Online Aphasia Groups: Navigating Issues of Voice and Identity.

PURPOSE: Participation in aphasia groups is associated with increased communication, reduced feelings of social isolation, and increased quality of life. Despite the growing popularity of online aphasia groups, little is known about how to manage conversation in this format. We examined online aphasia book club sessions to examine how the facilitator supported group members' participation in conversation. METHOD: Interactional sociolinguistic discourse analysis was used to analyze the behaviors and actions of the facilitator and group members. Qualitative data for this study were drawn from four recorded online aphasia book club sessions held through a university's free aphasia clinic on the Zoom web-conferencing platform. RESULTS: Sociolinguistic discourse analysis revealed strategic facilitator behaviors that served to (a) give members with varying levels of verbal language abilities voice, (b) foreground or background aspects of voice, and (c) minimize her own voice to promote interactional symmetry between herself and group members. CONCLUSIONS: Identity formed the backdrop for facilitators' actions when leading online groups, guiding decisions about who got to talk, when, for how long, through what modality, and about what topics. A better understanding of the interactions that occur online, such as how to develop and protect the identities of group members, could equip facilitators with the tools necessary for facilitating positive, engaging aphasia therapy groups online.

Still Searching for Understanding: The Importance of Diverse Research Designs, Methods, and Perspectives.

BACKGROUND: Evidence-based medicine and evidence hierarchies have been widely adopted and have strongly influenced decision making across many fields, including clinical aphasiology. However, questions remain about the creation, usefulness, and validity of current evidence hierarchies. AIMS: This article builds on ideas about scientific approaches and evidence originally shared by Elman (1995, 1998, 2006). This article reviews the history of evidence hierarchies and argues that improving the diversity of research designs, methods, and perspectives will improve understanding of the numerous and complex variables associated with aphasia intervention. Researchers and clinicians are encouraged to synthesize diverse types of scientific evidence. It is hoped that this article will stimulate thought and foster discussion in order to encourage high-caliber research of all types. MAIN CONTRIBUTION: Concepts from a wide variety of fields including philosophy of science, research design and methodology, and precision medicine are brought together in an attempt to focus research on the scientific understanding of aphasia treatment effects. CONCLUSION: It is hoped that by incorporating diverse research designs, methods, and perspectives, clinical aphasiologists will become better able to provide effective, personalized treatments, ensuring that each person with aphasia is able to improve their communication ability and quality of life.

Ethical Responsibilities to Adults with Communication Impairments Involved in Group Therapy.

Ethical challenges can arise when providing group therapy to adults living with communication impairments. In addition to the ethical challenges that may be encountered when conducting one-to-one therapy intervention, practitioners must also consider dilemmas that are specific to group therapy. This article considers the principles and rules of the American Speech-Language-Hearing Association (ASHA) Code of Ethics via a series of clinical vignettes that illustrate four ethical challenges that may be encountered when providing group therapy: acquiring sufficient clinical competency to conduct group therapy; handling issues related to client confidentiality; resisting external pressure to provide groups solely for financial gain and/or other administrative efficiencies; and handling practitioner-client boundaries.

Starting an aphasia center?

Starting an aphasia center can be an enormous challenge. This article provides initial issues to review and consider when deciding whether starting a new organization is right for you. Determining the need for the program in your community, the best size and possible affiliation for the organization, and available resources, as well as developing a business plan, marketing the program, and building awareness in the community, are some of the factors that are discussed. Specific examples related to starting the Aphasia Center of California are provided.

Negotiation of identity in group therapy for aphasia: the Aphasia Café.

BACKGROUND: There has been increasing interest in ensuring that aphasia intervention includes attention to the negotiation of a robust identity after the life-altering changes that often accompany the onset of aphasia. But how does one go about simultaneously improving communication and positive identity development within aphasia therapy? Socially oriented group therapy for aphasia has been touted as one means of addressing both psychosocial and communicative goals in aphasia. AIMS: This article describes the results of a sociolinguistic analysis of group therapy for aphasia in which positive personal and group identity are skilfully negotiated. METHODS & PROCEDURES: Sociolinguistic microanalysis of discourse in a group therapy session was undertaken. The session, described as group conversation therapy, included eight adults with aphasia, a speech-language pathologist and an assistant. The session was videotaped and transcribed, and the data were analysed to identify 'indices of identity' within the discourse. This included discourse that exposed members' roles, values or beliefs about themselves or others. The data were further analysed to identify 'patterns' of discourse associated with identity. The result is a detailed description of identity-enhancing discourse within group therapy for aphasia. OUTCOMES & RESULTS: The findings included several categories associated with the negotiation of identity in therapy including: (1) discourse demonstrating that group members were 'being heard', (2) that the competence of group members was assumed, (3) that 'solidarity' existed in the group, (4) that saving face and promoting positive personal identity was important, and (5) that markers of group identity were made visible via discourse that referenced both member inclusion as well as non-member exclusion. CONCLUSIONS & IMPLICATIONS: The results suggest that it is possible to create identity-enhancing interactions as part of therapy for aphasia; the analysis demonstrates the potential role of the group leader/clinician in managing identity negotiation in aphasia therapy.

The Burden of Stroke Scale (BOSS) provides valid and reliable score estimates of functioning and well-being in stroke survivors with and without communication disorders.

BACKGROUND AND OBJECTIVE: This study describes the conceptual foundation and psychometric properties of the Burden of Stroke Scale (BOSS), a patient-reported health status assessment designed to quantify the physical, cognitive, and psychological burden of stroke. METHODS: Qualitative research methods were used to develop a 112-item pilot version of the instrument. The pilot version was administered to healthy controls (n=251) and stroke survivors with (n=135) and without (n=146) communication disorders on a single occasion for the purposes of reducing the global item pool, describing the resulting scale properties, examining the dimensionality of the burden of stroke construct, and examining the known-groups validity of the instrument. RESULTS: Sixty-four items were retained, comprising 12 internally consistent and unidimensional scales. Principal components analysis revealed three second-order factors (Physical Activity Limitations, Cognitive Activity Limitations, and Psychological Distress) comprising the Burden of Stroke construct. Comparisons between groups revealed that stroke survivors reported greater activity limitations and psychological distress on all scales relative to controls, and that stroke survivors with communication disorders reported greater activity limitations on swallowing, communication, cognition, and social relations scales relative to non-communicatively disordered stroke survivors. CONCLUSION: These findings support the internal consistency of the BOSS scales, the hypothesized dimensionality of the burden of stroke construct, and the known-groups validity of the instrument.