ACQ Vol 13 No1 2011

two measures of Activities and Participation: a conversational rating to determine the person’s conversational ability and an informant’s rating in which a family member or friend rated the person’s functional language use. Bollinger, Musson, and Holland (1993) also demonstrated the benefits of a group treatment within the components of Body Functions and Structures and Activities and Participation. The groups involved 10 participants with chronic aphasia who received two blocks of contemporary group treatment (e.g., greetings and socialisation, practising money concepts) and structured television viewing treatment (e.g., viewing a television program segment, recalling the main events of the segment), as well as two periods of treatment withdrawal. Participants’ scores on the PICA (Porch, 1981), a linguistic measure that falls within the Body Functions and Structures component, improved significantly after both treatment blocks. The participants also showed significant changes on the Communicative Abilities in Daily Living test (CADL; Holland, 1980) after the first block of treatment, but not after the second period. The CADL is a measure that falls within the Activities and Participation component, assessing an individual’s abilities to simulate everyday communication activities. Body Functions and Structures, Activities and Participation, and Environmental Factors Elman and Bernstein-Ellis (1999a) conducted one of the key studies in the area, comparing the effects of aphasia treatment groups to social groups. Twenty-four adults with chronic aphasia were randomly assigned to either a 4-month treatment group or a deferred treatment group. The treatment group involved 5 hours/week of communication group treatment with an SP, while the deferred treatment involved participating in 3 hours/week of social activities of the individual’s choice prior to receiving the group treatment. The communication treatment group focused on improving the participants’ understanding of the communication disorder, their ability to convey a message using any strategy and their self-awareness of personal goals, and encouraging initiation of conversational exchanges and the development of confidence for attempts at personally relevant communicative situations. Post-treatment, the therapy group demonstrated significant changes on a linguistic measure, the Western Aphasia Battery (WAB; Kertesz, 1982), indicating improvements within the Body Functions and Structure component. The treatment group also made significant changes post-treatment on the CADL (Holland, 1980). The deferred treatment group did not make significant changes on any of the measures prior to receiving the treatment. Elman and Bernstein-Ellis (1999b) also conducted a qualitative study to investigate the participants’ perceptions interviews were completed with 12 of the participants with aphasia who participated in the Elman and Bernstein-Ellis (1999a) study two times during the treatment phase, as well as four to six weeks after the treatment had been completed. Participants with aphasia reported three positive aspects of group treatment that related to speech-language and communicative abilities: enjoying conversations, improvement in talking, and improvement in reading/writing, all of which could be categorised within the Activities and Participation component. The participants also identified psychosocial positive aspects of participating in the groups, four of which involved the Activities and Participation component: liking being with others, liking making friends, liking being able to help others, and liking seeing others of the positive and negative aspects of the aphasia communication treatment groups. Semi-structured

language,” whereas Body Structures refer to “the anatomical parts of the body” (WHO, 2001, p. 10). The ICF refers to Activities as the “execution of a task or action by an individual,” such as “conversing with one person,” while Participation is defined as “involvement in a life situation” such as participating in “community life” (WHO, 2001, p. 10). The third ICF component, Environmental Factors, is defined as “the physical, social, and attitudinal environment in which people live and conduct their lives” (WHO, 2001, p. 10). An example of an Environmental Factor would be having “support and relationships” from/with friends. The final component, Personal Factors, involves “features of the individual that are not part of a health condition” such as age, coping styles, and education (WHO, 2001, p. 17). Although the ICF does not address the QOL construct directly, it recognises the importance of establishing links between the classification and QOL (WHO, 2001). The relationship between QOL and Personal Factors and Environmental Factors is thought to be particularly crucial and requires the SP to consider the context of a client’s life as being central to therapy (Cruice, 2008). QOL in relationship to the ICF refers to what people feel about their health condition or its consequences and is viewed as a construct of subjective well-being (WHO, 2001, p. 251). The remainder of the review describes the benefits of group treatment for people with aphasia in relation to the four components of the ICF (i.e., Body Functions and Structures, Activities and Participation, Environmental Factors, and Personal Factors), as well as in relation to QOL. ICF components Body Functions and Structures Benefits for the Body Functions and Structures component have been demonstrated in a number of studies using constraint-induced aphasia therapy (CIAT, also referred to as constraint-induced language therapy) (Pulvermuller, Hauk, Zohsel, Neininger, & Mohr, 2005; Pulvermuller et al., 2001), a treatment that frequently uses groups. The main goal of CIAT is to improve the participants’ impaired spoken language using intensive massed practice, responses that are constrained to spoken verbal expression, response shaping, and relevant stimuli (Kirmess & Maher, 2010). In one study that used this approach, 10 individuals with chronic aphasia received 30 hours of group CIAT over 10 consecutive working days (Pulvermuller et al., 2005). The participants demonstrated significant improvements post-treatment on the naming, comprehension, and Token Test subtests of the (Huber et al., 1983) Aachen Aphasia Test, providing evidence of benefits for CIAT within the Body Functions and Structures component. Body Functions and Structures, and Activities and Participation Benefits of groups in relation to both Body Functions and Structures, and Activities and Participation have been identified in a few investigations such as one by Wertz et al. (1981) that compared individual with group treatment. The group treatment part of the study involved 16 participants with aphasia who completed 44 weeks of 4 hours/week therapy that focused on improving communication through group interaction and discussion, as well as 4 hours/ week of group recreational activities. Group participants made significant improvements post-treatment on the linguistic measures of the Porch Index of Communicative Ability (PICA; Porch, 1967), the Word Fluency Measure (Borkowski, Benton, & Spreen, 1967), and the Token Test (DeRenzi & Vignolo, 1962), all Body Functions and Structures measures. In addition, participants made significant improvements on

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ACQ Volume 13, Number 1 2011

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