The development and evaluation of a learner-centred training program for spouses of adults with chronic aphasia

The goal of this study was to address the psychosocial sequelae of aphasia by developing and studying the effects of a learner-centred training program for spouses of adults with chronic aphasia. Previous quantitative research, which has focused on training family members, has portrayed the speech-language pathologist in a more directive expert role. The first phase of this research included the development of a communication training program that integrated principles and strategies from speech-language pathology and adult education. The program was also guided by insights gained from a needs assessment. The second phase included the delivery and evaluation of the program using a qualitative case study methodology. This design resulted in a rich and holistic account of communication in couples with chronic aphasia and was useful in documenting change in complex communication behaviours after the training program. Using videotaped data, the Couple Questionnaire, and a semi-structured interview, this study examined changes in attitudes and communication behaviours in five couples immediately after training and at two months follow-up. All data were transcribed and analysed for patterns of change. Results indicated ways in which the adult learning principles were actualized across the five cases. These were a result of viewing learning as an “inside-out” versus an “outside-in” process. The previous learning of spouses and partners with aphasia was explicitly acknowledged. Reflective learning questions were used and initiated a process whereby spouses systematically reviewed their experiences with aphasia and came to an understanding of its significance on communication with their partners. The investigator collaborated with couples to set goals and design the program agenda. Couples' learning styles and diversity were explored and addressed. Training was adjusted to the “rhythms” of learning. The investigator built on the unexpected. Written materials and practice were guided by couples' needs. Self-evaluation was used throughout the program. Themes emerged related to the expression of emotion about aphasia. These included feelings of anger, sadness and grief, and increased acceptance of the aphasia after the training. Themes related to marital issues emerged and were intertwined with emotions and communication. Communication outcomes included changes in conversational interaction as well as in the transaction of information in conversation for all five couples. These included positive changes in the management of conversational repair. There was more balanced conversational control after training. The cognitive competence of partners with aphasia was revealed after training. In addition, different conversational genres emerged throughout the program that could be organized hierarchically. These results are discussed in relation to existing literature. A systemic process paradigm of communication intervention in chronic aphasia is then proposed. Implications for future research are discussed.

Keywords: Aphasia
Speech disorders
Language disorders
Chronic diseases, Nursing
Chronic diseases, Psychological aspects
Chronically ill, Family relationships
Chronically ill, Care
Spouses, Psychology
Adjustment (Psychology)