ACQ Vol 13 No1 2011

improve. A fifth positive psychosocial aspect identified in the study was the participants liking the support of others with aphasia, which can be categorised within the Environmental Factors component of the ICF . The sixth positive psychosocial aspect of feeling more confident can be categorised as part of the Body Functions and Structures component. Within the ICF , mental functions such as “confidence” can be coded as a Body Function or be considered to be a Personal Factor by identifying whether the characteristic existed prior to the onset of the health condition such as aphasia (Threats, 2007). If an individual tended to be confident prior to the onset of aphasia and continued to be confident after the onset of the communication disorder, then it may be considered to be a Personal Factor. However, if confidence has been affected by the onset of aphasia such as in the Elman and Bernstein- Ellis (1999b) study, then it is coded as a Body Function. All the positive aspects identified by the participants in this investigation can be considered to be benefits of the groups. Some of the positive aspects identified by the participants such as liking the support of others and being able to help others were not specifically identified within the intended goals of the therapy. This finding suggests that groups may provide indirect benefits that are not explicitly identified as goals of the treatment. Furthermore, even though there were specific goals for the group such as improving the participants’ understanding of the communication disorder, the outcome of some of the treatment goals was not explicitly measured or reported on in the study. Activities and Participation At least two studies have demonstrated benefits only within the Activities and Participation component of the ICF . For example, Aten et al. (1982) investigated a group treatment for seven participants with chronic aphasia that focused on improving specific functional communication activities such as using social greetings, supplying personal information, and reading signs and directories. The participants demonstrated improvements in the Activities and Participation component with statistically significant improvements in their post-treatment performance on the CADL. In another study, Ross, Winslow, Marchant, and Brumfitt (2006) investigated an aphasia group treatment for seven participants with chronic aphasia that focused on developing total communication and conversation skills, engaging in social participation, and developing an understanding of disability and rights. Immediately after treatment and at three months post-treatment, the participants demonstrated statistically significant positive changes on the Conversational Analysis Profile for People with Aphasia Part B (CAPPA-B; Whitworth, Perkins, & Lesser, 1997), a measure that requires participants to rate conversation experiences in areas such as conversation situations, conversation topics, and styles of conversations. This finding provides evidence of benefits of the group within the Activities and Participation component. The authors note that the groups did not specifically focus on improving conversation experiences, again suggesting that groups may provide indirect benefits that are not specifically related to the goals of the groups. In addition, although the group reportedly aimed to help the participants develop an understanding of disabilities and rights, the authors did not report how or if the outcome of this goal was assessed. Activities and Participation, and Environmental Factors As part of a larger study investigating the role of social networks in aphasia groups, Vickers (2010) examined the

impact of attending an aphasia treatment group compared to not attending the group. The group focused on the use of multi-modality communication in natural conversations and the development of new social networks. The aphasia group attendees comprised 28 participants, while the comparison group consisted of 12 individuals with aphasia who were not attending the aphasia group. Group attendees reported significantly higher levels of social participation on the Survey of Communication and Social Participation (Vickers & Threats, 2007) than that reported by the non-attendees, indicating benefits within the Activities and Participation component. In addition, compared to non-attendees, the participants who attended the aphasia group reported significantly greater frequency of contact within their social networks on the Social Networks Communication Inventory (Blackstone & Hunt-Berg, 2003) and less perceived social isolation on the Friendship Scale (Hawthorne, 2006), both findings associated with benefits within the Environmental Factors component of the ICF . Activities and Participation, and Personal Factors One study that found aphasia group benefits within the Personal Factors component was conducted by Brumfitt and Sheeran (1997). The investigators evaluated an aphasia group involving six individuals with aphasia in addition to two participants who had stuttering difficulties. The aim of the group was to improve the participants’ communicative competence, their attitude to communication, and their self-esteem and well-being. The participants with aphasia demonstrated significant improvements post-treatment on the Functional Communication Profile (Sarno, 1975), a rating scale that includes everyday communication functions (e.g., understanding conversation) and can therefore be considered to rate Activities and Participation. The participants also demonstrated statistically significant improvements after treatment on the Stutterer’s Self-Ratings of Reactions to Speech Situations Scale, a measure designed for individuals who stutter that requires self-ratings of reactions to or avoidance of various speaking situations. This scale can be considered to address an individual’s behaviour pattern and coping style, a factor within the Personal Factors component of the ICF . Quality of life At least one study has shown benefits related to QOL for individuals with aphasia participating in groups. Hoen, Thelander, and Worsley (1997) investigated the impact of a community-based group program that offered long-term support for people with aphasia. The group, led by volunteers under the guidance of SPs, focused on providing the individuals with opportunities to exchange ideas, to make new friends, and to learn to use adaptations such as drawing and gestures to improve communication effectiveness. Thirty-five participants with chronic aphasia, who had enrolled for varying lengths of time in the service, were assessed at two different time periods, six months apart. The participants demonstrated significant positive changes on five of the six psychological well-being scales of a condensed version of the Ryff’s Psychological Well-being Scale (Ryff, 1989): Autonomy, Environmental Mastery, Personal Growth, Purpose in Life, and Self-acceptance. This finding suggests that group attendance had a positive impact in the area of QOL. Again, although the group reportedly focused on goals such as improving communication effectiveness using adaptations, the outcome of this aim was not specifically assessed in the study.

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ACQ Volume 13, Number 1 2011

ACQ uiring knowledge in speech, language and hearing