The evaluation of a learner‐centred training programme for spouses of adults with chronic aphasia using qualitative case study methodology

Background: Family education, training, and counselling programmes have been cited as one way to complement traditional interventions for the individual with aphasia. However, the literature still represents the speech‐language pathologist as the expert in a directive role. Aims: This article describes the second phase of a research study aimed at addressing the psychosocial sequelae of aphasia by developing and studying the effects of a learner‐centred training programme for spouses of adults with chronic aphasia designed to improve conversational interaction between couples. The first phase of this research included the development of a communication‐training programme that integrated principles and strategies from speech‐language pathology and adult education (Sorin‐Peters, 2002). The second phase described in this paper included the delivery and evaluation of the programme using a qualitative case study methodology. The use of the qualitative case study methodology to study the psychosocial consequences of aphasia is described in a companion paper (Sorin‐Peters, 2004). This paper presents the results of one qualitative case study in detail to demonstrate how the qualitative case study methodology was implemented, and a summary of the cross‐case analysis for the five couples, examining the effectiveness of the programme. Methods & Procedures: Using videotaped data, the Couple Questionnaire, and a semi‐structured interview, this study examined changes in attitudes and communication behaviours in five couples immediately after conversation partner training and at 2 months follow‐up. All data were transcribed and analysed for patterns of change. Outcomes & Results: Communication outcomes included changes in conversational interaction as well as in the transaction of information in conversation for all five couples. These included positive changes in the management of conversational repair. There was more balanced control after training and the cognitive competence of the partners with aphasia was revealed following the training. In addition, different conversational genres emerged throughout the programme that could be organised hierarchically. Results indicated ways in which the adult learning principles were actualised across the five cases. Themes emerged related to the expression of emotion about aphasia, including feelings of anger, sadness, and grief, and increased acceptance of the aphasia after the training. Themes related to marital issues emerged and were intertwined with emotions and communication. Conclusions: The adult learning model approach promoted positive and comprehensive changes, and perhaps more than those achieved via existing medical‐model or psychosocial approaches. The adult learning approach to individuals with chronic aphasia extends the existing psychosocial model by acknowledging both the spouse's and person with aphasia's competence as adult learners, by viewing the person with aphasia not only as part of a social unit, including the family, but also as part of a broader system, including multiple environmental and cultural factors that interact interdependently to effect change, and by focusing on the importance of communication for the expression of emotions and the maintenance and development of marital relations. The results suggest the benefits of the expansion of the speech‐language pathologist's role with couples with aphasia to include an adult learning approach to improving conversational interaction between people with aphasia and their spouses.     

Effects of training volunteers to converse with nursing home residents with aphasia

Background: Nursing home residents with aphasia often experience social isolation. Providing trained conversation partners is one way to combat this problem, but evidence is needed for the effects of training conversation partners for persons with aphasia. The use of four college student volunteers was based on evidence for the benefits of intergenerational service‐learning programmes. Aims: The purpose of this study was to examine the effects of training four college student volunteers (SVs) to use multi‐modality communication with two nursing home residents with Broca's aphasia (RAs). Methods & Procedures: An ABA multiple baseline across subjects (SVs) and partners (RAs) design was used to examine the effects of the training programme in probe conversations. Each RA interacted with two SVs. Training consisted of five steps, with a criterion to move through each step of the programme, and to withdraw training. Thorough treatment fidelity procedures were used to ensure consistent training across subjects. Outcomes & Results: The SVs demonstrated marked increases in multi‐modality communication, with concomitant increases in RAs' comprehensibility. Sequential analyses revealed that multi‐modality communication is more likely than speech only to elicit RAs' comprehensible responses, with a stronger effect after training. Social validity ratings demonstrated that the changes in the quality of the conversations were clinically significant. Conclusions: This study revealed positive effects of training conversation partners of persons with aphasia to use multi‐modality communication. Intergenerational service‐learning programmes are one viable method to decrease social isolation and to increase opportunities for nursing home residents with aphasia to reveal their communicative competence.     

Reciprocal scaffolding treatment: A person with aphasia as clinical teacher

Background: Reciprocal Scaffolding Treatment (RST) is one of several potentially beneficial life participation approaches for aphasia. In RST, treatment occurs during genuine, relevant, and context dependent interactions that represent goals at the activity and participation levels of the World Health Organization International Classification of Functioning, Disability and Health (ICF; World Health Organization, 2001) and is based on an apprenticeship model of learning where novices are taught skills by a more skilled partner. RST was used to construct a communicatively challenging environment in which an expert with aphasia (AE) taught novices (graduate student clinicians) how to communicate with persons with aphasia in the context of conversation group treatment sessions. This is in contrast to many treatment techniques when the person with aphasia is the novice who is trying to relearn communication skills during treatment sessions with a speech‐language pathologist as the expert.

Aims: The goal of the study was to investigate the effect of RST on improvement in word retrieval and conversational components in an individual with anomic aphasia.

Methods & Procedures: This was a case study using pretreatment – post treatment assessment. The independent variable was application of RST and the contextual variables were the presence of novices (graduate student clinicians) and unfamiliar conversation partners (undergraduate speech‐language pathology students). The dependent variables were scores on a word fluency task (FAS) and conversational measures (CIUs and TTR). Over the course of a seven week training period, AE taught communication strategies to four novice graduate student clinicians, who used the strategies in conversation groups composed of 3 to 4 persons with aphasia.

Outcomes & Results: The individual with aphasia made positive changes in word fluency, Correct Information Units and Type‐Token Ratio.

Conclusions: These findings, while preliminary in nature, show how the authentic use of language in structured reciprocal interactions such as teaching may improve language. A reciprocal teaching environment carries with it the expectation that at least one participant have an intent to participate as an expert in order to convey information to novices. We speculate that the combination of reciprocal interaction and the intent to convey information, in this case in a unique manner, support improved language skills.     

Conversational partner training programmes in aphasia: A review of key themes and participants' roles

Background: Conversational training programmes are increasingly being reported for partners of people with aphasia. While these all aim to increase communicative effectiveness between people with aphasia and their communication partners, and all report measurable success, the programmes vary in terms of selection criteria for participants, the methods used, and the way in which they have been evaluated. This paper critically reviews a group of studies that have carried out conversation partner training (CPT) programmes for both familiar partners of people with aphasia (spouse or relative of a person with aphasia) and volunteers.

Aims: The purpose of the review is (1) to identify the type of people CPT might benefit, i.e., whether particular characteristics of the participants have been considered influential to the outcome of interventions and (2) to consider the outcomes of such training programmes more generally, i.e., whether they have been effective, whether the effectiveness of the programmes is dependent on the format of the training and, to some extent, the measures that have been used to evaluate their effectiveness.

Main Contribution: The review highlighted the positive outcomes reported by the studies, irrespective of whether the usual conversation partner or a volunteer was involved, in relation to the evaluation measures used. A paucity of information was found for the conversation partner participants compared to the person with aphasia, along with a limited analysis of the impact of the partner on the effectiveness of the intervention. Criteria underpinning selection for training programmes was related primarily to availability rather than behavioural or conversational characteristics. Longer‐term follow‐up of interventions was also limited.

Conclusion: That CPT interventions can be effective is not disputed here. However, the measurement of such effectiveness needs scrutiny and for whom these interventions work remains largely unknown. This review highlights the need for more information on both participants, with particular regard to the partner of the person with aphasia, to be both established and documented when reporting the impact of this type of intervention. This will permit an examination of the extent to which particular variables or partner profiles are influential and potentially predictive when determining suitable candidates for CPT. Equally, systematic follow‐up of all those participating in training will enable a clearer picture to emerge of the effectiveness of such interventions.     

Implementation of supported conversation for communication between nursing staff and in-hospital patients with aphasia

Background: Patients admitted with aphasia due to stroke may find it difficult to access information and participate in decision-making concerning their own treatment, care, and rehabilitation. An increased understanding of the importance of communicative access has prompted speech-language therapists to direct intervention at contextual factors, including communication partner training.

Aims: An implementation project is described in which supported conversation for adults with aphasia (SCA?) was adapted for use at a large hospital stroke unit. The project aims were (1) to develop a procedural guideline for interdisciplinary staff to communicate with in-patients with aphasia, (2) to develop an interdisciplinary training course and educate all staff members, and (3) to make available a set of shared communication tools. The present study reports the outcome of the training programme for nursing staff.

Methods & Procedures: A stepwise adaptation and implementation procedure is described which led to the development of the guideline, tools, and training programme. A mixed-methods design was used to measure changes pre- and post-training for nursing staff, including assessment of quantitative and qualitative outcomes. All nurses and nursing assistants received a questionnaire before and after their participation in an SCA workshop, and seven members from the nursing staff also participated in individual semi-structured interviews about their experiences with the SCA method.

Outcomes & Results: Questionnaires from 31 nursing staff members showed that they rated their understanding of aphasia higher after the workshop and they perceived communication to be less frustrating for the patient. Changes were also noted in the types of strategies they used. In the interviews, the nurses described feeling more confident about their ability to communicate with patients, more certain about establishing understanding with patients, and more willing to initiate conversations about complex topics. Difficulties with using tools and techniques were attributed to shortage of time, picture tools being too complex, and patient symptoms.

Conclusions: Implementation was considered successful based on the nursing staff’s evaluations. Contributing factors may have been staff’s involvement in adaptation, leadership support, and a working culture on the stroke unit characterised by readiness to adapt to guidelines. To ensure that the majority of staff members will actually apply tools and techniques, continued monitoring of the implementation process will be necessary as well as education of new staff and re-evaluation of procedures.     

Educating and training caregivers of persons with aphasia

Background: Because communication deficits caused by aphasia affect both persons with aphasia and their communication partners, most speech-language pathologists are aware of the importance of client and caregiver education. To maximise the effectiveness of their communicative interactions, training should be conducted for both the aphasic clients and their caregivers. Training conducted in group environments offers peer support through shared learning experiences and joint problem solving.Aims: The purpose of this study was to explore the benefits of a caregiver education and training programme in improving communication between caregivers and their aphasic partners using didactic and experiential approaches in a group setting.Methods & Procedures: Ten caregivers and their aphasic partners, ranging from 4 to130 months post-stroke, participated in a 12-week group training and education programme. Information about stroke and aphasia was provided in a didactic format, and facilitative communication strategies were discussed and practised using Kolb's (1984) experiential learning cycle model. The experiential learning cycle involved drawing on concrete experiences, engaging in reflective observation and abstract conceptualisation, and practising what was learned through active experimentation.Outcomes & Results: Analysis of communicative performance on transactional and interactional tasks demonstrated increased communicative success. Responses on a questionnaire indicated that participants had a better understanding of aphasia and were more confident using facilitating strategies.Conclusions: Group education and training for caregivers and their aphasic partners can be beneficial, even after the couple has been living with aphasia for a number of years. Having an opportunity to practise, observe, and reflect on their performances facilitated participants' learning, and there were observed and reported positive alterations in interactions.     

Partners' self-perceptions of the use of different communication strategies during total communication intervention

Background: Collaboration between people with aphasia and their communication partners is needed to achieve success in communication. Some of the partners change their own behaviour spontaneously and start to use different strategies to ensure that conversations are successful, but many require training to do so.

Aims: The aim of the present study was to examine to what extent communication partners perceive they use different strategies to support the conversation and if they perceive changes in the use of these strategies during an intervention concentrating on total communication.

Methods & Procedures: The data were collected during regular rehabilitation courses, which were carried out in two parts (8?+?4 days) with a 3-month interval. People with aphasia participated in the whole course and the partners joined in for the last 2 days of the first part and the whole of the second part (2?+?4 days). The aim of the intervention was to encourage people with aphasia to use total communication and to guide the communication partners to facilitate the use of total communication and to support the conversation. A total of 43 communication partners participated in the present study: 33 participated in a course with their aphasic partners, but 10 did not and formed the control group. Before the first and second parts of the course and 6 months after the course the partners completed a questionnaire comprising 20 questions concerning different communication strategies.

Outcomes & Results: Before the intervention both the participating partners and the control group perceived that they quite often used different strategies to support the conversation. The means of the 20 questions were 62.9/100 and 58.9/100 respectively. Both groups perceived an increase in the use of different strategies after the first part of the course but the change was statistically significant only in the participating group, F(1, 32)?=?8.025, p?=?.016. The participating group perceived a significant increase in the use of strategies supporting verbal comprehension and production after the first part of the course, F(1, 32)?=?6.925, p?=?.026, but perceived a decrease in the use of them when measured 6 months after the course.

Conclusions: Communication partners perceive that they often use different strategies to support communication. The self-assessment method can make the partners more aware of these strategies. An intervention can increase the partners' awareness of the comprehension problems of their aphasic partners.     

Group therapy as a social context for aphasia recovery: a pilot,observational study in an acute rehabilitation hospital

Background: Individuals with aphasia often receive therapy from a speech-language pathologist during acute rehabilitation. The literature demonstrates that group-based therapy provides a natural, social environment for language rehabilitation in mild-moderate and/or chronic aphasia; however, the communication of persons with acute, severe non-fluent aphasia during group treatment has not been fully explored.

Objective: This observational study investigated patient communication during acute rehabilitation. The primary objective was to determine whether participants initiate more communication during group therapy sessions when compared to individual therapy sessions.

Method: Ten participants with severe non-fluent aphasia were observed during one individual and one group session during their stay in an acute, inpatient rehabilitation facility. Communicative initiations were tallied and categorized based on type, target, and purpose.

Results: Participants initiated communication more often during group sessions than during individual sessions. During groups, participants used more vocalizations and facial expressions to communicate, and the purpose was more often for social closeness than in individual sessions. Participants produced fewer different, real words in group vs. individual sessions, but other measures of communication skill did not differ significantly between the two settings.

Conclusion: In the aphasia group treatment described in this study, participants initiated more communication, with greater diversity of expressive modalities and more varied communicative purposes. Participants in group therapy also showed an increased tendency to communicate for the purpose of social closeness. These findings suggest that there are important differences in the communication of patients participating in group vs. individual speech therapy for treatment of acute, severe non-fluent aphasia.     

Student speech pathologists’ experiences of an aphasia therapy group

Background: There is evidence that group therapy for people with aphasia is effective, but the skills needed to interact with people with aphasia are complex. There is also evidence that training and guided experience can improve the skills of family members and health professionals in communicating with people with aphasia. However, there is limited research into how student speech pathologists learn to develop the communication strategies that they will teach others to use when interacting with people with aphasia.

Aim: This qualitative study aimed to explore perceptions of the student learning experience in aphasia group therapy of four student speech pathologists, their clinical educator and group members with aphasia.

Methods & Procedures: Four student speech pathologists, three clients with aphasia and two spouses participated in four consecutive aphasia group therapy sessions under the supervision of a speech pathology clinical educator. Semi-structured interviews with each student and the clinical educator, following the first, third and final group session, were audio recorded. Following the final session, each participant with aphasia was also interviewed. The interviews were transcribed and qualitative content analysis was used to describe the perspectives of the participants.

Outcomes & Results: Analysis of the interviews revealed that student perceptions of their experience were linked to their understanding of group therapy for aphasia, their understanding of the role of communication strategies and their ideas concerning saving face and discourse equality. Findings indicated a close alignment of the perspectives of students, clinical educator and participants with aphasia in their understanding of the contribution of aphasia group therapy to student learning and client benefits.

Conclusions: The findings of the present study provide preliminary information for the development of educational practices relevant to speech pathology students preparing for work with people with aphasia.     

Evaluation of communication,life participation and psychological well‐being in chronic aphasia: The influence of group intervention

Background: The impact of change in communication, life participation, and psychological well‐being in aphasia is recognised but still not fully explored. Further, considerable scope exists to address these factors within the context of intervention. Innovative practices and group intervention are advocated for people with chronic aphasia but detail and evidence remains limited.

Aims: To explore the experience of aphasia within the context of communication, life participation and psychological well‐being and evaluate the outcomes of these phenomena in people with chronic aphasia following participation in a group intervention involving a social model approach.

Methods & Procedures: A group of seven people with chronic moderate aphasia were assessed on communication measures, by means of the Conversational Analysis Profile for People with Aphasia (CAPPA), and aspects of psychological well‐being, by means of The Hospital Anxiety and Depression Scale (HADS) and The Visual Analogue Self‐esteem Scale (VASES) pre, post, and at 3‐month follow‐up of a group intervention. The group involved a social model approach and the use of Total Communication to support conversation. Speech and language therapy and social care personnel, including an equality disability trainer, contributed to the group.

Outcomes & Results: Although variation in individual participants was demonstrated, results showed evidence of statistically significant beneficial change in conversation experiences (many of these related to life participation) and, to a lesser degree, beneficial change in conversation abilities. Additionally there were beneficial changes for some participants on psychological well‐being measures. Due to the small sample, participant variation, and (in the case of psychological well‐being measures) the lack of evidence of serious reduction in psychological well‐being at the outset, the results have to be evaluated with caution.

Conclusions: Appropriately planned group intervention can produce benefits in conversation, life participation, and psychological well‐being in chronic aphasia.     

Communication style before and after aphasia: A study among Finnish population

Background: Communication difficulties in aphasia have a big effect on communicative activity and social participation. Contacts with other people than family become more infrequent because of problems in communicating. Rehabilitation should make a real difference in being able to communicate and in the life of people with aphasia.

Aims: The aim of this study was to explore the impact of aphasia on the communication style of people with aphasia in the Finnish population. The term “communication style” is used to describe how active the person is in communication situations and in participating in social interaction. In addition, a clinical evaluation of the communication style was made 6 months after an intervention concentrating on training total communication and guiding the partner to facilitate the use of different communication methods and support the interaction.

Methods & Procedures: The data were collected during natural rehabilitation courses for people with aphasia and their communication partners. The participants were 38 communication partners of people with aphasia. The courses were carried out in two parts (8 + 4 days) with a 3-month interval. A questionnaire concerning the communication style of people with aphasia was constructed using parts of Green’s questionnaire (1984) and its unpublished Finnish modification. The communication partners estimated the communication style of people with aphasia. At first, they estimated how the communication style was before the onset of aphasia and how it was 2 weeks before the intervention. Six months after the intervention, they estimated the communication style again.

Outcomes & Results: Aphasia has a drastic impact on the communicative activity and social participation of people with aphasia in Finland. Activity in conversations decreases and contacts with people other than family members and relatives become much more infrequent. The social interaction occurs mostly at home. The conversation topics focus on health, home matters and TV programmes when other topics such as work, hobbies, leisure time and plans for the future are discussed much less often.

Conclusion: Aphasia has a drastic impact on communication style, activity in communication and participation in social interaction, also according to this study conducted in Finland. There seems to be a decrease in communication between the people with aphasia and people other than their significant others and outside the home. To be able to have an impact on social participation, interventions also including people other than family members are needed.     

Development of a procedure to evaluate the contributions of persons with aphasia and their spouses in an interview situation

Background: Although there has been increasing interest in the study of conversations between people with aphasia and their partners, the participation of persons with aphasia in conversation with their spouses in the presence of a third party has not been extensively investigated. Nevertheless, opportunities for such situations are frequent, and therefore provide an interesting opportunity to examine how couples collaborate.

Aims: (1) To develop a procedure to analyse conversations that would specifically address the contributions of persons with aphasia and their spouses in an interview situation. (2) To describe spousal contributions in an interview situation, including what preceded and followed these contributions, in a group of couples with a member with aphasia. (3) To verify the inter‐judge reliability of the procedure.

Methods & Procedures: Videos of three couples with aphasia in an interview situation were analysed. Contributions of the spouse when the participant with aphasia was clearly speaking with the interviewer, contexts in which spouses contributed, reactions of persons with aphasia, and their participation following contributions were described. Definitions were created, operationalised, tested, and refined on 11 other similar couples in the same interactive situation. Eight other couples were then videotaped and studied.

Outcomes & Results: Results revealed that half the contributions produced by the spouse were “repairs” and the other half were “speaking for” behaviours. Most often, contributions were unsolicited. Generally, the person with aphasia approved the spouse's contribution and continued afterwards to take an active part in the conversation. Inter‐judge reliability coefficients varied between 89% and 97%.

Conclusions: The procedure employed is representative of situations encountered by couples affected by aphasia. The data collection and analysis methods could be applicable to clinical situations. It is important to consider spousal contributions and their impact on the person with aphasia in conversations when helping couples adjust to the consequences of aphasia.     

Addressing the long-term impacts of aphasia: how far does the Conversation Partner Programme go?

Background: Approximately 176,000 new individuals in the United Kingdom and Ireland are diagnosed with stroke annually with up to one third experiencing aphasia. Qualitative research methods are increasingly used to capture the complexity of service users’ experiences of health and illness; however, the voice of service users with aphasia continues to be limited in published healthcare literature. This participatory research study included people with aphasia as co-researchers in the exploration of aphasia and a Conversation Partner Programme (CPP).

Aims: To describe participants’ insider (emic) experiences of (1) aphasia and (2) a CPP.

Methods & Procedures: Following a pilot study, the generation and analysis of qualitative data involved a Participatory Learning and Action (PLA) approach based on the interpretive paradigm. Using purposeful sampling, participants included people with aphasia (n = 5) who had experience of the CPP. Through (n = 5) 3-hr data generation sessions across 12 months using PLA techniques—Flexible Brainstorming and Card Sort—participants’ unique perspectives of aphasia and the CPP were recorded. The principles of thematic analysis guided the co-analysis of data with participants. To explore transferability of findings, data generated in Ireland were presented to an international interstakeholder group in Connect UK.

Outcomes & Results: Participants identified eight themes describing the lived experience of aphasia including (1) Back to Pre-School, (2) Tiredness, (3) It’s Like in Prison, (4) Emotions, (5) Not Able to Talk the Words, (6) Escape, (7) Changing and Adapting, and (8) Family. Five additional themes were co-generated capturing the value of the CPP. It appeared that because the CPP training and programme acknowledged the expertise of individuals with aphasia and provided opportunities for conversations with unfamiliar people, the negative feelings of communicative incompetence described in “Back to Pre-School” and “Not Able to Talk the Words” were minimised. Feelings of marginalisation captured in “Escape,” “It’s Like in Prison,” and “Emotions” were reported to be reduced through the social aspects of the programme.

Conclusions: Aphasia changes communication situations and interpersonal relationships often resulting in psychosocial impacts and disempowerment. The CPP contributed to promoting successful communication and reducing social exclusion. Participants reported transformative experiences related to identity, independence, and confidence. These outcomes are encouraging as marginalisation and vulnerability to “secondary handicap” are recognised long-term risks of aphasia. Findings will be of interest to those living and working with people with aphasia and to those designing, delivering, and participating in CPPs.     

Effects on communication from intensive treatment with semantic feature analysis in aphasia

Background: Anomia, a persistent and frequent symptom of aphasia after stroke, obstructs the transfer of information in conversation, which can have serious consequences for participation in everyday social interaction with significant others and in society.

Aims: This study aimed to replicate the findings of Coelho and his colleagues, as well as Boyle, and Wambaugh and Ferguson regarding the use of semantic feature analysis (SFA) for individuals with aphasia after stroke. Its main purpose was to explore whether intervention could (1) increase the ability to participate in conversation and (2) lead to positive changes in functional communication as perceived by the participants themselves and their significant others.

Methods & Procedures: In this multiple-baseline across-subjects-design study, three participants with chronic aphasia were treated with intensive training using SFA. Treatment outcome was assessed with repeated measures of confrontation naming of actions and objects and with quantitative ratings of the quality of speech as well as communicative participation in conversation. The ratings were made by independent assessors blinded as to what phase of the study the data were obtained from. In addition, a questionnaire measuring perceived functional communication as reported by the participants and their significant others was administered before and after the training as well as at a follow-up session 10–12 weeks after the training was completed.

Outcome & Results: Only minor treatment outcomes were apparent in this study. Visual inspection of the results showed a slight increase in the ability to participate in conversation for two of the three participants as well as a fall in the number of complex paraphasias for one of them and an increase in self-corrections for two. There was no improvement in the participants’ confrontation-naming ability. Two of the three participants rated their own functional communication skills higher at follow-up than before training while the third participant reported no change. As regards the ratings by significant others at follow-up versus before training, there was one slight decrease, one slight increase, and one considerable increase.

Conclusions: Treatment with SFA might improve communicative skills and increase participation in everyday conversation despite not having a measurable effect on confrontation-naming ability in a formal assessment situation. Further research is needed to identify the individuals with aphasia who can benefit from treatment with SFA and to determine the nature of its impact on communicative participation.     

Communication therapy for people with aphasia and their partners (APPUTE)

Background: Severe aphasia is a chronic condition and can have a big effect on how people with severe aphasia (PWSA) succeed in their communication. The communication partner’s support for the person with aphasia has been shown to be essential in achieving successful communication. However, interventions combining training both the partner and the PWSA to use hierarchical strategies in nonverbal communication are still needed.

Aims: The aim of the present paper is to describe a new intervention (APPUTE) where both the person with aphasia and the partner receive therapy equally and practise finding functional communication strategies to convey everyday messages or more complicated ones. The data collection during the APPUTE intervention is also presented.

Methods & Procedures: The data were collected during a development project including an evaluation period, two rehabilitation periods and follow-up measurement. Thirty-four PWSA and their partners participated. The linguistic functions and communication efficiency of PWSA were evaluated three times during the rehabilitation. The communication skills of the partner were also assessed, along with the success of the mutual communication.

Outcomes & Results: The communication skills and communication efficiency of the PWSA and their partners improved significantly during the rehabilitation period, and the acquired skills were retained for 6 months after the intervention. The linguistic skills of the PWSA also improved. The advanced age of the partner explained both the variance of the partner’s communication skills and the success in the mutual communication. The amount of earlier outpatient speech therapy explained the variance of the communication efficiency of PWSA as evaluated by the partners. Regarding success in mutual communication, all of the couples were able to communicate at least simple issues at the end of the rehabilitation period. The more demanding the tasks, the more difficult it became for them to succeed, especially for older PWSA with severe motor paralysis. Both the people with aphasia and their partners mainly experienced benefits from the APPUTE intervention and for the most part, the benefits were retained during follow-up.

Conclusions: The APPUTE method appears to improve the communication skills of PWSA and their partners, as well as the linguistic skills of PWSA.     

Profession-specific training on decision-making and capacity assessment in aphasia for speech-language therapy students

ABSTRACT

Background: Speech and Language Therapists (SLTs) play a vital role in supporting people with aphasia to communicate. Recent studies have shown that despite SLTs’ expertise, skills, and knowledge to support people with aphasias’ communication needs; they are not regularly involved in the decision-making and capacity (DMC) assessments for people with aphasia. Literature suggests three key contributors to this under-involvement: (1) SLTs do not feel they understand their role in a DMC assessment, (2) they do not feel there is enough profession-specific training, and (3) they feel members of the multidisciplinary team do not fully understand their role and responsibilities to involve them in the process.

Aims: This research reports the development of a profession-specific DMC training programme for SLT trainees, and its implementation to document change in their confidence, knowledge and understanding of the DMC process in people with aphasia.

Methods & Procedures: Thirty-nine SLT students attended a two-hour DMC training session conducted in three phases: pre-training questionnaire, the training programme, and the post-training questionnaire. Topics in the training programme included: the knowledge and tenets of the Mental Capacity Act (MCA); DMC for people with aphasia, focusing specifically on the barriers faced by people with aphasia and professionals; the SLTs’ role within a multidisciplinary team regarding DMC assessments; and resources available for facilitating DMC assessments. The change in participants score from pre- to post-training questionnaire was taken as a measure of efficacy of the training programme.

Outcomes & Results: Following training there was a significant increase in the confidence levels of SLT students in terms of ability to complete capacity assessments and train others in their role within a capacity assessment. Participants also had a better understanding of the MCA and an increased knowledge of resources available to support people with aphasia in these assessments. These results demonstrate a crucial need for profession-specific training, which has implications for inter-professional education.

Conclusions: The findings highlight the effectiveness of a short training session in increasing SLT trainees’ knowledge and confidence in DMC for aphasia, and improving their understanding of SLTs’ role and responsibilities. It is anticipated that this type of training will place SLTs in a better position for future clinical practice, reducing the risks currently present not only to patients, but also to staff themselves. We propose that similar training programmes should become mandatory for SLT trainees as part of their clinical training.     

Intensive multimodal communication treatment for people with chronic aphasia

Background: Clinicians often teach persons with aphasia (PWA) non-verbal strategies to compensate for reduced verbal communication. The manner in which they teach the strategies may have an impact on how well PWA generalise and use the strategies. Previously, multimodal communication treatment (MCT) taught multiple modalities simultaneously. While participants demonstrated some increase in the flexible use of strategies, many communication breakdowns continued to occur. Recent research suggests that intensive treatment protocols result in the greatest increase in skills.

Aims: The purpose of this study was to determine whether intensive (2–3 hours/day, 5 days/week, for 2 weeks) multimodality communication training for aphasia resulted in increased successful use of verbal and non-verbal communication modalities as well as increased successful communicative repairs during structured communication tasks.

Methods & Procedures: Three participants with chronic aphasia completed four baseline sessions, 10 treatment sessions across two phases (i.e., five sessions per phase), and three post-treatment sessions.

Outcomes & Results: Two of the three participants demonstrated gains in the acquisition of non-verbal strategies during training and increased use of strategies on a referential communication task.

Conclusions: Although MCT delivered intensely resulted in increased use of non-verbal modalities for two out of three participants, the results were similar to that achieved through the use of a non-intensive treatment protocol. Therefore, future research is needed to examine other potential modifications to maximise the gains people with aphasia receive from multimodal interventions.     

Do picture‐naming tests provide a valid assessment of lexical retrieval in conversation in aphasia?

Background: Word‐finding problems commonly occur in aphasia and can significantly affect communication. Assessment of this deficit typically involves naming pictures. However, this method has been criticised as lacking ecological validity. Alternative methods include the measurement of lexical retrieval in narration or conversation, although few published studies have quantified word finding in the latter.

Aims: We aimed to identify a reliable and valid assessment of lexical retrieval in conversation, and to elucidate the nature of the relationship between lexical retrieval in picture naming and in conversation.

Methods and Procedures: We developed a quantitative measure of word finding in conversation in aphasia and established the reliability and stability of the method. We compared the scores of a group of people with aphasia on this measure with their scores on a picture‐naming test.

Outcomes and Results: We found significant relationships between picture‐naming scores and a number of key variables analysed in the conversation measure. We propose that scores on picture naming relate to the ability to retrieve nouns in everyday conversation for the people with aphasia who took part in this study.

Conclusions: The use of picture‐naming tasks is justified, providing a valid and rich means of assessment of lexical retrieval. Further research is required to replicate these results with more people with aphasia. We offer the quantitative assessment of conversation developed here for use in research and clinical spheres.     

Treatment of word retrieval impairments in aphasia: Evaluation of a self-administered home programme using personally chosen words

Background: While previous research has shown that a number of tasks can be successful in improving word retrieval following aphasia, the majority of studies result in improvement restricted to treated items. This has two major implications: first it is essential that personally relevant items of communicative value are treated. Second, treatment is likely to be required long term. Therapy provided as a self-administered home programme has the potential to improve the long-term accessibility of therapy and to be more cost effective. This research was part of a larger investigation into treatment for lexical retrieval difficulties in adults with aphasia. Our earlier research found that treatment using repetition in the presence of a picture conducted by a clinician was effective in improving the later retrieval of treated words. In this study we modified the treatment programme such that it could be carried out independently by the participants as a home programme using personally chosen words.

Aims: The aims of our study were first, to determine if a home treatment programme for word retrieval with personally chosen words could result in significant improvements in lexical retrieval, and second, to observe if there would be carry over to improved word retrieval in conversation.

Methods & Procedures: Three people with aphasia participated, and selected 60 personally relevant words for treatment. These stimuli were treated in two sets, each for eight sessions over 2 weeks. Outcomes of treatment were evaluated by comparing naming of these items on three pre-treatment baselines, with naming following the completion of the programme. Semi-structured conversations based around topics relating to the target words were sampled prior to treatment and following treatment to observe generalisation to conversation.

Outcomes & Results: Two participants showed evidence of increased accuracy for naming of treated items following the home programme with no change in naming of unseen controls. The conversation outcomes were less clear, with only one participant showing any evidence of greater production of treated items in conversation.

Conclusions: This study found that the home treatment programme using personally chosen words improved word retrieval for some participants. However, the outcomes were less robust than those of a clinician-directed therapy study previously conducted by the researchers. There were limitations in the sensitivity of the measures of transfer to conversation and further investigation is required into the extent to which benefits in single word retrieval carry over into word retrieval in conversation.     

The efficacy of an inter-disciplinary community aphasia group for living well with aphasia

Background: Community aphasia groups (CAGs) are argued to have various benefits for people with chronic aphasia. However, there is a paucity of evidence regarding the feasibility of conducting an interdisciplinary programme with content and outcome measures encompassing ICF domains, making it difficult to ascertain the full potential of this service option. As another key population living with aphasia, family members have received little attention in CAG research to date.

Aim: To determine potential efficacy of a speech-language pathologist- and social worker-led CAG model for four people with aphasia (PWA) and their spouses on living well with aphasia within a proof-of-concept trial.

Methods & Procedures: Informed by extensive study of the existing CAG literature, we developed a comprehensive 12-week interdisciplinary CAG model and trial protocol (the InterD-CAG). We used a Phase I pre-post design with a follow-up phase. The group was co-facilitated by a speech-language pathologist and social worker with support from aide staff. The group met at a university clinic for 2 h per week over 12 consecutive weeks. The protocol comprised a combination of communication therapy; conversation practice; social, peer, and psychological support; stroke and aphasia information; and participation in meaningful and accessible activities. Group session time was split into two formats: (1) concurrent sessions dedicated to members with aphasia alone/spouses alone and (2) mixed sessions with both members with aphasia and spouses together. The Therapeutic Factors Inventory was administered at regular intervals during the programme to ascertain participants’ perceptions of group process. Pre, post, and follow-up outcome measures spanned all WHO ICF domains for PWA, with measures for spouses addressing supported conversation skills, psychological health, and carer burden.

Outcomes & Results: Both PWA and spouses perceived the presence of therapeutic factors to be medium or high by Week 12 in the programme. Our hypotheses for significant improvement for PWA in quality of life, aphasia impairment, activity & participation, and contextual factors were partially supported and maintenance of gains was observed in some cases. No clear changes were evident for spouses.

Conclusions: This study contributes preliminary evidence for the efficacy of the InterD-CAG model for people with chronic aphasia. Larger-scale studies with comparison groups are required to build on the present findings with specific attention to spouse support needs.