Enhancing the Hospital Environment for aphasia Care and Recovery (EnhanCeR)

Communication Enhanced Environment intervention incorporates ward level and individual level interventions (see below description). Ward level interventions are implemented across the hospital ward stroke rehabilitation unit). Individual level interventions will be offered to patients, and patients will collaborate with their ward speech pathologist to determine which individual level interventions will be implemented for the patient. The Communication Enhanced Environment intervention incorporates: Ward level interventions to commence prior to first participant recruitment and continue until final participant data collected: i. Staff and volunteers will receive 1-hour of face-to-face training provided by the researchers and hospital site investigators focussed on educating the hospital team on the Communication Enhanced Environment intervention, processes for the intervention, staff and volunteer roles in the intervention, as well as aphasia communication partner training. Training will start 2-months prior to participant recruitment and offered monthly until final data collection is complete to ensure new or rotating staff and volunteers have access to training; ii. Aphasia communication supporting strategy posters including strategies to support message exchange including comprehension, expression and word finding strategies; iii. Access to communal areas (pending COVID restrictions) including a social lounge and dining area for meals (approximately 1-hour per day), group activities (approximately 1-hour per week) and socialisation (approximately 1-hour per day). Patient level interventions will be tailored to each patient in collaboration with the hospital site speech pathologist based on the patient’s needs, preferences and goals. Patient level interventions will commence for each participant at recruitment until discharge from hospital (up to 12-weeks’ post stroke): iv. Volunteer supported social activities (offered 1-hour per week) including group sessions (music group, conversation group); v. Communication boards displaying patients’ tailored communication strategies; vi. Communication support packs (whiteboard markers, augmentative alternative communication boards) to implement communication strategies; vii. Interdisciplinary therapy sessions (with speech pathologists) to train and support hospital staff use of communication strategies (minimum of 1-hour per week); viii. Scheduled social interactions between patients and trained volunteers offered twice per week (approximately 30 minutes or longer if the patient requests); ix. Loaned electronic tablets with therapy apps (Tactus Advanced Language Therapy, Tactus Language Therapy), audiobooks (Audible) and music (Spotify); x. Apps and electronic games that promote speech and interactions (EVA Park virtual world). The hospital site investigator will lead the team of hospital site champions (involving a representative for each discipline) to ensure the Communication Enhanced Environment intervention is implemented and sustained throughout the trial. A trained speech pathologist who is not involved in patient care on the participating ward will complete fidelity monitoring of participant access to the intervention. Fidelity checks to commence 7 working days after participant recruitment (i.e., after the Communication Enhanced Environment intervention has been implemented) and completed 1 x week every 7 days (48 hours either side). Participant access to the intervention will be fed back to the hospital team. This will allow for the intervention to be implemented if it is not present or meeting the minimum benchmark at the time of the check. This will be recorded across the participant admission to track how much feedback was required to implement the intervention. Feedback will not be provided for the final 20% duration of the participant’s admission. This will be calculated based on the participant’s estimated date of discharge at the time of participant recruitment.