Interaction-focussed therapy for aphasia: Effects on communication and quality of life

Abstract

Purpose: This study examined the effects of an interaction-focussed therapy for aphasia, which involved both people with aphasia and their familiar conversation partners. It was hypothesised the interaction-focussed therapy would lead to positive changes in targeted conversation behaviours, and improved quality of life for participants with aphasia.

Method: Three people with chronic aphasia and three of their familiar conversation partners completed an 8-week interaction-focussed therapy programme. A series of single case multiple-baseline ABA experiments were conducted. Outcome measures focussed on changes in targeted behaviours between pre- and post-therapy conversation samples, and changes in quality of life.

Result: All participant dyads improved their conversations. Familiar conversation partners demonstrated significant changes in targeted behaviours, while only one participant with aphasia achieved significant improvements. There was little evidence of a positive impact on quality of life for participants with aphasia.

Conclusion: Interaction-focussed therapy enhances everyday communication for people with aphasia and their conversation partners. However, the complex nature of learning in this intervention means that further, likely interdisciplinary work is required to better understand what mediates skill acquisition and therapeutic change and its psychosocial impact. This information is particularly important for optimising interaction-focussed therapy for people with aphasia.

Keywords:

• aphasia
• conversation partner training
• adult learning

Notes

Acknowledgements

The authors would like to thank the participants, and acknowledge the contributions of Tommie Clark, Jessica Cooper, Samantha Maunder, Nicola Shelton and Christine Taylor.

Declaration of interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the article. This research was funded by a Macquarie University “New Staff” grant entitled “Learning in conversation therapy” awarded to the first author. The second author was funded by an Australian Research Council Future Fellowship (FT120100102).

Supplementary material

Supplemental data for this article can be accessed at http://dx.doi.org/10.1080/17549507.2017.1329851

Notes

1. For example, a person with aphasia could make lasting improvements in language processing as a result of complying with constraint-induced aphasia therapy without being aware of how their behaviour was supporting improvements in language processing. However, it would be much less likely that someone could achieve lasting improvements via interaction-focused therapy without explicitly learning how their behaviour affects communication (e.g. how a strategy facilitates communication, how the strategy is administered and when to use it).

2. Some participants also collected more than four recordings during the pre- and post-therapy periods. In these cases, the first four recordings collected were included in the primary outcome measures.

3. It should be noted that Dyads 2 and 3 recorded pre-therapy samples that were, on average, longer than their post-therapy samples. This meant that more of their pre-therapy recordings were omitted from the materials that were coded than their post-therapy recordings. Nonetheless, as outlined above, the parts of the interactions subjected to coding were commensurate, which ensured that comparisons of communicative behaviours between pre- and post-therapy samples were valid. Moreover, the treatment effects reported below seem unlikely to be undermined by inclusion of more pre-therapy materials.

4. As outlined in Table V, Dyad 2 collected the shortest set of conversation samples. A2’s poor responsiveness might also reflect reduced opportunity to demonstrate learning.

5. This is not to say that executive functioning is the only factor that mediates responsiveness in interaction-focused therapy. For example, motivational, attitudinal and personality factors seem intuitively likely to contribute. Of course, this is just scratching the surface of the possible “active ingredients” in behavioural interventions (see Johnson, 2015; Michie et al., 2011).

6. For an interesting parallel, see the development of the Profile of Word Retrieval Errors in Speech (POWERS) (Herbert, Best, Hickin, & Howard, 2013).

7. Readers currently using or interested in conversation therapy are encouraged to visit the Better Conversations with Aphasia website (https://www.ucl.ac.uk/betterconversations/aphasia). This is a free e-learning resource, and offers access to materials relevant for conducting conversation therapy (e.g. activity materials and session plans).