People with severe and moderate aphasia and their partners as estimators of communicative skills: A client‐centred evaluation

Abstract

Background: According to the philosophy of the social model of disability, clients are the best estimators of their own life situation. Eliciting the experiences of people with severe aphasia is demanding because of their language and possible other cognitive problems. They are therefore usually excluded from the studies. However, there is evidence that modified assessment tools are accessible for them and help them to give self-reports. Aims: The aim of the present study was to ascertain how people with aphasia evaluate their own communicative skills during rehabilitation by means of modified assessment tools. In addition, their answers were compared with the estimations of their significant others or other partners. Methods & Procedures:The data were collected during regular rehabilitation courses, which were carried out in two parts (8 + 4 days) with 3 months in between. Participants were 35 respondents with aphasia, aged 26 to 65 years, and 35 of their significant others or other partners, aged 29 to 71 years. The study was completed according to an initial, interim, and delayed post-test questionnaire design. Two measures were used: the Finnish version of the Communicative Effectiveness Index (CETI) and an investigator-constructed questionnaire, the Use of Different Communication Methods (UDCM). The questionnaires for the people with aphasia were made more accessible by pictures. Outcomes & Results: The self-assessments of the participants with aphasia indicated that their functional communication skills did not change, but that the use of different communication methods improved slightly during the intervention. The significant others' and other partners' estimations showed that their communication skills improved significantly. Ratings of the two groups in functional communication skills differed significantly from each other before the intervention but thereafter the estimates correlated. There were no significant differences in the ratings of the use of different communication methods at any phase of the follow-up study. However, the ratings correlated significantly only at the last assessment.

Expert Versus Proxy Rating of Verbal Communicative Ability of People with Aphasia after Stroke

“…Hierarchical multivariate regression analysis of agreement between proxy and expert rating of the verbal communicative ability of a person with aphasia (absolute difference between ANELT and PCQ) at 6 months, range 0 to 4 (n = 53) proxies' and experts' view on the communicative abilities of the people with aphasia. Our finding that the proxies rated the verbal communicative ability of people with aphasia slightly higher than the SLTs is in line with previous studies (Helmick et al, 1976;Taylor, 1965) and provides some support for the notion that people with aphasia communicate better in natural contexts than would be anticipated by results of standardized tests (Manochiopinig et al, 1992;Rautakoski et al, 2008). It is unknown whose judgment most accurately appraises the actual communication of the person with aphasia, the expert's or the proxy's.…”

“…The ANELT appears to be a fair test with significant ecological validity, particularly in people with milder aphasia. The fact that all participants received therapy in our study might have influenced the level of agreement: expert and proxy ratings have been shown to align better in couples of whom the person with aphasia was receiving aphasia treatment (Rautakoski et al, 2008;Shewan & Cameron, 1984).…”

Partners' self-perceptions of the use of different communication strategies during total communication intervention

“…They also listen to lectures by a neurologist and a social worker. More information concerning the structure and activities of the courses can be found in Rautakoski (2011) and Rautakoski, Korpijaakko-Huuhka, and Klippi (2008).…”

“…The second questionnaire was returned when the couple entered the second course period and the third when the investigator made a home visit 6 months after the intervention. More information concerning the data collection can be found in Rautakoski (2011) and Rautakoski et al (2008).…”

The self-determined and partner-predicted topic preferences of adults with aphasia

“…Adults with moderate to severe expressive aphasia are the target population for the proposed study due to the overall paucity of research involving the active participation of adults with moderate to severe expressive aphasia (Rautakoski, Korpijaakko-Huuhka & Klippi, 2008). Adults with this classification of aphasia are also appropriate candidates for AAC (Hux et al, 2001).…”