ACQ Vol 13 No1 2011

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ACQ Volume 13, Number 1 2011 3
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
of the positive and negative aspects of the aphasia
communication treatment groups. Semi-structured
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
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