Relations entre les orthophonistes et les proches de personnes aphasiques en contexte de réadaptation

The role speech-language therapy (SLT) services play in significant others’ adjustment to stroke and aphasia as well as the context in which SLTs offer interventions to significant others are currently unknown. The present dissertation aims to understand how in rehabilitation settings, relationships between SLTs and significant others of persons with aphasia develop, and fit within significant others’ process of change, on one hand, and into SLTs’ practice, on the other hand. A grounded theory approach was used in four studies to analyze interviews conducted with significant others of persons with aphasia and with SLTs. In study 1, four daughters of aphasic women were each interviewed three times over the first year post-stroke and their discourse was analyzed. A theoretical model of the daughter-mother relationship was constructed. This model shows how the daughters’ perception of maternal fragility, problems, and abilities motivated daughters to take on protective and trusting behaviors that resulted in maternal reactions of satisfaction and dissatisfaction that, in turn, reinforced the daughters’ initial perceptions. Four relational patterns may therefore coexist in a given dyad. Aphasia could make relational adjustments more complex. In study 2, three interviews conducted over the period of one year with the daughter of a woman with severe aphasia were analyzed. A theoretical model representing the experience of caregiving was elaborated. This model illustrates that for the daughter, perceiving her mother’s problems and feeling their previous relationship was threatened triggered the caregiving process. In parallel, the daughter’s recognition of her mother’s competence encouraged her to offer care aiming to make her mother happy and to foster her mother’s independence. Increases in her mother’s independence, a renewal of their relationship and adaptation to aphasia were consequences of this type of caregiving. In study 3, the interviews conducted with 12 significant others of aphasic persons were analyzed. A theoretical model representing significant others’ experience of aphasia and rehabilitation following stroke was developed and showed that significant others participated in rehabilitation as caregivers centered on the person who had aphasia. This disposition influenced their expectations of rehabilitation, their interactions with professionals, such as SLTs, and how they appraised rehabilitation. In study 4, the interviews conducted with eight SLTs working in rehabilitation settings were analyzed. A theoretical model representing SLTs’ process of working with significant others of persons with aphasia was elaborated. SLTs mostly perceived work with significant others as a challenging bonus to their fundamental approach centered on the person with aphasia. As a consequence, SLTs felt professional satisfaction while dreaming for something more to offer significant others. The relationship between significant others and SLTs thus mainly seem to focus on the caregiver role endorsed by significant others as a result of the experience of each of them. Expanding the shared territory of SLTs and significant others could support significant others’ adjustment to the relational changes induced by stroke and aphasia and could help SLTs attain their professional dreams.

Keyphrases: Aphasia, Stroke, Rehabilitation, Significant others, Speech-language therapists, Professional practice