Outcome of Strategy Training for Partners of Individuals with Aphasia

1
Outcome of Strategy Training for Partners of
Individuals with Aphasia

• Pamela Johnson and Mary Purdy
• Southern Connecticut State University

2
Abstract

• Aphasia impacts individuals with aphasia and
  their communication partners. This study
  investigated whether training partners to use
  communication strategies would improve
  communication. A woman with severe aphasia and
  her significant other participated in a group
  education/training program. Transactional
  communication samples were transcribed and
  analyzed pre- and post-training. Results yielded
  an increase in the number and type of strategies
  used by the partner post-intervention in the
  clinic and home. However, the effectiveness of
  the exchanges did not change. Results are
  discussed relative to severity of aphasia and
  partner participation.

3
Introduction

• Management for persons with aphasia is shifting
  from treatment of the impairment to increasing
  the level of participation at home, at work, and
  in the community.
• There is recognition of the need to include
  caregivers in management, and promising treatment
  effects are evident with partner-based
  interventions.
• However, studies have varied in terms of
• who received the training (volunteer, family
  member)
• the type of training (individual or group,
  strategy usage or feedback on conversation
  style)
• where the training occurred (clinic or home)
• whether training generalized to other settings

4

• The present study was a replication and extension
  of Purdy and Hindenlangs (2005) study.
• Partner training was implemented in a group
  setting within the clinic.
• However, generalization to the home environment
  was also examined.
• Quality of life of the communication partner was
  also assessed.

5
METHOD

• Participants
• 72 year-old woman with severe aphasia, verbal
  apraxia, and right-sided hemiparesis, one year
  post her third stroke.
• CADL-2 raw score 35, 38th percentile
• WAB yes/no questions 13/20
• BDAE-3 picture identification 0/12 (semantically
  related choices) 13/18 (unrelated choices).
• Stereotypic speech yes, yes, yesno other
  verbal output
• Lives alone in an assisted living facility
• Her 84 year-old significant other of 4 years.
• Lives in nearby condominium

6
Assessment

• Participant with aphasia was shown 2 pictures
  (e.g., A woman holding a cat) and asked to
  communicate its contents to her partner.
• Props were available for communication partner to
  use.
• Modified version of Burden of Stroke Scale
  (BOSS), 27-item QoL questionnaire (Doyle
  McNeil, 2005) given to communication partner.

7
Training

• Couple participated in an 8-week group
  education/training program with 3 other dyads.
• Information regarding stroke/aphasia was provided
  in didactic format.
• Strategies were discussed/practiced using Kolbs
  (1984) experiential learning cycle model
  (concrete experiences, reflective observation,
  abstract conceptualization, active
  experimentation).

8
Analysis

• All verbal and nonverbal exchanges were
  transcribed from videotapes.
• Each exchange was coded (e.g., adequate/
  inadequate responses communication
  breakdowns/repairs).
• Transactions were scored as successful (content
  of picture accurately communicated) or
  unsuccessful (none or part of picture
  communicated).

9
Reliability

• Intra- and inter-rater reliability obtained by
  having researchers independently score 2
  transcripts (one pre- and one post-intervention).
• Point-to-point agreement ranged from 95-100. All
  discrepancies were resolved.

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RESULTS

• 1. Will training a communication partner in a
  group setting to use specific strategies with his
  partner with aphasia result in increased strategy
  usage?
• An increase in frequency and variety of
  strategies was documented (Table 1).
• 2. Will training a communication partner in a
  group setting result in more effective
  communication?
• Transactional exchanges during both pre- and
  post-intervention were unsuccessful (0/2 0/1).

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• 3. Will training a communication partner in a
  group setting result in more efficient
  communication?
• Efficiency could not be determined.
• Elements contributing to efficiency were
  examined.
• Pre-intervention 8 communication breakdowns, 3
  successfully repaired (38).
• Post-intervention 4 communication breakdowns, 2
  successfully repaired (50).

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• 4. Will changes in communication noted in the
  clinic occur in the home environment?
• Communication partner maintained or increased
  frequency of strategy usage in home (see Table
  2).
• 5. Will training result in an improvement in
  overall quality of life for the communication
  partner?
• Total pre-intervention combined score 52
  (mean1.9) suggesting borderline mildly impaired
  QoL.
• Total post-intervention combined score 61
  (mean2.3) also suggesting mildly impaired QoL
  (see Table 3).

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Table 1. Comparison of the type and frequency of
strategies used by the communication partner pre-
(N60) and post-intervention (N24) in the clinic
(some strategies were used simultaneously)

• Pre-Intervention (Clinic)
  Post-Intervention (Clinic)
• Yes/no questions (85) Yes/no
  questions (71)
• Gesture (18) Gesture (4)
• Repetition (10)
  Repetition (42)
  Spoken/written choices (21)
• Props (13)
• Slow rate
• Broad to specific
  questions

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Table 2. Comparison of the frequencies and types
of strategies used (total24) by the
communication partner post-intervention in the
clinic and home (some strategies were used
simultaneously)

• Post-Intervention (Clinic)
  Post-Intervention (Home)
• Yes/no questions (71) Yes/no
  questions (88)
• Gesture (4) Gesture (8)
• Repetition (42) Repetition (33)
• Spoken/written choices (21) Spoken/written
  choices (42)
• Props (13) Props (4)
• Slow rate Writing (42)
• Broad to specific questions Drawing (0)
• Slow rate
• 
  Broad to specific questions

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Table 3. BOSS revised for caregivers mean
scores pre- and post-intervention
Category Pre
Post ______________________________
___________________ Communication
Difficulty 2.5 2.6 Social Situations/Relationsh
ips 1.1 1.9 Negative Emotions
2.0 2.4 Positive Emotions 2.0 2.0 Mean

1.9 2.3___ 1normal 2mild
3mild-moderate 4moderate-severe
5severe
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DISCUSSION

• Training had a successful impact on communication
  partner learning new facilitative techniques.
  Results consistent with Cunningham and Ward
  (2003), Kagan et al. (2001), and Purdy and
  Hindenlang (2005).
• Communication partner increased use of
  strategies.
• Level of frustration for both partners reduced
  when strategies were used.
• Trends resulted in communication partner
  acknowledging and revealing competence.

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• No improvement in overall effectiveness of
  transactional exchanges. Results differed from
  Purdy and Hindenlang (2005) and Kagan et al.s
  (2001) studies but were similar to Cunningham and
  Wards (2003) study.
• No substantial change in the number of individual
  units of information determined by the
  communication partner.
• There was a qualitative shift, however, in
  communicative attempts.

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• Limited success likely due to severity of
  aphasia.
• Individuals with severe aphasia need additional
  support.
• Individual speech therapy in conjunction with
  training program.
• Individualized AAC system in combination with
  facilitative strategies communication partner
  learned in training program.

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• Overall efficiency could not be determined
  because transactional exchanges remained
  unsuccessful.
• Post-intervention
• number of communication breakdowns decreased.
• percent of successful repair sequences increased.
• Communication partner used facilitative
  strategies learned in the clinic and incorporated
  them into the home environment. Findings
  consistent with Simmons-Mackie et al. (2005).

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• No clinical change in quality of life for the
  communication partner. Findings inconsistent with
  Purdy and Hindenlangs (2005) study consistent
  with Cunningham and Wards (2003) study. This may
  be due to
• Level of severity of the participant with aphasia
• Fewer training sessions
• Communication partner did not live with
  participant with aphasia
• Additional life stresses for communication partner

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Clinical Implications

• Benefits of group education and training program.
• Fostered bonding
• Social/psychosocial support
• Communication successes/challenges
• Joint problem-solving
• Provided avenues for facilitating successful
  interactions and improving collaboration.

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Limitations and Suggestions for Future Research

• Limited number of participants.
• Examine benefit of training program on a larger
  group of participants with a range of aphasia
  severity.
• Limited number of training sessions.
• Examine benefit of a more intensive training
  schedule.

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• Participant with aphasia may have additional
  cognitive impairments due to multiple strokes.
• Assess cognitive functions of partner with
  aphasia and their impact on performance.
• Communication partner did not reside with
  participant with aphasia.
• Explore benefit of training with a partner who
  has ample opportunities to communicate with
  person with aphasia.
• Specific partner variables were not identified.
• Acknowledgement of specific traits of
  communication partner.

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• Future studies may also explore
• Success and maintenance of learned strategies in
  the home after a period of time.
• Factors predicting who is most likely to benefit
  from training.
• Therapy approach/system of training related to
  specific severity of aphasia.

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References

• Cunningham, R. Ward, C.D., (2003). Evaluation
  of a training programme to facilitate
  conversation between people with aphasia and
  their partners. Aphasiology, 17(8), 687-707.
• Doyle, P.J., McNeil, M.R. (2005). The burden of
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  Pittsburgh.
• Goodglass, H., Kaplan, E., Barresi, B. (2001).
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• Holland, A., Fratalli, C., Fromm, D. (1999).
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• Kagan, A., Black, S.E., Duchan, J.F.,
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• Kolb, D. (1984). Experiential learning
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  Inc.
• Purdy, M., Hindenlang, J. (2005). Educating and
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• Simmons-Mackie, N., Kearns, K.P., Potechin, G.
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