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Abstract
Background: When the relationship between a clinician and a client with aphasia is not strong, engaging the client in therapy may become a clinical challenge. Engagement, in this context, refers to the client’s interpersonal involvement and emotional connection to the individuals, activities and ideas present in the therapy session. It is foundational for evoking the interest needed to achieve clinical goals. Persons with aphasia may internalise positional designations associated with illness rather than authority, and as a result become disengaged in the therapeutic process. Including an intergenerational participant in therapy may offer those with aphasia an opportunity to assume new roles. Favourable outcomes have been reported when intergenerational relationships are formed for the purpose of generating engagement, although these studies are limited in the field of aphasia.
Aim: The aim of this instrumental case study was to describe how introducing an intergenerational relationship between a participant (Anna) with aphasia and a preschool-age boy (Jacob) influenced Anna’s engagement during aphasia therapy.
Methods & Procedures: Recordings of four routine language therapy sessions with Anna and her clinician, and six intergenerational therapy sessions with Jacob, Anna and Anna’s clinician were examined in this pilot study. The Myers Research Institute-Engagement Scale (MRI-ES) , the Observed Emotion Scale (OES) and a speech act analysis were used to compare Anna’s behaviours during routine language-therapy sessions and intergenerational therapy sessions.
Outcomes & Results: Poor engagement during routine therapy session was considered a barrier to Anna’s clinical progress. Anna’s behaviour suggested that she found the environment created with the intergenerational participant more engaging. She displayed more interpersonal involvement in the session as measured by the MRI-ES and more emotional connection to the activities/participants in the session as measured by the OES. During the intergenerational sessions, the speech acts that Anna used were similar to those reportedly used by speech–language clinicians, which was not the case during routine sessions.
Conclusions: Acknowledging a less than ideal relationship between Anna and her clinician, and then modifying the sessions by introducing an intergenerational participant created an environment that was more engaging for the client with aphasia. Outcomes are discussed from the perspective of interactional role theory.