Social validation as a measure of improvement after aphasia treatment: Its usefulness and influencing factors

Abstract

Background: Standardised language tests are the most commonly used assessment tool of aphasia by Speech-Language Pathologists (Katz et al., 2000), yet they are limited in their ability to provide information regarding a person's ability to communicate in daily life. Social validation is a less commonly used type of assessment, but one that may provide additional information regarding language and communication abilities, based on the perceptions of persons not directly involved in the treatment. Despite its potential, there remain questions regarding its optimal use.

Aims: The goals of this study were to examine the usefulness of social validation in measuring communicative change after aphasia treatment, and to investigate the potential influence of rater characteristics on raters' perceptions.

Methods & Procedures: Narratives were elicited before and after naming treatment from 11 participants with aphasia: 7 participants were treated, 4 of whom improved and 3 of whom did not; 4 participants did not receive treatment. Three groups of 10 raters (speech-language pathologists, older and younger naïve adults) evaluated the narratives, and their ratings of the pre- and post-treatment narratives were analysed for perceived improvement.

Outcomes & Results: Results indicated that all three groups of raters observed improvement in the two treated groups of participants with aphasia, but not in the untreated group of participants with aphasia.

Conclusions: Raters' perceptions of narratives (i.e., social validation) provide a useful measure of change after aphasia treatment, which can easily be used to supplement objective language measures. Additionally, factors such as the rater's experience with aphasia or life experience do not appear to have an important influence on rater perceptions.

Keywords:

• Social validation
• Aphasia treatment
• Assessment
• Communication
• Language

Portions of this work were presented at the TENNET meeting in Montreal, 2007 (Cupit, Rochon, Leonard, & Laird, 2008), the Living Successfully with Aphasia: Intervention, Evaluation and Evidence Conference in Toronto, 2007, at the Academy of Aphasia meeting in Washington, 2007 (Cupit, Rochon, Leonard, & Laird, 2007), and the Canadian Association of Speech-Language Pathologists and Audiologists meeting in Kananaskis, Alberta, 2008.

This project was supported by grant number NA 5379 from the Heart and Stroke Foundation of Ontario, as well as a Doctoral Research award from the Canadian Institutes of Health Research to J. Cupit. The authors are grateful to the Aphasia Institute, the York Durham Aphasia Centre, and the Aphasia Centre of Ottawa-Carleton for allowing us to recruit participants from their institutions and to all the individuals who participated in this research. Lauren Reznick provided valuable assistance.

Notes

¹Parameter taken from Le Dorze et al. (1994).

²Note that during each session raters heard both the narratives that are the subject of this paper as well as shorter, 30-second narratives that are the subject of another experiment.

³Although the sample size is relatively small, a parametric statistic was used as the ANOVA is quite robust to violations to the assumptions of homogeneity of variance if the sample sizes are equal (Howell, 2004).

⁴The univariate test was adjusted with the Huynh-Feldt epsilons because the assumption of sphericity was violated. (Leech, Barrett, & Morgan, 2004).

⁵We thank two anonymous reviewers for pointing this out.