Life with communication changes in XXXX .

@entity1 @entity191
BACKGROUND: Acoustic and perceptual changes to speech in @entity191 ( @entity191 ) have been widely studied. Little empirical evidence exists concerning the individual's own perception of changes, the impact these have on their life and coping strategies to deal with them. OBJECTIVE: To establish if, and how, changes in communication impact on the lives of @entity1 with @entity191 . DESIGN: In-depth interviews with qualitative analysis of content. SETTING: Community. SUBJECTS: Twenty-three @entity1 and 14 @entity1 with @entity191 . METHODS: @entity1 were purposively sampled to give a mix of @entity1 , @entity1 , family circumstances, stage and duration of @entity191 and severity of speech symptoms. Individuals were interviewed at home. Interviews were transcribed. Emergent themes were identified and fed back to @entity1 for confirmation and clarification. RESULTS: @entity1 identified changes to voice and articulation. Language changes featured prominently. Four impact themes: (i) interaction with others, (ii) problems with conversations, (iii) feelings about intelligibility and (iv) voice; and four corresponding coping themes (a) helping others understand, (b) managing conversations, (c) monitoring and adjusting and (d) physical strategies emerged. Of main concern was not the nature of speech-voice-language changes, but how these affected self-concept, participation inside and outside the family and family dynamics. Individuals employed a range of fluid coping strategies moving from background withdrawal to foreground striving strategies. CONCLUSIONS: Speech and language changes in @entity191 impact upon individual and family life long before frank impairment of intelligibility is apparent. The role of early referral to speech and language therapy is therefore worthy of detailed investigation.
