ACQ Vol 13 No1 2011

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Language disorders
2 ACQ Volume 13, Number 1 2011 ACQuiring knowledge in speech, language and hearing
This article
has been
peer-
reviewed
Keywords
APHASIA
GROUPS
TREATMENT
ICF
QUALITY OF LIFE
Tami Howe (top)
and Annette
Rotherham
ICF) (Cook, Mulrow, & Haynes, 1997). A narrative review,
unlike a systematic review, usually does not use an explicit
search strategy, making it more appropriate for the scope of
this Clinical Forum paper.
The benefits
Definitions
The key terms used in this article, i.e., “benefit”, the components
of the ICF, and quality of life (QOL), are defined in this
section. For the purposes of this review, a benefit of an
aphasia group refers to “a helpful or good effect” (Cambridge
University Press, 2010) for an individual with aphasia that
can be attributed to participation in a group treatment and
that has been documented as part of or as the main findings
of a study. A benefit includes statistically significant
improvements in post-treatment outcome measures and/or
positive effects reported by participants with aphasia during
qualitative interviews. Quantitative studies that do not
provide information about the statistical significance of the
results (e.g., Borenstein, Linell, & Wahrborg, 1987; Marshall,
1993) have not been included. Studies that have focused on
a varied range of group therapies for each participant, rather
than a specific group treatment, have also been excluded
(e.g., van der Gaag et al., 2005).
One approach for better understanding the range of
benefits identified in the research is to use an internationally
recognised framework such as the ICF to categorise the
findings. The ICF is a conceptual framework and classification
tool that provides clinicians with a standard language for
describing and documenting the impact of a health condition
such as aphasia within the context of an individual’s life (WHO,
2001). In Australia, the ICF has been used in the Speech
Pathology Australia Scope of Practice in Speech Pathology
document (Speech Pathology Australia, 2003). Similarly in
the United States, the ICF has been used as the framework
for the profession in the Scope of Practice for Speech-
Language Pathology (American Speech-Language-Hearing
Association, 2001). Furthermore, use of the ICF has been
recommended for identifying outcomes specifically in relation
to aphasia group therapy (Glista & Pollens, 2007). The ICF
has four components: (a) Body Functions and Structures, (b)
Activities and Participation, (c) Environmental Factors, and (d)
Personal Factors. The first two components are part of a
grouping called Functioning and Disability, whereas the latter
two components are part of a grouping called Contextual
Factors. Body Functions involve “the physiological functions
of body systems” such as the “expression of spoken
Group treatments are offered by many speech
pathologists for their clients with aphasia. Few
studies, however, have examined the benefits of
these groups. This paper provides a narrative
review of those investigations that have identified
benefits of group treatments for individuals
with aphasia. The World Health Organization’s
International Classification of Functioning,
Disability and Health (ICF) is used to categorise
these benefits. The review reveals that most of
the benefits in the investigations fall within the
Activities and Participation component of the
ICF. Speech pathologists can use the findings
to help them to deliver evidence-based group
treatments for their clients with aphasia.
Many speech pathologists (SPs) provide group
treatment for their clients with aphasia (Katz et al.,
2000; Verna, Davidson, & Rose, 2009). Aphasia
groups have focused on a variety of areas, such as reducing
activity limitations (Aten, Caligiuri, & Holland, 1982) and
improving the psychosocial well-being of individuals with
aphasia (Hoen, Thelander, & Worsley, 1997), as well as
addressing the needs of individuals’ spouses (Johannsen-
Horbach, Crone, & Wallesch, 1999). A survey of 91
American Veterans’ Administration Medical Centre clinicians
found that 80% had multiple goals for their aphasia group
treatments, including wide-ranging aims such as language
stimulation, emotional support, carryover or generalisation,
and socialisation (Kearns & Simmons, 1985). Although
there have been a number of clinical reports about aphasia
treatment groups (e.g., Avent; 1997, Elman, 2007), relatively
few studies have been conducted to determine whether
the intended goals or outcomes for a particular treatment
have been met and/or whether clients obtain benefits from
participating in these groups. This review examines the
benefits of aphasia group therapy that have been identified
in research reports. The World Health Organization’s (WHO;
2001) International Classification of Functioning, Disability
and Health (ICF) , an internationally recognised framework
for describing the impact of a person’s health condition
on their functioning, is used as a framework to categorise
the range of benefits that have been revealed in these
investigations. A narrative review was used in this paper.
Narrative reviews can be appropriate for discussing data in
light of an underlying context (e.g., a framework such as the
Group treatment for
people with aphasia
A review of the benefits according to the ICF framework
Tami Howe, Annette Rotherham, Gina Tillard, and Christine Wyles