannot just do a thematic analysis. We have to show that one experience can be both positive or negative or whatever. And that's why we came to those tensions and in that rose bush, so at the stem you see, for example, where you see the branches, and at the stem it's, for example, the tension between disconnection and connection. And connection is at the rose and disconnection at the stem, another tension is agency and disempowerment, and another one is living loss and personal growth. And then what we found was that people had coping voices and affirmative voices, but also challenging voices. And what we did was we put the challenging voices at the thorns and the coping and affirmative voices at the roses to reflect that they used that both to make sense of aphasia and of their identity, really. And so, they were moving along those branches, really. Sometimes they felt connected. Sometimes disconnected. Sometimes they grieved. Sometimes they cope by staying positive or focusing on the present. So that's how we tried to show that it's very complex that people move along those tensions, that it's never static. And those three existential tensions were really very tangible in the data. Katie Strong: It's just such powerful work. When I was reading it and I. I was talking with one of my students, she was saying she actually became pretty emotional when she was reading about all of that as well. It's really, really powerful work. And what I find so interesting, and you mentioned it earlier, but this role of the visual methods, the collage making, images as a way into identity. Could you paint a picture of what that actually looked like to sit with a participant in those sessions? Rianne Brinkman: Yeah. Well you really have to sit on your hands. And I learned a lot from my colleagues, creative therapists, because when I first did this…because sometimes people feel a bit awkward. You know that they all of a sudden have to draw something, or that they have to cut images from a magazine. And then you want to do something to help them feel less awkward. You shouldn't really. You should just let that happen and let that session develop. That's very important. So, I really learned to just tell them, "you are looking the magazines and you see what appeals to you. And I'll just give you some time to get into that" and then you just wait. And while you're waiting, you can just see, for example, if somebody finds it really hard, and then you can also see how long they look at an image, for example, if it means something to them. Or they stop on a certain page all the time. And then you can help them a little bit and say, "Oh, you're looking a long time at this image. Maybe, is this something that appeals to you for some reason?" And then you can help them. But also, very often, people just know what to do. I don't know. It's very intuitive. So first, they don't know what they will choose, or they don't know what kind of collage it will be. But it comes to them for some reason.   Katie Strong: Yeah, it's interesting. I think we had talked about this previously, but a person with aphasia and research collaborator that I worked with, Todd Berreth, and I did some, we called it. We the "cut-up" style using images to be able create a story about yourself and integrate those pieces. And it was so interesting to watch people who came to our workshop, and just as you're saying, like how they chose and what they did. Some people were very, "I know what I'm doing", and others were hesitant, or wanted to take their work home before finalizing it and everything in between.   Rianne Brinkman: Yeah, that's very that's very nice. You really get that extra layer, I think. And also, when people really can't talk very well, you know, they can maybe say yes or no and sometimes a word, you know, then it's very hard to talk about your identity. Using images then that really helps. So, I remember one lady, she couldn't talk very well, but she was very creative. And she started, you know, with those magazines, and then straight away, there was that butterfly symbolizing her mom, connection to her mother. And maybe, I think we would never have reached that trying to do this in words. So, yeah, very powerful.   Katie Strong: Thank you. Another thing I wanted to talk about is that you use something called the Listening Guide as part of your analysis. And I'm thinking that a lot of our listeners may not have come across this before. Could you give a sense of what it really means to listen in the way that that approach demands?   Rianne Brinkman: Yes. So, what you do is, first you well, you listen to the plot of the story. So, you listen to, what does this story contain? What's the big line of the story? And you write that down. And then you look again at the data, and then you look at all the "I" positions and I also look at the "me" positions. So, everything that's "I" and "me". You get that out and you create "I-poems". We created all those "I-poems" about certain experiences. I could give maybe an example of one. This one is a bit connected to, on the one hand, feeling very sad that somebody suffered from stroke and aphasia, and on the other hand, tried to stay positive. So, I've got one here. I was crying last weekend. I realized, Oh no, this happened to me. I have to deal with this. I have changed. I also stayed positive that I will be okay. I just say it will be okay and I won't think negatively. So, then you get an "I-poem" that reflects different voices, like, in this case, the voice of grief and positivity. Then you look at those voices. In the next step, you look at the contrapuntal voices, and like grief and positivity are very contrapuntal. So very often, I think also we as human beings do the same, you know, you talk to yourself in your head, you know. And you've got all those different positions towards an experience. And those are the contrapuntal voices. And what we tried to do, so we adapted this approach by Gilligan and Eddy, and we tried to incorporate the visuals, the visual data, and also embodiment, because sometimes people with aphasia do very interesting things. They give a lot of information, non-verbally. Also you want to be sure that you really understood the person, so checking if you're on the same page is very important also. Sometimes you have to interpret what somebody means, or you have to give words to what somebody says as a researcher, which is the ethical part, of course, which is hard sometimes, but you can't avoid that. So, yeah, so that's how we integrated all the data. And tried to get those stories out and get the depth of the depth of the story.   Katie Strong: I love it. That's really fascinating. And the "I-poems" are really powerful. And I think we'll put a link to the Listening Guide reference in the show notes if people are interested in learning more about that technique. You mentioned earlier that this is a longitudinal study that you're undertaking for your dissertation work, which is pretty amazing. I mean, very amazing. And you're, you're two years into this longitudinal study, and this paper we've been talking about is the six to eight week snapshot. What are you most curious about as you continue following those participants over time? And also, what do you want clinicians who are listening today to take away from what you've already found?   Rianne Brinkman: Tomorrow, I'm doing another two sessions. One of them is the last session with somebody with P5 and with another person, P4. I think I am about I'm halfway through. Well, I'm almost, I think I've got another year to go to have collected all the data. And what I see really is that it's very clear that identity formation and reconstructing, renegotiating your identity, is a very long and complex process, and that at different points in time, different things happen. You see different patterns also along those moments in time that I'm doing the sessions. What I also realize, I'm not sure how that is in states, but in the Netherlands, I think communicative access, for example, if you want to start working again, you know, to understand what all the letters you get the process, and that it's very hard. Also in health care. And people are really struggling with that, and get really a lot of stress from this, and that it's very unclear often, and that people feel very uncertain. And I think we've got to realize that we should take a longer role in this. You know, not stop too soon, or just at least keep, well, the finger on the pulse, like we say in Netherlands, just keep following people. I think that's very important. And I also realized that the combination of a narrative approach with visual participatory methods really gives you a lot of information. And I also think the listening skills, to really listen to that story and try to get that story out, that gives you such a powerful connection with somebody. So, every time I see them again, I'm really curious, and they're really happy to share their story again and to show me where they are at that point in time. Yeah, and then I'm working together with colleagues with aphasia also, which is really great because they learn from each other. You know, that's nice.   Katie Strong: I love all of that. And I think maybe one of the things I'd like to reiterate, or we could talk about a little bit more, is that what I think I hear you're saying is we know aphasia is a chronic change to their life and the way they communicate and how they can connect with others, and ultimately how that impacts who they are, as people, or their identity. And our health care systems, I know in the US, we're set up for lots of intervention, or maybe the most that they're going to get, even if it's just a little, early in that phase, and then having them have to navigate that process on their own, as they become farther from having the stroke. And this work showcases their journey along the way. But I just wonder is there something that a clinician who's listening could implement or do with their client, wherever they're seeing them, in the journey? Rianne Brinkman:  I think using creative arts is always a good idea. You could keep it really simple. You could just ask them to bring a special object or to show a photo that they're proud of, or make a collage, or use Legos to build with. So, I think that's a good possibility. And also, I think a peer contact is very important. So do that together with a little group or people that are interested in exploring and sharing their stories. And I think we should realize that it's important to check in. So even if you finish therapy with somebody, then it's a good thing after a few months, to ask how they how they are, and stand still with the process. That's something very important also. Katie Strong: And sometimes harder to do than it would seem, but I think, as you're talking it seems like connecting people with peers and following up. I know here in the states, making  sure they're a part of a support group so that they can have a community to be able to connect with. Rianne Brinkman: Yes, because what I've seen a lot is that after a while, there's that phase of uncertainty, really. You don't know if you can get your work back, maybe in a different form, maybe not. And then there's no therapy anymore. And then how are you going to navigate all that uncertainty? And I think that usually speech therapy has stopped. I think then it's hard, of course, because it's not always doable, but I think it would be a very good moment. So, after eight months to really start up something again and then really discuss the identity of somebody. Really use narrative approaches to help them renegotiate all those dilemmas that they're experiencing. Katie Strong: Yeah, and certainly, I guess you know, advocacy work on big levels to recognize that people should be able to access therapy whenever they feel like they need it. Rianne Brinkman: Yeah, definitely. Katie Strong:  We've got some work to do. I appreciate this conversation, and I just wanted to let the listeners know that Rianne and I have been in conversation since we met at the International Aphasia Rehabilitation Conference in Philadelphia in 2019 and what started as a conversation in a parking lot I might add, has grown into some real research and educational collaboration. And Rianne, together with Sabine Corsten and Bianca Spelker, we have been developing and studying training programs for future SLPs in life storytelling approaches across three countries, so the US, Germany and the Netherlands and Rianne, I was hoping you could tell our listeners a bit about what we're actually building together and what you're learning from that work about what students need most before they walk into the room and try to do this identity centered practice, style of work. Rianne Brinkman: Well, we based it a lot on your work, of course, and the My Story project and Narraktiv from Sabine. So, Katie you started this in the US, and then we thought, "oh, this would be great in the Netherlands and in Germany also." The students first of course, need to be trained in supportive communication techniques, because that's very important for them. I think in the Netherlands, it's maybe a little bit different than in the States and in Germany, because I work with students that are still in their bachelors. So they've had only one year of theory, and they haven't done their training or internship yet. Although some of them have. And then you see a very different student. So, but I've got the students that are really for the first time meeting someone with aphasia, for example. And they're very scared, because they think, "Oh, am I able to adapt my communication and what if somebody's going to cry, or what if that story is really going to touch me?" So, you really need to prepare them with a lot of information about what narrative identity is and also what identity work entails. We also must train on how you can really, truly listen. Active listening skills from that nice paper you wrote with Barbara Shadden on the power of story and taking the PULSE of people with aphasia. Appreciating their uniqueness, And also what we do in the Netherlands is practicing with them how they use visual methods, creative methods, to use in their sessions with the people with aphasia. And then once they start, I always say to them, "Well, at least the first session maybe is very exciting, but you're there, you're listening, you're engaged. That's already means so much to somebody if you do that, if you truly listen." And then after one session, they realize that, and then it goes really nicely.   Katie Strong: There's this that feeling very uncomfortable and not sure where to go. And then being able to let that person with aphasia kind of take you on that journey. Rianne Brinkman: Yeah. That's so nice because it contributes to both, to the person with aphasia who participates, and also to the students and their development. Katie Strong: I strongly believe you can't do identity, story based work without being influenced yourself, by the work   Rianne Brinkman: Yeah, definitely. Katie Strong: Well, before we wrap up, I would be remiss if we didn't talk about some tips or strategies, resources or readings for clinicians who are interested in implementing identity, focused story work into their practice. So, can you share a few things with us? Rianne Brinkman: Definitely. Yeah. When I started this work, I really liked the work of Carol Pound and her colleagues, and that's a book called Beyond Aphasia. It's very interesting theoretically, but also very practical. It really helped me to develop methods for my aphasia group to talk about identity. I really think that's a very good book. And then also the book of Barbara Shadden and her colleagues on Neurogenic Communication Disorders. There are some really practical cases in there, and it's very broad. It's not only about aphasia, but also a different neurogenic disorders. And I what I really like is it's such a nuanced theoretical perspective; they gather lots of theory, but they do that in such a good way. It's a very book. Katie Strong: Yeah, I agree, both Carol Pound and Barbara Shadden's work. It's approachable, but it does have the meat of the theory in it.   Rianne Brinkman: Yeah. So that's helped me a lot. And what I said earlier, the paper you wrote with Barbara on the power of story, I think that's very helpful to better understand what happens when you use narrative interventions, and what kind of interventions there are. And then, of course, the different interventions, like the work of Sabine Corsten on Narraktiv in your work, on My Story. And I have a book but it's only in Dutch. I attempted to share all those methods I created for the group, and it's very practice based. So that's why I started later on my PhD. But those practice-based methods are combined in a book, but it's only in Dutch. Katie Strong: It looks fabulous. I'm not able to access it with my limited language skills, but we'll make sure to have all of those references listed in the show notes so people can explore and take a look around it. And I think you know your book that you're talking about, Rianne even though it is all in Dutch, so maybe not accessible to everyone, but it's got beautiful graphics and photos and things like that you can get an essence of what it is that you're expressing. Rianne Brinkman: It's all, it's all painted or drawn by Reno Hubers. He's a Dutch person with aphasia, and he was in one of my groups. And then every time I was reading about something, he was just drawing it or painting it. And I thought, "Oh, I really need to ask him help me make the images for this book." So, it was together with him that we created this. Katie Strong: Beautiful. And what a great story. Thank you for being here with me today. And I don't know if you have anything else you want to add before we wrap up our conversation. Rianne Brinkman: Well, thank you for inviting me. But also, I want to say thank you to my team, because they really stimulate me to think differently about identity. I've got a very interprofessional team, and that's really helpful. And also, of course, our identity group meetings with you and Sabine and Bianca and Barbara. That's very helpful to shape my thinking on identity. And, of course, the participants of my research who are so open and vulnerable and want to share their stories. I would like to acknowledge that that's very important.   Katie Strong: For sure! We sure appreciate you sharing your experiences with us and look forward to what's to come from the longitudinal study. We wish you well in your studies as well. Thanks Rianne. What strikes me most about this conversation is how Rianne's work reminds us that identity reconstruction isn't a detour from aphasia care — it is aphasia care. And the tools she brings, the collage, the listening guide, the willingness to simply sit and wait, are more accessible than we might think. What began as a chance conversation in a parking lot in Philadelphia in 2019 has grown into something neither of us anticipated. Rianne, together with colleagues Sabine Corsten and Bianca Spelker, and alongside my own work through the Strong Story Lab, we have been developing and studying training programs for future clinicians in life storytelling approaches — across the US, Germany, and the Netherlands. It is the kind of international collaboration that only happens when people are genuinely working toward the same thing. On behalf of Aphasia Access, thank you for listening. For references and resources mentioned in today's show, please see our show notes, available on our website at www.aphasiaaccess.org. There you can also become a member of our organization, browse our growing library of materials, and find out about the Aphasia Access Academy. If you have an idea for a future podcast episode, email us at info@aphasiaaccess.org. For Aphasia Access Conversations, here at Central Michigan University in the Strong Story Lab, I'm Katie Strong.   Resources Brinkman, R. (2018). Bouwen aan identiteit. behandeling van afasie – met 25 werkvormen [Building identity. Breindok. Treatment of aphasia – with 25 methods]. http://refhub.elsevier.com/S0021-9924(26)00012-2/sbref0006  Brinkman, R., Cardol, M., Neijenhuis, K., Luinge, M., & Leget, C. (2026). "Leave the thorn, enjoy the rose" identity formation of people with aphasia in the early rehabilitation phase. Journal of Communication Disorders, 120, 106627. https://doi.org/10.1016/j.jcomdis.2026.106627  Brinkman, R., Neijenhuis, K., Cardol, M., & Leget, C. (2024). Who am I now? A scoping review on identity changes in post-stroke aphasia. Disability and Rehabilitation, 47(5), 1081-1099. https://doi.org/10.1080/09638288.2024.2367606  Gilligan C., & Eddy J. (2017). Listening as a path to psychological discovery: An introduction to the Listening Guide. Perspectives on Medical Education, 6(2),76-81. https://doi.org/10.1007/S40037-017-0335-3  Pound, C., Parr, S., Lindsay, J., & Woolf, C. (2000). Beyond aphasia: Therapies for living with communication disability. Routledge. https://doi.org/10.4324/9781315169057  Shadden, B. B., Hagstrom, F., & Koski, P. R. (2008). Neurogenic communication disorders: Life stories and the narrative self. Plural Publishing. https://www.pluralpublishing.com/publications/neurogenic-communication-disorders-life-stories-and-the-narrative-self  Strong, K. A., & Shadden, B. B. (2020). The power of story in identity renegotiation: Clinical approaches to supporting persons living with aphasia. Perspectives of the ASHA Special Interest Groups, 5(2), 371-383. https://doi.org/10.1044/2019_PERSP-19-00145   

Lenkijos valdžios veiksmai siekiant atpiginti degalus davė akivaizdų rezultatą. Sumažintas akcizas ir pridėtinės vertės mokestis, įvestos kuro kainos ribos ir už pažeidimus gresiančios didelės baudos, gerokai atpigino degalus kaimyninėje šalyje.Estijoje vėl buvo paskelbtas oro pavojus. Pranešama, kad keli dronai naktį įskrido į Estijos oro erdvę. Perspėjimus šiąnakt gavo ir prie Rusijos sienos gyvenantys Latvijos gyventojai. Tikėtina, kad Baltijos šalių oro erdvę pažeidė nuo kurso nuklydę Ukrainos dronai. Ukraina jau daugiau kaip savaitę atakuoja Rusijos Leningrado sritį ir netoli Estijos ęsantį Ust Lugos uostą.Nepavykstant atverti Hormūzo sąsiausrio, Amerikos prezidentas Donaldas Trampas lieja pyktį ant sąjungininkų. Kartu jis pareiškė, kad šalys kurioms reikia per sąsiaurį plukdomos naftos, pačios turi jį ir atverti.Artėjant parlamento rinkimams Vengrijoje, šalyje toliau tęsiasi audringa rinkimų kampanija. Pagrindinės politinės partijos rinkėjus bando pasiekti įvairiausiais būdais, įskaitant ir plakatus Vengrijos gatvėse. Šalies aktyvistams, pasisakantiems prieš Viktorą Orbaną, plakatai tapo ir kovos su valdančiaisiais lauku.Ved. A. Kavaliauskas

Praėjusi savaitė Alytaus ugniagesiams gelbėtojams buvo itin intensyvi. Kaip informavo Alytaus priešgaisrinės gelbėjimo tarnybos vyriausiasis specialistas Aidas Pileckas, per savaitę mieste ir rajone kilo net 11 gaisrų.

Vilniaus ir Lietuvos stačiatikių vyskupija išlieka priklausoma nuo Maskvos patriarchato, teigiama grėsmių nacionaliniam saugumui vertinimo ataskaitoje. Valstybės saugumo departamento ir Antrojo operatyvinių tarnybų departamento parengtame dokumente nurodoma, kad stačiatikių bažnyčia užima reikšmingą vietą formuojant ir palaikant Rusijos režimo ideologinius naratyvus.Grėsmių nacionaliniam saugumui vertinime taip pat konstatuota, kad priešiškos žvalgybos taikosi ir į Lietuvos nepilnamečiu: Valstybės saugumo departamentas fiksuoja vaikų verbavimo atvejus socialiniuose tinkuose, kai nepilnamečiai įtraukiami į neonacių judėjimus.Lietuvoje įsteigtos įmonės naudojamos siekiant apeiti tarptautines sankcijas bei vystyti ir perimti aukštąsias technologijas, teigiama metiniame grėsmių Lietuvos nacionaliniam saugumui vertinime. Paminėtos bendrovės „BK Software“, „NTLab“ ir „Kosminis Vytis“. Vienas Rusijos pilietis, įsteigęs įmonę Lietuvoje ir jai vadovavęs, su partneriais tiekė programinę įrangą Rusijos nepilotuojamų orlaivių „Orlan“ gamybai. Lietuvoje ilgai gyvenęs ir čia verslą įkūręs Kirilas Lupandinas jau seniau buvo patekęs į Saugumo akiratį, tačiau grėsme nacionalinam saugumui pripažintas visai neseniai. Plačiau apie tai Marius Jokūbaitis.Ukraina kaltina Vengriją paėmus įkaitais Ukrainos banko darbuotojus, kurie gabeno keturias dešimtis milijonų dolerių ir devynis kilogramus aukso.Ved. Edvinas Kučinskas

Karas Artimuosiuose Rytuose plečiasi. Atakuojamos Amerikos karinės bazės Persijos įlankos regione. Izraelis sudavė smūgį Libanui, o Irano dronas pataikė į britų karinės bazės teritoriją Kipre.Konfliktas Artimuosiuose Rytuose paralyžiavo naftos tiekimą vienoje svarbiausių pasaulio transporto arterijų – Hormūzo sąsiauryje. Perspėjama, kad konfliktui užsitęsus, naftos kaina gali smarkiai pakilti.Kipro lietuvių bendruomenės pirmininkė sako, kad turistai jau atšaukinėja keliones į Kiprą.Nors prognozuojamas potvynis dar neprasidėjo, specialistai teigia, kad tikėtis, jog jo pavyks išvengti dar tikrai negalima. Nacionalinio krizių valdymo centro ir atsakingų institucijų atstovai pasiruošimą potvyniui aptarė su Vakarų Lietuvos savivaldybių atstovais.Traukiantis žiemai keliuose atsiveria duobės. Vairuotojai piktinasi dėl patirtų nuostolių, o kelininkai teigia, kad dėl itin šaltos žiemos duobių daugiau, nei įprastai.Sensacingai Islandijai pralaimėjusi Lietuvos krepšinio rinktinė, netrukus Klaipėdoje sieks revanšo.Ved. Andrius Kavaliauskas

Lietuvos hidrometeorologijos tarnybos duomenimis, ankstesniais laikais potvyniai būdavo įprasta situacija artėjant pavasariui. Visgi, šią žiemą gausiai prisnigus, potvynis gali būti didesnis, todėl svarbu jam pasiruošti iš anksto. Valstybinės maisto ir veterinarijos tarnybos atstovai įvardija, kad dažniausia klaida potvynio metu – likimo valiai palikti gyvūnai.Širvintų rajone 500 ha augalininkystės ūkį puoselėjantis ūkininkas Donatas Ručinskas tikina, kad dirba ne dėl apdovanojimų ar įvertinimų, didžiausia motyvacija dabar yra bankiniai įsipareigojimai. Ateityje vyras ketina mažinti ūkį.Rubrika „Užsienio naujienos“. Domėsimės, kokios ekologiškų produktų naujovės buvo pristatytos parodoje BIOFACH 2026, vykusioje Vokietijoje.Ved. Rūta Simanavičienė

Guests: Chelsie Esek-Onyeahialam, MS, CCC-SLP, and Jordyn R. Montique, MS, CCC-SLPEarn 0.10 ASHA CEUs for this episode with Speech Therapy PD: www.speechtherapypd.com/courses/blackslpmagic-part-2FREE Black History Month Conference: www.speechtherapypd.com/courses/culture-care-knowledgeThis course meets ASHA's Content Area 2 PD requirement for providing culturally responsive services and effective self-reflection, adaptability, and collaborative practice.In this episode of First Bite, Michelle Dawson, MS, CCC-SLP, CLC, BCS-S, continues the conversation with Chelsie Esek-Onyeahialam, MS, CCC-SLP, and Jordyn R. Montique, MS, CCC-SLP, founders of #BlackSLPMagic. Part 2 shifts from awareness to action, focusing on practical ways to advance diversity, equity, and inclusion within the field of speech-language pathology.Together, Michelle, Chelsie, and Jordyn examine systemic barriers that continue to impact BIPOC professionals and discuss evidence-based strategies for creating more welcoming, supportive, and inclusive professional environments. The conversation centers on reducing obstacles to professional growth, increasing representation, and strengthening meaningful connections across the SLP community.Listeners will gain concrete tools for advocacy, professional networking, and allyship, along with actionable steps they can take within their own workplaces, organizations, and professional circles. Chelsie and Jordyn share grounded insights on how intentional actions, not just intentions, can help shift culture and create lasting change.Whether you identify as an ally, advocate, or leader in speech-language pathology, this session offers practical strategies to move beyond awareness and toward meaningful action, supporting a profession where all voices are valued and reflected in the communities we serve.Show Notes: Contact Chelsie: @esekhealth on InstagramContact Jordyn: @jrc_theslp on InstagramBlack SLP Magic: @blackslp magic on Instagram, www.blackslpmagic.orgDonate to Black SLP Magic: ko-fi.com/blackslpmagicslpsocialseenSLP Social Scene: @slpsocialseen on InstagramProfessional Identity in Speech-Language Pathology Students: pubs.asha.org/doi/abs/10.1044/2024_PERSP-24-00043Cultural Competence Check-ins: www.asha.org/practice/multicultural/self/Cultural Responsiveness: www.asha.org/practice-portal/professional-issues/cultural-responsiveness/Bias, Appraisal Tools, and Levels of Evidence: www.asha.org/research/ebp/bias-appraisal-tools-and-levels-of-evidence/Related Courses:#BlackSLPMagic Paving the Way for the Future

Netrukus apie priverstines atostogas. Ar gali darbdavys versti darbuotoją išeiti atostogų?Dar kartą atkreipsime dėmesį į sukčių veikimą - laukdami, kol gyventojų sąskaitas pasieks atsiimtos antrosios pensijų pakopos lėšos, sukčiai rengiasi apgavystėms - ieško lietuviškai kalbančių darbuotojų apgaulingiems skambučiams, nes rusų kalba žmones apgauti vis sunkiau.Po pusės aštuntos žinių - „Aktualus klausimas”. Šįkart panagrinėsime LRT užsakymu atliktą apklausą, kuri parodė, kad per praėjusius metus pablogėjo daugiau nei pusės šalies gyventojų nuomonė apie prezidentą Gitaną Nausėdą.„Aukso amžiuje” kolegė Irma Janauskaitė pasidomės, ar gyventojai jau sulaukė pirmųjų sąskaitų už šildymą sausio mėnesį. Rinkos reguliuotojas perspėja, kad tikrai nenudžiugins.Šiandien minima Pasaulinė kovos su vėžiu diena. Ir kaip tik šiomis dienomis krūties vėžiu sergančios pacientės skundžiasi, kad Lietuvoje trūksta vaistų, skirtų hormoninei terapijai po krūties vėžio gydymo.O vis labiau artėjant olimpinėms žaidynėms, šiandien pasakojimas apie biatlonininką Maksimą Fominą.Ved. Liuda Kudinova

Lietuvą užklupus lijundrai, tarnybų perspėjimas: sudėtingos oro sąlygos išliks ir šiandien, ir rytoj. Kai kur žadamas ir gausesnis sniegas.Prezidentas sušaukė Valstybės gynybos tarybą. Aptariama saugumo situacija, žvalgybos ir nacionalinio saugumo strategijos.Ateinantį ketvirtadienį Prancūzijos teismas nagrinės žlugusio banko „Snoras“ akcininko, Rusijos piliečio Vladimiro Antonovo ekstradicijos į Lietuvą bylą. Antonovas buvo sučiuptas dar gruodžio 9 dieną Prancūzijoje pagal Lietuvos išduotą Europos arešto orderį. Teisininkai sako, kad procesas gali ir užtrukti. Sugrąžintas Vladimiras Antonovas gali įkvėpti ir politikus vėl kalbėti apie „Snoro“ nacionalizavimo aplinkybes.Bulgarijai prisijungus prie eurozonos, šalyje fiksuojamas padirbtų pinigų antplūdis. Atsiskaityti bandoma ir žaidimams skirtomis eurų kupiūromis.Ved. Andrius Kavaliauskas

Alytaus priešgaisrinės gelbėjimo tarnybos specialisto Aido Pilecko apžvalga, kurioje aptariama situacija metų sandūroje bei pagrindinės saugumo gairės žiemą.

In this episode of SLP Coffee Talk, Hallie sits down with Kylie Helm — school SLP, private practice owner, and PhD student who's doing the research we all desperately need. Kylie shares how growing up low-SES herself and then working in a Title I school opened her eyes to the massive disconnect between what grad school teaches us and what these kids actually need. She gets real about the dangerous assumptions SLPs make (spoiler: poverty ≠ language disorder), why standardized vocabulary tests are basically useless for this population, and how syntax is actually the diagnostic hero we've been ignoring. If you've ever felt pressured to qualify a student just because they're from a low-income family or wondered how to write a report that says “they bombed the test but don't need services,” this conversation is packed with research-backed truth bombs and practical ways to do better.Bullet Points to Discuss: The myth that every low-SES kid has “bad language” and automatically needs servicesWhy we need to stop using vocabulary scores as our diagnostic smoking gunLanguage samples and test-teach-retest: where the real answers actually liveHow to tell teachers the difference between functional communication gaps and academic language concernsWhen low vocabulary + low syntax = actual red flag vs. just environmental differenceHere's what we learned: Stop assuming multilingual + immigrant + low-SES + busy parents = needs speech therapy.Syntax is ability-based, vocabulary is environment-based—that changes everything about diagnosis.Dynamic assessment (test-teach-retest) shows learning ability, not just current knowledge.Strong syntax + weak vocabulary? Probably environmental. Weak syntax + weak vocabulary? Now we're concerned.Teachers need to step outside their comfort zone too—it's not all on us to adapt.​​​​​​​​​​​​​​​​Learn more about Kylie Helm:  Instagram: https://www.instagram.com/kylietheslpStudy: https://pubs.asha.org/doi/abs/10.1044/2024_PERSP-23-00299 Developing Cross-Cultural CompetenceLearn more about Hallie Sherman and SLP Elevate:  

Diane Mizrachi is the Jewish and Israeli Studies Librarian at UCLA. She discusses her work on the Academic Reading Format International Study and the discovery of Nazi-looted books in the UCLA Library. SHOW NOTES: Shoham, Snunith, and Diane Mizrachi. "Library anxiety among undergraduates: A study of Israeli B. Ed students." The journal of academic librarianship 27, no. 4 (2001): 305-311. Mizrachi, Diane, Alicia M. Salaz, Serap Kurbanoglu, Joumana Boustany, and ARFIS Research Group. "Academic reading format preferences and behaviors among university students worldwide: A comparative survey analysis." PloS one 13, no. 5 (2018): e0197444. Mizrachi, Diane, and Alicia M. Salaz. "Reading format attitudes in the time of COVID." The Journal of Academic Librarianship 48, no. 4 (2022): 102552. Mizrachi, Diane, and Michal Bušek. "Discovery and recovery: Uncovering Nazi looted books in the UCLA library and repatriation efforts." College & Research Libraries 84, no. 6 (2023): 920. Mizrachi, Diane. "Digitized Collections and Provenance Issues: Who Owns What?." In Digital Libraries Across Continents, pp. 209-230. Routledge. (chapter in book edited by Alicia & Le Yang) Research Notes: Michael Stern is an associate professor of German and Scandinavian at the University of Oregon. He talks about his new book "Thinking Nietzsche with Africana Thought: Towards an Alluvial Poetic of Worlding." SHOW NOTES: Ifi Amadiume: "Male Daughters Female Husbands" ‘'''''''''''''''''''''''': "Reinventing Africa: Matriarchy, Religion, and Culture" Oyeronke Oyewumi: "The Invention of Women" Fabienne Eboussi Boulaga: "Muntu in Crisis: African Authenticity and Philosophy" Friedrich Nietzsche: “On Truth and Lies in an Extra Moral Sense” Oregon Humanities Center: https://ohc.uoregon.edu Undergraduate Perspectives: Emma Kersgaard talks about her experience as a Humanities Undergraduate Archival Fellow.

In this episode you will discover: Diversity Means Everyone - Race is just one piece. Consider how age, language, immigration status, religion, sexual orientation, and geography intersect to shape each person's experience with aphasia. Go Into the Community to Build Trust - Sustainable partnerships require leaving your institution and showing up consistently. Visit centers, share meals, and invest time where people gather. Trust develops gradually through authentic presence. Listen to Real-Life Struggles First - Before starting therapy protocols, hear what families actually face: shifted gender roles, children as language brokers, lack of community aphasia awareness, and disrupted family dynamics. Train Future Clinicians Differently - If you're building or revising academic programs, front-load diversity with a foundational intersectionality course in semester one, then integrate these principles across every subsequent course and clinical practicum.   If you've ever wondered how to better support multilingual families navigating aphasia, or felt uncertain about cultural considerations in your practice, this conversation will give you both the framework and the practical insights you need. Welcome to the Aphasia Access Aphasia Conversations Podcast. I'm Katie Strong, a faculty member at Central Michigan University where I lead the Strong Story Lab, and I'm a member of the Aphasia Access Podcast Working Group. Aphasia Access strives to provide members with information, inspiration, and ideas that support their aphasia care through a variety of educational materials and resources.   I'm today's host for an episode that tackles one of the most important conversations happening in our field right now - how do we truly serve the increasingly diverse communities that need aphasia care? We're featuring Dr. Jose Centeno, whose work is reshaping how we think about equity, social justice, and what it really means to expand our diversity umbrella. Dr. Centeno isn't just talking about these issues from an ivory tower - he's in the trenches, working directly with communities and training the next generation of clinicians to do better. Before we get into the conversation, let me tell you a bit more about our guest. Dr. Jose Centeno is Professor in the Speech-Language Pathology Program at Rutgers University. What makes his work unique is how he bridges the worlds of clinical practice and research, focusing on an often overlooked intersection: what happens when stroke survivors who speak multiple languages need aphasia care?   Dr. Centeno is currently exploring a critical question - what barriers do Latinx families face when caring for loved ones with post-stroke aphasia, and what actually helps them navigate daily life? His newest initiative takes this work directly into the community, where he's training students to bring brain health activities to underserved older adults in Newark's community centers.   As an ASHA Fellow and frequent international speaker, Dr. Centeno has made it his mission to ensure that aphasia research and care truly serve diverse communities. His extensive work on professional committees reflects his commitment to making the field more inclusive and culturally responsive. So let's get into the conversation.   Katie Strong: As we get started, I love hearing about how you came into doing this work, and I know when we spoke earlier you started out studying verb usage after stroke and very impairment-based sort of way of coming about things. And now you're doing such different work with that centers around equity and minoritized populations. I was hoping you could tell our listeners about the journey and what sparked that shift for you.   Jose Centeno: That's a great question. In fact, I very often start my presentations at conferences, explaining to people, explaining to the audience, how I got to where I am right now, because I did my doctoral work focused on verb morphology, because it was very interesting. It is an area that I found very, very interesting. But then I realized that the data that I collected for my doctorate, and led to different articles, was connected to social linguistics. I took several linguistics courses in the linguistics department for my doctorate, and I needed to look at the results of my doctoral work in terms of sociolinguistic theory and cognition. And that really motivated me to look at more at discourse and how the way that we talk can have an impact on that post stroke language use. So, I kept writing my papers based on my doctoral data, and I became interested in finding out how our colleagues working with adults with aphasia that are bilingual, were digesting all this literature. I thought, wait a minute. Anyway, I'm writing about theory in verb morphology, I wonder where the gaps are. What do people need? Are people reading this type of work? And I started searching the literature, and I found very little in terms of assessing strengths and limitations of clinical work with people with aphasia.   And what I found out is that our colleagues in childhood bilingualism have been doing that work. They have been doing a lot of great work trying to find out what the needs are when you work with bilingual children in educational settings. So that research served as my foundational literature to create my work. And then I adopted that to identifying where the strengths and needs working with people by new people with aphasia were by using that type of work that worked from bilingual children. And I adapted it, and I got some money to do some pilot work at the from the former school where I was. And with that money I recruited some friends that were doing research with bilingual aphasia to help me create this survey. So that led to several papers and very interesting data.   And the turning point that I always share, and I highlight was an editorial comment that I got when I when I submitted, I think, the third or fourth paper based on the survey research that I did. The assessment research. And one of the reviewers said, “you should take a look at the public health literature more in depth to explain what's going on in terms of the needs in the bilingual population with aphasia”. So, I started looking at that and that opened up a huge area of interest.   Katie Strong: I love that.   Jose Centeno: Yeah, that's where I ended up, you know, from an editorial comment based on the studies of survey research. And that comment motivated me to see what the gaps were more in depth. And that was in 2015 when that paper came out. I kept working, and that data led to some special issues that I invited colleagues from different parts of the world to contribute. And then three years later, Rutgers invited me to apply for this position to start a diversity focused program at Rutgers, speech language pathology. At Rutgers I met a woman that has been my mentor in qualitative research. Pamela Rothpletz-Puglia is in nutrition, and she does qualitative, mixed methods research. So, her work combined with my interest in identifying where the needs were, led me to identify the needs in the work with people with aphasia through the caregivers using her methodology. And I'll come talk more about it, because it's related to a lot of different projects that I am pursuing right now.   Katie Strong: I love this. So, it sounds like, well, one you got a really positive experience from a reviewer, which is great news.   Jose Centeno: Well, it was! It's a good thing that you say that because when we submit articles, you get a mixed bag of reviews sometimes. But, this person was very encouraging. And some of the other reviews were not as encouraging, but this was very encouraging, and I was able to work on that article in such a way that got published and it has been cited quite a bit, and it's, I think it's the only one that has pretty much collected very in depth data in terms of this area.   Katie Strong: Yeah, well, it sounds like that really widened your lens in how you were viewing things and taking an approach to thinking about the information that you had obtained.   Jose Centeno: And it led to looking at the public health literature and actually meeting Pamela. In fact, I just saw her last week, and we met because we're collaborating on different projects. I always thank her because we met, when our Dean created an Equity Committee and she invited the two of us and somebody else to be to run that committee. And when Pamela and I talked, I said to her, “that qualitative work that you are doing can be adapted to my people with aphasia and their caregivers”. And that's how we collaborated, we put a grant proposal together, we got the money, and that led to the current study.   Katie Strong: I love that, which we're going to talk about in a little bit. Okay, thank you. Yeah, I love it. Okay, well, before we get into that, you know, one of the things I was hoping you could talk about are the demographics of people living with aphasia is becoming really increasingly more diverse. And I was hoping you could talk about population trends that are driving the change or challenges and opportunities that this presents for our field.   Jose Centeno: Yeah, that is actually something that I've been very interested in after looking at the public health literature because that led to looking at the literature in cardiology, nursing, social work, psychology, in terms of diversity, particularly the census data that people in public health were using to discuss what was going on in terms of the impact of population trends in healthcare. And I realized when I started looking at those numbers that and interestingly, the Census published later. The Census was published in 2020, several years after I started digging into the public health literature. The Census published this fantastic report where they the Census Bureau, discussed how population trends were going to be very critical in 2030 in the country. In 2030 two population trends are going to merge. The country gradually has been getting older and at the same time in 2030 as the country is getting older, 2030 is going to be a turning point that demographic transition, when the population is going to be more older people than younger people. So that's why those population trends are very important for us because people are getting older, there is higher incidence for vulnerabilities, health complications. And of those health complications, neurological, cardiovascular problems, stroke and also dementia.   Katie Strong: Yes. So interesting. And maybe we can link, after we finish the conversation, I'll see if I can get the link for that 2020 census report, because I think maybe some people might be interested in checking that out a little bit more.   Jose Centeno: So yeah, definitely, yeah.   Katie Strong: Well, you know, you've talked about diversity from a multilingual, bilingual perspective, but you also, in your research, the articles I've read, you talk about expanding the diversity umbrella beyond race to consider things like sexual orientation, socioeconomic background and rural populations. Can you talk to us a little bit about what made you think about diversity in this way?   Jose Centeno: Very good question, you know, because I realized that there is more to all of us than race. When we see a client, a patient, whatever term people use in healthcare and we start working with that person there is more that person brings into the clinical setting, beyond the persons being white or African American or Chinese or Latino and Latina or whatever. All those different ethnic categories, race and ethnicity. People bring their race and ethnicity into the clinical setting, but beyond that, there is age, there is sexual orientation, there is religion, there is geographic origins, whether it's rural versus urban, there is immigration status, language barriers, all of those things. So, it makes me think, and at that time when I'm thinking about this beyond race, I'm collecting the pilot data, and a lot of the pilot data that was collected from caregivers were highlighting all of those issues that beyond race, there are many other issues. And of course, you know, our colleagues in in aphasia research have touched on some of those issues, but I think there hasn't been there. There's been emphasis on those issues but separately. There hasn't been too much emphasis in looking at all of those issues overlapping for patient-centered care, you know,  bringing all those issues together and how they have an impact on that post stroke life reconfiguration. You know, when somebody is gay. Where somebody is gay, Catholic, immigrant, bilingual, you know, looking at all of those things you know. And how do we work with that? Of course, we're not experts in everything, and that leads to interprofessional collaborations, working with psychologists, social workers and so on.   So that's why my work started evolving in the direction that looks at race in a very intersectional, very interactional way to look at race interacting with all these other factors. Because for instance, I am an immigrant, but I also lived in rural and urban environments, and I have my religious and my spiritual thoughts and all of those, all of those factors I carry with me everywhere you know. So, when somebody has a stroke and has aphasia, how we can promote, facilitate recovery and work with the family in such a way that we pay attention to this ecology of factors, family person to make it all function instead of being isolated.   Katie Strong: Yeah, I love that. As you were talking, you use the term intersectionality. And you have a beautiful paper that talks about transformative intersectional Life Participation Approach for Aphasia (LPAA) intervention. And I'd love to talk about the paper, but I was hoping first you could tell us what you really mean by intersectionality in the context of aphasia care, and why is it so important to think about this framework.   Jose Centeno: Wow. It's related to looking at these factors to really work with the person with aphasia and the family, looking at all these different factors that the person with aphasia brings into the clinical setting. And these factors are part of the person's life history. It's not like these are factors that just showed up in the person's life. This person has lived like this. And all of a sudden, the person has a stroke. So there is another dimension that we need to add that there in that intersectional combined profile of a person's background. How we can for aphasia, is particularly interesting, because when you work with diverse populations, and that includes all of us. You know, because I need to highlight that sometimes people…my impression is, and I noticed this from the answers from my students, that when I asked about diversity, that they focused on minoritized populations. But in fact, all this diverse society in which we live is all of us. Diversity means all of us sharing this part, you know, sharing this world. So, this intersectionality applies to all of us, but when it comes to underrepresented groups that haven't been studied or researched, that's why I feel that it's very important to pay a lot of attention, because applying models that have been developed to work with monolingual, middle class Anglo background…it just doesn't work. You know, to apply this norm to somebody that has all of these different dimensions, it's just unfair to the person and it's something that people have to be aware of. Yeah.   Katie Strong: Yeah. And I think you know, as you're talking about that and thinking about the tenets of the Life Participation Approach, they really do support one another in thinking about people as individuals and supporting them in what their goals are and including their family. You're really thinking about this kind of energized in a way to help some clinicians who are maybe thinking, “Oh, I do, LPAA, but it's hard for me to do it in this way”. You probably are already on you road to doing this, but you really need, just need to be thinking about how, how the diversity umbrella, really, you know, impacts everybody as a clinician, as a person with a stroke, as a family member.   Jose Centeno: Yeah, and, you know, what is very interesting is that COVID was a time of transition. A lot of factors were highlighted, in terms of diversity, in terms of the infection rate and the mortality was higher in individuals from minoritized backgrounds. There were a lot of issues to look at there. But you know, what's very interesting in 2020 COVID was focusing our attention on taking care of each other, taking care of ourselves, taking care of our families. The LPAA approach turned 20 years old. And that made me think, because I was thinking of at that time of disability, and it made me think of intersectionality. And I just thought it would be very helpful for us to connect this concept of intersectionality to the LPAA, because these issues that we are experiencing right now are very related to the work we do as therapists to facilitate people with aphasia, social reconnection after a stroke and life reconfiguration. So, all of this thinking happened, motivated by COVID, because people were talking about intersectionality, all the people that were getting sick. And I just thought, wait a minute, this concept of intersectionality, LPAA turning 20 years old, let's connect those two, because my caregiver study is showing me that that intersectionality is needed in the work that we're doing with people in aphasia from underrepresented backgrounds.   Katie Strong: Yeah, I'm so glad that you shared that insight as to how you came to pulling the concepts together. And the paper is lovely, and I'll make sure that we put that in the link to the show notes as well, because I know that people will, if they haven't had the chance to take a look at it, will enjoy reading it.   Jose Centeno: And just let me add a bit more about that. Aura Kagan's paper on, I forgot where it was in [ASHA] Perspectives, or one of the journals where she talks about the LPAA turning 20 years old. [And I thought], “But wait a minute, here's the paper! Here's the paper, and that I can connect with intersectionality”. And at the same time, you know, I started reading more about your work and Jackie Hinckley's work and all the discourse work and narrative work because that's what I was doing at the time. So that's how several projects have emerged from that paper that I can share later on.   Katie Strong: I love it. I love it. Yeah, hold on! The suspense! We are there, right?   Jose Centeno: This is turning into a coffee chat without coffee!   Katie Strong: As I was reading your work, something that stood out to me was this idea of building sustainable community relationships in both research and clinical work with minoritized populations. You've been really successful in doing this. I was hoping you could discuss your experiences in this relationship building, and you also talk about this idea of cultural brokers.   Jose Centeno: Wow! You know this is all connected. It's part of my evolution, my journey. Because as I started collecting data in the community from for my caregiver study, I realized that community engagement to do this type of qualitative work, but also to bring our students into the community. It's very important to do that work, because I you know this is something that I learned because I was pretty much functioning within an academic and research environment and writing about equity and social justice and all these different areas regarding aphasia, but not connecting real life situations with the community. For example, like having the students there and me as an academician taking that hat off and going into the community, to have lunch, to have coffee with people in the community, at Community Centers. So those ideas came up from starting to talk with the caregivers, because I felt like I needed to be there more. Leave the classroom. Leave the institution. Where I was in the community it's not easy. I'm not going to say that happened overnight, because going into any community, going into any social context, requires time. People don't open their doors automatically and right away. You know you have to be there frequently. Talk about yourself, share experiences. So be a friend, be a partner, be a collaborator, be all of these things together, and this gradually evolved to what I am doing right now, which is I started the one particular connection in the community with a community center.   How did I do that? Well, I went all over the place by myself. Health fairs, churches, community centers. People were friendly, but there wasn't something happening in terms of a connection. But one person returned my email and said, “we have a senior program here. Why don't we meet and talk?” So, I went over to talk with them, and since then, I have already created a course to bring the students there. I started by going there frequently for lunch, and I feel very comfortable. It is a community center that has programs for children and adults in the community. They go there for computer classes, for after school programs for the children. The adults go there for English lessons or activities and they have games and so on. And it's very focused on individuals from the community. And the community in Newark is very diverse. Very diverse.   So that led to this fantastic relationship and partnership with the community. In fact, I feel like I'm going home there because I have lunch with them. There's hugs and kissed. It's like  seeing friends that that you've known for a long time. But that happened gradually. Trust. Trust happens gradually, and it happens in any social context. So, I said to them, “Let's start slowly. I'll bring the students first to an orientation so they get to know the center.” Then I had the opportunity to develop a course for summer. And I developed a course that involved activities in the community center and a lecture. Six weeks in the summer. So this project now that I call Brain Health a health program for older adults, is a multi-ethnic, multilingual program in which the students start by going to the center first in the spring, getting to know people there, going back there for six weeks in the summer, one morning a week, and taking a lecture related to what brain health is, and focusing that program on cognitive stimulation using reminiscence therapy. And it's done multilingually. How did that happen? Thank God at the center there are people that speak Portuguese, Spanish and English. And those people were my interpreters. They work with the students. They all got guidelines. They got the theoretical content from the lectures, and we just finished the first season that I called it. That course they ran this July, August, and the students loved it, and the community members loved it! But it was a lot of work.   Katie Strong: Yeah, of course! What a beautiful experience for everybody, and also ideas for like, how those current students who will be soon to be clinicians, thinking about how they can engage with their communities.    Jose Centeno: Right! Thank you for highlighting that, because that's exactly how I focus the course. It wasn't a clinical course, it was a prevention course, okay? And part of our professional standards is prevention of communication disorders. So, we are there doing cognitive stimulation through reminiscence activities multilingually, so we didn't leave anybody behind. And luckily, we have people that spoke those languages there that could help us translate. And my dream now the next step is to turn that Brain Health course into another course that involves people with aphasia.   Katie Strong: Oh, lovely.   Jose Centeno: Yeah, so that is being planned as we speak.   Katie Strong: I love everything about this. I love it! I know you just finished the course but I hope you have plans to write it up so that others can learn from your expertise.   Jose Centeno: Yeah, I'm already thinking about that.   Katie Strong: I don't want to put more work on you…   Jose Centeno: It's already in my attention. I might knock on your door too. We're gonna talk about that later.   Katie Strong: Let's get into the work about your caregivers and the work that you did. Why don't you tell us what that was all about.   Jose Centeno: Well, it's a study that focuses on my interest in finding out and this came from the assessment work that I did earlier when I asked clinicians working in healthcare what their areas of need were. But after meeting Pamela Rothpletz-Puglia at Rutgers, I thought, “Wait a minute, I would like to find out, from the caregivers perspective, what the challenges are, what they need, what's good, what's working, and what's not working.” And later on hopefully, with some money, some grant, I can involve people with aphasia to also ask them for their needs. So, I started with the caregivers to find out in terms of the intersectionality of social determinants of health, where the challenges were in terms of living with somebody with aphasia from a Latinx background, Latino Latina, Latinx, whatever categories or labels people use these days. So, I wanted to see what this intersectionality of social determinants of health at the individual level. Living with the person at home, what happens? You know, this person, there is a disability there, but there are other things going on at home that the literature sites as being gender, religion, and all these different things happening. But from the perspective of the caregivers. And also I wanted to find out when the person goes into the community, what happens when the person with aphasia goes into the community when the person tries to go to the post office or the bank or buy groceries, what happens? Or when the person is socializing with other members of the family and goes out to family gatherings? And also, what happens at the medical appointment, the higher level of social determinants in terms of health care? I wanted to find out individual, community and health care. The questions that I asked during these interviews were; what are the challenges?, what's good?, what's working?, what's not working?, at home?, in the community?, and when you go with your spouse or your grandfather or whoever that has a stroke into the medical setting?, and that's what the interviews were about.   I learned so much, and I learned the technique from reading your literature and reading Aura Kagen's literature and other people, Jackie Hindley literature, and also Pamela's help to how to conduct those interviews, because it's a skill that you have to learn. It happens gradually. Pamela mentored me, and I learned so much from the caregivers that opened all these areas of work to go into the community, to engage community and sustainable relationships and bring the students into the community.   I learned so much and some of the things that were raised that I am already writing the pilot data up. Hopefully that paper will be out next year. All these issues such as gender shifting, I would say gender issues, because whether is the wife or the mother that had a stroke or the father that had the stroke. Their life roles before the stroke get shifted around because person has to take over, and how the children react to that. I learned so much in terms of gender, but also in terms of how people use their religions for support and resilience. Family support. I learned about the impact of not knowing the language, and the impact of not having interpreters, and the impact of not having literature in the language to understand what aphasia is or to understand what happens after stroke in general to somebody.   And something also that was very important. There are different factors that emerge from the data is the role of language brokers, young people in college that have to put their lives on hold when mom or dad have a stroke and those two parents don't speak English well in such a way that they can manage a health care appointment. So, this college student has to give up their life or some time, to take care of mom or dad at home, because they have to go to appointments. They have to go into the community, and I had two young people, college age, talk to me about that, and that had such an impact on me, because I wasn't aware of it at all. I was aware of other issues, but not the impact on us language brokers. And in terms of cultural brokers, it is these young people, or somebody that is fluent in the language can be language brokers and cultural brokers at the same time, because in the Latinx community, the family is, is everything. It's not very different from a lot of other cultures, but telling somebody when, when somebody goes into a hospital and telling family members, or whoever was there from the family to leave the room, creates a lot of stress.   I had somebody tell me that they couldn't understand her husband when he was by himself in the appointment, and she was asked to step out, and he got frustrated. He couldn't talk. So that tension, the way that the person explained that to me is something that we regularly don't know unless we actually explore that through this type of interview. So anyway, this this kind of work has opened up so many different factors to look at to create this environment, clinical environment, with all professions, social work, psychology and whoever else we need to promote the best care for patient-centered care that we can.   Katie Strong: Yeah. It's beautiful work. And if I remember correctly, during the interviews, you were using some personal narratives or stories to be able to learn from the care partners. And I know you know, stories are certainly something you and I share a passion about. And I was just wondering if you could talk with our listeners about how stories from people with aphasia or their care partners families can help us better understand and serve diverse communities.   Jose Centeno: You know, the factors that I just went through, they are areas that we need to pay attention to that usually we don't know. Because very often, the information that we collect during the clinical intake do not consider those areas. We never talk about family dynamics. How did the stroke impact family dynamics? How does aphasia impact family dynamics? Those types of questions are important, and I'll tell you why that's important. Because when the person comes to the session with us, sometimes the language might not be the focus. They are so stressed because they cannot connect with their children as before, as prior to the stroke. In their minds, there is a there are distracted when they come into the session, because they might not want to focus on that vocabulary or sentence or picture. They want to talk about what's going on at home.   Katie Strong: Something real.   Jose Centeno: And taking some time to listen to the person to find out, “Okay, how was your day? How what's going on at home prior?” So I started thinking brainstorming, because I haven't gotten to that stage yet. Is how we can create, using this data, some kind of clinical context where there is like an ice breaker before the therapies, to find out how the person was, what happened in the last three days, before coming back to the session and then going into that and attempting to go into those issues. You know, home, the community. Because something else that I forgot to mention when I was going through the factors that were highlighted during the interviews, is the lack of awareness about aphasia in the community. And the expectations that several caregivers highlighted, the fact that people expected that problem that the difficulty with language to be something that was temporary.   Katie Strong: Yeah, not a chronic health condition.   Jose Centeno: Exactly. And, in fact, the caregivers have turned into educators, who when they go into community based on their own research, googling what aphasia is and how people in aphasia, what the struggles are. They had started educating the community and their family members, because the same thing that happens in the community can happen within the family network that are not living with this person on a day-to-day basis. So, yeah. All of this information that that you know, that has made me think on how clinically we can apply it to and also something how we can focus intervention, using the LPAA in a way that respects, that pays attention to all of these variables, or whatever variables we can or the most variables. Because we're not perfect, and there is always something missing in the intervention context, because there is so much that we have to include into it, but pay attention to the psychosocial context, based on the culture, based on the limitations, based on their life, on the disruption in the family dynamics.   Katie Strong: Yeah, yeah. It's a lot to think about.   Jose Centeno: Yeah. It's not easy. But I, you know. I think that you know these data that I collected made me think more in terms of our work, how we can go from focusing the language to being a little more psychosocially or involved. It's a skill that is not taught in these programs. My impression is that programs focus on the intervention that is very language based, and doing all this very formal intervention. It's not a formula, it's a protocol that is sometimes can be very rigid, but we have to pay attention to the fact that there are behavioral issues here that need to be addressed in order to facilitate progress.   Katie Strong: Yeah, and it just seems like it's such more. Thinking about how aphasia doesn't just impact the person who has it. And, you know, really bringing in the family into this. Okay, well, we talked about your amazing new class, but you just talked a little bit about, you know, training the new workforce. Could you highlight a few ideas about what you think, if we're training socially responsive professionals to go out and be into the workforce. I know we're coming near the end of our time together. We could probably spend a whole hour talking about this. What are some things that you might like to plant in the ears of students or clinicians or educators that are listening to the podcast?   Jose Centeno: You know this is something Katie that was part of my evolution, my growth as a clinical researcher. I thought that creating a program, and Rutgers gave us that opportunity, to be able to create a program in such a way that everybody's included in the curriculum. We created a program in which the coursework and the clinical experiences. And this happened because we started developing this room from scratch. It's not like we arrived and there was a program in place which is more difficult. I mean creating a program when you have the faculty together and you can brainstorm as to based on professional standards and ASHA's priorities and so on, how we can create a program, right? So, we started from scratch, and when I was hired as founding faculty, where the person that was the program director, we worked together, and we created the curriculum, clinically and education academically, in such a way that everybody, but everybody, was included from the first semester until the last semester. And I created a course that I teach based on the research that I've done that brings together public health intersectionality and applied to speech language pathology. So, this course that students take in the first semester, and in fact, I just gave the first lecture yesterday. We just started this semester year. So it sets the tone for the rest of the program because this course covers diversity across the board, applying it to children, adults and brings together public health, brings together linguistics, brings together sociology. All of that to understand how the intersectionality, all those different dimensions. So, the way that the I structured the course was theory, clinical principle and application theory, and then at the end we have case scenarios. So that's how I did it. And of course, you know, it was changing as the students gave me feedback and so on. But that, that is the first course, and then everybody else in their courses in acquired motor disorders, swallowing, aphasia, dementia. You know, all those courses, the adult courses I teach, but you know the people in child language and literacy. They cover diversity. Everybody covers diversity. So, in the area more relevant to our conversation here, aphasia and also dementia. In those courses, I cover social determinants of health. I expand on social determinants of health. I cover a vulnerability to stroke and dementia in underrepresented populations and so on. So going back to the question, creating a curriculum, I understand you know that not every program has the faculty or has the resources the community. But whatever we can do to acknowledge the fact that diversity is here to stay. Diversity is not going to go away. We've been diverse since the very beginning. You know, like, even if you look, if you look at any community anywhere, it's already diverse as it is. So, incorporating that content in the curriculum and try to make the connections clinically. Luckily, we were able to do that. We have a clinic director that is also focused on diversity, and we cover everything there, from gender issues, race, ethnicity, all of those, as much as we can. So, the curriculum and taking the students into the community as much as we can.   Katie Strong: Yeah, I love that. So, you're talking about front loading a course in the curriculum, where you're getting people thinking about these and then, it's supplemented and augmented in each of the courses that they're taking. But also, I'm hearing you say you can't just stay in a classroom and learn about this. You need to go out.   Jose Centeno: Exactly! It's a lot. It didn't happen overnight. A lot of this was gradual, based on students feedback. And, you know, realizing that within ourselves, we within the course, when we were teaching it, oh, I need to change this, right, to move this around, whatever. But the next step I realized is, let's go into the community.   Katie Strong: Yeah, yeah. Well how lucky those students are at Rutgers.   Jose Centeno: Thank you.   Katie Strong: Well, we're nearing the end of our time together today. Jose and I just wanted, before we wrap up, I just wanted to ask you, “what, what excites you most about where aphasia research and care could go, or what do you think might need our most attention?”   Jose Centeno: That's a great question, because I thought of it quite a bit. But I'll focus it in terms of our diverse population, where the aphasia research should be. I think my impression is that there should be more attempts to connect the theoretical aspects of language with the psychosocial aspect. In other words, and this is how I teach my aphasia class. I focus the students on the continuum of care. The person comes in after stroke. We try to understand aphasia, but we aim to promoting life reconfiguration, life readaptation, going back into the community. So, here's the person with aphasia, and this is where we're heading to facilitating functioning, effective communication in the best way we can for this person, right? So, if these are all the different models that have been proposed regarding lexicon, vocabulary and sentence production and so on. How can we connect those therapeutic approaches in a way that they are functionally usable to bring this person back? Because there is a lot of literature that I enjoy reading, but how can we bring that and translate that to intervention, particularly with people that speak other languages. Which is very difficult because there isn't a lot of literature. But at least making an attempt to recruit the students from different backgrounds, ethnic backgrounds. And this, regardless of the backgrounds, there are students studying, interested in studying other cultures. And the curriculum exposes students to ways that we that there is some literature, there is a lot but there is some literature out there to explain vocabulary sentences in other languages post stroke in people with aphasia that, you know, we can use therapeutically. I mean, this is what's been created. So, let's look at this literature and be more open-minded. It's difficult. We don't speak every language in the world, but at least try to connect through the students that speak those languages in class, or languages departments that we have on campus, how those projects can be worked on. I'm just trying to be ambitious and creative here, because there's got to be a way that we should connect those theoretical models that are pretty much English focused intervention paradigms that will facilitate social function/   Katie Strong: It's a lot a lot of work, a lot of work to be done, a lot of a lot of projects and PhD students and all of that. Amazing.   Jose Centeno: I think it's as you said, a monumental amount of work, but, but I think that there should be attempts, of course, to include some of that content in class, to encourage students attention to the fact that there is a lot of literature in aphasia that is based on English speakers, that is based on models, on monolingual middle class…whoever shows up for the research project, the participants. But those are the participants. Now, I mean those that data is not applicable to the people [who you may be treating]. So, it's a challenge, but it's something to be aware of. This is a challenge to me that, and some people have highlighted that in the aphasia literature, the fact that we need more diversity in terms of let's study other languages and let's study intervention in other populations that don't speak English.   Katie Strong: Absolutely. Well, lots of amazing food for thought, and this has been such a beautiful conversation. I so appreciate you being here today, Jose. Thank you very, very much.   Jose Centeno: Thank you, Katie. I appreciate the invitation and I hope the future is bright for this type of research and clinical work and thank you so much for this time to talk about my work.       Resources   Centeno, J. G., (2024). A call for transformative intersectional LPAA intervention for equity and social justice in ethnosocially diverse post-stroke aphasia services. Seminars in Speech and Language, 45(01): 071-083. https://doi.org/10.1055/s-0043-1777131 Centeno, J. G., & Harris, J. L. (2021). Implications of United States service evidence for growing multiethnic adult neurorehabilitation caseloads worldwide. Canadian Journal of Speech-Language Pathology and Audiology, 45(2), 77-97. Centeno, J. G., Kiran, S., & Armstrong, E. (2020). Aphasia management in growing multiethnic populations. Aphasiology, 34(11), 1314-1318.  https://doi.org/10.1080/02687038.2020.1781420 Centeno, J. G., Kiran, S., & Armstrong, E. (2020). Epilogue: harnessing the experimental and clinical resources to address service imperatives in multiethnic aphasia caseloads. Aphasiology, 34(11), 1451–1455. http://dx.doi.org/10.1080/02687038.2020.1781421 Centeno, J. G., Obler, L. K., Collins, L., Wallace, G., Fleming, V. B., & Guendouzi, J. (2023). Focusing our attention on socially-responsive professional education to serve ethnogeriatric populations with neurogenic communication disorders in the United States. American Journal of Speech-Language Pathology, 32(4), 1782–1792. https://doi.org/10.1044/2023_AJSLP-22-00325 Kagan, A. (2020). The life participation approach to aphasia: A 20-year milestone. Perspectives of the ASHA Special Interest Groups, 5(2), 370. https://doi.org/10.1044/2020_PERSP-20-00017 Vespa, J., Medina, L., & Armstrong, D. M. (2020). Demographic turning points for the United States: population projections for 2020 to 2060. Current Population Reports, P25-1144.             https://www.census.gov/library/publications/2020/demo/p25-1144.html    

In this week's episode dual-qualified speech pathologist and clinical psychologist, Natalie Manley, speaks about supporting children with co-occurring Developmental Language Disorder (DLD) and Attention Deficit/Hyperactivity Disorder (ADHD). She discusses cognitive and linguistic characteristics of these kids, and strengths-based approaches to motivation and engagement, and behavioural, emotional, and cognitive regulation. Resources: • Manley, N., Wilder, A. (2025). Clinical accommodations for children with co-occurring Developmental Language Disorder and Attention Deficit/Hyperactivity Disorder. Perspectives of the ASHA Special Interest Groups, 10(1), 18-28. https://doi.org/10.1044/2024_PERSP-24-00076 • Hancock, N., Redmond, S., Fox, A., Ash, A., Hogan, T. (2025). Word reading and Attention-Deficit/Hyperactivity Disorder in children with Developmental Language Disorder. AJSLP, 34(3), 1324-1340. https://doi.org/10.1044/2025_AJSLP-24-00052 • Hannig-Russell, K., Redmond, S. (2025). The Impacts of co-occurring Developmental Language Disorder on the academic, interpersonal, and behavioral profiles of children with Attention-Deficit/Hyperactivity Disorder. Perspectives of the ASHA Special Interest Groups, 10(1), 29-43. https://doi.org/10.1044/2024_PERSP-24-00035 • Redmond, S., Ash, A., Li, H., Zhang, Y. (2024). Links among Attention-Deficit/Hyperactivity Disorder symptoms and psycholinguistic abilities are different for children with and without Developmental Language Disorder. AJSLP, 33(5), 2344-2363. https://doi.org/10.1044/2024_AJSLP-23-00388 • DLD Project: DLD & ADHD short course with Natalie Manley: https://thedldproject.com/course/dld-and-adhd/ • Tuning in to Kids: https://tuningintokids.org.au/ Speech Pathology Australia acknowledge the Traditional Custodians of lands, seas and waters throughout Australia, and pay respect to Elders past and present. We recognise that the health and social and emotional wellbeing of Aboriginal and Torres Strait Islander peoples are grounded in continued connection to culture, country, language and community and acknowledge that sovereignty was never ceded. Free access to transcripts and a full list of resources / references for this podcast is available via the SPA Learning Hub (https://learninghub.speechpathologyaustralia.org.au/), you will need to sign in or create an account. For more information, please see our Bio or for further enquiries, email speakuppodcast@speechpathologyaustralia.org.au Disclaimer: © (2025) The Speech Pathology Association of Australia Limited. All rights reserved. Important Notice, Please read: The views expressed in this presentation and reproduced in these materials are not necessarily the views of, or endorsed by, The Speech Pathology Association of Australia Limited (“the Association”). The Association makes no warranty or representation in relation to the content, currency or accuracy of any of the materials comprised in this recording. The Association expressly disclaims any and all liability (including liability for negligence) in respect of use of these materials and the information contained within them. The Association recommends you seek independent professional advice prior to making any decision involving matters outlined in this recording including in any of the materials referred to or otherwise incorporated into this recording. Except as otherwise stated, copyright and all other intellectual property rights comprised in the presentation and these materials, remain the exclusive property of the Association. Except with the Association's prior written approval you must not, in whole or part, reproduce, modify, adapt, distribute, publish or electronically communicate (including by online means) this recording or any of these materials.

In this Speech Pathology Week episode, Dr Debbie Pu from Monash University discusses how we can have “Impact through communication” about dysphagia awareness. She discusses what different stakeholders understand about swallowing difficulties, how public awareness can support people living with dysphagia to enjoy safe meals, and how speech pathologists can communicate with impact about this issue. Resources: Pu et al., (2025). Awareness of dysphagia: An integrative review: https://pubs.asha.org/doi/full/10.1044/2025_PERSP-24-00293 Molfener et al., (2025). Assessing public awareness and understanding of dysphagia: A representative survey of US adults: https://link.springer.com/article/10.1007/s00455-025-10826-2 Packer et al., (2025). “I like to accommodate as much as possible”: A survey of food service professionals' awareness of dysphagia and experiences in dietary modifications: https://www.tandfonline.com/doi/full/10.1080/17549507.2025.2544738 SPA resources: Speech Pathology Week 2025; Impact through communication: https://speechpathologyaustralia.org.au/Public/Public/About-Us/News-media-campaigns/Campaigns/Speech-Pathology-Week.aspx Swallowing Awareness Day resources: https://speechpathologyaustralia.org.au/Public/Public/About-Us/News-media-campaigns/Campaigns/Swallowing-Awareness-Day.aspx Swallowing difficulty: https://speechpathologyaustralia.org.au/Public/Public/Comm-swallow/Swallowing.aspx Modified foods and fluids terminology: https://speechpathologyaustralia.org.au/Public/Public/About-Us/Ethics-and-standards/Modified-foods-and-fluids-terminology.aspx Speak Up podcast S6E25 A behind the scenes look at Maggie Beer's Big Mission: https://on.soundcloud.com/LGBBFOJQrlWvl5ECTn Speak Up podcast S7E6 Rethinking thickened liquids: https://on.soundcloud.com/KAOCtNrx4yM575DDFF Speech Pathology Australia acknowledge the Traditional Custodians of lands, seas and waters throughout Australia, and pay respect to Elders past and present. We recognise that the health and social and emotional wellbeing of Aboriginal and Torres Strait Islander peoples are grounded in continued connection to culture, country, language and community and acknowledge that sovereignty was never ceded. Free access to transcripts for podcast episodes are available via the SPA Learning Hub (https://learninghub.speechpathologyaustralia.org.au/), you will need to sign in or create an account. For more information, please see our Bio or for further enquiries, email speakuppodcast@speechpathologyaustralia.org.au Disclaimer: © (2025) The Speech Pathology Association of Australia Limited. All rights reserved. Important Notice, Please read: The views expressed in this presentation and reproduced in these materials are not necessarily the views of, or endorsed by, The Speech Pathology Association of Australia Limited (“the Association”). The Association makes no warranty or representation in relation to the content, currency or accuracy of any of the materials comprised in this recording. The Association expressly disclaims any and all liability (including liability for negligence) in respect of use of these materials and the information contained within them. The Association recommends you seek independent professional advice prior to making any decision involving matters outlined in this recording including in any of the materials referred to or otherwise incorporated into this recording. Except as otherwise stated, copyright and all other intellectual property rights comprised in the presentation and these materials, remain the exclusive property of the Association. Except with the Association's prior written approval you must not, in whole or part, reproduce, modify, adapt, distribute, publish or electronically communicate (including by online means) this recording or any of these materials.

Lietuvoje nusileidęs, Gerbera vadinamas, Rusijoje pagamintas dronas – dažnas Ukrainos padangių svečias.Kada ir kokias atvejais pranešimus į savo telefonus apie galimą pavojų turėtų gauti gyventojai?Jungtinių Valstijų prezidentas Donaldas Trumpas sako sudaręs susitarimą dėl JAV ginklų siuntimo į Ukrainą per NATO.Kaip numatoma perkelti Sovietų Sąjungos karių palaikus iš miestų ir miestelių? Pasak projektą parengusios Kultūros ministerijos, ši tvarka bus taikoma toms Antrojo pasaulinio karo karių kapavietėms, kurios specialios komisijos pripažintos propaguojančiomis totalitarinius, autoritarinius režimus bei jų ideologijas.Pasaulis mini trisdešimtąsias Srebrenicos genocido metines. 1995-ųjų liepos 11-ą dieną Bosnijos serbų pajėgos įžengė į Jungtinių Tautų saugumo zona laikytą miestą ir per trumpą laiką nužudė daugiau nei 8 tūkstančius bosnių musulmonų vyrų ir berniukų.Ved. Madona Lučkaitė

Ukrainos ir Lietuvos parlamentarų susitikime nedalyvaus „Nemuno aušros“ atstovai. Konservatoriaus Žygimanto Pavilionio teigimu, Remigijaus Žemaitaičio partijos nepageidavo patys ukrainiečiai. Ukrainos ambasados Lietuvoje atstovai teigia, kad pats Seimas sudarė tokią delegatų grupę.Minint Motiejaus Kazimiero Sarbievijaus ir Baroko literatūros metus, Kaune Ąžuolyno bibliotekos lankytojams - išskirtinė galimybė - pasitelkus virtualią realybę pavartyti vienintelį pasaulyje išlikusį Sarbievijaus leidinį „Odė palaimintajam Stanislovui Kostkai“.Į Lietuvą atvyko kylanti NBA krepšinio lygos žvaigždė Matas Buzelis. Dėl žaidimo rinktinėje šią vasarą abejojantis Čikagos „Bulls“ krepšininkas teigia, jog dėl rinktinės nieko nežino, o jos vadovas Linas Kleiza sako, kad Buzelis už Lietuvą žais, tačiau neaišku kada.Perspėjame, kad artimiausiomis naktimis numatomos stiprios šalnos.Ved. Andrius Kavaliauskas

„Įsilaužimas Baltijos mieste“ – tai mokslinės fantastikos ir kiberpanko stiliaus veiksmo detektyvas, komedija bei mistinis garso serialas, nukeliantis klausytoją į Baltijos miestą, tolimos distopinės ateities metropolį kažkur dabartinės Lietuvos teritorijoje. Serialas sugretina tolimos ateities transhumanistines idėjas, žmogaus ir technologijų simbiozę, dirbtinio intelekto etikos, sąmonės ir duomenų jautrumo temas kartu su žmogaus laimės, meilės, laisvės ir tikrojo savęs paieška.7 serija. Perspėjimas. Vizitas pogrindžio implantų klinikoje priveda prie netikėto posūkio. (S)Kūrybinė komanda: Karolis Balčius, Eglė Jarmolavičiūtė, Rasa Kregždaitė, Vakarė Leonavičienė, Edvardas Guželis, Giedrė Račkaitė, Jonas Šarkus, Inesa Paliulytė.Iliustracijos autorė Ugnė Glinskytė.

Europos šalių lyderiai šiandien renkasi Londone į specialų susirinkimą, kur bus tariamasi dėl saugumo žemyne ir paramos Ukrainai. Tiek šalių lyderiai, tiek NATO generalinis sekretorius išreiškė viltį, kad Ukrainos prezidentui Volodymyrui Zelenskiui pavyks pataisyti santykius su Jungtinių Valstijų prezidentu Donaldu Trumpu.Sapnų inkubacija vadinama sapnų turinio kontrolė, nors skamba magiškai, yra mokslo nagrinėjamas būdas, kuris gali padėti ieškantiems kūrybingų sprendimų. Kaip įgalinti sapnus, naujame „Miego DNR“ epizode pasakoja neuromokslininkė Laura Bojarskaitė.Į LRT kreipėsi klausytojas, teigdamas, kad dirbdamas pagal individualią veiklą ir patyręs stuburo traumą, iš „Sodros“ negauna ligos išmokos. Socialinės ir darbo apsaugos ministerija primena, kad ligos išmokas iš karto gauna tik tie asmenys, kurie socialinio draudimo įmokas moka kas mėnesį, o mokantiems įmokas metų pabaigoje ligos išmokų tenka laukti.Prieš 25 metus Kuršių nerija buvo įtraukta į UNESCO Pasaulio paveldo sąrašą kaip kultūrinio kraštovaizdžio vertybė. Tačiau dėl Rusijoje, Kaliningrado srityje, planuojamų statybos darbų, ši teritorija gali netekti šio statuso.Svorio numesti siekiantys žmonės griebiasi įvairiausių metodų – vieni stropiai stebi savo mitybą, užsiima sportu, o kiti ieško stebuklingų tablečių bei preparatų, kurie padėtų svorį numesti be didesnių pastangų. Žiniasklaida skelbia, kad Jungtinėje Karalystėje daugiau nei 80 žmonių mirčių yra siejama su diabetui gydyti bei svoriui mažinti skirtų preparatų naudojimu.Ved. Paulius Selezniovas.

Ieškai galimybių augti? Pabandyk Oxylabs! Kur? Čia -> https://bit.ly/3QxMELa Vaikystėje Armin Meiwes pasaką „Jonukas ir Grytutė“ laikė receptų knyga, o lėles – žaliava žmogienos šašlykui. Kaimynai sutarė, kad nors Arminas - malonus, jis neabejotinai keistokas tipas. Po valdingos mamos padu augo nuolankus ir užsidaręs vyras. Tačiau Arminas turėjo paslaptį. Daug jų. 20 tūkst. žmonių mirtis vaizduojančių nuotraukų, žudynių kambarys bei nenumaldomas alkis žmogienos pagalba išspręsti vaikystės traumas. Viskas buvo tik fantazija, tačiau į žinutes įslydo Bernd Brandes su kvietimu „suvalgyk mane“. Pristatome jums pirmąją istorijos dalį apie Rotenburgo kanibalą bei jo valingą auką. Perspėjame: gali raižyti skrandį, todėl patartina epizodo neryti nekramčius. Iliustracija: @tinymischiefs Muzika: InspectorJ, tams_kp, Jay_You, ERH, klankbeeld

Buvę Jungtinių Amerikos valstijų kariuomenės vadai tikina, kad po Trumpo pareiškimų apie Ukrainą ir Zelenskį – Lietuvos saugumo situacija nesikeičia. Vilniuje vykstantis dešimtasis saugumo forumas apžvelgia regiono saugumo situaciją.Rygoje viešėjęs premjeras Gintautas Paluckas teigia, kad artimiausiu metu kartu su Šiaurės ir Baltijos šalių kolegomis ketina vykti į Jungtines Amerikos Valstijas. Taip Ministras pirmininkas kalbėjo Europoje vykstant diskusijoms dėl JAV prezidento Donaldo Trumpo planuojamų taikos derybų su Rusija, kuriose, kaip baiminasi žemyno sostinės, nedalyvaus nei Ukraina, nei Europos Sąjunga.Šaltuoju metų laiku intensyviau pradėjus šildyti namus, ypač padidėjo gaisrų rizika individualiuose namuose. Kokių prevencinių priemonių reikėtų imtis siekiant sumažinti gaisrų šaltuoju metų laiku?LRT tarybai inicijavus visuomeninio transliuotojo turinio auditą, jos nariai šįvakar tai aptaria su LRT žurnalistais. Auditu tikrinama, kaip kurdami turinį žurnalistai laikosi politinio neutralumo principų.Pagerbti Gražiausių lietuviškų įmonių pavadinimų konkurso laureatai.Lietuvoje senjorai jau mokosi naudotis dirbtiniu intelektu ir pritaiko šią technologiją kasdieniame gyvenime, bet skaitmeninė atskirtis vis dar išlieka iššūkiu. Kokia senjorų ateitis technologijų pasaulyje?Ved. Madona Lučkaitė

Send us a textSeries: Mystical TheologyEpisode 28: Augustine's Essentialism and the Essence–Energies Distinction of Basil the Great, Part 9 of Augustine of Hippo: An Orthodox Perspective, Dr. C. VeniaminIn Part 9 of our presentations on Augustine of Hippo a comparison is made between the theological approach of Augustine and Basil the Great vis-a-vis the doctrine of the Holy Trinity, based on our reading of Augustine's De Trinitate Book IX, and of Basil's Epistles 2 and 234. A brief explanation of what is meant by the “substance and attributes” distinction is also given. Other themes touched upon are included in the Timestamps.Q&As available in The Professor's BlogRecommended background reading: Christopher Veniamin, ed., Saint Gregory Palamas: The Homilies (Dalton PA: 2022); The Orthodox Understanding of Salvation: "Theosis" in Scripture and Tradition (2016); The Transfiguration of Christ in Greek Patristic Literature (2022); and Metropolitan Hierotheos Vlachos, Empirical Dogmatics of the Orthodox Catholic Church: According to the Spoken Teaching of Father John Romanides, Vol. 1 (2012), Vol. 2 (repr. ed. 2020).Further bibliography may be found in our "Scholar's Corner" webpage.Join the Mount Thabor Academy Podcasts and help us to bring podcasts on Orthodox theology and the spiritual life to the wider community. Support the showDr. Christopher VeniaminSupport The Mount Thabor Academyhttps://www.buzzsprout.com/2232462/support The Professor's BlogFurther bibliography may be found in our Scholar's Corner.THE MOUNT THABOR ACADEMYPrint Books by MOUNT THABOR PUBLISHING eBooks Amazon Google Apple KoboB&NMembershipsJoin our Academy on Patreon: Membership TiersYouTube Membership LevelsContact us: ...

Send us a textSeries: Mystical TheologyEpisode 27: Further Reading & Commentary, Reading De Trinitate Book IX, Part 8 of Augustine of Hippo: An Orthodox Perspective, Dr. C. VeniaminIn Part 8 of “Augustine of Hippo: An Orthodox Perspective”, Episode 27 of our series in “Mystical Theology”, we continue our reading and commentary on Book IX of St. Augustine's De Trinitate; and in so doing we delve into Augustine's theological presuppositions. Other themes broached in this episode are listed in the Timestamps below.Q&As available in The Professor's BlogRecommended background reading: Christopher Veniamin, ed., Saint Gregory Palamas: The Homilies (Dalton PA: 2022); The Orthodox Understanding of Salvation: "Theosis" in Scripture and Tradition (2016); The Transfiguration of Christ in Greek Patristic Literature (2022); and Metropolitan Hierotheos Vlachos, Empirical Dogmatics of the Orthodox Catholic Church: According to the Spoken Teaching of Father John Romanides, Vol. 1 (2012), Vol. 2 (repr. ed. 2020).Further bibliography may be found in our "Scholar's Corner" webpage.Join the Mount Thabor Academy and help us to bring podcasts on Orthodox theology and the spiritual life to the wider community. Support the showDr. Christopher VeniaminSupport The Mount Thabor Academyhttps://www.buzzsprout.com/2232462/support The Professor's BlogFurther bibliography may be found in our Scholar's Corner.THE MOUNT THABOR ACADEMYPrint Books by MOUNT THABOR PUBLISHING eBooks Amazon Google Apple KoboB&NMembershipsJoin our Academy on Patreon: Membership TiersYouTube Membership LevelsContact us: ...

Series: Mystical TheologyEpisode 26: Reading & Commentary, Reading De Trinitate Book IX, Part 7 of Augustine of Hippo: An Orthodox Perspective, Dr. C. VeniaminIn Part 7 of “Augustine of Hippo: An Orthodox Perspective”, Episode 26 of our series in “Mystical Theology”, we continue our reading and commentary on Book IX of St. Augustine's De Trinitate; and in so doing we touch on such key questions as, “What is theology?” and “Who is a theologian?”. Other themes broached in this episode are listed in the Timestamps below.Q&As available in The Professor's BlogRecommended background reading: Christopher Veniamin, ed., Saint Gregory Palamas: The Homilies (Dalton PA: 2022); The Orthodox Understanding of Salvation: "Theosis" in Scripture and Tradition (2016); The Transfiguration of Christ in Greek Patristic Literature (2022); and Metropolitan Hierotheos Vlachos, Empirical Dogmatics of the Orthodox Catholic Church: According to the Spoken Teaching of Father John Romanides, Vol. 1 (2012), Vol. 2 (repr. ed. 2020).Further bibliography may be found in our "Scholar's Corner" webpage.Support the showDr. Christopher VeniaminSupport The Mount Thabor Academyhttps://www.buzzsprout.com/2232462/support The Professor's BlogFurther bibliography may be found in our Scholar's Corner.THE MOUNT THABOR ACADEMYPrint Books by MOUNT THABOR PUBLISHING eBooks Amazon Google Apple KoboB&NMembershipsJoin our Academy on Patreon: Membership TiersYouTube Membership LevelsContact us: ...

In this episode you will:  Learn about how the Aphasia-Friendly Reading Approach was developed. Hear about the importance of actively engaging care partners in therapy through this storytelling approach. Learn the importance of celebrating stories and how to host your own version of a Waffle Night.   Katie Strong: Welcome to the Aphasia Access Aphasia Conversations Podcast. I'm Katie Strong, a  member of the Aphasia Access Podcast Working Group. I'm also a faculty member at Central Michigan University where I lead the Strong Story Lab. Aphasia Access strives to provide members with information, inspiration, and ideas that support their aphasia care through a variety of educational materials and resources. I'm today's host for an episode that will feature Harold Regier and Dr. Erin O'Bryan. We'll be talking about the Aphasia-Friendly Reading Approach that Harold developed for his wife, Rosella, who had aphasia and how Dr. O'Bryan took this approach into the lab to refine it for clinicians to use in sessions. Before we dive into the conversation, let me share a few details about our guests. First a bit about Harold. Harold R. Regier, B.S. Ed., BDiv. Theol., is a retired minister with a career path in programs addressing social justice issues. In retirement, his spouse, Rosella, had a stroke resulting in aphasia. His passion shifted to becoming an aphasia care partner focused on helping to recover language and communication skills. He is the author of “A Decade of Aphasia Therapy,” subtitled “Aphasia-Friendly Reading: A Technique for Oral Communication,” published in 2021.  Our second guest is Dr. Erin O'Bryan. Erin is an Assistant Professor in the Department of Communication Sciences and Disorders at Wichita State University, in Wichita, Kansas. Her major research, teaching, and clinical interests focus on helping people with aphasia communicate through scripts, stories, and phrases and teaching students and care partners how to support communication. Dr. O'Bryan directs the Wichita Adult Language Lab whose current projects focus on supported storytelling and Melodic Intonation Therapy. Welcome Harold and Erin. I'm looking forward to our conversation today. Erin O'Bryan: Thank you, Katie! I've been listening to Aphasia Access Podcasts for years, and so many of my heroes have been interviewed in this series. It is really an honor that you invited Harold and I to be on the podcast today! Katie Strong: I am so excited for our listeners to hear about how the Aphasia-Friendly Reading Approach was developed and expanded. This work is near and dear to my heart – particularly in this unique way of developing and telling stories. I feel compelled to disclose to our listeners that I am grateful to have been involved in this work as it was refined for clinical environments. So, I am going to come right out and say, this is my bias. Harold, I'm a big fan of yours and the Aphasia Friendly Reading Approach and of you Erin for how you brought this approach into the lab and studied it so that clinicians can use this approach. So, now let's get started! Harold, can you share a bit with us about how the Aphasia-Friendly Reading Approach came to be? Harold Reiger: Sure. Thank you so much, Dr. Strong, for the privilege of being here to share just a bit of our story. You know, Rosella and I would have celebrated our 65th wedding anniversary if she had stayed with us just a few weeks longer. We had a very long and very happy marriage. She used to kid me, “We've been together so long we know what the other person will say before he or she says it.” Well, actually, aphasia kind of shattered that theory. But maybe there was a little bit of that was true. Well, anyway, Rosella was a retired public-school teacher with part of her career also involving children's curriculum development. She led many workshops, was a storyteller, and was a frequent guest speaker. Communication and broad coalitions were a strong suit for her. So, aphasia, loss of language was a huge loss for her. Perhaps that sets the stage for working so hard to restore some major storytelling. But I'm sure this is the same kind of feeling that every person who is a care partner with the person with aphasia has. How did we discover a technique for storytelling through oral reading? Really, I think I just stumbled into it. The cues came from Rosella. She could say many words. She had a strong voice, but she did not put words together in a way that made it possible for a listener to understand what she meant to communicate. So, I was highly motivated, wishing there was a way to help her tell her stories. Looking back, I now can see three of what I call ‘indicators' that led me to the technique that I eventually called Aphasia-Friendly Reading. They were painting, reading, and church liturgy. So let me explain. Indicator number one, completely on her own, Rosella began to paint. Just shy of two years after her stroke, Rosella began to paint. She painted for four years. She painted 250 paintings. The choice of her subjects were all hers. Objects, scenery, flowers, roadside sightings, trips and vacations, past memories. And yes, stories, family stories, stories that she didn't have words to tell, but she could tell them with a brush. She gave every picture a title or caption, signed it, and dated it. And somehow she found those one, two, or three words to intelligibly, that is accurately, identify the picture that she had just painted. But after four years of painting those pictures, she put her paintbrush down, never to pick it up again. And yet I kept remembering that she was able to identify pictures accurately using those few words to explain what it was that she was telling with her pictures. But then indicator number two came, reading periodicals and books. She underlined periodicals with many circles, much underlining. For a long time, Rosella delved through as many as 40 or 50 books per month. She turned every page, but did she understand what she was reading? Frankly, I often wondered and doubted it. One day, Rosella was reading orally beside me, and I pressed my iPhone video button. Listen to just a few seconds of that reading. And while you listen, think of two questions. Could you understand what she was reading? What was the story that she was trying to tell? And secondly, do you think that Rosella was understanding what she was reading? So listen to that clip. Excerpt of Rosella reading from a book. You heard Rosella reading the story of she and her sister, Anna Grace, requesting radio station KNEX out of McPherson, Kansas to surprise their mother by playing it for her birthday. It was a song that the girls knew that their mother loved. And you heard her read those words, “I love those dear hearts and gentle people.” And then as she continued reading the lyrics of that song, she exclaimed, “Oh, Harold”, which was her way of saying how excited she was to recall that particular story. Now, that explanation, of course, was not in the book. Then there was a third indicator that I recognized, and that was liturgical reading. One day in church we were reading a call to worship displayed on the screen. We were reading responsibly with the leader reading the first line and the congregation reading the second line. I glanced to my side and was surprised to see Rosella reading with the congregation. Maybe it was only the first three or four words of the line, but she read these words accurately. A light went on in my mind. Might this be a hint of how to help Rosella participate in oral reading? Short sentences read with a co-reader who read every other line and written in an easy to follow format? And so I adapted various psalms into very short lines formatted for us to read responsively. I read the first line, she read the second. The result was amazing success. Let me just illustrate by us reading just a very short psalm for you. This is Psalm 150 that Rosella and I will read together. H: Praise the Lord! R: Praise God in his sanctuary. H: Praise God in his mighty firmament. R: Praise Him for his mighty deeds. H: Praise the Lord for his greatness. R: Praise him with the trumpet. H: Praise him with the lute and harp. R: Praise him with the dance. My thought then was, could we try to write other stories and read them in what I began to call Aphasia-Friendly Reading format and style? And so, I began in earnest to try to write other stories. Short sentences, familiar words, larger font. Each line considered a sentence, even if it was only one word. Label the first line H for Harold and the second indented line R for Rosella. As I started reading and continued to read every other line, this could set the tone, the rhythm, and the pattern for saying every word clearly. I thought it was time to try. And then I began to wonder, is there a setting that we could read stories to others? Could we create an audience in some way? When COVID hit, of course, I could not see Rosella in person anymore, for an entire year we were separated. And the only contact we had was FaceTime telephone calls. And those were really a disaster because we found it very difficult to communicate with each other when Roselle was not able to understand me and I wasn't able to understand her, except when we read Aphasia-Friendly stories. And so, I wrote many stories during that year. And we read those stories then as our connection during our FaceTime calls. And somehow we were able to survive COVID. But it was after COVID then that we were able to again get back together occasionally. And I would bring her back to my apartment. And there I would invite friends, usually a couple or two individuals to come over and I would serve waffles. I'm not a kitchen person, but I could make waffles. So, we'd have a simple meal, a simple supper that we could visit with each other and talk about anything that we would like. And Rosella almost always simply said, “I remember exactly”. Because as others told stories that she was familiar with, she could comment that way. Otherwise, her conversation skills were not there. So that was our first hour that we would spend together simply informally visiting with each other. And the second hour that we spent together, we would go to what I would call “my theater,” our living room with a 50-inch television. And there we could read Aphasia-Friendly stories. I would stream the story to the television set. I would have them formatted so that there would be an H for Harold, an R for Rosella, and we would read the story so that the folks who were listening and watching could see the story as well as hear the story. And if we made any mistakes, they could make the corrections in their own mind. There was a way that she was able to, again, participate. It's worth telling. But there was one waffle evening when she turned to me, and said, “China”. I knew she had a story in mind, but her look said, “you tell it. I can't do it.” And so, I did. It was a story about a cracked tea cup And so I decided certainly next Waffle Night we need to let her help tell that story of the cracked tea cup. Here is that story. Cracked Tea Cup. H: This is as story of a cracked tea cup. R: Harold and I were youth sponsors. H: Rose was one of the youth. R: Winifred was her mother. H: She invited me to her home. R: “Thank you,” she said. H: “Thank you for being Rose's sponsor.” R: We visited. H: Before leaving, she said R: “Let me pray for you.” H: It was a pray of blessing… R: …for our work in Mississippi. H: Then she added, R: “Wait!” H: “I have something for you.” R: She got a tea cup. H: Erland brought it to me from China. R: It's cracked. H: Put it in your china cupboard. R: You'll never use it. H: “But you'll remember be when you see it.” R: Sixty years are gone. H: This tea cup is still in my china cupboard. R: And I remember Winifred. H: It reminds me R: Of the grace, H: Of the affirmation, R: Of blessing, H: Of the seminary president's wife.   And so those Waffle Nights became the favorite parts of our week when we could spend time with friends and Rosella could be part of the conversation by reading stories together with me. Katie Strong: So beautiful! This is really just a fabulous way of having such a natural thing, a shared meal, a celebration to share stories. And it sounds like everybody enjoyed Waffle Nights. So, thank you for sharing, Harold. Erin, I was wondering if come into the conversation a bit more and tell us how you got involved with Harold and the Aphasia-Friendly Reading Approach? Erin O'Bryan: Thank you, Katie. Even though I've heard Harold's story so many times, I still get teary every time I hear him talk about their year of not being able to see each other during COVID and the Waffle Nights that were just so wonderful. So, I met Harold in 2019 when I first became an Assistant Professor after 10 years of working as an SLP in healthcare. And Wichita State already had a weekly aphasia group, and I couldn't wait to meet the members. So, I went to aphasia group and there I met all of the care partners in the observation room and Harold showed me a video of him and Rosella reading a story together. I had been watching Rosella in the aphasia group and I'd seen that most of her utterances were short one- to two-word phrases and that much of her communication was nonverbal. But then in the video, she was reading full sentences aloud, taking turns with Harold. And what really struck me was that she was so motivated and happy to read the story. I was so impressed. Harold asked me, “Do you think that other people with aphasia could benefit from doing this?” So many thoughts were running through my mind as we were having this conversation. Earlier in 2019, I had visited Audrey Holland, who was one of my mentors when I was in grad school at University of Arizona. And we'd actually set up this meeting through an online Scrabble chat. She invited me to her home. Katie Strong: How very ‘Audrey'. Erin O'Bryan: Yes, it was lovely. And I got to visit her with all her kitty cats. So, I asked her advice because I was applying for an Assistant Professor position after 10 years of working in health care. And I remember that she was so excited about her speechpathology.com video series and the related book that she was working on with Roberta Elman that she liked to call the Social Imperative of the LPAA, which I believe is the subtitle of that book. And Katie, I think you were a part of both the video series and the book. Katie Strong: I was, yes. Erin O'Bryan:  Well, Audrey just loved that. She was so excited about that, and she told me to learn everything I could about the LPAA. And she said, “I must join Aphasia Access.” She said, “that's where all the important work is happening.” So that year I listened to loads of Aphasia Access podcasts, and I got very familiar with the Chapey and Colleagues LPAA Values chapter. So then as I'm sitting there talking to Harold, I'm thinking about the LPAA value, everyone affected by aphasia is entitled to service. So, I mean, who is affected more than a spouse? So definitely I was thinking about having the care partner being involved seemed like a wonderful thing. And I was also thinking that Harold and Rosella's approach shared so many similarities with Script Training, which I have loved and have been using in healthcare care since grad school. And there also are similarities with ORLA and Multiple Oral Rereading. And all of these are evidence-based treatment approaches. So, I felt pretty confident that Aphasia-Friendly Reading could be a very valuable intervention. So, I said to Harold, “I'd like to try using your approach with other people with aphasia and their care partners in our clinic”. And Harold was happy for us to try it. Katie Strong: I love that. I love that. And just for our listeners, we'll put some links and references in the show notes for some of the approaches like ORLA and Script Training that Erin has mentioned in addition to Harold's book and some other some other resources too. Erin O'Bryan: Yes, thank you, Katie. Those are all wonderful resources for people to be looking at. So, my grad students and I started a pilot study with a woman with aphasia and her husband. And they were actually friends of Harold and Rosella's from their aphasia group. We use the pseudonyms Cora and Dave when we describe them in our papers. It became clear that we needed to make a few adaptations to Harold's approach for use in the clinic. For one thing, I wanted the person with aphasia to have the largest role in selecting the story topic and deciding what she wanted to say. For our first session, we asked Cora and Dave to bring ideas for a story that Cora wanted to tell. And we also suggested they consider bringing some related photos. In our first session, Cora, Dave, my grad student, Addison, and I all sat around the table and together we brainstormed about the story. Cora wanted it to be about a Caribbean cruise that she and Dave had gone on. She brought photos from that trip. Dave helped with supplying names and information about places that Cora wanted to talk about. Places from their shore excursions, such as having their picture taken with a donkey in St. Thomas and visiting the Bomba Shack on the island of Tortola. We got Cora's feedback on every line that was proposed, fine-tuning the story until Cora liked every line. And we also adjusted some of the lines to make them easier for her to say. So once Cora and Dave were happy with the story, we helped them practice during our sessions, one hour per week with my grad student, Addison and I at the clinic. And we gave a printout of the story and a practice log to record notes about their home practice. In this first pilot project, Cora and Dave practiced their story for eight sessions until Cora said she was ready to plan their story sharing celebration. Then they shared their story with their friends in aphasia group. And the clinicians and the other people with aphasia in the room were just amazed. And other people in the aphasia group said, “I want to do that!” So, after two people with aphasia and their care partners did Aphasia-Friendly Reading projects, I wrote a manuscript reporting the pilot results. And Katie, I had seen online that you were an editor of Perspectives at the time. So, I emailed you my manuscript and asked if it was appropriate for Perspectives. And you emailed me back and said, “let's meet online and talk about it.” I was so delighted that you were interested in my project. You suggested that I consider exploring the value of the intervention by interviewing the participants. And I didn't know anything about qualitative research. But, Katie, you helped me write great interview questions for the care partners. And you helped me learn thematic analysis so we could find the themes in the care partner's quotes. And so, after learning from you, I have come to love the thematic analysis process. I really think it leads to deep listening. What we learned from the interviews is that the care partners felt empowered by being included in the intervention and the care partners really valued the collaborative nature of the storytelling project and especially that the intervention was so different than the previous therapy experiences that they had had because it was person-centered, it was fun, and they got to share their story with other people in their lives. So, then the three of us, Harold, Katie, and I wrote our first article about Aphasia-Friendly Reading and it's published in Aphasiology and the title is, “I wasn't just sitting there”: Empowering care partners through the Aphasia-Friendly Reading Approach. And then in 2023, the three of us went to Boston and presented it at ASHA. Katie Strong: Thanks for sharing that, Erin. You know, I think the experience of the care partners saying that therapy was fun important to note. And Harold has mentioned that Rosella thought it was fun, and the other participants thought it was fun. And I guess I just want to bring home that hard work can, can still be fun or therapy can be fun. And especially when it comes from the person with aphasia and their care partners. The topics are generated by the client and care partner. They're sharing things that are really important to them that have happened in their past. I love it. Erin O'Bryan: And one of the care partners even said that they learned better when it was fun. Katie Strong: I love it. Fantastic. Erin, I was wondering if you could share some tips for clinicians who might be listening that are thinking about how they might be able to incorporate this Aphasia-Friendly Reading Approach into their practice. Erin O'Bryan: Thank you for asking, Katie. So, in the past year, you and I have been talking about how we want to make it as easy as possible for clinicians to use our storytelling approaches in regular clinical settings, outside of research. And we really want clinicians to realize that it takes almost no time to prep for a person-centered storytelling session. You just have to go into the session ready to actively listen to what the person with aphasia wants to say. I love the acronym PULSE that you and Barbara Shadden wrote about in your paper, The Power of Story and Identity Renegotiation. And then in our paper, we reviewed PULSE again. So just for our listeners, I'm going to go through it real quickly because I think these are great things for clinicians to keep in mind. The P in pulse is for partnerships, partnering with the person with aphasia. And in the case of Aphasia-Friendly Reading, the clinician partnering with the care partner also. The U in pulse is for uniqueness. So, the clinician should be prepared to help the person with aphasia tell their unique story. The L is for listening. The clinician needs to learn how to really listen. And S is for supporting the person with aphasia in telling their stories. For example, using communication ramps in Supported Conversation for Adults with Aphasia strategies to support communication. And then finally, the E impulse is for explore. So as a clinician, be ready to go off-road with your client to explore the story that they want to share. And as a clinician, know that it's okay, even it's great for you to do that. Katie Strong: I love that. I love that. Erin, I guess that leads us into sharing that we do have a paper that came out in 2024 called Person Centered Stories on the Main Stage in Intervention, which highlights examples from three different story projects, including Aphasia-Friendly Reading. So, we'll link that to the show notes as well. Erin O'Bryan: Yes, and this year at ASHA 2024, Katie, you and I are going to be also giving a talk about this work called Elevating Person-Centered Stories to the Main Stage in Aphasia Intervention. And we are looking forward to presenting this work hopefully to an audience of clinicians. Katie Strong: Yes, yes, we hope to see folks in Seattle for sure. Well, I want to bring back both Harold and Erin into this conversation. And I think one of the things that I've recognized through this collaboration that you and Harold and Rosella and later on I got to be a part of is that we really are all better together. And I was hoping each of you could take a moment to share how this work has changed your thinking or maybe some ideas about sharing with others about what you've learned from this collaboration. Harold Regier: Well, for me, one of the things that I think I really learned from this is that we care partners need the therapist and the therapist needs us care partners. And there are more ways in which we can work together than perhaps sometimes we have done it when we have just been sitting there. And so, I really, I'm so pleased to be able to feel that that we care partners are more involved or can be more involved in the whole therapy process than what so often we have been. But I think that one of the things that the therapist needs to help us understand is when is it appropriate for us to be part of the process and when it is not appropriate for us to be part of the part process. It's not a matter of us being there all the time and sometimes being in the way. So, I think that kind of very frank candid conversation with us would help us understand that. And I certainly understood better that that the role of the care partner in terms of helping the person with aphasia be able to communicate better is very different from the role of the therapist. I never tried to be the person who was the teacher, trying to let Rosella know how she should do better and how we might be able to improve our reading. We just did it and it came out the way it came out. But then when I see how Erin was working with other clients and the persons with aphasia and the family members together identified the stories that they were interested in putting together, and the therapist helped put that together into words that they then could repeat or share together and in a storyline, that that is the place where I think we can be so much more collaborative with the therapist in a process like that. So I just always was telling myself, “Don't be a therapist. Don't be a teacher. Don't try to say, well, you can do better than that. Just simply do what is natural.” And then I wish that the therapist would take the other role and really work hard to help the person with aphasia do better with their reading and their performance. We didn't do our reading for production. We did it for fun, as you were saying earlier. And then we did it because we wanted to share that fun and that experience with others. And that was so very, very satisfying for us. Those are some of the thoughts that have come to me in terms of the relationship between therapist and care partner. Katie Strong: Thanks Harold. Yeah, Erin, any thoughts? Erin O'Bryan: I've learned so much from this collaboration. From Harold, I learned what a difference it makes when a care partner puts so much time and thought into supporting their partner with aphasia's communication and her quality of life. Also I've seen how much Harold has done and I hope that me you know as a busy professor stopping and taking the time to tell him that I saw so much value in what he was doing at home with Rosella reading those videos together. I hope that this helped him realize that it was valuable to share. And I'm thrilled to say that Harold has been going around the state of Kansas giving talks about aphasia at colleges and senior living facilities. He's doing so much and I love to see that. And from collaborating with you, Katie, I've learned the importance of making the story sharing a really beautiful celebration honoring the person with aphasia and you know bringing special things like favorite food treats, beverages, flowers, and especially inviting the people that are important to the person with aphasia. We've now had five or six story sharing celebrations. It seems like everyone is more beautiful than the last. I've learned so much about that. And I've also learned that qualitative research helps me capture the meaningfulness of these projects and the meaningfulness as we're working with people with aphasia and that this research can be so fun and rewarding. Katie Strong: I love that. I love that. As I was listening to you, Erin, respond to Harold, it just sounds like together we can validate one another. The work that you're doing, you were doing with Rosella, Harold is very validating and then Erin bringing it into the lab to test it out and it's all beautiful. It's, it really is. And I guess as I reflect on this thought about what I've learned is to reiterate, Erin, something you said, that listening to family members or care partners and the ideas that they have to engage their loved ones in communication activities are so powerful and taking that time even if you are busy to listen and think and validate and see how that connects to the existing evidence-based literature. I think is really powerful. But I also think that there's this collaboration and the combination of care partners and clinicians and researchers. And of course, the person with aphasia at the center of all of that, making a powerful team to develop innovative methods of storytelling is really one of my big takeaways from all of this. Erin O'Bryan: Yes, that's wonderful. Harold Regier: I would like to give kudos to the therapists who worked with Rosella over the many, many years. Ten years of aphasia therapy, four of which were one-on-one, six of which were part of a support therapy group. Those therapists were such relational people, such encouraging people, and also knew the techniques that work in therapy. So, I wanted to say that those years were very, very meaningful, very, very helpful, and helped us with the day-to-day kind of living with hope, with the expectations that things can continue to get better. Katie Strong: Thank you, Harold. Yeah. Erin, any other thoughts as we wrap this up today? Erin O'Bryan: Well, I just wanted to say that I would never recommend that all intervention involve the care partner because I understand that it's good for the person with aphasia to get one-on-one time with the clinician. But don't forget that that care partner is often with the person with aphasia almost 24/7 and we may only see them one or two hours a week. So, it's so important that we do more to really educate the care partner about how to acknowledge the competence of the person with aphasia and really how to support their communication. So that's why I really want us to do more with in involving the care partner and in intervention. So, I'll get off my soapbox. Thank you, Katie, for letting us share about this project that I love. Katie Strong: I'm so delighted that we could have this time together today. Harold, thank you for your generosity and sharing your ideas and Rosella's stories with us and this beautiful work of Aphasia-Friendly Reading and Erin for your work in the lab and bringing it to the clinic. On behalf of Aphasia Access, thank you for listening. For references and resources mentioned in today's show, please see our show notes. They're available on our website, www.aphasiaaccess.org. There you can also become a member of our organization, browse our growing library of materials, and find out about the Aphasia Access Academy. If you have an idea for a future podcast episode, email us at info@aphasiaaccess.org. For Aphasia Access Conversations, I'm Katie Strong. Thanks again for your ongoing support of Aphasia Access. Contact information for Guests – Harold Regier hrregier@cox.net  Erin O'Bryan, PhD., CCC-SLP erin.obryan@wichita.edu  Resources Aphasia Institute's Introduction to Supported Conversation for Adults with Aphasia (SCA™) eLearning. https://www.aphasia.ca/health-care-providers/education-training/online-options/ Chapey, R., Duchan, J. F., Elman, R. J., Garcia, L. J., Kagan, A., Lyon, J. G., & Simmons-Mackie, N. (2000).Life Participation Approach to Aphasia: A statement of values for the future. The ASHA Leader, 5(3). https://doi.org/10.1044/leader.FTR.05032000.4 Cherney, L. R. (2010). Oral reading for language in aphasia: Impact of aphasia severity oncross-modal outcomes in chronic nonfluent aphasia. Seminars in Speech and Language, 31, 42–51. https://doi.org/10.1055/s-0029-1244952 Cherney, L. Babbitt, E., Oldani, J., & Semik, P. (2005). Efficacy of repeated choral reading for individuals with chronic nonfluent aphasia. [Clinical Aphasiology Paper]  http://aphasiology.pitt.edu/1548/  Kaye, R., & Cherney, L. R. (2016). Script templates: A practical approach to script training in aphasia. Topics in Language Disorders, 36(2), 136–153. https://doi.org/10.1097/2FTLD.0000000000000086 O'Bryan, E. L., Regier, H. R., & Strong, K. A. (2023). “I wasn't just sitting there”: Empowering care partners through the Aphasia-Friendly Reading approach. Aphasiology. https://doi.org/10.1080/02687038.2023.2272956 O'Bryan, E. L., & Strong, K. A. (2024). Person-centered stories on the main stage in intervention: Case examples from the My Story Project, Aphasia! This Is Our World, and Aphasia-Friendly Reading. Perspectives of the ASHA Special Interest Groups. https://pubs.asha.org/doi/10.1044/2024_PERSP-23-00272 Regier, H. (2021). A Decade of Aphasia Therapy: Aphasia-Friendly Reading: A Technique for Oral Communication. Independently published Available on Amazon Strong, K. A. & Shadden, B. B. (2020). Stories at the Heart of Life Participation: Both the Telling and Listening Matter. Chapter 5. In A. L. Holland & R. J. Elman (Eds.) Neurogenic communication disorders and the Life Participation Approach: The social imperative in supporting individuals and families (pp. 105-130) Plural Publishing. Strong, K. A & Shadden, B. B. (2020). The power of story in identity renegotiation: Clinical approaches to supporting persons living with aphasia. ASHA Perspectives, SIG 2, 5, 371-383. https://pubs.asha.org/doi/pdf/10.1044/2019_PERSP-19-00145 Youmans, G., Holland, A., Munoz, M. L., & Bourgeois, M. (2005). Script training and automaticity in two individuals with aphasia. Aphasiology, 19(3/4/5), 435–450. https://doi.org/10.1080/02687030444000877

Pabėgti iš Rytų Berlyno, pasislėpus amerikietiškos ginkluotės dėžėje. Toks kažkada mamos puoselėtas planas įkvėpė Bavarijos žurnalistą sukurti šešių dalių audioserialą. Minint 35-ąsias Berlyno sienos griūties metines, laidoje „10-12“ kalbėsime, kokį pėdsaką ji paliko žmonių gyvenimuose.Ne tik karo lauke, bet ir kasdieniame gyvenime, nors dronų poreikis sparčiai auga, juos pilotuoti gebančių - trūksta. Kaip sprendžiami kylantys iššūkiai?Priimta nauja ES Miesto nuotekų valymo direktyva. Ja siekiama apsaugoti aplinką nuo neigiamo miesto nuotekų ir biologiškai skaidžių gamybinių nuotekų. Tačiau vaistų gamintojus vienijančios asociacijos tvirtina, kad direktyva priimta neatlikus išsamaus poveikio vertinimo, o joje numatytos nuostatos gali itin neigiamai atsiliepti farmacijos sektoriui: brangs būtiniausi ir kiti vaistai, taip pat ims jų trūkti.Vilniaus rajone ūkį ,,Geltoni botai“ kuria Ina Grecka su šeima. Kol kas šeima gyvena tarp miesto ir kaimo, bet didžiausia svajonė yra ir toliau puoselėti jau įkurtą vynuogyną ir uogų ūkį. Moteris sako, kad vynuogyne tenka taikytis prie besikeičiančio klimato ir galimų rizikų. Vynuogyne Vilniaus rajone lankėsi ir Iną Grecką kalbino LRT Radijo žurnalistė Rūta Simanavičienė.„Auksinio proto“ atrankos žaidimas.

Is PECS out as an AAC tool for autistic kids? Today, we're diving into a hot topic in the world of autism and communication: the Picture Exchange Communication System, or PECS. Over the years, PECS has been widely used as a way for autistic children to communicate, but as new research and insights have emerged, there's been a lot of conversation—some of it controversial—around its effectiveness and limitations. In this episode, I'm thrilled to be joined by two speech-language pathologists, Paulina Elias, and Amanda Blackwell, from Natural Communication, who share their invaluable expertise on PECS and the bigger picture of AAC (Augmentative and Alternative Communication) for autistic children. We explore how PECS started, what it offers, and why more and more professionals are moving toward more flexible, child-led communication methods that honor autonomy and individuality. You'll hear us discuss everything from the importance of giving kids the freedom to say ‘no' to strategies that empower communication beyond requests. Plus, we talk about the pitfalls of hand-over-hand prompting and the emerging preference for tools that grow with a child's communication needs. If you're an educator, parent, or anyone working with autistic children, this episode will give you new perspectives on PECS, AAC, and the role of true connection in supporting autistic communication. Get ready for a thought-provoking discussion that might change the way you think about communication support! Watch on YouTube: https://youtu.be/Tu4rKeAM0dc Bios:  Paulina Elias, M.Cl.Sc., SLP Reg. CASLPO Paulina is a multilingual speech language pathologist (SLP) living in Canada. Although she works with people of different ages and communicative needs, she has a special interest in the areas of multilingualism, gestalt language development, and autism. Paulina enjoys collaborating directly with families and interdisciplinary teams in each person's native language. At this time, Paulina offers international consults virtually, and evaluation and intervention services in Ontario, Canada. She regularly presents internationally on the topics of multilingualism, gestalt language development, and AAC. Dr. Amanda Blackwell, EdD, SLPD, CCC-SLP Dr. Amanda is passionate about communication in all forms. She has had the opportunity to learn from a variety of people from diverse cultural backgrounds as she has lived and worked full time as a bilingual (English/Spanish) SLP in Guatemala since 2013. Dr. Blackwell teaches postgraduate courses in autism and AAC at Minot State University and Saint Mary's College, and mentors SLPD students in their capstone research projects through the MGH Institute of Health Professions and Rocky Mountain University. She loves to travel around the world (with recent trips to Spain, Argentina, Ecuador, Mexico, Paraguay, Honduras, and Sri Lanka) to collaborate with professionals in presentations, workshops, research, and autism identification (ADOS-2). Topics Covered: Podcast features Paulina and Amanda from Natural Communication discussing updates in PECS and AAC. Paulina is a multilingual speech-language pathologist from Guatemala; Amanda is a U.S. speech-language pathologist with 11 years in Guatemala, focusing on autism and AAC. Both advocate for accessible information in multiple languages, especially Spanish, and are expanding to French and Portuguese. PECS, created in 1985, is a structured communication system based on ABA principles, mainly for requests. Criticism of PECS includes its rigidity and lack of fostering true communication skills beyond requests. Hand-over-hand prompting is discouraged due to autonomy concerns; hand-under-hand is recommended for better control. Communication books should enable autonomous communication, including the ability to protest or reject. Building relationships and trust with clients is essential for effective communication and learning. The podcast calls for a shift from traditional methods like PECS to more flexible, multimodal communication strategies. Natural Communication provides resources in English and Spanish, including a crash course on Gestalt language development, and engages in research and workshops to enhance AAC practices. Listeners are encouraged to explore free printable communication boards and resources to support AAC implementation. Connect With Paulina & Amanda: Our English website (for free resources, our parent and professional courses, professional development events, and individual consultations info): www.naturalcommunication.com Our Spanish website (for free resources, our parent and professional courses, professional development events, and individual consultations info): www.comunicacion-natural.com Our socials: @natural.communication (English) and @comunicacionnatural (Spanish) Instagram: https://www.instagram.com/natural.communication/ and https://www.instagram.com/comunicacionnatural Resources Mentioned: ASHA Journal Article: https://pubs.asha.org/doi/10.1044/2023_PERSP-23-00098 Playground AAC board: https://www.prc-saltillo.com/articles/playground-core-communication-boards-from-prc-saltillo?mode=view PRC Saltillo core: https://saltillo.com/chatcorner/content/29 GRID core board: https://thinksmartbox.com/news/low-tech-super-core-resources/ Avaz core board: https://avazapp.com/avaz-aac-coreboards/ Assistiveware core boards in different languages: https://www.assistiveware.com/learn-aac/quick-communication-boards Project Core boards: https://www.project-core.com/communication-systems/ Smarty Symbols Core: https://smartysymbols.com/free-core-board-download/ You may also be interested in these supports: Visual Support Starter Set  Visual Supports Facebook Group Autism Little Learners on Instagram Autism Little Learners on Facebook Submit a question for the Q&A episodes.  Ask me anything and tune in to see if your question is featured on the show!

Paulina Elias y Dra. Amanda Blackwell son las SLPs detrás de Comunicación Natural (@comunicacionnatural), una plataforma de con cursos de formación sobre la Adquisición Natural del Lenguaje.   En este episodio hablamos sobre el desarrollo gestáltico del lenguaje y sobre como los autistas nos están enseñando a entender el mundo de una manera diferente. Nuestras invitadas comparan el desarrollo analítico del lenguaje (esa adquisición normativa) con el desarrollo gestáltico del lenguaje y describen las etapas de ese desarrollo gestáltico.  Pueden encontrar su artículo por aquí: https://pubs.asha.org/doi/10.1044/2023_PERSP-23-00098 

Visą savaitę didelė dalis Lietuvos gyventojų vargsta išvažiuodami iš kiemų ar keliaudami pėsčiomis dėl storos sniego dangos. Prisnigo tiek daug, kad draudikai įspėja – daugiau nei dvidešimties centimetrų sniego danga ant pastatų stogų graso gyventojų turtui ir praeivių sveikatai.Neramumai Raudonojoje jūroje energijos kainų kol kas nepaveikė, tačiau konfliktui užsitęsus, pirmiausia tai paveiktų naftos kainą. Kodėl Lietuva jaučiasi rami?Į LRT kreipėsi vilnietis, prieš ketverius metus vedęs Baltarusijos pilietę. Anot vyro, sausio pradžioje Lietuvos pareigūnai jo žmonai nebepratęsė leidimo gyventi šalyje ir, anot vyro nepaaiškinę tokio sprendimo, liepė skubiai išvykti į Baltarusiją.Sukčiai toliau siautėja. Visai neseniai Kėdainiuose sukčiai išviliojo pinigus iš vienišos senjorės. Ji neteko visą gyvenimą taupytų pinigų. Tiesa, į policiją kreiptis neplanuoja. Taip rašo Kėdainių laikraštis „Rinkos aikštė“. Kiek jūs susiduriate su sukčiais, ar su jais susidūrę kreipiatės į policiją?Taivano prezidento rinkimus laimėjo kandidatas, kurį Kinija vadina grėsme taikai dėl jo pareiškimų apie Taivano nepriklausomybę. Analitikai prognozuoja, kad Pekinas gali imtis trijų pagrindinių taktikų, siekdamas užkirsti kelią Taivano nepriklausomybės siekiui: karinių veiksmų , ekonominio spaudimo ir Taivano visuomenės susiskaldymo didinimo.Ved. Rūta Kupetytė

Lesley Edwards-Gaither, Ph.D., CCC-SLP, is an Assistant Professor at Metropolitan State University-Denver, Department of Speech, Language, Hearing Sciences. Her areas of research include the intersections of culture, communication, and technology. Lesley teaches undergraduate and graduate courses focusing on assessment, cultural-linguistic diversity, introduction to human communication disorders, and a speech-language pathology assistant pre-certification course. In addition to teaching, she is an independent eLearning consultant developing hybrid and online courses and educating students and SLPs on telepractice technology. She recently co-authored the textbook, Telepractice: A Clinical Guide for Speech-Language Pathologists with Melissa Jakubowitz. Links: MSU Denver SLHS Department: https://www.msudenver.edu/speech-language-hearing-sciences/ Viewpoint Telepractice 2025 article: https://doi.org/10.1044/2022_PERSP-22-00095 You can listen to this episode wherever you stream podcasts and at www.3cdigitalmedianetwork.com/telepractice-today-podcast    

Welcome to the Aphasia Access Aphasia Conversations Podcast. I'm Katie Strong and I'm a member of the Aphasia Access Podcast Working Group. I'm also a faculty member at Central Michigan University where I lead the Strong Story Lab. Aphasia Access strives to provide members with information, inspiration, and ideas that support their aphasia care through a variety of educational materials and resources. I'm today's host for an episode that will feature Dr. Sabine Corsten. We'll be talking about her work which focuses on supporting people with aphasia in reconstructing their narrative identity. Before we get into the conversation, let me first tell you a bit about our guest.   Dr. Corsten, Professor of Therapy and Rehabilitation Sciences (Speech Therapy), employed at the Catholic University of Applied Sciences, Mainz, Germany, has focused her research on participatory and quality of life-oriented interventions for aphasia and in old age.  Her research explores how identity changes after having aphasia. She has led the development of the biographical narrative approach 'narraktiv' in Germany. She is currently involved in the development of digital solutions to support peer biography work and social networking in aphasia and in old age. The app, BaSeTaLK, to support biography work in senior citizen facilities to improve quality of life and communication was awarded the Digital Health Award by Novartis. She has presented her work at international conferences and has published internationally. Dr. Corsten has been a visiting researcher at the Centre of Research Excellence in Aphasia Recovery and Rehabilitation at La Trobe University in Melbourne and at the University of Queensland in Brisbane.   In this episode you will: Learn about how identity and narrative are connected to quality of life. Hear about the development of the Biographic Narrative Approach. Learn about how an app, BaSeTaLK, was used for older adults in nursing home populations to improve their quality of life. Hear about how parking lot conversation in Philadelphia led to an international working group on narrative identity and that that group's vision is to train students and clinicians in gaining competence in narrative identity work.   Katie Strong: Welcome. I can't tell you how excited I am to have this conversation with you today.   Sabine Corsten: Yes, thank you for the invitation. I feel really honored to be invited. So yeah, I'm really excited too and I'm looking forward to our discussion today.   Katie Strong: Fantastic. As we get started, could you tell our listeners exactly what is meant by ‘narrative identity'? And why this is so important for our work with people who have chronic communication disabilities such as aphasia?   Sabine Corsten: Thank you for this first question because I really think it's important to have a clear concept of identity and narrative identity to understand the biographic narrative approach and similar approaches like your approach about storytelling. And also, I think narrative identity is kind of a key objective in improving quality of life, so it's really necessary to understand it. When we started our work, we looked at sociocultural theories and we found that identity is constantly transformed through, for example, social interaction with other people. So, this means identity is renegotiated in dialogue with others. Therefore, you need narrative competencies, which means the competencies to talk about oneself and intersubjective exchange. So, I think these social interactions are necessary to interpret and integrate important life events in your life story.   Important life events can be very positive things like a wedding, but also negative things like having a serious illness. And so, these processes to interpret and integrate these life events are crucial for optimal identity development and for psychological well-being. This means these kinds of life stories or life narratives facilitate the process of understanding what happens to you and your life, and they help you to make sense of these crucial or critical life events like a stroke, for example. By this, the sense of identity can be restored, or you can find a renewed meaning to life. And now, you can have this bridge to quality of life, because quality of life seems to depend on meaningfulness and optimal identity development gives this meaningfulness to your life. So, this is very closely connected.   Maybe to sum it up, identity development or identity work can be seen as an ongoing process that forms a connection between the past, the present, and the future, and also between different roles you have in life as somebody in a professional role or in a family role. It also connects different life areas. And this narrative character of identity means the medium to do this narration is telling about yourself so that you can connect these different times in your life and areas. And also, I think this is really important, it gives you a feeling of coherence so that you recognize yourself as the same person over time, despite changes in your life and your roles. So, you have the impression of continuity and the feeling of agency that you are able to make decisions and to act.   That was a long explanation about identity. Now looking at aphasia as a chronic communication disability and as a really critical life event, especially asked for this identity work. However, the really necessary competencies, the narrative competencies are limited. So, the intensity and the length of the conversations are limited. And you can say, yeah, aphasia is a biographical disruption, so it disrupts everyday life routines, disrupts aims and perspectives. But it also disrupts the possibility to cope. So, because of the language difficulties, and I mean, you know her better, but I think it's so impressive how Barbara Shadden equated aphasia to ‘identity theft', because people can't use language for these necessary coping processes. And so, people with aphasia often describe themselves as more deficit oriented. You can see, for example, about 60% of people with aphasia suffer from signs of depression one year after having a stroke. We also know that improvement in language skills does not mean there is the same improvement in quality of life. This was the starting point for our work.   Katie Strong: Thanks Sabine. Yeah, so it really is important. The stories that we tell others and the stories that we tell ourselves about ourselves have a significant impact on our quality of life. Well, I'm just so curious if you could share about how you became interested in this work?   Sabine Corsten: That's a very good question. I mean, you know a bit about it, and it was really an exciting journey because of when I started working with people with aphasia. When I started my professional career, my work was really about classical language-based therapy, so it was symptom-oriented, and we were looking at functional themes. For example, my Ph.D. was about phonological therapy and aphasia. And that was really changed when I started working in Mainz as a professor. So, we had this discussion at home about how language is connected with thinking. So, the connection between language and thinking and people with language difficulties. How can they work on their self-image because this essential to language is missing or limited?   From a sociological point of view, the question came up, “what does this mean for the experience of oneself?” And to be honest, I had no answer. And I was expected to be the expert, so I thought, “I have to look this up,” because this is a really new path. And thinking, “what does it really mean to have this language difficulties apart from word finding difficulties and symptoms I knew about?”   I was not sure if there was something in the literature, but then I found the articles from Barbara Shadden and I had to look up this work. But I know now that this was the initial spark for me, because then I really thought, okay, there's already somebody who wants to understand what it means for people with aphasia to work on their identity and what it means for their further life and coping processes. And, so yeah, this was the starting point. And my work was always about conceptualizing intervention, so I thought, “okay, I want to understand how identity processes can take place when you have suffered from aphasia.” But I also want to support the process because it seems that there is a deficit. So, I already had in my mind that I wanted to think about a kind of therapy method or approach.   Katie Strong: I think that's where our commonalities lie. You know, I've been a fan of your work since I was a doctoral student working on my dissertation, which was also in narrative methods to support people with aphasia. I would love for our listeners to hear a little bit about the behind the scenes of how you developed the biographic narrative approach and the philosophy behind it.   Sabine Corsten: When I found the work of Barbara Shadden, I thought, “okay, there is a starting point for our work.” So, this was when I learned more about the idea of narrative identity and about the idea of, “okay, we want to support people with aphasia to work on their narrative identity.” And in the beginning, it seemed a bit crazy because we wanted to use the thing that is really difficult for them, language to support identity-building processes. So, maybe it's important to mention that during that time, I also met Linda Worrall and Miranda Rose for the first time. They also supported us and said “no, go on. This seems to be a really good starting point,” and, “maybe a bit more about the philosophy is.”   The philosophy of biographic narrative work is not really that we found something totally new. What we wanted to do is to support this kind of exchange with other people and to support live storytelling, and people with aphasia despite the language difficulties. I think this is one very important thing. And other characteristics of the philosophy that we thought, “okay, it's not about language improvement, it's more about giving them the tools to tell their story.” So, using multimodal support as written language, or using photos of pictograms. So, all the stuff we already know from traditional speech and language therapy, but really using it to have a deep conversation about their life stories. As a third point, people with aphasia can use their life story as a kind of resource pool so that they could discover, for example, strategies that they used in their former life to overcome challenges. And so that they start thinking, “okay, we can use these strategies again,” and really people told us about that. For example, they realized, “I was always very good at math, so I can do my financial stuff again on my own, I don't need help from my carers.”  Another really important point about the narrative approach is that it's really not directive, it's non-directive. So, it's not about, “oh, you're telling me you like to meet other people, then it's a good idea to use or to visit a support group.”  No, it's really about finding the solution by themselves. We just listen and try to understand what people tell us, but it's not about giving them a direction.   Another very important point is that it has, in my opinion, a preventive character. So, it's not a kind of psychotherapy and it's not about working on depression. It's really about preventing depression or working with people with mild symptoms. I think these are really very important characteristics of the approach, and you asked about how we developed it. So, we work in an interdisciplinary team consisting of, of course, speech and language pathologists, but we also had an adult educator on our team to learn more about the theory behind narrative identity. And we also got advice from psychologists and sociologists, really to learn more about these other disciplines. So, this, I think, is what is behind the approach. Maybe, should I also tell you a bit about how it works?    Katie Strong: Please. Yes, please do!   Sabine Corsten: And I forgot, apart from the professional workers who were part of the team, we also asked people with aphasia, for example, about the language we use in the approach. So, to learn more about easy language, or, for example, to select topics that were really important for them and what they want to talk about.   The approach itself consists of individual and group sessions, five individual and seven group sessions, in the evaluated version, and the sessions took place over ten weeks in our study. For the individual sessions, we mainly based them on a kind of unstructured interview format, it's called the ‘narraktiv' interview or the narrative interview. So, this should really give people with aphasia the chance to tell about their life story. For example, we started these sessions by asking them, “tell us about your life, you can tell anything you want. We won't interrupt you, and you can just talk about what you really think is important to you.” So, they were not forced, for example, to tell their stroke story. And there were also people who started with very different things, for example, with the death of their mother or things like that.   The first three sessions were about this unstructured interview form, and then we had two more individual sessions which were a bit more guided about relevant biographic narrative, relevant topics, for example, family, or health, their professional career perspectives for the future, things like that. And we also used these last two individual sessions a bit to prepare the people with aphasia for the group sessions.   And during the seven group sessions, we had a speech and language therapist and educator who kind of moderated the conversations. So, they really worked as a kind of communication broker by just supporting the conversation, introducing people to the topic, and asking questions so that everybody was able to take part in the conversation. And we also decided to include people with really severe deficits in speech production, so people with severe apraxia of speech. And again, we offered them to use pictograms and written language. We also had some worksheets, for example, we had something like a card and people could write down, “so, this is me” in the middle, and then they could put people around themselves. So, “these (people) are my family. These (people) are my best friends,” to show how close they are to the individual persons. And after ten weeks, we stopped the intervention, and we had a conversation after three months to listen to the people and to hear how they felt after taking part in the intervention.   Katie Strong: Thank you. So, I do have a question. I guess in the group sessions, were they sharing things that they had prepared in their individual sessions? Is that what was happening?   Sabine Corsten: Yeah, exactly. For example, they had talking about their families as a topic in the individual sessions. And then they brought, for example, pictures from their family to the group session and introduced the members of their family to the other group members. Yeah, they shared the information that they discussed in the individual sessions.   Katie Strong: Fantastic, thanks for clarifying that. Since that initial project, you've been taking this storytelling approach in directions with different stakeholders, and also incorporating technology, specifically with nursing home residents and an app called BaSeTaLK. Could you tell us a little bit more about all of this?   Sabine Corsten: Yeah, I mean, really, the core of all of this is the biographic narrative approach. And we really started using this and other settings and with other target groups. And BaSeTaLK, again, an acronym, it's about using it with another target group. So, we decided to work with really old people, residents living at nursing homes, and the idea was to strengthen resources in the late stage of life. And I think you can compare getting old and especially moving into an institution to having a stroke because it's also a very critical life event.   You can see that people living in nursing homes really experience a kind of loss of connections and meaningful relationships, which means they also have high rates of depression. I think it's really up to twice as high as people living at home, so they are really in danger of getting a really serious psychological illness. And also, the rates for dying are higher there, so we thought it's another situation where people need support in communication to have the chance to talk about themselves. And again, it's our task to find this kind of preventive solution. It's also not new in working with older people, for example, there is already biographic work or reminiscent work. It's kind of quality characteristic of modern nursing and care for elderly people. But we found that it is mostly used for people with dementia, so then the aim is to facilitate the memory, really, it's not about identity work. So, it's really mostly offered for people with dementia.   And another point is, at least in Germany, this kind of reminiscent work is not systematically used in nursing homes because we have this shortage of staff, and this really limits the use. So, we thought that it might be a solution to work with volunteers and older people because we know from the literature that if volunteers and residents are similar, for example, in age, then it's easier for them to collaborate. And so, we thought that we would work with volunteers, and they could go into the nursing homes and have these life storytelling conversations with the residents. And we found in the literature that, for example, in palliative care, this kind of biography work is already done successfully by volunteers.   But it's also recommended to use technical devices, for example, specific apps to support the volunteers. And this was the moment when we thought, “okay, let's do this and try to develop an app like BaSeTaLK so that volunteers can use it as a kind of moderation guide and to stimulate these narrations in nursing homes.” The app, BaSeTaLK itself, is kind of about virtual journeys. Let's say it like that.  So, it offers the opportunity to go on virtual life journeys and you can visit different virtual places. For example, people can choose to talk during one session about a river or theater. So, it's not just a river or mountains or things like that, you can also go to casual places. And we had a long discussion about if we wanted to conceptualize the app around these locations, because in the beginning I thought that it was much better to have these biography important topics like family, health, and all the things I already knew. But we developed the app together in an interactive process with residents and possible volunteers. They told us that many old people don't want to talk about their family, for example, their partners may be dead or their relationship with their children might not be so good. They might also be a bit more open, so people can talk about their family, but they don't have to. And so, we decided, “okay, let's have these places,” for example, we have a place with a garden that has stimulating questions like, “what did you observe growing during your life?” And then people can decide if they want to stay with the plants and talk about plants, or if they think, “oh, I saw my family growing, and I want to talk about my grandchildren,” they can talk about that. So, the questions are quite metaphorical. You can stay close to the question, or you can give a broader answer. So, this was the idea when we chose to work with these locations. And then the app has a kind of stimulating feature by always asking these kinds of questions, but also having pictures of plants when you look at the garden or of nice places in the scenery. So, people can talk about what they associate with the picture and they can answer the questions. There's also always a kind of specific feature at each location. For example, when you visit the sea, there's the sound of the sea, or you can listen to a podcast or you can listen to music, things like that. The app can be used in one-on-one sessions to stimulate conversations about the life story, but it can also be used in group sessions to facilitate group conversation. I'm not sure, I think this gives the first impression of how the app might work.   Katie Strong: Absolutely. No, I think you've given us a great visual of how it can work. I guess one question that I know that's going to come up, Sabine, is “Can anyone access the app?” Or “How do we how do we get access to it?'   Sabine Corsten: Yeah, this question really comes up each time we talk about the app, and I think it's a very good question. And, yeah, I would really like to say yes, everybody can use it, because we really had very positive feedback from the users. So, we evaluated in a bigger study including fourteen residents in the target group, I think, and we also had a control group with more than ten people. And the data really showed that there was an improvement in quality of life and quantitative data. But I think it was more impressive that people told us, “yeah, we really started thinking about our lives.” For example, one older woman taking part in the intervention, I think she was 94 years old, she said, “so this intervention was a turning point in my life. So now I look at my past and much more positive way.” And I mean, she was a really old woman, and she took part in twelve sessions.   In total, we have 15 locations in the app, but we only work for three months with our residents. I think this tells so much about what happens when you take part in such biographic narrative interventions. And I mean, we really work with people with maximum mild cognitive deficits, so it was really for older people with almost no cognitive deficits. Now to your question, after this long answer, we published the app as open-source code, but I had to learn that it doesn't mean that it's an app shop or that you can immediately use it. It means everybody can work with this code, so other coders, IT people, tech people can start changing the code or working with the code, but companies can also do that. We don't have the funding to really go on with the app or to operate it on a regular basis. So, we are looking for bigger institutions, for example, institutions working with a lot of nursing homes in Germany so that they can operate the app. We are also discussing going on with the app with the colleagues from La Trobe with Miranda Rose. So, we already translated all the language stuff from the app so that it can be used, for example, in Australia. And there's the idea that it can also be used when you work with people with aphasia because it really has easy language with hardly any barriers. It's easy to use and the interface is very simple. So, at the moment, we think it might also be a good idea to train people with aphasia to use it as a kind of peer leader in support groups, for example. So, we try to find that kind of money to go on with the app and we also try to transfer to other targets.   Katie Strong: Important work and we certainly hope that the funding comes your way. I love that it can be applied to a variety of populations. You've talked a little bit about the coding but tell us more about what it was like to develop the BaSeTaLK app, and who was part of your team. All of that good stuff.   Sabine Corsten: It was a really new experience for me because it was my first tech project. And we started this tech journey before the pandemic so we didn't know that would become so important for people in the nursing homes. And, as I already mentioned, we started the development or process in a so-called user-centered process. So, this means all the possible users were involved in the whole process, to really old people living in nursing homes, to older people who might work as volunteers. So really from the starting point, we started working with them in focus group meetings. And these focus groups were led by two of our research workers, two speech and language pathologists, and also our tech guy who programmed the app was part of the focus groups. And they met on a regular basis. So, in the beginning, we started looking at recommendations in the literature and requirements. And then we presented this to our focus group members, and they commented on it, or they were also able to use some prototypes we developed. And so, this we presented it to them, and they would give new recommendations to us, or they talked about their requirements.   Katie Strong: I think it's so thoughtful and so important that we bring in stakeholders so early in a product development like this, you know.   Sabine Corsten: Yeah, we really learned about, for example, the selection of the topics. So, they told us not to offer topics like family or health, because this is so difficult for so many old people. So, start with other topics, maybe easier topics, and then you can create variety in the depths of the conversations by using different kinds of questions. So, this really came from the groups, it was not in our minds. I think this was really important to learn a bit more about that and also about the interface. I mean, now I say, “yeah, we work with a simple interface,” but this means really simple. So, because of all the things that we already know about the menu, and all these things are very difficult for people. I mean, we are talking about people 80 years and older. And I think you really have to ask them because otherwise, they can't use the product. What might be interesting is that we had to do this all during the pandemic, so it was difficult for the groups to meet. For example, we ended up clarifying some things, or some topics, by phone calls. So, it was not possible to meet all the people in the group together. This was one of the challenges.   I think it's really interesting, we have a Ph.D. project using interviews with the members of the focus groups after being part of this focus group work and phone calls and all of this stuff. And I think this is interesting because we are all still able to show that this participatory work or process was really a very good experience for the members of the group. So, we found some indications for personal growth and personal empowerment. So, they were talking about how they have found or developed some new competencies. And I think this was also interesting that even the people who were just part of the focus group meetings benefited.   Katie Strong: Yeah, right. It's all about meaningful work, right? Having purpose and doing meaningful things. I love that. Well, I'd like to shift gears a bit and share with our listeners about how we met at the International Aphasia Rehabilitation Conference (IARC) in Philadelphia, in the Hilton parking lot of all places to meet. And we ended up having this beautiful parking lot conversation with you, me, Sarah Northcott, Rhianne Brinkman, and Bianca Spelter. It was kind of the start of this international working group that we have for narrative identity. You've been the leader for this group, and I was just curious if you could share a bit about what we've been up to and a few of the goals of our working group.   Sabine Corsten: I mean, I already told you that I'm really not sure if I am the leader, but I really like being a part of the group or a member of the group. And, yeah, I really wanted to get to know you and also about Barbara Shadden to be honest, because I admired this work. And so, when I came to Philadelphia and saw you on the presenters list, I thought, “okay, I want to get to know her, and I want to get to know, of course, Barbara.” And then, I think it was really nice to get to know all of the other people you mentioned already. And I think it's so great that we have this group, and that we meet on a regular basis, since last summer. So, for me, I think it's really a very specific opportunity to learn more about the storytelling approach, about the theoretical background, and also to meet people who really believe in the same thing. This inspires a lot in me, I think, so that I think, “yeah, we are on the right way because we are together.” So I think, but you can correct me, one of the goals of our group is to have an exchange about our work and about the things that are important to us, looking at our professional work.   Another thing, and I think this is something I like very much, is to develop joint projects to have or to come to results, for example. And I think one really interesting path is to think of how to support storytelling, for example, in the acute or post-acute phase of aphasia. And I think we talked about this in the beginning and then we thought about other projects. And I mean, at the moment, I don't know what you think, but I think it's great that it has already started. So, we are already working on a joint project, and this was about introducing students and speech and language pathologist clinicians to the narrative approach, and especially to the approach you use, the life storytelling approach. And maybe combined a bit with the ‘narraktiv' approach, to work on the training together, to train and inspire other clinicians, and to facilitate them using the approach. And I mean, in the Netherlands, Rhianne Brinkman already started with a few students to do this course. And, yeah, I'm really curious about what she will find. And I think it's about giving the students or the clinicians more information about the theoretical background, but also giving them the opportunity to make their own experiences and to try the approach with people with aphasia.   Katie Strong: Absolutely, it's just been great to connect with all of our newfound colleagues. And I agree with the sharing of ideas and seeing what we can do to maybe move this work forward to be able to have a farther reach. You just talked a little bit about the student training. But I do think one of the things our group has been talking about is, you know, how can we begin to train clinicians in understanding the constructs related to narrative and identity and methods to use with our clients and exploring their own stories to help them move forward? I was wondering if you could tell a little bit about what the working group has been discussing and maybe has in the works.   Sabine Corsten: I already mentioned it a bit. So, it is about how to add to, what training could look like, or what we really want to share with clinicians and students. And to me, I don't know what you think, but there are two parts to it. There's this part about giving the theoretical background and really facilitating people in understanding why it is important to look at identity and how identity is connected to communication. And, again, this is connected to quality of life and to our work. So, because I think the aim of rehabilitation is a growth in participation and quality of life, and the training part is also closely connected to this. So, giving them the tools to do this, to feel comfortable so that they know how to ask questions, or how to react when people start crying, for example. I mean, it's normal to be upset when you talk about, for example, your stroke story. So, if you are sad that you've lost specific skills, this is very normal. I think this is the part, knowing about the background and knowing about the tools or methods you can use. And the second part is about the mindset to really see that this is our work, and we are responsible for it because we know how to facilitate communication and how to open the space for this kind of conversation. And I think this should also be part of this experience that we want to share with clinicians and students. That they can see this as really their responsibility, but also as a big chance for us to have a new kind of working area, in addition, of course, to the classical field and to the language-based therapy.   Katie Strong: Yeah, I agree. I agree. It's beautiful work, but it does take a different mindset to do. Well, Sabine, we're coming to the conclusion of our conversation, and I was just curious if you had any final thoughts you'd like to share with our listeners as we wrap this up?   Sabine Corsten: Whoa, that's a really difficult one, because I think we talked about a lot of important topics, or thoughts during the last hour almost. I think, maybe the take-home message is to first be aware of the psychosocial consequences of aphasia. I mean, I think a lot of people know about it, but really to be aware of all the changes these people suffer from. It's not only about language, it's about all the other life areas we mentioned. And maybe another take-home message I already mentioned is to feel that we as speech and language pathologists can be part of the solution. So that it's really our part to offer approaches and to conceptualize approaches that might help here. Because, when I look, for example, at the Stepped Care program, this is not established in Germany. But for example, in Australia, this means that really everybody suffering from aphasia can be part of a psychosocial approach. And then, depending on the severity of the psychological difficulties, you can decide if you only maybe have a kind of biographic intervention, or if you need problem solving therapies, or if you really need psychotherapy. I think this would be a good thing to start with, as maybe level one interventions like the storytelling approach, or like the biographic narrative approach, that we start establishing these kinds of approaches for people with aphasia. And that speech and language pathologists feel comfortable doing it, but they also have the opportunity to maybe collaborate with psychologists and can say, “okay, and now we have another level or another severity of psychological problems.” And now we need to collaborate, or the psychologist needs to take over. I think that if we can go on that journey, this would be great to find more solutions in collaboration with other disciplines.   Katie Strong: Yes, I agree. I agree that we, you know, have a role in supporting people beyond just their language impairment and that using story is one way to do that. Absolutely. Well, Sabine, I appreciate the conversation today. Thank you so much for being a part of this. And in the show notes, listeners, we'll have some ways for you to contact Sabine and also some links to references to some of the things that we've discussed today. So, thanks so much for being here.   Sabine Corsten: Thank you again for the invitation. It was really an honor for me, and I think the time flew by now. So, it really felt very fast.   Katie Strong: Well, thanks so much.   On behalf of Aphasia Access, we thank you for listening to this episode of Aphasia Access Conversations Podcast. For more information on Aphasia Access, and to check out our growing library of materials, go to www.aphasiaaccess.org. And if you have an idea for a future podcast topic, email us at info@aphasiaaccess.org. Thanks again for your ongoing support of Aphasia Access.     Contact for Sabine Corsten – email Sabine.Corsten@kh-mz.de   Acknowledgements – A special thank you to Amanda Zalucki from the Strong Story Lab at Central Michigan University for their assistance in the transcription of this episode.     Resources   Corsten S., Konradi, J., Schimpf, E. J., Hardering, F., & Keilmann, A. (2014). Improving quality of life in aphasia: Evidence for the effectiveness of the biographic-narrative approach. Aphasiology, 28(4), 440-452. Corsten, S., & Lauer, N. (2020). Biography work in in long-term residential aged care with tablet support to improve the quality of life and communication – study protocol for app development and evaluation. International Journal of Health Professionals, 7(1), 13-23.  https://doi.org/ten.2478/ijhp-2020-0002 Corsten, S., Schimpf, E. J., Konradi, J., Keilmann, A., & Hardering, F. (2015). The participants' perspective: How biographic-narrative intervention influences identity negotiation and quality of life in aphasia. International Journal of Language and Communication Disorders, 50(6), 788-800. https://doi.org/ten.1111/1460-6984.12173    Lucius-Hoene, G., Holmberg, C., & Meyer, T. (2018). Illness Narratives in Practice: Potentials and Challenges of Using Narratives in Health-related Contexts. Oxford, UK: Oxford University Press. Menn, L., Corsten, S., Laurer, N., & Wallace, S. J. (2020). The Effectiveness of Biographical Approaches in LongTerm Care: A Systematic Review. The Gerontologist, 60(4), e309-e238. https://doi.org/ten.ten93/geront/gnz074 Shadden, B. B. (2005). Aphasia as identify theft: Theory and practice. Aphasiology, 19(3-5), 211-223. https://doi.org/ten.ten80/02687930444000697 Strong, K. A., Lagerwey, M. D., & Shadden, B. B. (2018). More than a story: My life came back to life. American Journal of Speech-Language Pathology, 27, 464-476. https://doi.org/ten.ten44/2017_AJSLP-16-0167  Strong, K. A., & Shadden, B. B. (2020). The power of story in identity renegotiation: Clinical approaches to supporting persons living with aphasia. Perspectives of the ASHA Special Interest Groups, 5, 371-383. https://doi.org/ten.ten44/2019_PERSP-19-00145   Video Resources Aphasia CRE Talk - Improving the Quality of Life in Aphasia, The biographical narrative approach. - Prof Sabine Corsten https://www.youtube.com/watch?v=NGIFZkysDYA     If you liked this episode – more listening… Additional Aphasia Access Conversations Podcast episodes relating to the topic of narrative and identity.   Episode #5 – Insights and "Aha!" Moments About Aphasia Care with Professor Emeriti Barbara Shadden https://aphasiaaccess.libsyn.com/insights-and-aha-moments-about-aphasia-care-with-professor-emeriti-barbara-shadden Episode #55 - The Power of a Story: A Conversation with Katie Strong https://aphasiaaccess.libsyn.com/the-power-of-a-story-a-conversation-with-katie-strong

Episode 51: Interprofessional practice and qualitative research with Danika Pfeiffer. Welcome to See Hear Speak Podcast Episode 51. In this episode I talk with Speech Pathologist, Researcher, Educator and Podcast Host, Danika Pfeiffer about her experiences and research reporting on Interprofessional collaboration and her qualitative research working in school systems. We discuss important topics that can facilitate change so I hope you find it helpful to stimulate your thinking as well. Thanks for listening! Conference: Implementation Science IS for All: The Power of Partnerships | MGH IHP Danika Book Pic: Good night moon https://www.amazon.com/Goodnight-Moon-Margaret-Wise-Brown/dp/0694003611 Podcast: About, From and With https://podcasts.apple.com/us/podcast/about-from-with-an-slp-podcast/id1568966242 Publications: Pfeiffer, D. L., Pavelko, S. L., & Bronaugh, D. (2022). Get out of your silo: A qualitative examination of an interprofessional undergraduate course. ASHA Perspectives. https://doi.org/10.1044/2022_PERSP-22-00083 Pfeiffer, D. L., Long, H. L., El Amin, M. (2022). Accessing research beyond the paywall. ASHA Leader Live. https://leader.pubs.asha.org/do/10.1044/2022-0919-slp-aud-research/full/

          Welcome to the Aphasia Access Aphasia Conversations Podcast. I'm Katie Strong and I'm a member of the Aphasia Access Podcast Working Group. Aphasia Access strives to provide members with information, inspiration, and ideas that support their aphasia care through a variety of educational materials and resources. I'm today's host for an episode that will feature Dr. Debra Meyerson and Steve Zuckerman. We'll be talking about their bike ride across the country, Stroke Across America, as well as the importance of identity and storytelling in a person's journey with aphasia. Before we get into the conversation, let me tell you a bit about our guests. Debra Meyerson was, until her stroke in 2010, a tenured professor of organizational behavior at Stanford University's School of Education.  Debra's most significant contribution from that period was Tempered Radicals:  How Everyday Leaders Inspire Change at Work (HBS Press, 2001). More recently, she authored  Identity Theft: Rediscovering Ourselves After Stroke (Andrews McMeel Publishing, 2019) and is co-founder and co-chair, with her husband Steve Zuckerman, of Stroke Onward, a nonprofit working to ensure stroke survivors and their supporters have the resources needed to rebuild identities and rewarding lives.    Steve Zuckerman is, along with Debra, co-founder and co-chair of Stroke Onward; he has been Debra's care partner since her stroke in 2010.  He has held leadership roles at Self-Help, a nationally recognized economic justice nonprofit, since 2006 and still serves part time as a Senior Advisor.  Before that, he was a managing director at a private equity firm.      In the summer of 2022, Debra and Steve led Stroke Across America – a 100-day cross country bike ride, from Oregon to Boston, to raise awareness for stroke, aphasia, and the importance of the emotional journey in recovery.   In this episode you will: be inspired learning about the bike ride, Stroke Across America, and its effort to raise awareness about the emotional journal of living with stroke and aphasia. learn about the power of story in reconstructing identity in people living with aphasia. become aware of Stroke Onward's mission to support the emotional journey of rebuilding identities and rewarding lives.   Katie: Welcome Debra and Steve. I'm so happy that you are here with me today. Debra: Thank you so much, Katie. Steve: It's great to be here. Katie: Well, I'm just so excited for our listeners to be able to hear about what you've got going on, and I'd love to start with what you were up to last summer. You did an amazing bike ride across the U.S. called Stroke Across America. Congratulations! I mean it was a big deal! Can you tell us about it? Debra: Sure. Stroke Across America was a bike ride across the US and Canada to raise awareness about stroke, brain injury and aphasia. We wanted to spotlight the emotional journey after stroke. How do we rebuild our identities and live meaningful lives? We rode 4,500 miles over 100 days, traveling from Oregon to Boston. There was a core team of six riders and others who joined us for portions of the ride. We became a family. I didn't expect that. Katie: That's fantastic. Tell me about who rode with you and became family. Steve: As Deb said, we had six core riders most of the way across the country. In addition to the two of us, a woman named Whitney Hardy, who's actually a close family friend. She's a young woman in her thirties who unfortunately suffered a traumatic brain injury about four years after she graduated from college and suffers no ongoing physical disabilities but has some cognitive issues and memory issues. She rode with us from the beginning to the end. Another stroke survivor was Michael Obel-Omia, who I know is an active participant in Aphasia Access. Michael is a stroke survivor who also lives with aphasia. He joined us about 15 days late because his son was graduating from college, so he joined us in Missoula, Montana. We had two wonderful summer interns, Emily and Alex. We met Emily through her grandfather, who was a stroke survivor and hoped to ride with us but didn't end up riding with us. Emily and Alex are both students at Washington University, St. Louis. They traded off, one rode and one worked, every other day. We can't say enough about the wonderful, not just competent and great work they did, but the energy they brought. They really helped make it special. I guess our seventh team member was our then roughly one-and-a-half-year-old golden doodle named Rusty who was along for the ride. Sometimes she rode in a trailer behind our bike and sometimes in one of the support vehicles. We had a group called Bike Eternity, a gentleman named Arlen Hall, who really arranged all the on-road logistics and the route. He and his team were just fabulous in terms of just making everything work. That was our family. Katie: It's quite a crew. Fantastic. I was wondering if you could tell us about a favorite experience from the ride. Debra: We hosted sixteen community events across the country. They brought together survivors, families, friends, stroke care professionals, and more. It was really inspiring to be with all these people. Building community and collaborating with others is the only path to real change. And you were at the Ann Arbor event? Katie: Absolutely. Yeah. My friend Becca and I came down to the Ann Arbor event. I think it was Dexter or something. Debra: Yeah Katie: Boy, did we show you how we can have rain in Michigan! Debra: I know. Oh, yeah. Katie: Oh, my goodness. Yeah, it was great. Even though we had rain, there was so much great energy around the event. I can feel what you're talking about. Steve: I think the events were kind of really the most powerful experience. But Deb, you were going to talk about one particular ride you loved. Debra: I loved riding past Cameron Pass in Colorado for 30 miles up and 40 miles down. Katie: Wow! Steve: Yeah, so just to add a little bit to that, because I think that one day of riding really, I mean, every day was fantastic. We just loved the riding. But this one stood out for all of us. It was from a town called Walden in Colorado, a bit east of Fort Collins to a campground called Stove Prairie Landing. The pass we rode over was about 10,276 feet, so we were up there. And as Deb said, we rode up for 30 Miles about 2000 feet, but then got to come down 4000 feet. The whole ride was in a canyon with dramatic mountains and a river that we happened to catch at the right time of the year because the snow was melting. So, it was just a rushing river where we got the sound, the sights, and sometimes the spray of rapids as we're cruising downhill. And then there was just a perfect riverside campground at the end. It was just sort of a magical day. Katie: Yeah. As you were describing it, I wanted to use the word magical! So, I agree. Yeah. Fantastic. I'm sure it wasn't all easy street. I was wondering if you could tell us one of the hardest things about planning such a big activity. I mean, this was a big event. You had several events along the way, but you know, tell us a little bit about the planning. Debra: Organizing this event was so hard, but it was so important and so impactful. We had sixteen events: three events before we started riding in Palo Alto, Bend, and Portland, eleven along the way, and two in Boston after we finished. We had so much to do after the rides and after dinner, such as PR, social media, Stroke Onward, events, and a documentary film. There was so much to do! We are really tired. Steve: Yeah, I think the biking certainly was a lot, but we weren't trying to ride fast. You know, one thing I say about biking is, if you want to ride long distances, you just have to ride long distances. You get used to it. So, that didn't really feel like a strain for us. And the organizing of the route, particularly with the help of Arlen, kind of got done ahead of time. It was a lot of work, but he's a pro and we put it together. But it was really, I guess we're “Type As” who can't get out of our own way. We built so much into the trip that it really was those evenings and our theoretical “rest days,” which were nonriding days. We renamed them “stress days.” We felt like we had to get everything done. So, you know, that was the hardest part of the trip. It was just how much we packed in. We jokingly say, but it may not be a joke, “that someday we want to ride across the country where we have absolutely nothing to do but ride across the country.” That way, we can enjoy the evenings and the rest days, do a little more touristing, and spend time meeting people along the way. Katie: Yeah, it was very focused. You were very intentional about gaining awareness and supporting community. And I'm sure that it sounds like there was lots to do beyond just pedaling. You mentioned earlier about a campground, but I'm curious, where did you stay along the way? Steve: Our main support vehicle was an RV, pulling a trailer with a lot of gear. We organized mostly around staying in campgrounds. Partly to keep the cost down and partly because we didn't want to have to stay rooted to where the hotels and motels were. And so, Deb and I got the privilege of sleeping in the RV. It was a small RV, but very comfortable. And the rest of the group was camping, so we had tents and cots, and all you would need for relatively comfortable camping. About one or two nights a week, we would end up staying in a motel, partly just to give the folks who are camping a little bit of a break. We actually came to enjoy the RV so much; we almost preferred it to the hotels. Then, one of the real highlights of the trip was we were able to see a lot of friends going across the country. Particularly in the cities where we held events. We almost, with maybe one exception, always had a rest day connected to the event. Probably at about half of those we ended up staying with friends. That was really special to be able to involve more people in our lives in the journey. Katie: Yeah, I was thinking when you were in Ann Arbor. Deb, you had a number of colleagues and friends that came to the Dexter event. Debra: Yes, in Detroit, two days later, we met with my middle school buddies, Debbie and Debbie and Debbie. Katie: I love that, fantastic! That's great! Well, riding across the country is a huge endeavor. What made you decide to do it? Debra: Steve. Steve: Deb would say, “Steve made me decide to do it.” Well, actually, it is true. I had a close friend from college who rode across the country right after we graduated from college. From that day, I always said, “that's something I want to do”. As I got older and older and hadn't done it, it was kind of rising to the top of the proverbial bucket list. But cycling really has been a huge part of our recovery from Deb's stroke. It has been the best way that we can continue to do a lot of the things we love - exercise, adventuring, seeing new places, and spending time with friends. We had never ridden a tandem before Deb's stroke, we rode individual bikes. It was a bit of a challenge for Deb to give up control, understandably. But when we saw the opportunity to do it with a purpose, that's what kind of got us really excited. We were just starting to build Stroke Onward, we wanted to build awareness for the importance of the emotional journey, and events create good opportunities to attract attention. So, what better thing than to do something you've always wanted to do and do it with a purpose? That's kind of how we got going. Katie: Well, it is inspirational, and I know a big focus of the trip was to raise awareness about stroke and aphasia. Debra, for people who might not know, could you share a little bit about your life story. Debra: Of course. My life story started earlier. In 2010, I was a professor at Stanford. I studied, taught, and wrote about feminism, diversity, and identity. Then, I had a severe stroke. For three years, I did therapy almost full time. I had to get my old life back, but I couldn't. My disabilities, especially aphasia, forced me to leave my job at Stanford. Giving up tenure was like a second punch in the gut. It was a huge trauma on top of my stroke trauma that started my identity crisis. Who am I now? Katie: So, Debra, I think that's what sparked you writing a book called Identity Theft. Can you tell us a little more about that? Debra: I had written two books before my stroke. I decided to write another book after my stroke, Identity Theft. Writing Identity Theft became my learning journey. It has helped me rebuild my identity. It took me five years, and I learned to accept lots of help. No one told me rebuilding identity is so central to recovery. I learned firsthand that it's so important. While researching Identity Theft, I learned that other survivors think so too. They had no advice and support for this.  Steve: Maybe I'll add. Deb mentioned doing research for Identity Theft. From the very beginning when Deb decided to write a book, she didn't just want to write about her story. She was an academic, she wanted to bring in other people's points of view. And so, Deb interviewed twenty-five other survivors and probably another thirty-five people who were care partners, friends, families, and professional caregivers. Kind of the idea being that she wanted to be able to write about a diversity of people and stroke experiences because that would make the book more relatable and more accessible to more people. And that really kind of gets at one of the things that really struck me about Deb writing Identity Theft. In many ways, the writing of the book really reflected her personal journey. That at the beginning, she was kind of writing it to prove she could, she didn't want to let go of that identity as an academic. But very quickly, she realized that the process of writing it, as Deb said, was kind of her journey. She was able to turn her knowledge of identity and the lens on herself to really help rebuild her identity and her life. But along the way, she realized, “Man, there are so many other people out there who aren't being told about this and need resources.” I say this all the time, choosing to write a book when you have aphasia has got to be one of the bravest decisions because it puts you face to face with your frustrating disability every day. And there were a few times when Deb came downstairs and said, “I'm done,” “I'm not finishing the book,” “This is too frustrating,” and “I can't stand it”. But it was that knowledge that it could help other people that got her to push through that frustration. And that gets to kind of one of the big themes of our work, which is about finding purpose and having purpose and how that's often our biggest motivator in life, what we can give. So, that's kind of a little bit of the history of the book. Katie: I appreciate you sharing that. And as you were both talking, you were talking about this journey. And you know, thinking about the story and the writing and the rewriting of your identity. It really isn't about the product, not necessarily the book, which maybe initially that's what you were interested in Deb. But really, the journey is where all the work and the reintegration of who you are and who you're going to be is. very powerful. Very powerful. It's such a great read. I've enjoyed the book very much. So, you have even moved forward beyond a book, and you've started a nonprofit. It's been established for a little bit now. Can you tell us about your nonprofit, Stroke Onward? Debra: Yes. I created it three, no, four years ago? Our mission is to ensure stroke survivors and their supporters have those tools necessary to rebuild identities and rewarding lives. The vision is a stroke system of care that fully supports every survivor's emotional journey and recovery. Steve: Maybe I'll add. I think, clearly, the issues of critical care and helping people survive a stroke, and then all the work on rehabilitation is critical. What we saw is that a lot of people don't get all their capabilities back. It's almost like, well, if recovery means rehabilitation, then does that mean everybody who doesn't fully recover their capabilities, has a failed recovery? And we were just unwilling to accept that. Recovery had to mean more than just capabilities. That's why we decided to really focus on that next step in recovery, which is the emotional journey. So, we really think about our work around three areas. One is raising awareness, just that this whole issue of the emotional journey is really important and doesn't get enough attention. Even if people realize it's important and say, “Well, gosh, where can I get help with this?” There aren't enough resources out there. You know, at the end of the day, as Deb said, “it's about system change.” That we would hope that 10 years from now, a person who suffers a stroke and their family enters a system that not only provides good critical care and points them in the direction of good rehab, but also creates a framework and resources for this part of recovery, for the emotional journey. I won't go through all the actual things we do. Hopefully, you'll be able to post the website and people can go and see more about stroke onward, www.strokeonward.org, easy to remember. Katie: Absolutely.  Debra: And there's the book discussion guides. Steve: Yeah, well, one of the places in that the speech therapy community has been so supportive and such a wonderful partner is with the creation of our book discussion guides. Our colleague, Jodi Kravitz, led the creation so that the book can be more accessible. There's a guide, you know, with the idea being a group of people with aphasia can read the book together and have a facilitated discussion with a guide. But also, we created separate guides for families, speech therapists, and other health care workers. Just again, the whole idea of trying to make the material accessible, digestible, and useful for people who are going through what we went through, which was the identity crisis and having to rebuild our lives. Katie: Absolutely, we use the resources for our local book club here at Central Michigan University and our Lansing Area Aphasia Support Group. The materials were great, but the book just brought forth so much rich discussion. Debra: Yeah. Katie: You know, not all of it was easy to read. There is some tough stuff; you don't skirt the issues. I think it really was a very meaningful experience for our members and the students that were a part of the group to be able to hear the journey, to hear what maybe hadn't been addressed, to hear how people had moved forward with things, and the areas where we really do need to be thinking more about as healthcare providers. It is important that we can support the whole person and not just fix the physical or the language. It's a whole emotional journey that you're moving forward with, which in Stroke Onward is really important. Well, as you know, a lot of my work is about the importance of storytelling. Deb, I was wondering if you could talk about how storytelling impacts your work. Maybe even share a few stories from your work. Debra: Sure. Storytelling is so important. We are always changing, and our stories evolve over time. Storytelling helps us navigate the emotional journey after a stroke. And in my book, Identity Theft, I share my story and the stories of others so that survivors don't feel alone. I would like to share one story that helped me recognize that life could be good after my stroke. Seven months after my stroke, my friend Ann invited me to her 50th birthday weekend in Palm Springs with tennis, hiking, talking, and biking. I said, “No...no, no, no.” I would need so much help, and most of all, I could barely talk at all. Conversations would be loud and lively. I would feel frustrated, jealous, and sad. Kim, my friend, said she would help with everything. She said she would help me have fun. She was there for me. I was nervous, but I decided to give it a try. At first, I was determined to be the “old Deb” at the party, but the frustrations were constant. Conversations were too fast, and the friends trying to help did not give me time to find the words. I was frustrated constantly, but I decided to enjoy myself anyway. The night of the birthday party, I danced a lot! Great music, so fun. I was not the “old Deb” anymore, I was a newer version of myself. I could spend my time with my friends dancing, laughing, and enjoying what is essential in my life: friends, community, and fun. It is so hard, but it is so important. Pushing myself to be social and telling stories about it has been so important to my recovery. Katie: Thanks for sharing, it's a great story. And well, I mean, you sound like you have fabulous friends, but it sounds like Kim really was one that stuck around and was willing to help you through some of that change. Steve: And if I can add one other story, which kind of gets to how Deb reclaimed some of her old identity. In this case, her identity as a mom, and Deb tells the story in the book. When our daughter Sarah, who at the time of Deb's stroke was 15 and was not a big dater in high school. But about a year and a half after Deb's stroke, she got invited to the prom her senior year and she started going out with this guy. And I kind of said to Deb, you know, you never had that mother daughter talk with Sarah. And Deb hadn't been too active in parenting for that year, year and a half because she was you know, fighting for her recovery. I said, “You know, maybe you should be the one, as her mom, to have the talk.” And so, we kind of told Sarah that we wanted to talk to her. We were all standing around the island in the kitchen. Sarah kind of knew something was coming but didn't quite know what. And you know Deb's speech was nothing like as good as it is now back then. You could just see the concentration on her face trying to figure out what she was going to say. And she kind of slowly said, “Boyfriend? Yes. Pregnant, no!” And that has been dubbed by all of our friends for the world's most efficient and effective mother daughter talk. It was funny; we all just burst out laughing. It was really a great kind of wake up for us that Deb could reclaim a lot of aspects of her identity, but she would just have to live them out differently. And that just because they had to be different didn't mean she couldn't live them out. That was one of our favorites. Katie: That is a good story. What I love about your sharing of the stories and where your work brings storytelling to life. One of the things that's happening in the literature that's coming into practice, particularly in the UK, and over in Australia, and hopefully maybe over here in the U.S. sometime, is this idea of step psychological care for aphasia. We'll put something in the show notes if listeners want to check this out a little bit more. This idea consists of different tiers to support mental health and particularly depression in people with stroke and aphasia. At that bottom tier, which is supposed to be accessible to every stroke survivor, one of the level one interventions is storytelling. So, it's that powerful, you know. It's not just fun to tell stories; it's very important to who we are as people and integrating our mental and emotional health into who we are. Steve: Deb, did you want to mention somebody you interviewed for the book that particularly talked about storytelling? Debra: Yes. Randy enjoys storytelling, and he is a stroke survivor from St. Louis who I interviewed for the book. Randy and his wife, Rose, started their own aphasia meetup group. Social connections were really important to him. Steve: And he talked a lot about how he gradually got more and more comfortable telling his story and how much that helped him. He spoke at our community event in St. Louis, and I thought he kind of stole the show when he said, “My stroke changed my life, but it will not hold me back.” I just kind of well up because that's what it's all about. And he said it so eloquently. Katie: Powerful, powerful. Well, Debra, can you tell us a little more about this idea of identity? Debra: Sure. Barbara Shadden and you, Katie Strong, I am so thankful. Identity is our narrative about ourselves over time. We have not one static identity, we have multiple identities. We are always changing. Relationships like friends, family, colleagues, and others are a big part of making who we are. Identity is a choice. Instead of asking, “Who am I now?” ask “Who do I want to be now?”. Katie: Powerful. I like it. Debra, could you talk about aphasia specifically, and how that plays into your views on identity and your recovery? Debra: Yeah. Communication is so central to everything we do and to my identity. Having communication challenges just makes everything harder. Steve: And I'll just add that sometimes in recovery, the physical stuff, you know, trying to walk better or get use of a right arm back, would tend to be the focus. But in reality, the aphasia is really the thing that has challenged her identity the most because it was the communication that forced her from a career she worked so hard to achieve. Also, friends and interaction are so central to who Deb is, and that has just gotten so much more challenging. So, not to diminish the impact of physical disabilities, but aphasia is big and really central to the recovery process. Katie: And I think you know, you mentioned Barbara Shadden earlier, but you know her idea of identity theft. We are the stories that we tell and when we have trouble with the that one thing that we use for story, that tool of language that is impaired, or changed or broken, or, you know, smaller, or however we want to view it with having aphasia, it really makes a significant impact on how you view yourself and how you can connect with other people that are important to you. Debra: Yeah. I agree completely, and I am so lucky to have friends and family to support me. Steve: And I think what you said, Katie, is so powerful, and it's why we talk a lot about how few people really know and understand what aphasia is. I think that's because there's this, whatever the opposite of a virtual cycle is, it's the doom loop cycle of aphasia. Aphasia impacts people's identity so that they don't want to speak if they have aphasia because it's not consistent with who they think they are. But because people don't want to speak with aphasia, nobody knows what it is. And so that, you know, makes it that much harder to speak with aphasia. And I think, you know, that gets to this notion of purpose sometimes driving people through what's hard and what's uncomfortable. That was true for Deb and played a role in making a decision that “Yeah, I really wish I could speak the same way I used to.” We've had so many arguments about Deb saying, “I was terrible," because she was evaluating her speaking performance against the way she would have done it before her stroke. Yet, Deb's been willing to push through that, to be out there. You know, that's part of our work of trying to network with other people and encourage people to get out there and tell their stories because that's the only way the world is going to learn. Katie: And that you're doing, which is so appreciated and inspirational. Steve, I know your work is as much about supporting care partners and other family members as it is about supporting survivors. Can you share a bit about your journey through all of this? Steve: Oof, it feels like that could be a podcast in and of itself. But you know, I think maybe the nugget that I'll share is it's pretty obvious that people who are close to somebody who has a stroke or aphasia, our lives are going to change. Things we used to do; we can't do. Help we didn't used to have to provide, we do have to provide. I think the real “aha” for me personally, was that I needed to focus on my identity change as well. It wasn't just Deb's identity. And for me personally, and I've talked to a lot of care partners about this, really embracing “care partner” as part of my identity. Not just something I had to do to support Deb, but part of who I now am. This was really important to me because that mind shift actually helped me resent some of the changes in my life less. It was just, like Deb said, our identities change, our lives change, this is just another change. If I can embrace that as a change in who I am, then those just become part of life. Not that they're not frustrating sometimes, but it's a lot better. So I think, you know, Sarah, our daughter, is when you talk about the impact on family. And again, this story is in the book as well. But again, not just the impact on her life, but the impact on her and who she was. About two years after Deb's stroke, she gave a talk to her whole school community. Sarah talked about the experience of watching her mom have a stroke, and how she wanted to be like her mother and be strong and tough it out. People were offering to help, and she said “No.” She was going to soccer practice, she was doing all of her assignments, and she was visiting Deb in the hospital; she was going to tough it out because she wanted to be strong. Then, she started to see Deb accept more help and she started wondering, well, maybe I can accept some help. She started to let her friends in and let herself be vulnerable. She kind of realized that real strength isn't about toughing it out, real strength is about being vulnerable and using your relationships. Sarah's an athlete, and she ended the talk with, “Even the world's strongest person needs a spotter.” I well up just telling the story. When she told it, we went through boxes of tissues. But that changed her as a person in ways that actually, you know, maybe she would have gotten there eventually, but not when she was 17. I think that's what we talked to a lot of the families and care partners about. Allow yourself to think about how this experience can change you as a person and try to embrace some of that change where you can. Katie: Powerful. Debra: And the families, Danny, Adam, and Sarah. The families are affected. Katie: Yeah. Aphasia just doesn't happen to the person who has it. Well, Deb, you mentioned that there is one part in your book that sums up a lot of what you were trying to share with other survivors and their families. Maybe we can end with you reading from that paragraph. Deb: Faced with a trauma like stroke, the opportunities for both challenge and growth are great. We can clarify what we value most in life, set goals that will help us meet them, and achieve repeated small wins in pursuit of them. In this way, we can achieve not just recovery, but satisfying growth and fundamental meanings in our lives. Katie: I love it. Yeah. Challenge and adversity, thinking forward into the future, and having goals, purpose, and meaning. It's what life is about. Well, this has just been a fabulous conversation. Thank you both for taking time to share with us a little bit about what you've been up to over the summer and inspire us with some of your stories. Debra: Thank you. Steve: Thank you. Well, that wraps up this episode. Thank you for listening. For references and resources mentioned in today's show, please see our show notes. They're available on our website, www.aphasiaaccess.org. There you can also become a member of our organization, browse our growing library of materials, and find out about the Aphasia Access Academy. If you have an idea for a future podcast episode, email us at info@aphasiaaccess.org. For Aphasia Access Conversations, I'm Katie Strong. Thanks again for your ongoing support of Aphasia Access.   Information about Stroke Onward   https://strokeonward.org/  Stroke Onward website Instagram Facebook Twitter YouTube Identity Theft Book Club Materials developed by Jodi Kravitz, Ellen Bernstein-Ellis, Liz Hoover and Stroke Onward https://strokeonward.org/bookguides/   Resources Related to Identity and Aphasia   Meyerson, D., E., (2003). Tempered Radicals: How Everyday Leaders Inspire Change at Work. Boston, MA: Harvard Business School Press. Meyerson, D. & Zuckerman, D. (2019). Identity theft: Rediscovering Ourselves After Stroke. Andrews McMeel Publishing. www.identitytheftbook.org Shadden, B. (2005). Aphasia as identity theft: Theory and practice. Aphasiology, 19(3-5), 211-223. https://doi.org/10.1080/02687930444000697 Strong, K., & Shadden, B. (2020). The power of story in identity renegotiation: Clinical approaches to supporting persons living with aphasia. Perspectives of the ASHA Special Interest Groups. https://doi.org/10.1044/2019_PERSP-19-00145 Listen to Episode #5 of Aphasia Access Conversations Podcast featuring a conversation between Katie Strong and Barbara Shadden about the important role story has in supporting identity in people who are impacted by living with aphasia. https://aphasiaaccess.libsyn.com/insights-and-aha-moments-about-aphasia-care-with-professor-emeriti-barbara-shadden   Resources Related to Stepped Psychological Care Listen to Episode #34 of Aphasia Access Conversations Podcast featuring a conversation between Jerry Hoepner and Ian Kneebone about stepped psychological care and other research related to supporting the emotional journey of living with stroke and aphasia. https://aphasiaaccess.libsyn.com/34-in-conversation-with-ian-keebone Kneebone, I. I. (2016). A framework to support Cognitive Behavior Therapy for emotional disorder after stroke. Cognitive and Behavioral Practice, 23(1), 99-109. https://doi.org/10.1016/j.cbpra.2015.02.001 Ryan, B., Worrall, L., Sekhon, J., Baker, C., Carragher, M., Bohan, J., Power, E., Rose, M., Simmons-Mackie, N., Togher, L., & Kneebone, I. (2020). Time to step up: A call for the speech pathology profession to utilise stepped psychological care for people with aphasia post stroke. In K. H. Meredith & G. N. Yeates (Eds.), Psychotherapy and aphasia: Interventions for emotional wellbeing and relationships (pp. 1-16). Routledge.    Acknowledgements – A special thank you to Amanda Zalucki and Emma Keilen from the Strong Story Lab at Central Michigan University for their assistance in the transcription of this episode. Cite as: Bertram, M., Isaksen, J., Toft, L. E., Olsen, A. M., & Breckling, M. (2021). Evaluering af projekt Forløb for borgere med afasi samt afrapportering af implementeringsopfølgningen KomTil – fra udvikling til drift. Unpublished report from University of Southern Denmark.

For a long time, bilingual families were told to discard their native language and to only use English. Many practitioners and clinicians force English on their clients and patients during appointments. Ana Paula G. Souza Mumy and John Gomez join Tim for an interview. Ana Paula's research was recently published and a link to the article will be seen at the bottom of this paragraph. The title of the article is Culturally Responsive Guidelines for Serving Families of Bilingual Children Who Stutter. A few key take aways are: bilingualism does not increase the risk of stuttering, children can endure "code switching" as two languages are used simultaneously, clinicians want to allow the language of the parent to be used in the clinic or the office, and that language choice is about relationship and connection. John Gomez is the director of When I Stutter (keeneyeproductions.com). Ana Paula translated the movie into Portugese, her native language. John is an SLP working in Los Angeles, California and he serves a very diverse community with a heavily bilingual population. As America become more and more bilingual, this is eye opening and ground breaking work by Ana Paula. Link here: https://pubs.asha.org/doi/10.1044/2022_PERSP-21-00235

Welcome to this edition of Aphasia Access Conversations, a series of conversations about topics in aphasia that focus on the LPAA model. My name is Janet Patterson, and I am Research Speech-Language Pathologist at the VA Northern California Health Care System in Martinez CA. These Show Notes follow the conversation between Dr. Chaleece Sandberg and myself, but are not an exact transcript of the conversation. Dr. Chaleece Sandberg is Associate Professor in the Department of Communication Sciences and Disorders in the College of Health and Human Development at Penn State University.  She directs the Semantics, Aphasia, and Neural Dynamics Laboratory (SANDLab), which focuses on finding ways of optimizing language therapy for adult language disorders, with a primary interest in aphasia. Specifically, work in the SANDLab explores the neuroplastic processes that take place during successful therapy and how to enhance these processes. Additionally, SandLab work explores how cortical reorganization due to aging affects the way we interpret the cortical reorganization that results from language therapy.     In today's episode you will hear about: the importance of impairment-based treatment in a person-centered approach to aphasia therapy, the role of linguistic complexity in selecting treatment stimuli and supporting generalization, how speech-language pathologists can add aspects of counseling to treatment activities. Share Dr. Janet Patterson: Welcome to this edition of Aphasia Access Conversations, a series of conversations about community aphasia programs that follow the LPAA model. My name is Janet Patterson, and I am a Research Speech-Language Pathologist at the VA Northern California Health Care System in Martinez, California. Today, I am delighted to be speaking with my friend and research colleague, Dr. Chaleece Sandberg. Dr. Sandberg is associate professor in the Department of Communication Sciences and Disorders in the College of Health and Human Development at Penn State University. At Penn State, she directs the SANDLab, that is the Semantics, Aphasia and Neural Dynamics Laboratory. Efforts in the SANDLab are aimed at finding ways of optimizing language therapy for adults with language disorders, with a primary interest in aphasia. Specifically, the lab explores the neuroplastic processes that take place during successful therapy and how to enhance these processes. Additionally, the lab work explores how cortical reorganization due to aging affects the way we interpret the cortical reorganization that results from language therapy.   In 2022, Chaleece was named a Distinguished Scholar USA by the Tavistock Trust for Aphasia, UK. The Tavistock Trust aims to help improve the quality of life for those with aphasia, their families, and care partners by addressing research capacity related to quality-of-life issues in aphasia. Congratulations on this well-deserved honor, Chaleece.   Aphasia Access collaborates with the Tavistock Trust for Aphasia in selecting the awardees and is pleased to have the opportunity to discuss their work and the influence of the Tavistock award.   Welcome Chaleece, to Aphasia Access Conversations,   Dr. Chaleece Sandberg: Thank you so much for such a lovely introduction. I'm so glad to be here doing this with you and I'm so thankful to the Tavistock Trust for this recognition.   Janet: Chaleece, as we said, you were named a Tavistock Trust Distinguished Scholar USA for 2022 and join a talented and dedicated group of individuals. How has the Tavistock award influenced your work, both your clinical and your research efforts in aphasia.   Chaleece: So, first of all, I am so incredibly honored to be recognized as belonging to such an amazing group of scholars. These are definitely people that I admire, and I look up to and I want to be more like, and so receiving this award is not only supporting my ability to push some ideas forward that I've been having, but it's also giving me more confidence to go all in and make quality of life, an even larger focus in my teaching and research.   Janet: That is terrific to hear, because I think quality of life is so very important for all of us. We sometimes forget that idea when we get focused on our treatment or specific treatment protocol. In preparing for this interview Chaleece, I read several of your publications, including your work in treatment for lexical retrieval, and the Theory of Complexity. Would you briefly describe this theory and your work in this area?   Chaleece: I'd love to. The Complexity Account of Treatment Efficacy was introduced by Cindy Thompson, who is actually my research grandma, Lewis Shapiro and Swathi Kiran, who was my Ph.D. mentor. What they were finding was that while they were doing the Treatment of Underlying Forms, which is a treatment that supports sentence processing, when you train more complex sentence structures, like object class, something like, “It was the porcupine who the beaver hit”, right, you're going to get generalization to not only other object clefts, but simpler structures, like WH questions, so something like, “Who did the beaver hit?” Using this logic, Swathi started exploring the effects of semantically based therapies for word retrieval and found that training atypical words in a category promotes generalization to typical words in that category. The idea is that you're basically training this wider breadth of information that applies to more items. In the case of typicality, you're training semantic features that are really characteristic of these atypical items, like that “a penguin doesn't fly but swims”, and that you're also training these really typical features that apply to everything in that category, like, “a penguin lays eggs like most other birds”.   In my work, I've extended this logic to training abstract words. Now with abstract words the mechanism of generalization is slightly different. Rather than words sharing semantic features, they share associations. So, we train words in thematic categories, like “hospital” and “courthouse”, where there are these strong associative links between abstract words like “diagnosis”, and concrete words like “doctor”. The reason that it's more beneficial to train abstract words rather than concrete words is because they have a wider range of these associative links, so they can activate more concepts when you get that spreading activation within the semantic system. We've started calling it Abstract Semantic Associative Network Training for that reason, or it's AbSANT for short.   Janet: I think that is so fascinating. It makes sense because you're looking at a way to optimize therapy, which is what the SANDLab is all about. How can we, from a theoretical perspective and with data to support what we're doing, how can we be as efficient as possible in achieving the outcome that we would like to have for a person with aphasia? I think it's a perfect example of theoretically based treatment.   That leads me though, to the next question to say, I love your research. And I love that it's taken however many years and starting with grandma, Cindy and then Swathi, and now you. That's a lot of effort and a lot of work that clinicians don't have. The theory is so powerful, so I'd like to ask you, what are your thoughts on actions that clinicians might take to easily incorporate these treatment principles, or this treatment, into their clinical activities.   Chaleece: I've tried to really consider clinicians and keep clinicians in mind when I've been thinking about AbSANT. One thing that I've done is, I've made absent available for free on my lab website (SANDLab). There's also a tutorial published in Perspectives of the ASHA Special Interest Groups. And the idea is that that's kind of an easy to go to for clinicians. And even though we've only actually used a couple of categories in our research, so we focused on courthouse and hospital, we actually did norming on I think it's 17 categories, thematic categories, like football and holidays. And all of those words are available on the website, I also don't see why you can't create your own categories that are going to be personally relevant for your client.   One of our AbSANT clients that we had in our research study, after they were done, the husband wanted to continue to work with his wife on words for the holidays, actually. And so we talked about it, and he came up with some words in the category Christmas, that would be good targets, and they went off and used it. And it helped. They were very happy.   Janet: Kudos to you, Chaleece, for doing it like this. What you just described, about a person sitting in therapy and using your words and what you had created, and then going off and creating their own with your assistance, that is exactly what I think should be happening, as we think about therapy. That feeds quality of life, that feeds a person's ability to move back into whatever they want their life to be. Kudos to you for making this freely available to clinicians. They don't have to go digging into research papers or into journals to find and to piece together your work, it's there on your website. By the way, the link to your lab and this information will appear in the Show Notes that accompany this recording. So, thank you for that. I appreciate it. And I know clinicians will as well,   Chaleece: I understand being pressed for time, and I did want to make this as easy and accessible as I could   Janet: Chaleece, at the heart of your work in aphasia, as we just mentioned a few minutes ago has been optimizing treatment. One of your research interests supporting this direction, has been examining the neurological mechanisms that underlie behavioral change following treatment. Conducting research on this topic is challenging for many, many reasons. Yet, I think it's very important to aphasiology as we seek to understand the elements of a treatment protocol, and how the brain changes in response to stimulation. So, with that large question and that large research area, what have you learned from your work in this area?   Chaleece: You are right, it is a very challenging area to work in. One thing that is heartening is that my work seems to agree with some of the heavy hitters out there who are doing this work on a much larger scale. I think that in order to really get at the root of these questions, we do need these really large-scale studies across different sites that are going to be able to gather enough data so that we understand fully what's happening. But basically, it seems like no matter how chronic the person is, there is neuroplasticity related to treatment gains. We still don't really have a definitive answer regarding things like which hemisphere is better? Or is increased or decreased activation better? But it's looking like the answer is actually going to be quite nuanced and related to individual variability, which again, speaks to this idea that the more data the better. Luckily, there is a working group in the Collaboration of Aphasia Trialists, or CATS, that's working on this question. I am a part of that group and very honored to be a part of that group and contributing to this work. I do have some results from a pilot study that I did as a doc student. We found that left inferior frontal gyrus pars triangularis, so basically, Broca's Area appeared to be especially important for the AbSANT outcomes. We also found that when we saw generalization from the abstract to the concrete words, that areas that are normally responsible for concrete word retrieval, were being activated after therapy more so than they were before therapy. That's some nice evidence that generalization is actually affecting areas of the brain that are responsible for those items that are being generalized to. I have yet to analyze the data from my current study but stay tuned.   Janet: Oh, we will. I think that there's a large body of data, as you said, from other people who've done larger studies, and lots of people have been focused on this question for a while, and you are as well. It's a bit daunting for clinicians, again, to think about how to wrap your head around the idea and the evidence. We all believe that the brain is changing, but to wrap your head around the evidence that says, “Well, how is this happening?” and, “What can I do that will facilitate it happening a little bit more quickly or a little bit more thoroughly?” So, I realize I'm asking you a speculative question that's sort of out there, but I'm going to ask it anyway. What are some of the ideas from your work that clinicians may find useful to think about on Monday morning, when they walk in to interact with their clients who have aphasia, and their family members and care partners.   Chaleece: I think one of the things that I really would like to underline is don't be afraid to challenge your clients. We actually learn better when we're challenged, and learning is what's going to cause those changes in the brain. Probably the most important thing that I would like for clinicians to take away from my AbSANT work is that it's worthwhile and not impossible to work on abstract word retrieval using a semantically based approach. Abstract words are so important for natural conversation. Training them seems to really help support retrieval of concrete words as well, and so you get more bang for your buck. I found that people, especially those with a little bit milder aphasia who are up for the challenge, really enjoy the metalinguistic discussion, and the chance to defend these really strong opinions that people have about the personal meanings of abstract words. And, again, the most important thing in terms of l the neural imaging in the neuroplasticity is that the brain always has the ability to change. I realize that our clients are later in life, they've had a stroke, maybe they're in the chronic phase of recovery, and they can still show neuroplastic changes. One of my highest achievers, in my study, when I was a doctoral student, both behaviorally and neurophysiologically, one of the people who showed the most neurological changes was 20 years post stroke.   Janet: That's amazing. When you talk about abstract language, it makes me think that so much of what we do, or at least as I look back on a lot of the treatments that we do, single words or visual nouns or concrete nouns, very simple, sometimes we say functional words. But then you step aside and listen to people talk and so much of what people's conversation contains is nonliteral words and abstract words. We don't talk like the words that we're using in therapy, and it makes perfect sense then, the way you're approaching this challenge of aphasia, to try to make your work more like what people with aphasia are going to experience during conversation. It's a big problem and a big challenge, but I think you're up to it, and I'm looking forward to seeing some of more of your work on AbSANT. Especially since it's such a challenging area of work. I appreciate you giving us specific suggestions of things that we might do Monday morning when we see our patients. So, this is not just a conversation and it's not just another academic lecture in how we think about treatment, but it has some very important real world applications for us. Thanks so much for that piece.   I'd like to switch for a few minutes, Chaleece, and talk to you about your interest and work in bilingual aphasia. How did you become interested in this line of work? And more importantly, what have you learned from your work in this area.   Chaleece: So, I've always been interested in learning other languages. I have actually attempted to learn a few languages and have not been that successful. But one thing that I realized while trying to learn these other languages is that I was really intrigued by the way languages work. As you're learning another language, you start to really kind of put the pieces together and see kind of under the hood of what's actually happening. And so, I got my undergraduate degree in linguistics, and I think that this kind of fascination with how languages work also partly fueled my interest in aphasia in the first place. I remember sitting in my language in the brain class, and a light bulb went off, I was like, “Oh, my gosh, this is exactly what I want to study!” This idea that this full language system that was completely developed, all of a sudden can get destroyed by damage to particular areas. And so, you know, that kind of set the stage for me wanting to study aphasia. And then when I got into Swathi's lab and she was doing bilingual research, I was so excited. I was like, “Oh, I am totally on board with this”. So, I volunteered for all the bilingual studies that I could, actually not speaking any other languages myself, but realized that I can still research other languages, even if I don't speak them. That was kind of an “aha” moment for me, which was very nice.   During my Ph.D., I got to know Theresa Gray, who was a fellow doc student, and she and I became really good friends. After graduation, we immediately began a collaboration. This was good news for me because I had gotten a job at Penn State, and we're in Central PA and there is not a huge bilingual population there. But there is an excellent center for language science at Penn State started by Judy Cole, Janet van Hell and Carol Miller. That has really helped to support my efforts in understanding bilingualism in general, and bilingual aphasia. So, the work that Teresa and I have done together has actually been really focused on getting culturally and linguistically appropriate materials out to bilingual clinicians. That was where we saw that we could do kind of the most good in this area.   But along the way, we found some really interesting patterns related to cross language generalization and language dominance and cognitive control. We've also had some really interesting insights from our students who've been working on these projects who have just made comments about the adequacy of the assessments that we're using. And so we're really starting to think about how that's going to affect what we know about people's languages that they speak as we're trying to figure out, you know, what's going on, after a stroke with these different languages. And it also just kind of brings to the surface, that there are so many limiting factors for individuals who don't speak English as their first language or don't speak English at all. There's such an enormous service disparity, at least in the United States, and work in aphasia research has been so English centric, that it's created these major barriers to having adequate services. But luckily, we're starting to kind of get on the ball a little bit, this field is receiving a lot more attention. There are some really great researchers on the case. I've been to some recent conferences where there have been a lot of great presentations. The Saffran Conference was dedicated to this idea, there was a great workshop by Jose Centeno. At the Academy of Aphasia, there were some really great presentations there on this topic. So I feel like we're, we're moving forward in trying to close the gap in services for people who are bilingual.   JANET: I agree with you on that. And many times, it's also on the clinician. Clinicians might be bilingual themselves, but they might not be. How can you best support the clinicians who does not share a language with the client or the family members yet still has to serve that individual? It's, again, another challenging area that you've undertaken the study. You are busy, I bet.   So in addition to everything you've been doing over all these years, I mean, the complexity and absent and bilingualism, you also have now added something to your area of interest. I'd like you to talk for a little bit about that, if you would, and that is your interest in counseling persons with aphasia. How did you become interested in that area of research? And I ask, because it just seems that there might be a story of a professional journey here. I love to tell stories and hear them, so I think this is a story that wants to telling.   Chaleece: All right, well, yeah, twist my arm.   Janet: Good, I was supposed to be twisting your arm, because I want to hear your story.   Chaleece: So, my husband and I, when we first got to Penn State, we became friends with a couple of people who are over in counselor education. The more we got to know each other and talk more about our work, the more we realized that we were missing a lot of information in each of our fields. I never had any training and counseling, and my friends, who were counselors, hadn't really heard of aphasia. One of these friends, you know, after we had started talking about aphasia, actually, her brother had a stroke and had aphasia and so this became a very personal topic for her. She's a rehabilitation counselor and I was so shocked to learn that this was not something that she had been taught in her training, not something that she had really come across. So, we decided to start lecturing in each other's classes, and start exposing each other's students to these ideas that we felt we had missed out on in our training. We also started digging into the literature, because we wanted to see exactly what was out there, like were we crazy and thinking that this was like missing information from each of our fields. And we weren't crazy, we weren't alone. There's a whole slew of professionals in mental health that don't know about aphasia and SLPs, on the whole appear to not feel adequately prepared to do any sort of counseling. So, we decided that we wanted to write a couple of papers to help practicing clinicians to provide counseling and for SLPs, to kind of understand more about counseling skills, and for counseling students to understand more about aphasia and things that they could do to help people with aphasia, and kind of bring more awareness to the issue. We also applied for some internal funding to start an interprofessional education project, aimed at better preparing our counseling students to work with people with aphasia and our SLP students to provide basic counseling. We're starting this in terms of a one off.  We take one counseling student and one SLP student.  We need to have them work together with a person who has aphasia, who's expressed some desire for counseling. Every semester we rotate out and have a new group. This has been such a rewarding experience. I've learned so much from my colleagues, the way that I teach my pastor students, the way that I run my research experiments, the way that I mentor students in my lab, all of that has changed so much, I kind of feel like my eyes have been open to this, this whole issue. In turn, I feel like I'm helping my students to be much more mindful in the way that they approach clinical practice and research to like, truly put quality of life first.   Janet: I think that's exactly right, and the way we should be thinking, and I agree with everything you said about counseling. We have a little project where we've been looking at motivation, which is different, I realize, but it strikes me that when you think about how we counsel and bring that into our treatment, and also think about motivation, or patient engagement and bring it into treatment, there's so much more that helps us facilitate behavioral change in a patient than just a specific treatment protocol that we're delivering. Because if we haven't got someone who we can empathize with or we can connect with or who's interested in change or understands why we're doing what we're doing, it's going to be a very long road, if we're only focused on the impairment based or the specific treatment protocol. So, I think it's great that you're exposing your students to different professions and really thinking about counseling. It's a great idea.   So that's a big journey that you've undertaken, and I'm sure it's not stopping here. It's an interesting journey. It's more exciting as I hear you talk about it; I hear the excitement in your voice and the passion in your voice. It's almost like you want to do everything, but of course, you have to go to sleep, and you know, there are limitations.   Chaleece: Right, right. Yeah, all of those things, right?   Janet: Yeah. Oh, exactly, exactly. But I will bet that you have a lot of new ideas out there and you are considering some next steps, both in clinical research and clinical activities. I heard this story of starting from a linguistic basis and maybe focused impairment, and now you're completely coming around, I don't think it's full circle, I think it's more like full spiral. You're still thinking about complexity and AbSANT, but you've got other pieces that I think will make a rich program. What are your new ideas that are percolating in that brain of yours that you'd like to see move forward?   Chaleece: So, I've applied for sabbatical? I haven't heard back yet whether or not I've received it, but I'm hoping that I can spend the next year focusing my efforts, specifically on what I see as being health disparities. It is related to both bilingualism and mental health and aphasia. So one of the things that I'm really interested in is, is expanding our IP program for counseling and SLP students. I'm also hoping to work with Jose Centeno to work to address service disparities in bilingualism. I know that that's a really big topic of interest for him and our interests seem aligned on there. I'm excited to learn more from him. I'm planning to meet with Amy Dietz and work with her to think more about some of these holistic approaches to aphasia rehabilitation. I've really enjoyed hearing about her yoga program that that she's been doing. I've always had this kind of nagging thought this was something that she and I kind of talked about and really connected on, it kind of goes back to interprofessional practice. It's this idea that we tend to ignore all of these other things that we don't see as being language related, right? We don't think about diet and exercise and sleep on cognitive outcomes. But there's so much research out there showing how these things can affect your thinking. So they must be affecting the rehabilitation outcomes in people with aphasia.   I have been interested in the role of exercise in aphasia rehabilitation, we I'm part of an am CDs writing group, and we did a review looking at the effects of exercise and aphasia. There's just a huge gap in the literature. So it's definitely an area that we should be focused on. I don't currently have an exercise research project going but, in the meantime, I have actually partnered with Francine Cohen at Temple to establish Aphasia Cycling Club. This thought had been in the back of my mind for a long time, my husband and I are avid cyclists. And I thought, you know, if people with aphasia could find this much joy in in cycling, and if they could do it together, like that would be great. But then I hesitated because I thought, you know, would they actually be interested? Is this something that anybody wants to do? Am I just a freak, because I like cycling, and I think everybody else should. But I decided to go ahead and reach out through the ARCH network, and I got a surprisingly positive amount of responses back that people were really jazzed about this. Frannie was one of those people that got back right away and said, “I am an avid cyclist, and I would love to do this.” So, I got really excited about it. I got pushed a little bit in the direction by Deb Myerson and Steve Zuckerman, because I don't know if people are aware, but they did this stroke across America campaign where they rode from Northern California all the way to Boston, to spread awareness for aphasia, they have stops along the way. I recommend looking it up because it's a very inspiring journey that they took. These things got me thinking that this could work. We've started meeting with some physical therapists and adaptive sports people in Philadelphia and in Hershey so far, to try and get this going. We're hoping to try and get some people in Pittsburgh as well. We're super excited about where this could go. If anybody listening to this has any suggestions, please contact me. I'm happy to receive any sort of feedback and suggestions that people have to offer.   Janet: What a terrific idea! Francine is such an enthusiastic person and. I think with the two of you leading this, it's just going to grow greatly, I think sometimes as we talked earlier, we get so focused on the language, we forget the people with aphasia would like to do other things. Or maybe they did other things before they had their strokes, and perhaps they have some physical challenges right now, so we tend not to think about bicycling. I think it's awesome. A Bicycle Club. That's wonderful.   Chaleece: I hope it works out. I hope that it provides people with as much joy as it's provided me,   Janet: I bet it will. I can see you doing something like, even if there's someone who has aphasia, who simply cannot end up riding, but if you have riders, and you take videos, and you involve the people who cannot ride with you in that manner, well, that also achieves a quality of life goal. I think.   Chaleece: That's a great idea.   Janet: Good. I hope it works out. I think of that because we have an friend who's an avid bicyclist, and he always straps on his head camera and will post his videos all the time about places he goes. Your cycling group, your aphasia cycling club, can do the same thing. What a great idea, I look forward to seeing it actually happen and seeing the videos that you make and the work that you do.   Chaleece, as we bring this conversation to a close, I would like to ask you to reflect on your interest in aphasia, your work with persons with aphasia and their family members and care partners, and in particular, your amazing journey from starting as a linguist to developing a bicycle club for people with aphasia. And I'm wondering if you have any pearls of wisdom, you might share with our listeners, or what I sometimes like to call Monday morning practices. And by that I mean ideas that clinicians can incorporate into their busy practices quickly and easily to perhaps change their thinking or change how they engage with clients.   Chaleece: In reflecting on my journey, I really maybe just to encourage other researchers to think about, so I started out really kind of focused in this kind of an impairment based mode, and gradually moved over to this person centered care, but I haven't discarded the idea of impairments based treatment, right? The idea is that you just kind of, house that in, you know, you fold it in to your person-centered care to the life participation. From my own research, the things that kind of float to the surface for me are, first that the brain can change long after the chronic stage has started. This, this idea of a plateau, I know that I feel like I'm preaching to the choir, probably about this idea, but it's still kind of amazing to me, how many people still feel like this is there's a plateau, right.   The other is not to be afraid to work on challenging tasks, like digging into the meanings of abstract words. With supportive conversation I found that this can be very rewarding, even for people who have very limited verbal output. In terms of I don't know, Monday morning practices like something easy to incorporate. I feel like I'll my pearls are kind of borrowed. There's a great one that I borrowed recently from Linda Worrall's amazing presentation as IARC. She suggested a way to form a simple habit was to just ask two questions at every treatment session. This could be a small change just to form better counseling habits as SLPs. She suggested at the beginning of the session to ask, “How are you feeling?”, which is a very different question from “How are you doing?” It allows people to open up a little bit more and actually talk about how they're feeling. Then at the end to ask, “What is the best thing that you're going to do today?” I started doing this as soon as she mentioned, I'm like, I'm going to do this. And I did it. I started doing it with all of my clinical research sessions that I do. It's really helped me to form better relationships faster with my research clients. I feel like they are telling me more about themselves. They really open up at the beginning of the session telling me how they're feeling, and that actually helps me to gauge how I go about this. Yes, for treatment research, you have a protocol, right? But the way you go about these treatment steps, you know, you can frame them in different ways, right? If I have a client who's feeling very anxious, I can say before each thing that we do that's challenging, I can say, “Okay, take a deep breath. All right. Now let's do this. This piece of the puzzle.” That seems to really, really help, It helps me to know where my clients are at to begin with, and asking “What they're doing? What's the best thing that you're doing today?” It's just so much fun to hear people get really excited about what they're doing. Sometimes they might say, “Well, nothing today, but tomorrow, I've got this great thing planned.” It's a really nice way to end the session on a really positive note,   Janet:  Borrowed or not, those are excellent pearls, and they are simple things that we can do. I do remember Linda Worrall's talk that you were referring to. It makes so much sense. We have these grandiose ideas, but you have to start with a couple of small things and how can you change your behavior tomorrow, very small, but that will pay great dividends. It sounds like those changes have paid great dividends for you already in your research sessions.   Today's conversation for me, has been exciting and interesting and thought provoking and would like to thank my guest, Dr. Chaleece Sandberg for sharing ideas, results, outcomes and thoughts from her clinical research journey in aphasia. Chaleece I greatly appreciate your taking the time to speak with me today, and again, congratulations on receiving a Tavistock Scholar Award.   Chaleece: Thank you so much. This was delightful. I   Janet: would also like to thank our listeners for supporting Aphasia Access Conversations by listening to our podcasts and learning from all of the guests that we've had over the years.   For references and resources mentioned in today's show, please see our Show Notes. They are available on our website, www.aphasiaaccess.org. There, you can also become a member of our organization, browse our growing library of materials, and find out about the Aphasia Access Academy. If you have an idea for a future podcast episode, please email us at info at aphasia access.org   For Aphasia Access Conversations, I am Janet Patterson and I thank you again for your ongoing support of aphasia Access   References Kiran, Swathi, and Cynthia K. Thompson. “The Role of Semantic Complexity in Treatment of Naming Deficits: Training Semantic Categories in Fluent Aphasia by Controlling Exemplar Typicality.” Journal of Speech, Language, and Hearing Research 46, no. 3 (June 2003): 608–22. https://doi.org/10.1044/1092-4388(2003/048   Mayer, J., Sandberg, C., Mozeiko, J., Madden, E. & Murray, L. (2021). Cognitive and linguistic benefits of aerobic exercise: A state-of-the-art systematic review of the stroke literature. Frontiers in Rehabilitation Sciences, 2. https://doi.org/10.3389/fresc.2021.785312   Sandberg, C. (2022). Tutorial for Abstract Semantic Associative Network Training (AbSANT): Theoretical rationale, step-by-step protocol, and material resources. Perspectives of the ASHA Special Interest Groups: 7, 35–44. https://doi.org/10.1044/2021_PERSP-21-00176   Sandberg, C. W., Bohland, J. W., & Kiran, S. (2015). Changes in Functional Connectivity Related to Direct Training and Generalization Effects of a Word Finding Treatment in Chronic Aphasia. Brain and Language, 150, 103–116.   Sandberg, C. W., Nadermann, K., Parker, L., Kubat, A. M., & Conyers, L. M. (2021) Counseling in Aphasia: Information and Strategies for Speech-Language Pathologists. American Journal of Speech Language Pathology, 30(6), 2337-2349.   Thompson, C. K., Shapiro, L. P., Kiran, S., & Sobecks, J. (2003). The role of syntactic complexity in treatment of sentence deficits in agrammatic aphasia: The complexity account of treatment efficacy (CATE). Journal of Speech, Language, and Hearing Research, 46(3), 591–607. https://doi.org/10.1044/1092-4388(2003/047)   Worrall, L. (2022). The why and how of integrating mental health care into aphasia services. Presentation to the International Aphasia Rehabilitation Conference. Philadelphia PA, June.     URLs AbSANT    Abstract Semantic Associative Network Training. SANDLab. https://sites.psu.edu/sandlab/projects/absant/   Academy of Aphasia https://www2.academyofaphasia.org/about/   ANCDS    Academy of Neurologic Communication Disorders and Sciences. www.ancds.org   ARCH Network    Aphasia Resource Collaboration Hub  https://aphasiaresource.org   Collaboration of Aphasia Trialists https://www.aphasiatrials.org/   Eleanor M. Saffran Conference https://www.saffrancenter.com/conferences   Stroke Across America https://www.stroke.org/en/stroke-connection/stroke-onward/stroke-across-america

During this episode, Dr. Katie Strong, Associate Professor in the Department of Communication Sciences and Disorders and Director of the Strong Story Lab at Central Michigan University talks with Dr. Jackie Hinckley from Nova Southeastern University about stakeholder engaged research and Project BRIDGE.   Dr. Jackie Hinckley is Professor and Director of the Undergraduate Program at Nova Southeastern University. She is Board Certified in Neurogenic Communication Disorders by the Academy of Neurologic Communication Disorders and Sciences (ANCDS) and Fellow in Person-Centered Care. Dr. Hinckley is currently a Board Member of Aphasia Access and the National Aphasia Association. She is Executive Director Emeritus of Voices of Hope for Aphasia. She is Project Lead for Project BRIDGE, formerly funded by two PCORI Engagement Awards and now supported by NSU. She is the author of two books, Narrative-Based Practice in Speech-Language Pathology, and What Is It Like to Have a Communication Impairment?  Simulations for Family, Friends, and Caregivers. She is an Editor for The Qualitative Report, and on the Editorial Board of Topics in Stroke Rehabilitation and Journal of Interactional Research in Communication Disorders.        In this episode you will:  Learn about the importance of including people with aphasia and clinicians in the research process to make the research better. Find out what stakeholder engaged research is and its importance in developing relevant evidence for clinical practice Hear how Project BRIDGE has enhanced stakeholder engagement in research related to aphasia. Be empowered to embrace your own expertise and the expertise of your clients and their family members. KS: Jackie, Welcome back to the Aphasia Access Conversations Podcast. I believe you were first interviewed on our podcast in 2016 – Episode #2! We now have over 86 episodes that are available! Who knew the series would have such staying power. It's really amazing! Thanks for joining me today. I'm really excited about this conversation with you and having our listeners hear about what you've been up to lately and how that is impacting our clinical practice and the people with aphasia that we work with. JH: Well, thank you, Katie, for the introduction, and thank you to you and Aphasia Access for the opportunity to be on this podcast. I'm really excited to talk about these issues and talk about them with you. KS: Well, let's dig in. So, today's topic is “everyone's an expert”. How does that relate to our clinical work and our research?  JH: Well, you know, Carl Rogers, the famous psychologist said that we are the best experts on ourselves. And I think that we all have that thought in our minds, but it really hits at the core of person-centeredness. An expert is someone with authoritative knowledge. So that has two parts, the authority and the knowledge. And an expert comes about when people agree that an individual has high performance or high knowledge in an area. I think that the idea of person-centered care in our clinical work is that we acknowledge that our clients are the best experts on themselves. And I think most of us who are practicing speech pathologists would certainly acknowledge that and agree with that. But in reality, in a normal clinical process, it's actually kind of hard to do. Because the clinician is, by definition, an expert, and has a certain degree of authority in the clinical interaction. So, for example, clinicians need to do an assessment and a diagnosis. And the client really can't self-diagnose, so there's an issue of authority and knowledge from the point of view of the clinician. But now that authority tends to seep into other areas like goal setting, where really the client needs to bring forward their own expertise about themselves. When we continue to exercise authority over what the goal should be,  and yet, evidence shows that collaborative goal setting like goal attainment scaling significantly improves not just the immediate outcomes of therapy, but also how active the client is after they are discharged home. So, there's a tension around expertise. It has to shift back and forth during the clinical process. And a lot of times, it starts with the clinician having a lot of authority, but we have to know how to give our client that authority about themselves. So, it's only in the last decade or so that the idea of who's an expert and person-centeredness really has been applied to research.  For example, if we think about a traditional research process, the researcher reads the literature and identifies the knowledge gap comes up with the experiment or whatever study that can contribute to that gap. And the researcher determines the design, the method, the measurement, does the research, publishes it and gets it out in a way that the researcher basically is crossing their fingers is going to have the impact that they hoped for. The problem is that it this ignores who is going to be affected by the research. So, aphasia in, our specialty in our world here, is, is always existing in persons. It's not something that we can be that we can study in a petri dish. So anytime we do research that has to do with aphasia, we need to be acutely aware that we're creating knowledge that is going to actually affect somebody's life. And so maybe this knowledge is going to affect how the aphasia is assessed or treated, or what we do to support people with aphasia, but whatever it is, it's the lives of people with aphasia that are being affected by this research.  So, you know, let's step back a minute. And let's say I invented some new kitchen gadget, or a shoe or something, right. So. I'm the researcher of this new gadget. If I want to be successful in selling the product and having the product being used, I would have incorporated the views of people who might use it by trying out the products way before I ever try manufacturing and selling it because I need that feedback. I need to know if there are potential customers out there and whether they're actually going to use it.  And the same thing really applies to research. So, if I'm a researcher and I create a new research product (a.k.a = knowledge, or study to create knowledge). If I create some research product, but I'm not an expert user of that knowledge, in other words I'm a researcher who doesn't do assessments every day or treatment every day, then I run the very great risk that I'm creating a product that can't quite be used by the people was originally intended for. If we really embraced person-centeredness in research, then we would start by thinking about who are the people who are going to end up being affected by this research product or this research outcome. And we would incorporate people living with aphasia, and also clinicians into our research, and that would make the research better. KS: Powerful stuff! I remember the Disability Rights initiative using a slogan, “Nothing about us without us.” JH: Yes, that is a great slogan that has been around for a while. And that definitely reflects the idea of person-centeredness. And I think we need to remember that slogan and everything we do, whether it's our clinical practice, but also in our research. And that's a little bit of a new way of thinking about research. So, research is not just about the people with aphasia, sometimes it is, but a lot of times it's also about what are the best practices in clinical activities. So, we need to include both people with aphasia, their families, clinicians, maybe policymakers, other people who are really the stakeholders who are affected by the research products that we make, and they need to be involved in planning and doing the research and saying what kind of research would be most helpful. KS: I'm thinking a lot about researchers out there, Jackie, you and I included. We have clinical experience. So maybe they have a good idea of what clinicians need to know from research.  JH: You know, I have heard this from some people saying, “Well, I've been a clinician, so I know.” And maybe that's true. I think that people like you and I, who have been spent a good amount of time being clinicians in our past, probably are ahead of the game. In a sense, we might have a better sense of what we don't know, right? Because we've been out there doing it. But I will, in my opinion, I think researchers who aren't actively out in clinical settings, and they mostly aren't, still aren't quite totally up to date with the current challenges that are being faced by people. Anthony Bourdain, the celebrity chef said, “Just because I like sushi doesn't mean I can make sushi.” So, I think we may think that…but if we're not right in the thick of it, we may not know as much as we think. And we need to bring in the experts who actually do know what it's like to do that daily clinical work. KS: Point well taken. This leads us to the idea of stakeholder-engaged research. What is it? JH: The term stakeholder engaged research is an umbrella term. It covers a lot of different approaches to the idea of bringing in individuals who are going to be affected by the research to actually help can plan, conduct, and disseminate the research. So, there are various ways that stakeholders can be involved in research. They could be consultants, or they could be co-researchers, and full collaborators. In the case of a co-researcher, they help come up with research questions, help design the research, pick the outcome measure, help with data analysis, or interpretation, and even contribute to dissemination of the research results. We have found that people, family members, clinicians, other stakeholders, and people with aphasia can participate it fully as collaborators in all of these things if they so choose. KS: Amazing. I know there are a few examples of this kind of research in Ireland. For example, Ruth McMenamin …. and also, in Denmark Jytte Isaksen is doing interesting work, and of course there is Ciara Shiggins in Australia….what about in the US? JH: Yeah, so in other places, like in Europe, as you say, in Australia, I, you know, I think they've been a little ahead of the United States in terms of understanding that they need to bring in the people who are affected by research into the actual conducting of research. And that also brings up the point that I said, stakeholder engaged research is an umbrella term. There are many different terms and in some other countries, they also use different terms for this. But I'm using stakeholder engaged research here, because as you point out, it really is the term that's coming to the forefront here in the United States. So, in the United States, and in our all of our ASHA journals, we unfortunately have very few examples of stakeholder engaged research, where clients and family members are fully engaged collaborators are involved. There's only a handful of studies. So, it hasn't been a widely used approach in our field yet, but I think it's growing quickly. KS: What makes you think it will grow quickly? JH: There are three broad reasons why I think this is changing fast. First, I think the idea that people who are being affected by something – whether it be a policy, regulation, legislation – is taking a broader hold in certain areas of our lives. For example, in academics where we have student-centered learning. Second, research funding agencies in the United States are starting to value, and therefore reward with funding, research projects in which stakeholders play an important role and make a substantial contribution to the research project. The most important landmark in terms of funding agencies in the United States is the creation of the Patient-Centered Outcomes Research Institute, called PCORI. It was created as part of the Affordable Care Act in 2010 and it was charged with funding comparative effectiveness research – in other words, research that would help patients and clinicians what is the best treatment for them. Their slogan is “Research Done Differently”, and I think that captures that the research they are producing is not at all the kind of traditional research that we mentioned earlier. PCORI is funding all kinds of health research across many disciplines in innovative ways. This is really changing the landscape of research and research funding, because other funding agencies are starting to follow their lead. The third reason why I think stakeholder-engaged research will grow quickly in our field is the experience we've had with Project BRIDGE. KS: I've been a Regional Coordinator and also a member of a few research teams for Project BRIDGE. Honestly, it's been a gamechanger for me in how I think about approaching research. Can you tell us about how Project BRIDGE got started? JH: Sure. So, 10 years ago, I was at a conference called the Clinical Aphasiology Conference. And for anyone who's not familiar with that conference, until the last couple of years, the only people who could attend the conference were people who submitted presentations. So, this means the conference in that sense rather exclusive, and that the audience, the people who are present at the conference, were really only researchers. So, 10 years ago, I was at this conference, listening to three days of presentations, all about aphasia treatment and I suddenly realized that we're all researchers talking to other researchers about aphasia treatment, but no one at the conference was either using the treatment as a clinician or receiving the treatment as a client. So, I said to some of the folks at the meeting, “There should be some people with aphasia at this conference. We're talking about their treatment.” And the response I got 10 years ago was, “Well, they don't really belong here.” The timing of that was one year after PCORI, became really active and started funding initiatives.  Around the same time, we had done a project with the Sarasota Aphasia Community Group, which is a fabulous group, if anyone needs a referral in that area. They run themselves. The group is really great. We asked their members to come up with ideas about what research they think would be important. We talked to them about research, and we set them off. So, they were off on their own and we did not interfere with this. They had their own group meetings and came up with the research ideas. So, they came up with 22 ideas.  Now most of their research, and by the way, these were really good questions. And most of them, you know, were formulated pretty close to how we would normally formulate research questions. I mean, they did a fabulous job with very little information about research. Most of their research questions were about the best treatment for different kinds of language issues. For example, “What's the best treatment for being able to produce sentences?” But then they came up with some really special questions that I don't think that you or I even despite all of our clinical experience, and our research experience, I'm not sure we would come up with these questions.  For example, they wanted to know, “How can the speech pathologist engage the person with aphasia, not just do rote exercises, but rather connect with the aphasic as a personality, tailor the therapy to the individual needs?” KS: Wow, that's mind blowing. And that's 10 years ago, right?  JH: Yeah, yeah, maybe even more than that. And by the way, I said aphasic. I'm reading what they wrote, so I just wanted to let everyone know that those are their words. Another question they came up with was, “What is the effect on the person with aphasia if they do not like their speech pathologist? or ‘The speech pathologist doesn't understand the patient's needs or doesn't customize the therapy towards them?'” Wow. I think as clinicians, we probably know, in our hearts that when we don't have a good match in terms the rapport between the clinician and client, it probably doesn't go that well. It's not the best outcome. We all know this. But we don't know very much about it from a research point of view. And then another question they came up with was “What makes a speech pathologist excellent?” These are from their point of view. It was just people with aphasia and family members coming up with these questions. KS: Wow, well I'm certain that I wouldn't be able to come up with those types of questions. They are so meaningful and important. They really get right down to what's important, don't they? JH: Yeah. I'm really pleased that we were able to publish that paper with the founders of the Sarasota Aphasia Community Group. They were co-authors. They were equal collaborators with us in the project. That was published in 2014.  And then two years later, in 2016, we submitted a proposal to PCORI, when I was the Executive Director of Voices of Hope for Aphasia. And although that first proposal was not funded, we got great feedback. When I read the feedback, I thought, you know, if we make this actually a little bit bigger, maybe it's going to be successful, which is not always the way you go. But we partnered with the University of South Florida. So, it was Voices of Hope for Aphasia and University of South Florida. And that was funded, and that proposal created Project BRIDGE.  The first two years of funding allowed us to create a working conference. The goal was to bring together people with aphasia, family members, clinicians, and researchers to form collaborative research teams. One challenge with this kind of work and you know, it's this is not just in the world of aphasia, this is any health domain that uses this kind of stakeholder engaged research. So, one challenge is that researchers know about how to do research but other people who aren't researchers don't know so much about research. On the other hand, researchers are not experts on daily clinical processes, nor are they experts on living with aphasia. So, we created some video trainings, and some of them were for people with aphasia and family members to learn more about the research process, and some were for researchers about communication supports role dynamics, and plain language. Because, you know, most researchers have never been trained in doing this kind of collaborative research. So that conference was held in October 2018. And after a two-day meeting, 11 research teams were formed. And you were there, Katie. KS: Yes! Project BRIDGE was a career changing experience for me. I had invited two of our Lansing Area Aphasia Support Group members, Chris and Ruby, to join me, and we flew down to Florida together. I think from that beginning of travelling together to a conference set a stage for something different. Actually, Chris's sister, who lived in Florida joined us at the conference too. None of us really knew what to expect, but from the very beginning, we all knew this was different. At the conference, I remember just having my mind blown that there were over 100 people attending the conference- many who had aphasia or were family members whose lives were impacted by aphasia. One of my favorite parts was when we were in our teams, I had a team about storytelling and aphasia, and everyone was brainstorming on research questions. The training, the collaboration, the energy, it was really impactful. I'd love for you to tell our listeners more about Project BRIDGE. JH: So, after that conference, we were very happy that these research teams were formed and there was so much energy. And I want to say that, you know, from the very beginning, before we even got funding, we had an advisory team that was made up of people with aphasia, families, clinicians, and researchers. And so, after the conference and a little bit of follow up with our teams. The whole advisory team was so excited, and we there was so much momentum, and we knew we wanted to keep Project BRIDGE going.  So, we applied for a second round of funding from PCORI. And with the second round of funding, we created what we call a research incubator. And we were able to create four regional centers around the United States because we knew there are many people who wanted to participate, but who cannot travel across country to a conference. So, we started Project BRIDGE as a research incubator in January 2020. Our mission was to train 48 people with aphasia, family members, clinicians, and researchers on stakeholder engaged research and get them connected to a collaborative multistakeholder research team. Katie, you are one of the regional coordinators in Michigan yourself for the Midwest, so you know how busy we got! KS: Oh yes, busy is an understatement. Suma Devanga from Western Michigan University and I were the Midwest Bridge Regional Coordinators. We had so much interest we just kept meeting with various stakeholders, holding trainings, connecting people with research teams. Definitely Project BRIDGE was the place to be!  JH: All the regional centers were very busy. At the end of two years, we had three times as many people sign up to participate than we planned, and we trained 25% more people than we planned. Many more stakeholder-engaged research teams have been formed, and they're studying topics like the effects of yoga on aphasia. The yoga team actually started in the original 2018 conference. And, you know, check it out, maybe we can share some links to a couple of their publications, because it's a very productive team. KS: Absolutely , we'll put we'll put the links to that and some of the other things you've mentioned in the show notes.  JH: Great. Another team that has been influenced by Project BRIDGE is aphasia games for health. There's more than one team now working on mental health interventions for people with aphasia. We also have a couple of teams working on different aspects of friendship and aphasia. One team is a collaborative team working on how to run aphasia groups. I mean, isn't that great? Get the people with aphasia to run a study on the best way to run the aphasia groups, right? It makes total sense.  We've got lots of teams working, and we've had several different presentations at various conferences. And, you know, please stay tuned in the coming months and, and years, because more and more the work will get to a point where it'll be out in different publications.  When I look back at the work that we did with the Sarasota Aphasia Group, and the questions that they came up with, I'm so overjoyed that many more of them are now being addressed because people with aphasia, care partners, clinicians are being involved in not just coming up with the questions but planning and actually doing the research. KS: Powerful stuff! This is all very exciting. But there must be some challenges…  JH: Definitely, there's definitely challenges. First of all, you know, most researchers who are active today have not been trained in this kind of research. They were not trained in their doctoral program, to sit down with people who have expertise in a completely different area. They may have been trained to collaborate with people who are more or less like them. But that is a very different game. So, one thing that I think we'd like to do in the future is help foster the incorporation of the skills needed to do this kind of research into doctoral training programs. When we talk to researchers who have gotten into this, like you. We find that this is a recommendation that many people come up with. Another challenge of this kind of work is that it takes more time. It is time consuming. It takes time to involve people who come from a different background. And it doesn't matter if they are people with aphasia, a community partner, whoever they are, when they have a different background, then an academic researcher, that's going to take more time, and it's really, truly an investment. That is an issue for this kind of work. Another challenge or risk is as there are more incentives for in involving stakeholders of different types into the research process, there's always a risk of tokenism. So, if that starts becoming rewarded in some way, like through funding, then there's a risk that, you know, stakeholders are up serving on advisory boards, so it looks like they're involved, but they're not really, truly collaborators or really involved. So that is a risk I think that we're going to run, especially in the future.  But you know, honestly, I think that's a risk that we run in our clinical work, too. Sometimes we don't mean to be to be tokenistic. But I think when we ask our clients a general question, like, “What would you like to work on in therapy?” You know, our heart is there, we want to involve the client. But that's a question that the client is not really prepared to answer in that form. Most of our clients, probably, they never been in therapy, they don't know what therapy is in the first place. They don't even know how to start thinking about that question. If we don't take extra steps to seek out their perspective, and what's important to them, that that's a little bit tokenism too. You know, we don't mean it to be, but it really kind of is, I think. We need to ask specific questions; we need to use tools that we have. For example, Aphasia Access now has the Life Interests and Values cards, which is a fabulous way of getting the idea of clients' priorities for therapy, in an aphasia friendly way. I think the other thing for clinicians for our clinical work is when we do ask questions of our clients, and they give us the answer, I think we have to do a better job at taking them at their word. Because I think sometimes, if the answer is not quite what we think it should be, or we're a little surprised by the answer, we're very likely to attribute insight, problem solving issues, motivation, issues, whatever it is, into that client's response, when perhaps, that that is their answer for them. And you know, they are the experts on themselves.   KS: Yes, that's such great perspective and food for thought. I think we really need to listen and embrace what our clients put forth with ideas for how to work on goal areas and be open to receiving the goals and the ideas that they that they have. Even if it takes us a little off road from where we typically go. How can we help them explore and develop and operationalize their ideas? And I think it is challenging, it's new territory for us as clinicians and research but I think once we're open to this, I mean, honestly, sky's the limit. And the cool thing is that we as researchers get to learn and grow alongside our clients as well. Jackie, this has been such a thoughtful and great conversation. The time has just flown by. But as we wrap up today, do you have any final thoughts? JH: Well, you know, a lot of times we hear people say, “I'm no expert”, and Project BRIDGE has really taught me and showed all of us involved I think that a few things. Clinicians might not feel like experts around researchers, but they are experts about what they do and the clinical process. People with aphasia and care partners probably don't feel they don't feel like experts around researchers or clinicians, but in point of fact they are experts about themselves and their own lives and, and what's important, and what we can best do to fit into those priorities. So, I think that we've learned from Project BRIDGE that a researcher or a clinician who exudes cultural humility. You know, we might not feel like experts in front of clinicians or people with aphasia and care partners. So, I think we need to acknowledge, we're all experts on ourselves and our little corner of the world, what we do all day, and other people are experts on other things. And hopefully, we don't impose that onto other people and that we can just collaborate with each other.  When some kind of research is going on, that might potentially affect something that a clinician routinely does, or how a person with aphasia is living, or the kind of therapy they're going to get, etc. We need to be willing to step up and contribute to a collaborative team. You know, probably not every kind of research in the world is a perfect fit for this kind of stakeholder engaged research. But a lot of what we do in aphasia, I think, and especially things that are important to members of Aphasia Access, would be better, more effective and more efficiently done with a collaborative team. We need everyone's expertise to change things for the better. When we do this kind of collaborative research, it speeds up how fast the research gets used in practice settings. So, it benefits people faster, because it's more effective. So, we need people to be aware of this and get involved. Project BRIDGE, fortunately, is now supported by Nova Southeastern University. So, it's not going away just because the funding ended in this year. And we are continuing to help people, whether they be researchers, clinicians, people with communication disabilities, or family members to get going on stakeholder engaged research. We still have our video trainings, And, coming soon, we'll be offering customized research team trainings. I invite everyone to please check out our website, www.projectbridge.online  You can sign up for our newsletter and we post various resources that are helpful tools. KS: Thanks, Jackie. I'll be sure to put all of your contact information and Project BRIDGE as well as some articles on stakeholder engaged research in the show notes. Thank you, Jackie. you've given us lots of food for thought and inspiration for action during the conversation. But I also just want to say, thank you for your forward thinking and helping us in the world of aphasia get on this stakeholder engaged research train. Project BRIDGE is a great conduit for who knows what's to come. JH: Well, thank you, Katie. And, and thanks again, for this opportunity to talk about this effort. You know, there's so many people around the United States who are participating in this, I could have spent the whole podcast just probably listing their names, but that might not be too engaging. KS: It's a big posse, Project BRIDGE! JH: It's very big. Broadly, I definitely want to acknowledge them, even though I can't acknowledge everyone by name. Everyone's doing such exciting work and people are finding their own paths through this, which is what we need. I didn't say it earlier, but the idea of incorporating people living with communication disabilities into the research really springs out of my own personal experience with disability and in life. And it's such a privilege for me to meld my personal experience into things that hopefully will help others too. So, thank you very much. On behalf of Aphasia Access, we thank you for listening to this episode of the Aphasia Access Conversations Podcast. For more information on Aphasia Access and to access our growing library of materials go to www.aphasiaaccess.org If you have an idea for a future podcast topic email us at info@aphasiaaccess.org. Thanks again for your ongoing support of Aphasia Access.   Resources Referenced in Episode Project BRIDGE www.projectbridge.online  Email: flaaphasia@gmail.com Twitter @ProjectBridge3 Facebook @bridgeresearch  Instagram @projectbridge2  Dr. Jackie Hinckley - Jh988@nova.edu   PCORI Engagement Resources: https://www.pcori.org/engagement/engagement-resources  Project BRIDGE (and resources) on PCORI: https://www.pcori.org/research-results/2020/building-bigger-bridge-research-incubator-network-pcor-communication-disabilities  Project BRIDGE Published Abstract: https://www.frontiersin.org/10.3389/conf.fnhum.2019.01.00030/event_abstract    Examples of Stakeholder Engaged Research Project with Sarasota Aphasia Community Group:  https://www.tandfonline.com/doi/full/10.3109/09638288.2013.829528  Team Yoga - 1: https://pubs.asha.org/doi/10.1044/2020_PERSP-20-00028  Team Yoga  - 2: https://pubmed.ncbi.nlm.nih.gov/34797684/  Aphasia Games for Health: https://www.aphasiagamesforhealth.com/    Canadian Institutes of Health Research Patient Engagement in Research Resources https://cihr-irsc.gc.ca/e/51916.html  Ethics in Patient Involvement: Hersh, Israel, & Shiggins 2021 https://www.tandfonline.com/doi/full/10.1080/02687038.2021.1896870    Goal Setting Resources for Aphasia Live Interests Values Cards (LIV! Cards) https://www.aphasiaaccess.org/livcards/ 

  Episode 159   Marie, Matt, Michael, Michelle, and Rachel dive into the research and pop news in and related to the field of Speech and Language Pathology and the Informed SLP breaks down the latest research.  Matt's microphone had mishap for the first 14 minutes of the show but it gets fixed after that! On this week's episode the group dives into what it means if health care workers can be sued for mistakes and why snacking in a SNF is good for patients.  The Informed SLP stands on the Oral Care Soap Box! The Discord is up and ready for people to interact with the crew 24/7 with a new website, www.discord.speechsciencepodcast.com. SSPOD Shoutout: Do you know an SLP who deserves a digital fist bump or shout-out?  We want to know your #SSPODSHOUTOUT, which is recognition for someone doing something awesome somewhere.  SSPOD Due Process: Your opportunity to message us about a problem in your area that you would like us to talk about, use the #SSPODDUEPROCESS.  Contact Email: speechsciencepodcast@gmail.com Discord: https://discord.speechsciencepodcast.com Speech Science Stuff: http://merchandise.speechsciencepodcast.com/ Presence Learning GiveAway: http://giveaway.speechsciencepodcast.com/   New Episode and Interact here: www.speechsciencepodcast.com podcast.speechsciencepodcast.com   Support Patreon – https://www.patreon.com/speechsciencepodcast   Rate and Review: https://podcasts.apple.com/us/podcast/speechscience-org-podcast/id1224862476?fbclid=IwAR3QRzd5K4J-eS2SUGBK1CyIUvoDrhu8Gr4SqskNkCDVUJyk5It3sa26k3Y&ign-mpt=uo%3D8&mt=2   Credits Intro Music: Please Listen Carefully by Jahzzar is licensed under a Attribution-ShareAlike License. Bump Music: County Fair Rock, copyright of John Deku, at soundcloud.com/dirtdogmusic The Informed SLP: At The Count by Broke For Free is licensed under a Creative Commons Attribution License Closing Music: Slow Burn by Kevin MacLeod is licensed under a Creative Commons Attribution License.   Show Links The Informed SLP: https://www.theinformedslp.com/review/stepping-onto-the-oral-care-soapbox https://pubs.asha.org/doi/10.1044/2021_PERSP-21-00108   WHATS UP ASHA? https://www.asha.org/slp/clinical/speech-language-pathologists-as-the-preferred-providers-for-dysphagia-services?fbclid=IwAR3VL4Da7er7qBwcs5CTBD3Jze7ldOCkQI2EQ-9R4uIcdHAOCgsWLoEGwHU     Snacking in the SNF https://www.sciencedirect.com/science/article/abs/pii/S0197457222000015?fbclid=IwAR2_rN91JCpaKd6-6iGAO83fnLFZ1AlHoyvwxfUbIBz5ijJck5yMH96pq6E'   RaDonda Vaught https://amp.tennessean.com/amp/4826562002?fbclid=IwAR0ahVCwNShk5MLX0Cl2q2BQqRMT00CjrPYeI5wy4Xx0KkU_aOhzLjNUX6I   Matt's Book Link https://www.amazon.com/gp/product/B09JS6BK1F?ref_=dbs_mng_crcw_0&storeType=ebooks   Speech Science Powered by: PresenceLearning! https://www.presencelearning.com/    

Get .1 ASHA CEU hereEpisode SummaryDLD isn't a new text abbreviation or IG expression. It's a real thing in the field of SLP and if you don't know about it, you gotta' tune in to get the scoop. This week, Tim DeLuca and Kate Radville- SLP's and doctoral candidates basking in language and literacy nerdom - chat about all things DLD for the SLP. What is DLD? And why is it so important to get a handle on it in the vast and murky sea of semantics that we painfully stir in the SLP field? Kate and Tim explore how challenges with oral language have a domino effect on the attitudes and skills of students, impacting literacy, behavior, and more. You'll gain assessment and intervention tips that hold fast to the golden thread of most SLP Nerdcast episodes - the importance of EBP and collaboration. There are some four letter words (ahem, “dysteachia”) and a big spotlight on resources in this engaging episode that confronts the strong connections between all aspects of the whole student and their whole future. Course AccommodationsThe transcript for this course is provided below. You can also email us at ceu@slpnerdcast.comLearning OutcomesDefine DLD and dyslexia, understand how they are related, and report on at least five behavioral presentations across academic and social settingsUnderstand the SLP's role in assessing and treating both DLD and dyslexia as members of an interdisciplinary team across the lifespanBe able to locate at least five free resources to further explore both DLD and dyslexia and assessment and treatment optionsResources:Bishop, D. V. M., Snowling, M. J., Thompson, P. A., Greenhalgh, T., & CATALISE consortium. (2016). CATALISE: A Multinational and Multidisciplinary Delphi Consensus Study. Identifying Language Impairments in Children. PLOS ONE, 11(7), e0158753. https://doi.org/10.1371/journal.pone.0158753Bishop, D. V. M., Snowling, M. J., Thompson, P. A., Greenhalgh, T., & and the CATALISE-2 consortium. (2017). Phase 2 of CATALISE: A multinational and multidisciplinary Delphi consensus study of problems with language development: Terminology. Journal of Child Psychology and Psychiatry, 58(10), 1068–1080. https://doi.org/10.1111/jcpp.12721Gough, P. B., & Tunmer, W. E. (1986). Decoding, Reading, and Reading Disability. Remedial and Special Education, 7(1), 6–10. https://doi.org/10.1177/074193258600700104Mitchell, M. P., Ehren, B. J., & Towson, J. A. (2020). Collaboration in Schools: Let's Define It. Perspectives of the ASHA Special Interest Groups, 5(3), 732–751. https://doi.org/10.1044/2020_PERSP-19-00125Redmond, S. M., Ash, A. C., & Hogan, T. P. (2015). Consequences of Co-Occurring Attention-Deficit/Hyperactivity Disorder on Children's Language Impairments. Language, Speech, and Hearing Services in Schools, 46(2), 68–80. https://doi.org/10.1044/2014_LSHSS-14-0045Snow, P. C. (2021). Psychosocial Adversity in Early Childhood and Language and Literacy Skills in Adolescence: The Role of Speech-Language Pathology in Prevention, Policy, and Practice. Perspectives of the ASHA Special Interest Groups, 6(2), 253–261. https://doi.org/10.1044/2020_PERSP-20-00120The Simple View of ReadingMulti-Tiered Language Instruction and InterventionDyslexia in the Schools: Assessment and IdentificationDLD and MeThe Florida Center for Reading ResearchThe International Dyslexia AssociationCourse Disclosure - Financial and In-KindFunding for this course was provided by one of our Corporate Sponsors, Language Dynamics Group.Speaker DisclosuresTim DeLuca financial disclosures: Tim is employed by private practice and university.Tim DeLuca non-financial disclosures: Tim is an ASHA member, a certified speech-language pathologist and reading specialist, a doctoral student at the MGH Institute of Health Professions, and a member of the Sail Lab at the Massachusetts institute of health professions. Kate Radville financial disclosures: Kate does not have any financial relationships to disclose. Kate Radville non-financial disclosures: Kate is an ASHA member, a certified speech-language pathologist, and a doctoral student at the MGH Institute of Health Professions. Kate Grandbois financial disclosures: Kate is the owner / founder of Grandbois Therapy + Consulting, LLC and co-founder of SLP Nerdcast. Kate Grandbois non-financial disclosures: Kate is a member of ASHA, SIG 12, and serves on the AAC Advisory Group for Massachusetts Advocates for Children. She is also a member of the Berkshire Association for Behavior Analysis and Therapy (BABAT), MassABA, the Association for Behavior Analysis International (ABAI) and the corresponding Speech Pathology and Applied Behavior Analysis SIG. Amy Wonkka financial disclosures: Amy is an employee of a public school system and co-founder for SLP Nerdcast. Amy Wonkka non-financial disclosures: Amy is a member of ASHA, SIG 12, and serves on the AAC Advisory Group for Massachusetts Advocates for Children.Time Ordered Agenda:15 minutes: Introduction, Disclaimers and Disclosures15 minutes: Descriptions of DLD and dyslexia, how they are related, and behavioral presentations across academic and social settings15 minutes: Descriptions of the SLP's role in assessing and treating both DLD and dyslexia10 minutes: Descriptions of resources to further explore both DLD and dyslexia and assessment and treatment options 5 minutes: Summary and ClosingDisclaimerThe contents of this episode are not meant to replace clinical advice. SLP Nerdcast, its hosts and guests do not represent or endorse specific products or procedures mentioned during our episodes unless otherwise stated. We are NOT PhDs, but we do research our material. We do our best to provide a thorough review and fair representation of each topic that we tackle. That being said, it is always likely that there is an article we've missed, or another perspective that isn't shared. If you have something to add to the conversation, please email us! Wed love to hear from you!A big THANK YOU to our Corporate Sponsor, Language Dynamics Group for the financial support to make this course possible!__SLP Nerdcast is a podcast for busy SLPs and teachers who need ASHA continuing education credits, CMHs, or professional development. We do the reading so you don't have to! Leave us a review if you feel so inclined!We love hearing from our listeners. Email us at info@slpnerdcast.com anytime! You can find our complaint policy here. You can also:Follow us on instagramFollow us on facebookWe are thrilled to be listed in the Top 25 SLP Podcasts!Thank you FeedSpot!