Communication changes and SLP services according to significant others of persons with aphasia

Abstract

Background: Significant others are important to persons with aphasia. For several reasons they should be involved in speech-language pathology (SLP) services, including acquiring facilitating communicative strategies and receiving support. In order to further adapt SLP services there is a need to know the perceptions and views of the significant others. Little is known about how they perceive changes in communication as well as received SLP services and in what way they want to be involved in these services.

Aims: The study aimed to investigate which communicative changes significant others of persons with aphasia had experienced after a stroke event and to what extent these changes were experienced. A further aim was to describe the significant others' experiences of SLP services and their motivation to participate in these services. Finally, the significant others' experiences were compared in terms of sex, age, type of relationship, time since stroke onset, and type and severity of aphasia.

Methods & Procedures: An 80-item study-specific questionnaire was answered by 173 significant others of persons with aphasia living throughout Sweden (response rate 69%). Of these, 33% were male and 67% female. Mean age was 64.2 years (range 33–87 years) and 85.5% of the participants were a cohabiting partner to a person with aphasia.

Outcomes & Results: A total of 64% of participants perceived their conversations as being less stimulating and enjoyable compared with conversations before stroke onset. Aphasia was considered a substantial or very substantial problem by 64%. The participants took on an increased communicative responsibility, and 70% had changed their communicative behaviour in order to facilitate conversations. A total of 75% (n = 130) had met with the SLP of the person with aphasia. Of those, 63% perceived their own support from SLP services to be adequate; 87% considered language ability training as the most important SLP service. Type and severity of aphasia were especially related to the communicative experiences of the participants and their motivation to be involved in SLP services.

Conclusions: The substantial decrease from pre- to post-stroke regarding enjoyment and meaningfulness of conversations suggests the need to further improve SLP services in order to help the people in question communicate at an optimal level. We suggest that clinicians should put more emphasis on explaining the benefits and availability of different kinds of aphasia rehabilitation services, such as functional communication training and communication partner training in addition to language ability training.

Keywords:

• Aphasia
• Significant others
• Interpersonal communication
• Communication strategies
• Speech-language pathology services

Acknowledgments

Special thanks go to the significant others who took time to share their perceptions and experiences with us. The authors would also like to thank Eva Sandin (SLP) and Marianne Åkerlund (The Swedish Aphasia Association) for valuable comments and support during the working process. Further, the authors would like to express gratitude to the SLPs who recruited the participants. The project was undertaken with the financial support from the Swedish Stroke Foundation and the Department of Public Health and Caring Sciences, Uppsala University.

Notes

¹Regarding the classification of type of aphasia, the following instruction was given to the recruiting SLPs: “This is a rough division into type of aphasia. ‘Anterior aphasia’ comprises Broca's aphasia and transcortical motor aphasia, ‘Posterior aphasia’ comprises Wernicke's aphasia, anomic aphasia, conduction aphasia, and transcortical sensory aphasia. If the person has symptoms of both anterior and posterior aphasia, state the type that dominates, i.e., predominantly anterior or posterior aphasia. ‘Global aphasia’ should only be stated if the person has substantially posterior and anterior aphasia symptoms.”

²Perceived aphasia severity was estimated by the significant other and used in this analysis because data about the aphasia of the AA-recruited participants could not be collected. In all other analyses the aphasia severity as classified by the recruiting SLP was employed, which means that these analyses only comprise the SLP-sample, n = 139.

³Psychosocial intervention was explained as “discussions with the person with aphasia or significant other about living with aphasia and how aphasia affects their lives”.