JCPSLP November 2016

Development, these graduates have received continuing professional development in their workplaces from visiting lecturers and clinical mentors to develop their skills and knowledge base, research capacity and culturally appropriate resources in the Vietnamese language. Vignette 2. Reflecting on the effects of an art group for people with brain dysfunction Le Khanh Dien and Christine Sheard People with communication disorders (PWCD) due to stroke or other acquired or congenital brain dysfunction often experience social exclusion (Dorze, Salois-Bellerose, Alepins, Croteau, & Halle, 2014; Douglas, 2013). However, by participating in groups run by speech-language pathologists, PWCD can be assisted to engage with others and increase their confidence (Ewing, 2007; Hawley & Newman, 2010; Holland, 2007; van der Gaag et al., 2005). Furthermore, making art also has been shown to help many people with disability to express their ideas and emotions via their participation in this meaningful life activity (American Art Therapy Association, 2013; Kim, Kim, Lee, & Chun, 2008; Parrish, 2014). Combining the benefits of being in a group with other PWCD, but with a focus on producing art, inspired the first author during a visit to Sydney where he observed such a group established for people with aphasia. He was so impressed by the group’s apparent effects on participants’ attitudes and skills, he decided to establish one for a mixed group of his current speech therapy clients in Vietnam. With mentoring from the second author in Australia, he developed an Art Group program to extend beyond the existing impairment-focused speech therapy services at An Binh Hospital in HCMC. The program’s aim was to offer socially restricted PWCD with varying brain dysfunction an opportunity to participate in a real-life social activity to learn new artistic skills and have natural communication, rather than remediation of their speech-language limitations. It was hoped this might produce positive changes in some factors (e.g., having good communication partners and independence in some meaningful life activities) commonly associated with quality of life (Douglas, 2013). This paper is a reflection on some informal but carefully gathered clinical data collected to assess the outcomes of the Art Group as perceived by its participants. The Art Group was established in December 2013 for PWCD (including apraxia, aphasia, dysarthria, cognitive- communication difficulties and intellectual disability) who were also receiving concurrent speech therapy treatment. The invited participants were all known to have much restricted or virtually no meaningful social inclusion or communication beyond daily routine interactions with family or clinical appointments for their health needs. Art students from Sai Gon University were recruited to facilitate 2 hour, weekly art lessons and the program was overseen by the hospital speech therapists. Activities included simple colouring, painting and collage. Drawings or greeting cards were usually produced, with a focus on accepting and extending participants’ free expression. Communicating about their art and having occasional parties for special occasions were also integral to this program. Typically, six to 11 PWCD supported by up to six art students participated in the program. After 23 weeks the first author asked the seven regular long-term

participants and six family members the same set of 16 author-generated informal questions that focused on obtaining each participant’s general perceptions of the impact of the group , as well as their perceptions of any social opportunities, self-confidence, communication and/or drawing skills that they felt were related to their art group participation. Because the PWCD had limited expressive communication skills, most questions were closed questions, asked orally via a multiple-choice format with a large-font, written selection of simple, categorical or descriptive ratings to simplify the communication task. This informal, but systematic questioning also enabled the authors to readily target and compare the respondents’ perceptions. In order to reflect on the effects of the Art Group as a therapy process, some of the most frequent and total group responses are reported here in a general manner as our aim was to assess the effect of the group from the PWCDs’ perspectives. They should be interpreted as systematically acquired clinical information rather than research data. From the questioning, all PWCDs reported positive feelings about attending the Art Group, and were mostly keen to attend each week. Those with acquired communication disorders liked that the Art Group gave them a chance to meet and talk with other people. This affirmed the clinicians’ aim for establishing the group as a means for real-life socialisation. The aspects of the group the participants spontaneously reported they enjoyed most related both to communicating and/or building their art skills. They typically liked to meet with people with shared interests and said that it was good to communicate in a cheerful environment. The clinicians agreed with the PWCDs’ perceptions that Art Group made the PWCDs feel happy. Similarly all appeared and reported to be more confident when communicating. Family members also observed that the PWCDs generally initiated and engaged more in communication at home and with others, and appeared less self-conscious and more joyful as the group progressed. Several families also noted having more calm communication interactions over time. There was a general perception that learning new skills to design and create art was most enjoyable. Participating in independent activities and having communication with others who listen have been associated with finding new identity, self-esteem and living successfully after brain injury (Brown, Worrall, Davidson, & Howe, 2012; Douglas, 2013). Clinicians and relatives typically observed that the PWCDs had more self-confidence in general as the group progressed and this was confirmed by the participants’ responses. Our conclusion from the clinical appraisal of participants’ perceptions, which were affirmed by clinicians’ and families’ observations, is that participation in the Art Group provided an opportunity for most of these PWCDs to interact socially with others in natural and comfortable ways that appeared to improve their self-esteem, general cheerfulness and confidence. Learning new and creative skills and mixing in a comfortable environment with peers appeared to give participants an improved sense of personal well-being. Our clinical observations and reports of the participants’ perceptions could reflect clinician bias or a desire of the participants to please the first author. However, the concurrence between the observations of clinicians, relatives and participants suggests that the PWCDs’ perceptions of increased socialisation opportunities,

Christine Sheard (top), Le Thi Thanh Xuan (centre) and Trà Thanh Tâm

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JCPSLP Volume 18, Number 3 2016

Journal of Clinical Practice in Speech-Language Pathology