Rehabilitation targeted at everyday communication: can we change the talk of people with aphasia and their significant others within conversation?

Abstract

Objective: To investigate whether aphasia therapy can change the talk of speakers with aphasia and/or their significant others within conversation.

Design: Small number of intervention studies targeting conversations involving speakers with aphasia are reviewed. All are single case studies.

Setting: Key assessment in the studies was an audio or video recording of 1 or more conversations between the dyad, usually made in the home setting. Intervention in these studies took place in the participants' home or another setting, such as a therapy room.

Participants: In all of the studies reviewed, the participants consisted of a person with aphasia (PWA) and a significant other, usually the PWA's spouse.

Interventions: In all studies, therapy took the form of a behavioral intervention involving the provision of feedback to the significant other and/or PWA on their conversational behaviors uncovered by a conversation analysis assessment. Handouts, transcripts, discussion, and video feedback were used. Suggestions to permit participants to cope better with the effects of aphasia within conversation were given, and opportunities for practicing these strategies within conversation were provided.

Main outcome measures: Postintervention, 1 or more conversations involving the PWA and significant other were recorded in the same manner as the preintervention. Conversations were analyzed in relation to changes in the behaviors targeted in intervention, such as those involved in topic initiation or repair of linguistic errors.

Results: Each of the studies reviewed presented evidence that the talk of people with aphasia and/or their significant others can be changed in conversation. In some studies the evidence is primarily qualitative, in the form of observed changes to conversational behaviors postintervention. Some studies produce stronger evidence by combining qualitative and quantitative analyses of change.

Conclusions: There is evidence that intervention targeting conversations involving an aphasic speaker can achieve change. Future studies should move beyond single case designs, include more robust, quantifiable evidence of change, and provide evidence of maintenance of change.