Communication partner training for persons with aphasia: a systematic review of Portuguese language publications

Figures & data

Figure 1. PRISMA flow diagram.

Table 1. Characteristics of CPT intervention studies included.

Study	Country	Study Design	Study aim/objective	Method of analysis
Machado (2004)	Brazil	Quasi-experimental (quantitative, qualitative)	To investigate the impacts of an educational program with caregivers in PWAs perception of communicative abilities and difficulties	Descriptive and inferential statistical analysis
P. A. S. Valente (2013)	Portugal	Case study (prospective)	To analyse the effect of a CPT program directed at a couple in which the husband has aphasia, with a greater focus on turn-taking and repairing strategies	Discourse analysis
Pereira (2014)	Portugal	Quasi-experimental (quantitative, qualitative)	To evaluate the effects of a CPT program for health professionals in the context of palliative care	Thematic analysis
Magnus et al. (2019)	Brazil	Quasi-experimental (quantitative)	To develop a short educational program about aphasia (SEPA) for family caregivers of people with aphasia and verify its effect in their burden and quality of life	Descriptive and inferential statistical analysis

CPT – Communication partner training.

Table 2. Participants characteristics in CPT Intervention studies included.

Study	Country	Number of participants with aphasia	Age (mean)	Sex	Control matching criteria	Time post-onset	Etiology	Aphasia type	Aphasia severity
Machado (2004)	Brazil	10	62.7	3 M, 7F	NA	27.7 months (±21.8)	Stroke	1 conduction, 5 Broca’s and 4 global	NS
P. A. S. Valente (2013)	Portugal	1	55	M	NA	48 months	Stroke (hemorrhagic)	Global	Level 3 (Aphasia Severity Scale)
Pereira (2014)	Portugal	4	78	3F, 1 M	NA	NS	Stroke and ALS	NS	NS
Magnus et al. (2019)	Brazil	4	65	3 M, 1F	NA	30 months (median)	Stroke	Broca’s Aphasia	NS

NA = not applicable, NS = not stated, M = male, F = female, ALS = Amyotrophic Lateral Sclerosis.

Table 3. Characteristics of communication partners in CPT intervention studies included.

Study	Number of CP	Age (mean)	Sex	Education	Employment	Affinity
Machado (2004)	10	47.5	8F, 2 M	9.4 years (±4.2)	NS	Family members: 1 sister-in-law, 1 mother, 3 spouses, 5 daughters
P. A. S. Valente (2013)	1	57	F	12 years	Unemployed	Spouse
Pereira (2014)	14	30	10F, 4 M	6HS, 8C	6 nurses, 2 PT, 6 HA	Formal carers
Magnus et al. (2019)	4	61 (median)	3F, 1 M	2ES, 1C, 1HS	NS	Family members: 1 brother-in-law, 1 sister, 1 spouse,1 daughter

NA = not applicable, NS = not stated, M = male, F = female, ES = elementary school, HS = high school, C = college, PT = Physiotherapists, HA = Health Assistants.

Table 4. Intervention descriptions for included CPT studies.

Study	Category of intervention	Training length	Total training amount	Intervention setting	Intervention description	Predominant intervention focus with CP	Training format
Machado (2004)	Orientation/education program	6 weekly meetings of 50 minutes each	5 hours	University	Three exposition sessions covering stroke and aphasia, how it affects language in general and in the specific case of each patient, psychological effects of aphasia, how to manage stress, how CP can help, and three training sessions based on conversational samples between PWA and their CP, focusing on communication strategies tailored to each dyad.	Broad intervention with focus on communication strategies and quality of life.	Groups comprised of PWA and CP + guide
P. A. S. Valente (2013)	Individual training of CP and PWA + education program about aphasia	9 sessions	22 hours	Patient’s home	3 phases: 1st phase just with CP: What is aphasia; type of aphasia; characteristics of “good conversation”; effect of aphasia on conversation; psychosocial consequences; supported communication; importance of communication partners. 2nd phase just with CP: general communication strategies (according to the principles of SCA); conversation structure: Turn-taking and repair; specific strategies for the couple. 3rd phase: both PWA and CP: practical training of strategies with the couple; role-playing and “conversational coaching”; final self-assessment.	Communication strategies	Individual + Dyad
Pereira (2014)	Education program	2 months	2-hours workshop	Palliative Care Unit	Two groups of formal carers were involved. An experimental group and a control group, both assessed before and after intervention using the MECQ-LTC. A 2-hour workshop was given to the experimental group. In this workshop the communication strategies found in the literature to facilitate communication were explored. By the end of this workshop, a communication plan, with the specific strategies used by each patient with communication disorders involved in the study and the strategies each CP should use to facilitate communication with each of them was shared.	Communication strategies	Group of health professionals + communication plan per patient
Magnus et al. (2019)	Short education program about aphasia (SEPA)	2 meetings of 1 hour each with a one-week interval	2 hours	University	Two expositive sessions. The first session covered the topics: neural substrates of language, stroke and other brain diseases, and aphasia (concept, types, symptoms, consequences). After 7 days, the second session was carried out and covered the topics: relationship between people with aphasia and caregivers, strategies to improve communication, and general orientation about quality of life and health. At the end of each session, 30 minutes were dedicated to questions and an open discussion.	General intervention covering education about aphasia, strategies for communication and relationship with caregivers.	Group

CP = communication partner, PWA = people with aphasia, SCA = Supported Conversation for Adults with Aphasia, CAPPA = Conversation Analysis Profile for People with Aphasia.

Table 5. Outcome measures for CPT intervention studies included.

Study	Category of intervention	Participants	Outcome category	Outcome measures	Test description	Results	Change	Remarks to caution for interpretation
Machado (2004)	Orientation/ educational program	PWA and CP	Perception of conversational abilities	Percentage of agreement between CP and SLT regarding functional abilities. (Complete CAPPA)	Quality of Life was only assessed pre-intervention, using the SF-36. CAPPA was used pre- and post-intervention. CAPPA consists of an interview with the CP, a 10-minute recording of a conversation between CP and PWA/an analysis of agreement between findings of interview and discourse analysis. Therefore, the measure is one of agreement between CP and SLT perception of communicative abilities.	The first analysis (covering pre and post intervention agreement) did not find any statistically significant change in any of the dyad groups. The second analysis investigates the internal groupings within each group, i.e., similarities across dyads. Results indicate aphasia classification is not a determinant factor for CAPPA score. The third analysis compares CP perception before and after intervention. The only statistically significant finding regarded speech apraxic errors in PWA discourse.	Greater agreement between rating by CP and PWA, but no statistical difference was observed.	Definitions of functionality and difficulties in communication might differ between individuals.
P. A. S. Valente (2013)	Individual training of CP and PWA + Educational Program about aphasia	PWA and CP	Perception of conversational abilities/ Communication Profile	Performance in CAPPA and Measure of Skill in Supported Conversation (Parts A and C of CAPPA)	CAPPA consists of an interview with the CP/a 10 minute recording of a conversation between CP and PWA and analysis of conversation/Measure of Skill in Supported Conversation provides an index of the ability of a CP to provide support for the PWA by communicating in a way that acknowledges the person’s inherent competence while at the same time facilitating his/her ability to exchange thoughts, opinions, and feelings that help to reveal inherent competence.	The results suggest that the training undertaken with the wife, in order to improve their communicative behaviors and attitudes, had a very positive impact on the quality of the conversation with the husband with aphasia.	Positive change, mainly described in a qualitative way – The CP was more aware of aphasia’s impact in her husband’s communication and of the right strategies to use to facilitate conversation.	Small sample size, no control group.
Pereira (2014)	Orientation/ educational program	Formal Carers	Communication Strategies	MECQ-LTC	MECQ-LTC is a tool to determine the needs and problematic communication situations specific to long-term care. It also aims to reveal a resident’s usual means of communication and the strategies used by speakers to better understand or be understood by the resident.	The results obtained showed changes in terms of communication between professionals and patients, with an increase in the number and frequency of the use of various strategies by both.	There was an increase in the number and frequency of the communication strategies used, which lead to a decrease of the communicative effort in areas such as nutrition, health care and general communication. More verbal strategies were used, though there is greater difficulty in adaptation and use of AAC. The program was generally well structured and implemented, meeting the needs of participants.	Small sample size
Magnus et al. (2019)	Short educational program about aphasia (SEPA)	CP	Burden assessment and quality of life	Performance in Zarit and WHOQOL-Bref at pre- and post-intervention times	Zarit’s Burden interview is aimed at caregivers of people with mental and physical illnesses. The WHOQOL-Brief is an evaluation of quality of life in 4 domains: physical, psychological, social relations.	No statistically significant change in pre-post intervention, but greater median values in all outcome measures post intervention.	There was a generalized trend of improvement in several measures. Qualitative observation by therapists and participants supports a generally positive impact of the intervention.	Small sample size, no control group, lack of adherence of family caregivers.

PWA = people with aphasia, CP = communication partner, SLT = Speech-Language Therapist, MECQ-LTC = The Montreal Evaluation of Communication Questionnaire for use in Long-Term Care, AAC = Augmentative and Alternative Communication, MSSC = Measure of Skill in Supported Conversation, WHOQOL-Bref = World Health Organization Quality of Life – Bref.

Table 6. Characteristics of CPT-adjacent studies.

Study	Country	Study design	Study aim/objective	Method of analysis
Ângera (2011)	Portugal	Quantitative, transversal, descriptive-exploratory	Describe how the students of 3rd year of Bachelor of Nursing of a Portuguese university communicate with aphasic patients. To identify the strategies they use, their difficulties and knowledge they have about the characteristics of different types of aphasia.	Descriptive statistics (Microsoft Excel) and qualitative analysis.
Barros (2016)	Portugal	Transversal, qualitative	Explore the knowledge of formal caregivers about the person who is a victim of stroke, contributing to the improvement of communicative quality in the Continuing Care Units.	Thematic Analysis.
Coelho (2020)	Portugal	Quantitative, descriptive, and cross-sectional	To know the nursing interventions used by rehabilitation nurses when communicating with PWA.	Descriptive analysis using the SPSS.
Galamba (2012)	Portugal	Literature review	To understand the changes of communication in people with neurological disease and how the rehabilitation nurse contributes to the recovery of those who experience a new stage of their life cycle.	The author used the following MeSH terms: Rehabilitation AND Nursing AND Communication.
Gil et al. (2020)	Portugal	Scoping review	To answer the research question: Which nursing interventions enable the informal caregiver of a person with aphasia in the home context?	The research was carried out with MeSH descriptors, combining the research strategy Nurs*AND Aphasia OR Homenursing AND Caregivers. Data collection used the Joanna Briggs Institute method and PRISMA guidelines.
Jesus (2021)	Portugal	Exploratory, cross-sectional, descriptive, qualitative and quantitative	To identify the communication strategies used with PWA by HP and final year health students trained in Portuguese higher education institutions, as well as to explore their knowledge, training and needs on the subject.	Descriptive statistics of quantitative data (Microsoft Excel) and thematic analysis.
Mano et al. (2015)	Portugal	Non experimental, quantitative, qualitative, descriptive, transversal	Identifying communicative difficulties presented by the CP in interaction with PWA; identifying communicative difficulties presented by the PWA; identifying strategies that simplify the communication between the CP and the PWA and determine the dyad’s communicative profile: PWA – CP.	Descriptive analysis using the SPSS Program; discourse analysis.
M. A. Matos (2012)	Portugal	Observational, descriptive, transversal	To carry out the translation and adaptation to Portuguese of the Communication Disability Profile (CDP) (Swinburn & Byng, 2006) and the Participation Objective Participation Subjective (POPS) (Brown et al., 2004) in order to equip the SLTs of our country with tools to cover the different areas mentioned. It was also intended to meet the real needs of Portuguese PWA, make a survey of the consequences of stroke and aphasia in their daily lives and see how chosen instruments accurately identify these needs.	Thematic Analysis (using ICF categories).
Salgueiro (2014)	Portugal	Quantitative, descriptive	To identify communication difficulties of nurses when communicating with PWA; to identify diagnostic activities implemented by nurses for aphasia assessment; to identify the interventions performed by nurses to communicate with PWA.	Descriptive analysis using the SPSS; content analysis for qualitative data.
Silva and Patrício (2010)	Portugal	Qualitative, observational, descriptive, transversal	To verify if informal caregivers of PWA consider relevant their participation in the habilitation/rehabilitation process of their relatives in speech-language therapy, considering the impact of aphasia in their own lives.	Thematic analysis.
Bassi (2006)	Brazil	Descriptive, observational, qualitative	To explore the social-cognitive path of enunciative and pragmatic meaning construction in situations of face-to-face interactions, involving aphasic and non-aphasic subjects.	Discourse analysis.
Carleto (2011)	Brazil	Descriptive, cross-sectional, quantitative	To investigate factors that impact quality of life of PWA and their caregivers.	Descriptive statistics of quantitative data (Microsoft Excel and SPSS).
DiGiulio (2011)	Brazil	Exploratory, descriptive, qualitative	To investigate the impacts of aphasia on caregivers or relatives of PWA who had fluent and non-fluent aphasia and who used Augmentative and Alternative Communication.	Thematic analysis.
Dresch et al. (2017)	Brazil	Descriptive, observational, qualitative	To discuss health promotion and prevention practices in a group context for caregivers of PWA.	Not specified
Godoy (2016)	Brazil	Descriptive, observational, quantitative	To describe the quality of the relationship between family members/caregivers and adults and elderly poststroke, who are attending a rehabilitation program.	Descriptive statistics of quantitative data.
Kiyan et al. (2008)	Brazil	Descriptive, observational, qualitative	To explore how the family of PWA experience difficulties in communication.	Thematic analysis.
Lima et al. (2021)	Brazil	Quantitative, clinical study, pre-post test, non-randomized	To verify whether the multicomponent aphasia group therapy program could significantly improve quality of life and communication in people with sub-acute stroke-related aphasia.	Descriptive and inferential pre-post intervention statistical analysis of quantitative data.
Miolo et al. (2017)	Brazil	Exploratory, transversal, qualitative	To discuss the impact of individuals’ motor and aphasia-related impairments on relatives/informal caregivers’ daily lives	Thematic analysis.
Moleta et al. (2011)	Brazil	Descriptive, observational, qualitative	To analyze the views of an aphasia caregiver’s family group about the caregiver definition and its implications.	Content discourse analysis.
Monje (2007)	Brazil	Descriptive, observational, quantitative, qualitative	To assess the quality of life of people with aphasia and their caregivers.	Descriptive statistics of quantitative data and discourse analysis.
Panhoca and Pupo (2010)	Brazil	Descriptive, observational, quantitative, qualitative	To investigate the quality of life of caregivers of PWA.	Descriptive statistics of quantitative data and discourse analysis.
Ponte and Fedosse (2016)	Brazil	Descriptive, observational, quantitative, qualitative	To investigate the correlation between the impact of Acquired Brain Injury (ABI) on the labor activity of individuals of working age on their quality of life.	Descriptive statistics of quantitative data, content discourse analysis.

CPT – Communication partner training, ICF – International Classification of Functioning, Disability and Health, SPSS – Statistical Package for the Social Sciences, HP – Health Professionals.

Table 7. Data collection tools and findings from CPT-adjacent studies.

Study	Study Focus	Participants	Data collection tools	Data collection and description	Main findings
Ângera (2011)	Communication strategies used in health care by nursing students.	CP (nursing students)	Questionnaire	The questionnaire is composed of two parts: demographic data collection and students’ feedback regarding aphasia knowledge and communication strategies used in health practice.	The students identified some communication strategies to use with PWA although they refer to having some difficulties during the communication process and don’t always feel prepared to treat/care PWA.
Barros (2016)	Communication strategies used by CP with PWA; knowledge of formal CP about aphasia; importance of communication in the professional intervention of formal CP; main communication difficulties experienced by formal CP with PWA; importance of an intervention in terms of training professionals in the field of communication.	CP (HP)	Semi-structured interviews	The interviews were structured in the following sections: demographic data, aphasia and communication knowledge, and communication strategies used with PWA.	All participants agreed that aphasia is characterized by a difficulty in expression/understanding; that communication is a way of interacting with others and with the environment; that the gesture and writing are the most used strategies, and that there is a need for training to improve communication in the context studied.
Coelho (2020)	Strategies used by formal CP.	CP (nurses)	Questionnaire	The questionnaire was adapted from one previously developed in the study of Salgueiro (2014).	Rehabilitation Nurses mentioned performing “Often” or “Always” interventions such as “Promoting adequate physical space”, “Ensuring privacy”, “Introducing yourself to the patient”, “Enhancing the patient’s ability to communicate”, “Referring availability to communicate”, “Giving simple guidance each time”, “Giving the patient time to complete the message, without interrupting him”, “Listening carefully”, “Using simple words and short sentences”, “Using keywords”, “Showing images for the patient to name”, “Using non-verbal communication”, “Encouraging the patient to repeat words”, “Recognizing the patient’s progress, praising him”, “Teaching how to manipulate usual objects”, “Teaching how to verbalize words”, “Teaching how to use non-verbal communication”, “Using drawings”, and “Providing the patient with written input”.
Galamba (2012)	Importance of the intervention of rehabilitation nurses to the communication improvement of patients with neurologic disease.	NA	Guyatt and Rennie (2002) levels of evidence	Scale that proposes 7 levels of evidence.	Nurses need specific training regarding communication problems so that they can commit more to the care of PWA. It is necessary for nurses to establish effective communication with patients with post-stroke aphasia so that they are able to understand the oral or written information that is transmitted to them.
Gil et al. (2020)	Nursing interventions that empower informal caregivers of PWA in home context.	NA	PRISMA 2009 Flow Diagram and Joanna Briggs Institute review protocol	NA	The importance of an empathic relationship with the PWA as it is important to guarantee effective communication. They also stated the relevance of using communication strategies with the PWA and the caregiver in order to enable a better social interaction and psychological state.
Jesus (2021)	Communication strategies used with PWA by HP and final year health students.	CP	Self-administered online questionnaire	Structure of the questionnaire: 1) demographic, academic, and professional information; 2) knowledge, training, and intervention in the areas of communication and aphasia; 3) strategies used in communicating with PWA; and 4) the need for training about communication with PWA.	Most used communication strategies are visual/physical strategies (e.g., gestures, images, writing and drawing). The level of knowledge is low for both groups studied, but the demand for training can be considered high, reaching 50% in both groups. There was also a tendency to use the same strategies (gestures, images/symbols, reduction of verbal discourse, use of concise speech, writing and drawing) for different purposes (understanding, expression, recognition of competences).
Mano et al. (2015)	Communication strategies used by CP and the difficulties felt by the dyad during conversation.	PWA and CP (FM)	CAPPA-P Brief, sociodemographic questionnaires	The CAPPA-P Brief is an instrument for analyzing the conversational profile of PWA. The questionnaire is applied by SLTs to obtain specific information about the impact of aphasia in the conversation between the PWA and CP. For its application, this instrument presents a structured interview for each of the elements of the communication dyad, and an analysis of a sample conversation between both.	The findings showed that the CP has a more realistic knowledge of the PWA abilities than themselves. It also was able to confirm that there are a wide range of strategies diversity used by the dyad, being its effectiveness variable.
M. A. Matos (2012)	Assessment of Activity limitations and Participation Restrictions of PWA and their FM. Identification of Barriers and Facilitators.	PWA, FM and SLTs	Semi-structured interviews (individual and in group)	The topics approached were consequences of stroke and aphasia in terms of body functions and structures and in levels of activity and participation of the person interviewed.	Regarding activities/participation, all felt the consequences focus on categories of interaction and personal relationships, social, civic and community life and major life areas. In terms of barriers and facilitators SLTs value information and structural barriers as the most important barriers to social participation of PWA, while PWA and family member groups value personal factors as well as environmental and attitudinal barriers.
Salgueiro (2014)	Communication strategies and barriers when communicating with PWA, diagnosis and intervention for PWA performed by nurses.	CP (nurses)	Questionnaire	The questionnaire approached the following three domains: sociodemographic, education on communication and intervention regarding communication with PWA.	When communicating with PWA, nurses often encounter challenges in comprehending the patient’s oral expression and accurately perceiving their feedback on the message. Other difficulties, such as lack of time, space and communication tools, dealing with both personal and the patient’s anxiety, intervening with the family and identifying appropriate strategies, were also reported. Nurses reported the need for more training on communication, more research in this field, greater involvement with families, regular use of communication strategies, having more support material and technological means available, having better conditions in the service and better articulation with SLTs.
Silva and Patrício (2010)	QOL analysis and the importance of caregiver participation in SLT intervention.	CP (informal carers)	Semi-structured interviews and analogical visual scale	The interviews used a 5-point analogical visual scale (1 – very poor, 5 – very good). The interviews analyzed the following domains: physical health, psychological health, level of independence, environment, and social relationships.	Caregivers’ QOL decreased and there were changes in their communication patterns, their roles and relationships. They consider SLT important for the improvement of communication skills of their own and their relatives, and for the relationship between them; they consider their participation relevant, even if they cannot always be in SLT sessions.
Bassi (2006)	Perspectives on discourse	PWA and CP	Recordings of semi-structured group interactions.	Group setting interaction was conducted and recorded (persons with and without aphasia). Analysis focuses on the interactive contexts of language use.	The examples explored via qualitative analysis revealed the importance of considering the approaches that individuals with aphasia and their caregivers take on language to their own possibility of discourse organization.
Carleto (2011)	Quality of life of people with aphasia and their family members.	PWA and CP	SSQOL and Aphasia Semiology Assessment for PWA; WHOQOL-Bref CP	Data collection consisted of socioeconomic questionnaires, standardized scales for quality-of-life measures, as well as an Aphasia Semiology Assessment by the author.	The quality-of-life domains least affected were mobility and personal care, while the most affected domains were language and behavior. Regarding relatives, personal relationships and psychological state were found to be least affected, while physical and environmental aspects were the most affected. A statistical correlation was found between the quality of life of people with aphasia and their relatives. Both the family members and people living with aphasia had their quality of life reduced after the stroke episode.
DiGiulio (2011)	Impact of aphasia on caregivers	CP	Semi-structured interviews	Conversations were recorded and transcribed. Data then underwent qualitative, exploratory analysis based on two major thematic points: (1) the process of caring for someone and how SLP can contribute to it; (2) language and the impact of aphasia on caregivers and their communication.	The reports of overload and impacts on family relationships indicate a delicate terrain for CPT interventions, above all because caregivers already perceive their position as one with many responsibilities and little support. It seems likely that a framework that empowers PWA and that seeks for community effort could help alleviate these difficulties. AAC was not discussed in detail, being generally addressed as useful, especially in non-fluent aphasia.
Dresch et al. (2017)	Health and QOL of caregivers to PWA	CP	Qualitative descriptions	Systematic observations.	The group activities promoted health and QOL for participants and their families. Caregivers felt free to expose their desires and successes in relation to their personal life.
Godoy (2016)	Impact of aphasia on the family caregiver	PWA and CP	Questionnaires	For data collection interviews with questionnaires to characterize the interactional aspects between the family/caregiver and the cared person (Burden interview).	The study reports negative correlations between levels of independence in PWA, both in basic and instrumental activities, and caregiver burden. A positive correlation was found between the level of dependency in daily activities and daily care hours by the caregiver. The burden levels were considered low to moderate, which the author links to a naturalistic learning curve for dealing with stroke and aphasia difficulties, thus justifying the need for educational and training programs targeted at caregivers.
Kiyan et al. (2008)	Caregiver stress due to communication difficulties in aphasia	CP	Semi-structured interview.	Conversations were recorded and transcribed. Afterwards, a thematic analysis followed, targeting the psychological impacts of difficulties in communication through a psychoanalytical framework.	The study focuses on three thematic categories: caregivers’ subjective perception of their relationship to the PWA; caregivers’ emotional states; and changes and necessary adaptations in daily life. Analysis showed significant caregiver distress associated with feelings of grief over the irreversible change in communicative configuration, as well as a lack of understanding about stroke and aphasia.
Lima et al. (2021)	Multicomponent group intervention	PWA, CP	Burden Interview – Zarit (CP), BDA. SAQOL-39 (PWA)	Individual interviews, as well as individual assessment were conducted with the caregivers in two separate groups: one receiving multicomponent group intervention, and the other not receiving it.	The communication domain in the quality-of-life score was significantly higher than that obtained prior to therapy for participants with caregiver presence. All caregivers presented mild to moderate overload and with a higher prevalence of females playing the role of caregiver.
Miolo et al. (2017)	Impact of aphasia on the family caregiver	CP	Semi-structured interviews	The main data collection tool was interviews with caregivers/relatives in which information about their background, such as age/marital status/financial conditions, changes in routine, was collected. Furthermore, caregiver’s perception of the condition after the injury was also noted.	After the injury, major changes and transformation in the daily routines, personal, social and economic lives of both the PWA and their relatives are noted. Additionally, caregivers have a hard time understanding and communicating with their affected family members. Moreover, it was also noted that the caregivers tend to prioritize caring for the affected patient.
Moleta et al. (2011)	Caregiver implications	CP (FM)	Semi-structured interview	Interviews were recorded and transcribed, with subsequent discourse analysis.	In respect to the caregiver implications, it was verified some conflicts in the relations between the individual with aphasia and their caregivers, because there are difficulties to recognize the possibilities and autonomy of aphasic individuals in the context of aphasia when considering the emotional, physical, and linguistic dimensions
Monje (2007)	Experiences of communication challenges (caregivers and PWA)	PWA and CP	Questionnaire, semi-structured interview.	Both quantitative and qualitative data were obtained. The quantitative data was collected through generic questionnaire for assessing QOL – World Health Organization Quality of Life – abbreviated, WHOQOL-BREF version in Portuguese, to both groups (people with aphasia and caregivers). Qualitative data were obtained by oral testimony, in the light of the Oral History methodology, through analyzing recordings of interviews that were built with a script of specific questions for people with aphasia and their caregivers.	The interviews give voice to the point of view of people with aphasia and their caregivers about the communication challenges they face and the coping strategies that they developed to deal with aphasia in their daily lives.
Panhoca and Pupo (2010)	Caregiver stress due to communication difficulties in aphasia	CP	Burden Interview, Zarit; Demographic Questionnaire; Semi-structured interview.	Standardized questionnaire: Burden Interview, Zarit as well as demographic data via interview. Physical, social and emotional burden; Demographic data: sex, age, education (years), time spent as a caregiver, relationship to the PWA, difficulties in dealing with PWA, Aphasia type. Qualitative data from interviews.	Approximately 94% of participants reported difficulties in being a caregiver of PWA. The biggest complaint was about language and communication (43.3%). Those who had this complaint had on average a greater burden score. Caregivers reported distress when the PWA shows irritation due to not being understood, implying emotional consequences to issues of communication.
Ponte and Fedosse (2016)	Impact of aphasia on the family caregiver	PWBI, CP	Questionnaires, semi-structured interview	International Classification of Functioning, Disability, and Health (ICF) and World Health Organization Quality of Life – Bref (WHOQOL – Bref) were both applied to the participants. Qualitative analysis of the interview was also utilized.	The onset brain damage related impairments disrupt the injured individuals and their families (informal caregiver), affecting QOL in all domains, especially in the physical and environmental domains of relatives/caregivers. The relatives/caregivers (77.7% women; 96.3%, primary caregivers; mean age 52.6 years, and low schooling), observed changes in the work routine and family structure (85.2%). Communication difficulties with the caregiver results in consequences in care.

NA = not applicable, NS = not stated, M = male, F = female, ES = elementary school, HS = high school, C = college, PT = Physiotherapists, HA = Health Assistants, SLT = Speech-Language Therapist, OT = Occupational Therapist; FM = family members, HP = Health Professionals, FYS = final year health students, PWBI = People with brain injuries, QOL = quality of life.

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