How does communication advice provided to members of the community of the person with aphasia affect those involved?

Resumen

Background: Simmons-Mackie et al. (2010) stress the importance of the relationship between the environment and the person with aphasia and the key role of the communication partner. Intervention programmes for communication partners are based on the identification of barrier behaviours in conversation and the use of facilitating strategies for communication. Aim: To explore the effect of providing communication information to shopkeepers with no previous knowledge of aphasia. Method Participants: A 60 year old woman (MM) who has lived with agrammatic aphasia for 10 years and three employees of a small supermarket, one specialising in cold meats, one in bread and the other in Italian food. MM was video-recorded at the start of the project, buying her groceries, with the aid of a shopping list. The shopkeepers were then given written information about aphasia and how to facilitate communication with MM. Four weeks later, MM returned to the supermarket and was video-recorded again. Analysis: Both tapes were transcribed and behaviours of all participants were coded. MM’s speech output was explored at impairment (e.g. frequency of verb use, function words) and activity level (e.g. asking for items from the shopkeeper). Communicative interactions between the person and the shopkeepers were observed (turn taking, repetitions, facilitators, overlaps). Results MM increased her use of function-words and verbs. Her activity level remained stable across time and shopkeepers.The shopkeepers increased their use of facilitative strategies and decreased the amount of overlap. All three reported a lack of knowledge of aphasia prior to the study and that taking part had been useful and interesting. Discussion The engagement of conversation partners in their everyday environments provides a different window of opportunity for everyone concerned. The normality of the environment facilitated the person with aphasia. The shopkeepers adapted with creativity to her needs, once they had been given some basic understanding and confidence about how to help. This kind of intervention requires time, local knowledge and organisation to accomplish. A follow up with shopkeepers would be useful to explore what else may be needed and to check how easily their learning can transfer to new people with communication disabilities. Implications for clinical practice Real world settings have challenges for time and set up and require serious consideration about how to scaffold for success while keeping the task relevant and of sufficient challenge. Conclusions. Engaging in the known environment of people with aphasia and providing information and help to those in that environment may be a useful step in the rehabilitation process for all concerned.