Audio - ASHA Poster

The study focuses on the return to work for individuals with mild aphasia, highlighting the impact of aphasia on communication and everyday functioning. While people with mild aphasia may appear to have mild language deficits, research shows they still experience a decrease in quality of life. The study aimed to explore the factors influencing return to work for individuals with mild aphasia and identified barriers and facilitators to returning to work. The research involved a systematic review of literature and interviews with five adults with mild aphasia, revealing themes such as communication difficulties, employer support, and the value of speech-language therapy. Return to Work in People with Mild Aphasia, Exploring Facilitators, Barriers, and the Role of Speech-Language Pathology. As a disclosure, the authors do not have associations, activities, personal and professional perspectives, and financial associations related to the content of this session. The impact of aphasia on communication cannot be overlooked, as it is crucial to everyday functioning. Literature has indeed shown that the severity of aphasia directly impacts life participation, but mild aphasia is one that has historically been overlooked in research and clinical practices. This is despite the fact that almost half of all sustained strokes are mild. People with mild aphasia typically demonstrate the least severe language impairment, especially during structured assessments such as the Western Aphasia Battery Revised. However, even though their test scores may only show mild impacts, research shows that people with mild aphasia often experience a decrease in quality of life similar to those with more severe language deficits, as noted by Kavanaugh and Haley in 2020. That said, they still have the highest likelihood of return to work compared to those with more severe aphasia. Although individuals with mild aphasia may retain basic language and communication skills, they still experience persistent functional impacts and our understanding of their needs remains limited. Difficulties associated with mild aphasia can be thought of as an iceberg. Above the surface or towards the top of the iceberg, you may see a person who appears fluent in familiar contexts or maybe shows only minimal word-finding difficulty. However, deep down, individuals with aphasia may struggle with self-expression through spoken or written language, difficulties in learning new skills, and challenges in pursuing leisure activities. For example, you may find someone who has difficulty with fast talkers, avoids certain social situations due to anticipated language breakdowns, and may even need to depend on others to assist in carrying out their responsibilities. Regardless of severity, people with aphasia often experience social isolation and may depend on family members to manage personal and household responsibilities. Classifications such as mild aphasia by standardized batteries, such as the WAB-R, lead to the assumption that these difficulties are mild and have a limited impact on a person's life. However, this is not the case. One definition of social participation is the performance of people in actual activities in social life domains through interaction with others in the context in which they live. In the United States, work is often the most prominent example of social participation. Research shows that people with aphasia often do have a desire to socially participate and return to work. Accordingly, our research had two aims. First, we sought to determine the documented factors that influence the return-to-work process for individuals with mild aphasia, and in the absence of such articles, aphasia more broadly. Second, we sought to discover the specific reported needs, facilitators, and barriers to return-to-work for individuals with mild aphasia. To explore our first objective, we conducted a systematic search and narrative review to summarize the existing literature on mild aphasia and return-to-work. Due to the limited nature of this search and the available studies, we also included studies about aphasia of all severity levels that fit the rest of our inclusion criteria. Between January and February of 2025, a range of databases, as indicated on the poster, were systematically searched using this predetermined criteria. We isolated our search to direct research only, eliminating reviews, meta-analyses, dissertations, and the like. We decided to limit our search to the year 2001 and beyond, as this was the year the World Health Organization proposed the International Classification of Functioning, Disability, and Health to highlight the importance of participation in daily activities for those with disabilities. Examples of keywords used in our search strings included stroke, return-to-work, vocational rehabilitation, workplace communication, language, aphasia, and work reintegration. Using covenants, two independent reviewers conducted a title, abstract, and full-text screening to isolate the literature that would help answer our question. Any discrepancies were resolved by a third reviewer. As a result of our search and screening, we ultimately eliminated many of the 415 studies that we had initially found using our developed search strings. Unsurprisingly, the literature on mild aphasia in the context of return-to-work specifically was quite limited, resulting in a search that included aphasia of all severities. In the end, we extracted seven studies to include in our review. These selected studies explored various outcomes after cerebrovascular accidents, with a particular focus on return-to-work and social participation. Across studies, sample sizes of participants with aphasia varied considerably. Garcia, Rudolph, and colleagues in 2024 included 253 individuals with aphasia, while Lu, a and others in 2020 studied 59. Hofgren and colleagues in 2016 conducted a prospective exploratory study with 15 participants ranging from mild to severe aphasia, and Morris and colleagues in 2017 presented a single case of mild aphasia. Sushant and colleagues in 2018 analyzed qualitative responses from 10 individuals with mild to moderate aphasia. Wozniak and colleagues in 2019 included a small unspecified number of participants with aphasia, while Arnao and colleagues in 2021 examined 99 individuals with mild and 63 with moderate to severe aphasia. When reviewing these seven studies, it is clear that aphasia itself is a major predictor of not returning to work, with a noted 43% decrease in the odds of doing so for people with aphasia, and in one small sample, only 7% returning to work after a year. Even with positive prognosis for recovery, communication challenges are persistent limiting factors. Functional independence matters too, as gaining independence in activities of daily living boosts return-to-work odds, while lingering motor weakness lowers them. Job type and employer support play a big role, with white-collar positions seeing much higher return-to-work rates than blue-collar positions. Success heavily depends on whether employers offer understanding and flexibility, so return-to-work is clearly about more than just recovery. That said, the relative lack of in-depth research into specific barriers and facilitators that impact return-to-work for people with aphasia are not necessarily explored in detail across larger mild aphasia cohorts and across studies. To address our second aim, our study included five adults with aphasia as a result of a stroke who met our inclusion criteria, which required a mild aphasia classification based on the lob R and stroke onset before the age of 65. Additionally, we ensured that participants had functional levels of hearing and visual acuity and no history of other neurological conditions, psychiatric disorders, or developmental language disorders. These criteria aim to isolate the effects of stroke-related impairments and avoid confounding influence from other conditions. Our participants ranged from the ages of 53 to 65 at the time of interview and held a variety of jobs prior to sustaining their strokes. You can see the detailed demographic information in our table. While four out of the five participants in the group have been retired since their stroke, one individual continues to work as a self-employed psychiatrist. These five individuals participated in a semi-structured interview about returning to work for someone with aphasia. These interviews were transcribed and then analyzed using thematic analysis by two independent coders. An inductive approach was applied in which themes emerge organically from the data with no expected or predetermined themes or codes. Excel was used to store the analysis codebook, allowing for an iterative process with as much recoding as we saw fit. This analysis revealed three major themes. The first was barriers to return to work, second was facilitating return to work, and third was accommodating for aphasia. Notably, all five participants shared information that aligned with these three themes. Within each major theme, the analysis found several sub-themes that further captured the essence of these individuals' experiences. As detailed in the graph in the second results section on the poster, many discussed similar concepts related to return to work with aphasia. Within each major theme, as noted on the left side, each bar on the graph represents the percentage of participants that commented on a given sub-theme. Every participant commented on communication difficulties and occupational demands as barriers, with many discussing other factors like lack of knowledge of aphasia. One participant said, you can't speak to people. You know everything is difficult. You can't tell people what you need or what you want or what you're doing. It drives you nuts that you can't find the words. You can't say them. Within the major theme of facilitating return to work, all five individuals emphasized the importance of employer support, with many mentions made about at-work accommodations, social support, and even intrinsic motivation. As one individual shared, you need people to understand that you need more time to do things. With regards to accommodating for aphasia, the purpose and value of speech-language therapy was a widespread theme, with helpful strategies and supports frequently mentioned. One participant shared, anything that helps me will do it. It, referring to speech-language therapy, will help me get back. The more things I say, the more things I write, the more things that I do. Across all participants, it was clear that they experienced many frustrations related to their communication and how this impacts their interactions with others and the world. There are factors that can and do support their social participation and potential return to work. It is just a matter of finding people and environments that will be conducive to implementing these. The key takeaway is, though, that even though these individuals' aphasia is mild, their difficulties and the supports they would benefit from are not. Overall, the evidence found when exploring both of our research aims paints the picture of a population that is under-researched and clinically underserved. Our narrative review underscores the need for more comprehensive investigations focused specifically on the interaction between mild aphasia and vocational outcomes. Implementing such research can significantly aid speech-language pathologists in developing more precise and individualized intervention plans. This can improve collaboration with multidisciplinary teams and empower people with aphasia with evidence-based strategies to navigate the complexities of return to work, a process that is not easy nor simple. Our qualitative research and somatic analysis similarly revealed many important takeaways. People with mild aphasia report that speech-language pathology services directly support work readiness, even when the SLP is functioning as an advocate or to provide support with procedural return to work aspects. The difficulties people with mild aphasia experience are not to be overlooked, and they report that knowledge and understanding of aphasia matters across contexts. Overall, adaptation and flexibility encourage participation and allow for support when individuals encounter a variety of barriers. SLPs can and do play a very important role in the rehabilitation and recovery of these individuals, and ongoing discussions are needed on how best to support their social participation in ways that align with their goals. It should be noted that with regards to our second aim, further data collection and analysis is planned to strengthen our findings. 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