Alison Ferguson

What people with aphasia want: Their goals according to the ICF

Background: The goals of people with aphasia should guide service delivery. Services are increasingly influenced by the International Classification of Functioning, Disability and Health (ICF) (WHO, 2001), but little is yet known about whether the goals of people with aphasia span the full spectrum of the ICF. Aims: The purpose of this study was to describe the goals of people with aphasia and to code the goals according to the ICF. Methods & Procedures: A qualitative descriptive research approach was used involving semi-structured in-depth interviews with 50 participants with aphasia post-stroke. Interviews were videotaped and transcribed verbatim and then analysed using qualitative content analysis. The goals of a 30% consecutive subsample were then coded using the ICF. Outcomes & Results: Nine broad categories of goals were identified. Participants with aphasia wanted to return to their pre-stroke life and to communicate not only their basic needs but also their opinions. They also wanted information about aphasia, stroke, and available services; more speech therapy; greater autonomy; and dignity and respect. They identified the importance of engagement in social, leisure, and work activities as well as regaining their physical health. Interestingly, their goals included wanting to help others. Goals could be linked to all ICF components within the ICF, with the majority linked to Activities and Participation, followed by Environmental Factors, Body Functions and Structures, and Personal Factors. Conclusions: People with aphasia in this study were able to articulate a wide range of goals post-stroke that encompassed all of the ICF components but had a particular focus on the Activity and Participation components.

The influence of aphasia, familiarity and activity on conversational repair

Abstract This study investigated the influence of aphasia, familiarity and activity on conversational repair in interactions between nine aphasic individuals and 18 normal subjects (nine of whom lived with the aphasic subjects, and nine of whom were visiting the aphasic subjects). Data were collected in the homes of the aphasic subjects, and comprised unstructured conversation, semi-structured interaction involving retelling the events witnessed in a mock car accident, and structured testing. Conversation Analysis investigated the frequency of interactive trouble-indicating behaviour (metalinguistic comment and hypothesis forming per minute), and the nature of repair pattern (proportional pattern of repair trajectories used). Normal subjects increased their frequency of interactive trouble-indicating behaviour, and used more interactive repair patterns when conversing with aphasic partners as compared with when conversing with normal partners. The difference in familiarity between subjects did not appear ...

Aphasia rehabilitation in Australia: Current practices, challenges and future directions.

Abstract This study reports on current aphasia rehabilitation practices of speech-language pathologists in Australia. A 30-item web-based survey targeted approaches to aphasia rehabilitation, education, discharge, follow-up practices, counselling, interventions to improve communication access, community aphasia support services, and challenges to practice. One hundred and eighty-eight surveys were completed representing ˜ 33% of the potential target population, with 58.5% urban and 41.5% rural participants across all states and territories. Respondents reported embracing a wide variety of approaches to aphasia rehabilitation; however, significant challenges in providing aphasia management in acute and residential care were identified. Low levels of knowledge and confidence were reported for both culturally and linguistically diverse clients and discourse approaches. Group and intensive services were under-utilized and clinicians reported inflexible funding models as major barriers to implementation. Few clinicians work directly in the community to improve communicative access for people with aphasia. Despite the chronic nature of aphasia, follow-up practices are limited and client re-entry to services is restricted. Counselling is a high frequency practice in aphasia rehabilitation, but clinicians report being under-prepared for the role. Respondents repeatedly cited lack of resources (time, space, materials) as a major challenge to effective service provision. Collective advocacy is required to achieve system level changes.

Conversational turn-taking and repair in fluent aphasia

Abstract This study replicated and extended the previous investigation of conversational turn-taking in fluent aphasia by Schienberg and Holland. The present study analysed a series of casual conversations which were videotaped between two fluent aphasic speakers talking with each other, and with non-aphasic partners who varied with regard to clinical experience with aphasia and personal familiarity with the aphasic speakers. Analysis was based on transcription and examined general aspects of turn-taking, as well as turn allocation techniques and their success, with results being compared with those presented by Schienberg and Holland. Additionally, repair trajectories and their acceptance were analysed for each dyad. Results supported Schienberg and Hollands previous findings and conclusions with regard to the relative preservation of communicative competence in aphasia. Additionally, results suggest that measures of turn-taking allocation showed no effect of the familiarity of the partners. For some in...

Language, meaning, context, and functional communication

Background  : In the 1970s Audrey Holland first emphasised the importance of “functional communication” rather than “linguistic accuracy” for individuals with aphasia, noting that they could often “communicate” better than they could “talk”. Her approach inspired many to explore why and how this could be so, and to look for avenues that tapped everyday communication skills, rather than the person with aphasias performance on decontextualised language tests. Aims: This paper addresses the kinds of issues that are involved in “functional communication” and specifically addresses the role of language in this endeavour. It aims to highlight language as a set of “meaning-making resources” rather than as a set of syntactic/semantic constructs that exist outside of the communicators everyday environment, that have to be mastered before being put into practice and that exist regardless of specific contexts. Main Contribution: The paper discusses languages role in social life in which speakers not only convey information to each other but also maintain social relationships through communication. A taxonomy of the different kinds of social meanings that speakers use to communicate is proposed for use in aphasia research, based on the work of Halliday (1994)—those related to conveying ideas and experiences (e.g., vocabulary related to particular experiences, topics), those related to interpersonal relationships (e.g., speech acts, evaluative language devices, exchange structure), and those related to maintaining continuity and coherence across the speakers discourse (e.g., cohesion). In addition, the systematic relationship existing between language and context and its clinical implications are explored. Conclusions: Language as information is only one form of language use. The paper argues for further consideration in aphasiology of the importance of multiple language uses and their relation to context. It is proposed that regarding language forms from these different perspectives of use will enable clinicians to further address the different aspects of communication required for meaningful and satisfying interactions in everyday social life.

Analysing aphasia treatment sessions

This paper presents a preliminary investigation into the descriptive adequacy of a linguistic approach to the analysis of clinical interaction. The analyses involved description of Generic Structure and the Exchange, based on Systemic Functional Linguistics. The research investigated the extent to which the findings from the analyses reflected interpersonal aspects of the clinician/client relationship, and the extent to which the analyses may be sensitive to the experience of the clinicians. Three video recorded treatment sessions were analysed, involving three different aphasic subjects and their clinicians, varying in clinical experience. Findings suggest that clinician and client roles are strongly reflected in the manner and structure of the therapy exchange, regardless of the experience of the clinician. However, it was also found that the more experienced clinicians were observed to spend more time in building rapport with clients. The more experienced clinicians were also observed to exploit the structural opportunities within sessions to allow for a repeated review of tasks, progress, and planning. It is suggested that this linguistic approach allows for critical reflection on important aspects of the clinical process and, hence, provides a useful tool in clinical education and reflective practice.

Linguistic analysis of discourse in aphasia: A review of the literature.

ABSTRACT This review examined previous research applications of linguistic discourse analysis to assess the language of adults with aphasia. A comprehensive literature search of seven databases identified 165 studies that applied linguistic measures to samples of discourse collected from people with aphasia. Analysis of methodological applications revealed an increase in published research using linguistic discourse analysis over the past 40 years, particularly to measure the generalisation of therapy outcomes to language in use. Narrative language samples were most frequently subject to analysis though all language genres were observed across included studies. A total of 536 different linguistic measures were applied to examine language behaviours. Growth in the research use of linguistic discourse analysis and suggestions that this growth may be reflected in clinical practice requires further investigation. Future research directions are discussed to investigate clinical use of discourse analysis and examine the differences that exist between research and clinical practice.

Interpersonal aspects of aphasic conversation

Abstract This paper presents preliminary work which explores some of the theoretical issues and methodological usefulness of the systemic-functional approach to the analysis of interpersonal aspects of aphasic conversation. Results are presented for the analysis of natural and elicited conversation samples for five mildly aphasic individuals. The results highlight the diverse resources of language which remain accessible to aphasic individuals, and indicate the potential of this approach to describe strengths and weaknesses in how interpersonal meanings are expressed within communicative contexts.

Assessment practices of speech-language pathologists for cognitive communication disorders following traumatic brain injury in adults: an international survey.

Abstract Primary objective: This study’s objective was to examine the current assessment practices of SLPs working with adults with acquired cognitive communication impairments following a TBI. Methods and procedures: Two hundred and sixty-five SLPs from the UK, the US, Canada, Australia and New Zealand responded to the online survey stating the areas of communication frequently assessed and the assessment tools they use. Main outcomes and results: SLPs reported that they routinely assessed functional communication (78.8%), whereas domains such as discourse were routinely assessed by less than half of the group (44.3%). Clinicians used aphasia and cognitive communication/high level language tools and tools assessing functional performance, discourse, pragmatic skills or informal assessments were used by less than 10% of the group. The country and setting of service delivery influenced choice of assessment tools used in clinical practice. Conclusions: These findings have implications for training of SLPs in a more diverse range of assessment tools for this clinical group. The findings raise questions regarding the statistical validity and reliability of assessments currently used in clinical practice. It highlights the need for further research into how SLPs can be supported in translating current evidence about the use of assessment tools into clinical practice.

Speech pathologists’ current practice with cognitive-communication assessment during post-traumatic amnesia: A survey

Abstract Primary objective: To investigate speech pathologists’ current practice with adults who are in post-traumatic amnesia (PTA). Method: Speech pathologists with experience of adults in PTA were invited to take part in an online survey through Australian professional email/internet-based interest groups. Results: Forty-five speech pathologists responded to the online survey. The majority of respondents (78%) reported using informal, observational assessment methods commencing at initial contact with people in PTA or when patients’ level of alertness allowed and initiating formal assessment on emergence from PTA. Seven respondents (19%) reported undertaking no assessment during PTA. Clinicians described using a range of techniques to monitor cognitive-communication during PTA, including static, dynamic, functional and impairment-based methods. Conclusions: The study confirmed that speech pathologists have a key role in the multidisciplinary team caring for the person in PTA, especially with family education and facilitating interactions with the rehabilitation team and family. Decision-making around timing and means of assessment of cognitive-communication during PTA appeared primarily reliant on speech pathologists’ professional experience and the culture of their workplace. The findings support the need for further research into the nature of cognitive-communication disorder and resolution over this period.