Abstract
Background: Studies of therapy with people with aphasia tend to use impairment‐based and functional measures of outcome. The views of participants are not formally evaluated. Current health and socialcare practice requires intervention to be explicitly client‐centred and evidence‐based. It is therefore important to investigate the broader effects of speech and language therapy.
Aims: To explore the outcome of a therapy for anomia using the Communication Disability Profile (CDP), focusing particularly on participants' ratings of ‘activity’.
Methods & Procedures: Overall eight people with aphasia and their conversation partners participated in the study. There was a range of severity and type of aphasia. Following two baselines (at least 8 weeks apart), there were two phases of therapy for anomia each lasting 8 weeks. This first involved the use of spoken and written cues to aid word finding. The second encouraged the use of targeted words in connected speech and conversation. Eight weeks later, after no further therapy, participants were reassessed.
Outcomes & Results: Participants' word finding in picture‐naming improved significantly, as did their activity ratings. The relationship between the group's word‐retrieval scores and CDP activity ratings over the course of the study tended towards significance, although there was considerable variation across individuals. Furthermore, all participants rated participation in activities requiring communication higher at the end than the start of the project.
Conclusions: The findings suggest that therapy which targets word retrieval can have an impact on people with aphasia's views of their communicative activity and life participation. The findings support therapists' clinical insight that impairment‐based interventions can effect change beyond scores on language tests.
Notes
1. We have not included a detailed overview of measures of quality of life as this paper does not focus on this. Here we simply describe an important new measure and why the CDP was chosen for the current study. The Stroke and Aphasia Quality of Life scale (SAQOL) (for a discussion, see, for example, Hilari et al. (Citation2003a, Citationb)) is an interviewer administered, self‐report measure of health‐related quality of life (HRQOL) in people who have had a stroke and aphasia. HRQOL reflects the impact of the health state on a person's ability to lead a fulfilling life. In so doing, it incorporates individual evaluation of physical mental/emotional, family and social functioning. The SAQOL has 39 questions in four domains: physical, psychosocial, communication and energy. In covering different aspects of a person's life, inevitably the focus on communication is less than in the CDP. The SAQOL asks seven questions about communication with only two asking about impact on family/social life.
2. The background language assessments are not considered in detail here as the focus is on the relationship between therapy outcome on naming and on wider measures of ability/disability.
3. The items are described in detail in Howard et al. (Citation1995). The set has ratings for imageability and, familiarity from the MRC database and frequency from the Celex database, the items range in length from one to three syllables.
4. An example of a choice of cue is a picture of a computer being presented with the target phoneme/grapheme C alongside the two distracter cues P and T. This would be followed by the target cue COM alongside the distracter cues POT and LAWN and, if necessary, the whole word forms: COMPUTER accompanied by POTATO and LAWNMOWER. The results for single and choice of cues did not differ. In this paper therefore the results are collapsed across the two cueing conditions and this issue is not discussed further.
5. The issue of generalization to untreated items is being addressed elsewhere in conjunction with the findings from the study described by Hickin et al. (Citation2002), Best et al. (Citation2006, Citationin preparation). See also note 6.
6. The change in word finding over the first phase of therapy was limited to treated items for all but two participants (TE and PP), both of whom showed generalization to unseen items from the first phase of therapy. There is not a straightforward relationship between generalization to untreated items in naming and change as measured by the CDP. This relationship is explored for TE in Greenwood et al. (Citation2007). It is also important to note that, although item specific, the changes in some participants word finding were not inconsiderable. For example F.A., named a further 39 experimental items after therapy and also made gains on her personally chosen set.
7. LM's score at final assessment returned to less that that at A2, but remained above A1 and above the mean of the two baseline assessments.
8. All participants who had used the CDP at A1 and A5 were included.
9. The y‐axis for naming and the y‐axis for CDP activity rating are not meaningfully related. The two lines are shown on the same graph for ease of comparison. It is the relationship between the two lines across the five occasions that is important.
10. A non‐parametric test is used here as the relationship is investigated over only five occasions of testing.
11. This phase of therapy was less effective on average. This was not the case for all individuals. Indeed one individual benefited considerably more from the second phase of the therapy than from the first.