ACQ Vol 13 No1 2011

Language disorders

Group treatment for people with aphasia A review of the benefits according to the ICF framework Tami Howe, Annette Rotherham, Gina Tillard, and Christine Wyles

Group treatments are offered by many speech pathologists for their clients with aphasia. Few studies, however, have examined the benefits of these groups. This paper provides a narrative review of those investigations that have identified benefits of group treatments for individuals with aphasia. The World Health Organization’s International Classification of Functioning, Disability and Health (ICF) is used to categorise these benefits. The review reveals that most of the benefits in the investigations fall within the Activities and Participation component of the ICF . Speech pathologists can use the findings to help them to deliver evidence-based group treatments for their clients with aphasia. M any speech pathologists (SPs) provide group treatment for their clients with aphasia (Katz et al., 2000; Verna, Davidson, & Rose, 2009). Aphasia groups have focused on a variety of areas, such as reducing activity limitations (Aten, Caligiuri, & Holland, 1982) and improving the psychosocial well-being of individuals with aphasia (Hoen, Thelander, & Worsley, 1997), as well as addressing the needs of individuals’ spouses (Johannsen- Horbach, Crone, & Wallesch, 1999). A survey of 91 American Veterans’ Administration Medical Centre clinicians found that 80% had multiple goals for their aphasia group treatments, including wide-ranging aims such as language stimulation, emotional support, carryover or generalisation, and socialisation (Kearns & Simmons, 1985). Although there have been a number of clinical reports about aphasia treatment groups (e.g., Avent; 1997, Elman, 2007), relatively few studies have been conducted to determine whether the intended goals or outcomes for a particular treatment have been met and/or whether clients obtain benefits from participating in these groups. This review examines the benefits of aphasia group therapy that have been identified in research reports. The World Health Organization’s (WHO; 2001) International Classification of Functioning, Disability and Health (ICF) , an internationally recognised framework for describing the impact of a person’s health condition on their functioning, is used as a framework to categorise the range of benefits that have been revealed in these investigations. A narrative review was used in this paper. Narrative reviews can be appropriate for discussing data in light of an underlying context (e.g., a framework such as the

ICF ) (Cook, Mulrow, & Haynes, 1997). A narrative review, unlike a systematic review, usually does not use an explicit search strategy, making it more appropriate for the scope of this Clinical Forum paper. The benefits Definitions The key terms used in this article, i.e., “benefit”, the components of the ICF , and quality of life (QOL), are defined in this section. For the purposes of this review, a benefit of an aphasia group refers to “a helpful or good effect” (Cambridge University Press, 2010) for an individual with aphasia that can be attributed to participation in a group treatment and that has been documented as part of or as the main findings of a study. A benefit includes statistically significant improvements in post-treatment outcome measures and/or positive effects reported by participants with aphasia during qualitative interviews. Quantitative studies that do not provide information about the statistical significance of the results (e.g., Borenstein, Linell, & Wahrborg, 1987; Marshall, 1993) have not been included. Studies that have focused on a varied range of group therapies for each participant, rather than a specific group treatment, have also been excluded (e.g., van der Gaag et al., 2005). One approach for better understanding the range of benefits identified in the research is to use an internationally recognised framework such as the ICF to categorise the findings. The ICF is a conceptual framework and classification tool that provides clinicians with a standard language for describing and documenting the impact of a health condition such as aphasia within the context of an individual’s life (WHO, 2001). In Australia, the ICF has been used in the Speech Pathology Australia Scope of Practice in Speech Pathology document (Speech Pathology Australia, 2003). Similarly in the United States, the ICF has been used as the framework for the profession in the Scope of Practice for Speech- Language Pathology (American Speech-Language-Hearing Association, 2001). Furthermore, use of the ICF has been recommended for identifying outcomes specifically in relation to aphasia group therapy (Glista & Pollens, 2007). The ICF has four components: (a) Body Functions and Structures, (b) Activities and Participation, (c) Environmental Factors, and (d) Personal Factors. The first two components are part of a grouping called Functioning and Disability, whereas the latter two components are part of a grouping called Contextual Factors. Body Functions involve “the physiological functions of body systems” such as the “expression of spoken

This article has been peer- reviewed Keywords APHASIA GROUPS TREATMENT ICF QUALITY OF LIFE

Tami Howe (top) and Annette Rotherham

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ACQ Volume 13, Number 1 2011

ACQ uiring knowledge in speech, language and hearing