Inclusion in digital environments for people with aphasia

Abstract

Background: Individuals with aphasia may wish to engage with the Internet for work, communication, or leisure. Pre-stroke Internet skills will vary, as will other factors such as availability of equipment and support. This thesis aims to investigate how aphasia influences Internet use and skills. Further, it aims to explore and evaluate assessment, intervention, and outcome measurement to support Internet use with aphasia. Method: A supported questionnaire was used to compare Internet and technology use between people with and without aphasia post-stroke (stage one). Forty-two participants were recruited, twenty-five of whom had aphasia. The two groups shared known risk factors for digital exclusion. A series of four experimental single case studies followed using a structured assessment and decision-making process with a focus on exploring interventions for participants with post-stroke aphasia who had particular goals around Internet use (stage two). Results: There was a very broad spectrum of levels of independent and supported Internet use amongst people with and without aphasia. Age was a stronger predictor than aphasia for Internet use/non-use. People with aphasia were less likely to use linguistic tools such as emailing, text messaging, and e-readers. Level of education influenced self-perception of Internet skills. Case-study interventions differed according to individual needs and goals. Clinical decision-making and interventions were guided by a specific focus on cognitive and Internet skills alongside environmental factors relevant to Internet use. Assessment demonstrated that, for three of four participants, change was evident, with gains linked to their Internet related goals. Discussion: This study adds to knowledge by enhancing understanding of how people with aphasia may face specific risks related to digital exclusion. It demonstrates that a holistic understanding of factors influencing Internet use and skills can support the design and evaluation of tailored interventions to enable iv Internet use with aphasia. This provides guidance for clinical practice and for future aphasia research.