Biografisch-narrative Intervention bei Aphasie – ein innovativer Ansatz zur Steigerung der Lebensqualität^[*]

Zusammenfassung

Hintergrund:

Menschen mit Aphasie erleben massive Beeinträchtigungen in ihrer Lebensqualität und ein verändertes Identitätsgefühl. Soziokulturelle Theorien sehen das Konzept narrativer Identität als essentiell für Lebensqualität. Dies meint, dass mittels narrativer Kompetenzen, welche bei Aphasie eingeschränkt sind, eine Selbstthematisierung im Austausch mit anderen erfolgt, wodurch Identitätsarbeit geschieht. In dem Projekt wird ein interdisziplinärer biografisch-narrativer Ansatz zur Stimulation von Identitätsarbeit in angepasster Form entwickelt und evaluiert.

Methode:

In einem Vorher-Nachher-Design mit einer Follow-up-Untersuchung wurden biografisch-narrative Gespräche in 5 Einzel- und 7 Gruppensitzungen durchgeführt. Es wurden u. a. quantitative Tests eingesetzt.

Ergebnisse:

Für die ersten 2 Interventionsgruppen zeigten sich signifikante und stabile Verbesserungen in der Lebensqualität gemessen mit dem Aachener Lebensqualitätsinventar. Die kognitive Lebensbewertung in der Satisfaction-with-Life-Scale blieb stabil.

Diskussion:

Erstmals werden systematisch spezifische Effekte der biografisch-narrativen Intervention bei Aphasie gezeigt.

Abstract

Background:

People with aphasia experience a severe loss in quality of life accompanied by a changed sense of identity. Sociocultural theories postulate that narrative identity is a key objective in quality of life. Narrative identity is constantly transformed in social interaction with others. Therefore, narrative competencies are needed which are impaired in aphasia. In our project we develop and evaluate an interdisciplinary biographic-narrative approach to stimulate identity renegotiation. Because such an approach is talk-based it has to be modified.

Method:

In a before and after design with a follow-up assessment we conducted biographic-narrative face-to-face interviews and group interventions. For evaluation we used quantitative tests for self-assessment.

Results:

We present the results of the first 11 participants. We found a significant improvement in health-related quality of life measured by the Aachen Life Quality Inventory, which remained stable after 3 months without intervention. As expected, overall life satisfaction measured by the Satisfaction-with-Life-Scale which is very broadly based remained stable.

Conclusions:

Biographic-narrative interven­tion can effect an improvement in quality of life in cases of aphasia. Its integration into speech and language therapy has to be considered.

Schlüsselwörter

Aphasie - Lebensqualität - Identität - biografisch-narrative Arbeit - Partizipation

Key words

aphasia - quality of life - identity - biographic-narrative work - participation

² gefördert vom Bundesministerium für Bildung und Forschung (BMBF), FKZ 17S10X11.

• Literatur

• 1 Hartman-Maeir A, Soroker N, Ring H et al. Activities, participation and satisfaction one-year post stroke. Disabil Rehabil 2007; 29: 559-566
• 2 Simmons-Mackie N, Holland A. Aphasia centers in North America: A survey. Semin Speech Lang 2011; 32: 203-215
• 3 Hilari K, Needle JJ, Harrison KL. What are the important factors in health-related quality of life for people with aphasia? A systematic review. Arch Phys Med Rehabil 2003; 93: 86-95
• 4 Ayerbe L, Ayis S, Wolfe CD et al. Natural history, predictors and outcomes of depression after stroke: systematic review and meta-analysis. Br J Psychiatry 2013; 1: 14-21
• 5 World Health Organisation (WHO). ICF – International Classification of Functioning, Disability and Health. 2001 Im Internet: www.who.int/icf
• 6 Pavot W, Diener E. The Satisfaction with Life Scale and the emerging construct of life satisfaction. J Posit Psychol 2008; 3: 137-152
• 7 Shmotkin D, Shrira A. Happiness and suffering in the life story: an inquiry into conflicting expectations concerning the association of perceived past with present subjective well-being in old age. J Happiness Stud 2011; 4: 1-21
• 8 Lucius-Hoene G. Konstruktion und Rekonstruktion narrativer Identität [19Absätze]. Forum Qualitative Sozialforschung/Forum: Qualitative Social Research [OnlineJournal] 2000 1(2). Im Internet http://www.qualitative-research.net/index.php/fqs/rt/printerFriendly/1087/2377 Stand: 2.9.2013
• 9 Shadden BB. Aphasia as identify theft: Theory and practice. Aphasiology 2005; 19: 211-223
• 10 White M, Epston D. Narrative Means to Therapeutic Ends. New York: Norton; 1990
• 11 Korte J, Westerhof GJ, Bohlmeijer ET. Mediating processes in an effective life-review intervention. Psychol Aging 2012; 27: 1172-1181
• 12 Davidson B, Howe T, Worrall L et al. Social participation for older people with aphasia: the impact of communication disability on friendships. Top Stroke Rehabil 2008; 15: 325-340
• 13 Holland AL. Living successfully with aphasia: three variations on the theme. Top Stroke Rehabil 2006; 13: 44-51
• 14 Bronken BA, Kirkevold M, Martinsen R et al. The Aphasic Storyteller: Coconstructing Stories to Promote Psychosocial Well-Being After Stroke. Qual Health Res 2012; 22: 1303-1316
• 15 Huber W, Poeck K, Weniger D et al. Aachener Aphasie Test (AAT). Göttingen: Hogrefe; 1983
• 16 Sheik JI, Yesavage JA. Geriatric Depression Scale: recent evidence and development of a shorter version. In: Brink TL. ed.). Clinical gerontology: a guide to assessment and intervention. New York: Haworth Press; 1986: 165-173
• 17 Schütze F. Die Technik des narrativen Interviews in Interaktionsfeldstudien – dargestellt an einem Projekt zur Erforschung von kommunalen Machtstrukturen (MS). Bielefeld: Universität Bielefeld, Fakultät für Soziologie, Arbeitsberichte und Forschungsmaterialien Nr. 1; 1977
• 18 Engell B, Hütter B-O, Willmes K et al. Quality of life in aphasia. Validation of a pictorial self-rating procedure. Aphasiology 2003; 17: 383-396
• 19 Diener E, Emmons RA, Larsen RJ et al. The Satisfaction with Life Scale. J Pers Assess 1985; 49: 71-75
• 20 Levin T, Scott BM, Borders B et al. Aphasia Talks: photography as a means of communication, self-expression, and empowerment in persons with aphasia. Top Stroke Rehabil 2007; 14: 72-84