Favoriser l'évolution des pratiques orthophoniques en réadaptation vers la participation sociale des personnes ayant une aphasie

Because of communication limitations, people with aphasia are at risk of having restrictions in social participation after rehabilitation. It is unknown to what extent speech-language pathologists working with people with aphasia consider social participation in their practice. The general aim of this dissertation was to understand and support the evolution of speech language pathology practice in aphasia rehabilitation towards a more explicit consideration of social participation for people with aphasia, within the context of a community of practice. To answer the first research question about the extent to which speech-language pathologists from all settings of the aphasia rehabilitation care continuum consider social participation of people with aphasia, individual interviews conducted with 17 speech-language pathologist participants were analyzed according to the principles of grounded theory (study 1). Thirteen participants were engaged in a community of practice designed and implemented for the current research project, which was evaluated with logic analysis (study 2). To answer the second research question about how participants’ clinical practices were influenced by their engagement in a community of practice about social participation and aphasia rehabilitation, logbooks collected while the community of practice was ongoing were analyzed with thematic analysis (study 2). Individual interviews conducted after the end of the community of practice were analyzed on the basis of grounded theory (study 3). Study 1 revealed that speech-language pathology practice includes questions related to the ideal end purpose of aphasia rehabilitation and to the means used to reach that purpose. This resulted in a need for guidance on the part of the professionals. Clinical activities of speech-language pathologists in aphasia rehabilitation always included counseling, assessment, goal-setting, and conducting therapy with the person. Optionally, speech-language pathologists involved relatives or other parties in therapy. The use of specific therapeutic approaches was influenced by the perceived ideal end purpose of aphasia rehabilitation on the one hand, and by features of the workplace on the other hand. Study 2 pointed to the conclusion that in order to promote the development of speech-language pathology practice in aphasia rehabilitation, a web-based community of practice should include educational goals, have sufficient human and material resources and offer learning and reflection opportunities through online and offline activities that also involve social interaction. Logbooks revealed that the community of practice allowed participants to consider or implement practice changes. Study 3 indicated that after their engagement in the community of practice, participants included more therapeutic approaches aiming at helping the person resume life habits, but above all, achieved a better alignment of their practice with an ideal end purpose, which was now unanimously perceived to be the optimization of social participation. Opportunities to reflect and share material with peers facilitated the new alignment, and consequently, participants reported increased feelings of competence. Rehabilitation services aiming at helping the person resume life habits have the potential to accompany people with aphasia towards optimal social participation.

Keyphrases: Speech-language pathology, Rehabilitation, Professional practice, Aphasia, Stroke, Social participation, Community of practice, Knowledge transfer