A framework for description and analysis of therapy for language impairment in aphasia

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Background: The methods used by therapists in the process of language therapy with people with aphasia are seldom explicitly described in therapy studies. Language impairment therapy is often reported in terms of tasks or activities. Reference to cueing or feedback may be made, but the role played by the person with aphasia in these processes usually goes unreported. It has been argued, however, that therapy is not synonymous with the task but takes place through the interactive work between therapist and person with aphasia.

Aims: To examine therapy between experienced clinicians and people with aphasia in day‐to‐day practice, addressing a number of questions relating to: the characteristic features of the interaction between therapist and aphasic person; identification of the “main business” of the session; the relationship between the “main business” and other aspects of the session; the evidence for more explicit definitions of therapy techniques such as those described in the literature as “cueing”, “prompting”, “scaffolding”, “facilitation”, and “feedback”. These questions were addressed with the aim of making description of therapy practice more explicit in order (1) to improve the quality of therapy studies, including replications (which rely on, among other things, detailed reporting of treatment variables); (2) to improve understanding of what “works”/“doesn't work”; (3) to improve understanding of the contributions of both therapist and client; (4) to improve the quality and effectiveness of therapy; (5) to improve communication with clients, carers, other professionals, and students.

Methods and Procedures: In order to develop an explicit and consistent vocabulary for describing and analysing the enactment of therapy, an observational study was carried out. A total of 15 therapist–aphasic person dyads participated in the study, contributing videotape and audiotape recordings of 41 therapy sessions. Videotapes and audiotape transcriptions were subject to qualitative analysis using a variety of methods derived from ethnography and Conversation Analysis.

Outcomes & Results: This study describes the enactment of tasks in ways that (1) account for the interactive nature of therapist and aphasic person contributions; (2) demonstrate how processes of task‐related work are distributed across the session as a whole; and (3) address task‐related work as a technical and a social process.

Conclusions: In this study therapy is examined and the processes through which it takes place are made explicit in a systematic and orderly fashion, addressing the ways in which task‐related work is enacted, and revealing the roles of the participants in the conduct of that work.

This study confirms the scope of previous conceptualisations of the enactment of therapy, and provides a data‐driven description of therapy. In addition, processes through which therapists gained and maintained control of sessions were found to be similar to those reported in studies of other healthcare settings.
Original languageEnglish
Pages (from-to)528-564
Number of pages37
Issue number6
Publication statusPublished - 2006

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