PARTNERCENTERED INTERVENTION FOR APHASIA

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PARTNER-CENTERED INTERVENTION FOR APHASIA

• John D. Tonkovich, Ph.D., CCC-SLP/A
• The University of Toledo and the University of
  Toledo Health Science Campus, Toledo, Ohio
• Poster Session, ASHA Convention, Boston (2007)

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Abstract

• One of the core values of the Life Participation
  Approach to Aphasia is that all those affected by
  aphasia are entitled to service. This session
  will describe an approach for modifying the
  messages of the communication partners of those
  with aphasia to enhance conversational
  interaction and to facilitate participation in
  daily living.

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Rationale for Approach

• In order to modify the communicative environments
  for persons with aphasia, all potential
  communicative partners must learn to use
  different message forms. Among the message forms
  that can be taught to partners to facilitate
  participation in persons with aphasia (PWA) are

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Supporting Messages

• Those which support the conversation (e.g., using
  multiple modalities to help the PWA with
  comprehension, providing written and/or pictured
  choices to help the PWA with expression.)

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Including Messages

• Those which include the minimally expressive PWA
  in the conversation (e.g., "Remember the party we
  had on the Fourth of July?  It was fun wasn't
  it?  And Jimmy had a little bit too much to
  drink, didn't he?) PWA can nod or indicate
  agreement/disagreement.

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Confirming Messages

• Those which serve to confirm or clarify the PWA's
  message (e.g., a PWA who was moving to the South
  was asked what he'd miss about living in
  Michigan.  He wrote S-N-O-T.  Wife wrote S-N-O-W
  and asked "is THAT what you mean?"  He laughed
  and nodded.)

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Engaging Messages

• Those which serve to make the PWA feel valued and
  be of value (e.g., I'm having a problem and I was
  hoping you could help me solve it.  I know that
  you know a lot about cars.  I have a seven year
  old car with 80,000 miles on it.  It needs 3000
  worth of work.  Should I fix it or get a new
  car.  What do you think?)

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Instructing Messages

• Those which serve to direct the PWA to try
  another strategy for conveying a message
  instructing messages often involve the use of
  props (e.g., Maybe you could try to draw it for
  me Here's a map, maybe you could try to point to
  the place you mean.)
•  

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Instructing Messages

• Those which serve to provide the PWA with
  feedback that his/her message was not understood
  (e.g., "I'm doing a pretty bad job of figuring
  out what you're trying to say"  "I'm really
  stuck...can you help me?")

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Acknowledging Messages

• Those which serve to provide the PWA with
  feedback that his/her message was not understood
  (e.g., "I'm doing a pretty bad job of figuring
  out what you're trying to say"  "I'm really
  stuck...can you help me?")

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• Assisting Messages  those which serve
  to minimize the PWA's struggle with conveying a
  concept (e.g., PWA uses productive
  circumlocution to describe an event and partner
  says "Oh.  You mean the building explosion that
  was on the news today!") 
•  

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Accepting Messages

• Those which serve to accept the PWA's adequate
  (though not precise) messages.  (e.g.,  PWA
  answers question about a family member by
  pointing to her photo on the table.  Partner
  accepts response and doesn't say "tell me her
  name---you know it") 

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Assisting Messages

• Those which serve to provide the PWA with
  feedback that his/her message was not understood
  (e.g., "I'm doing a pretty bad job of figuring
  out what you're trying to say"  "I'm really
  stuck...can you help me?")

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Advocating Messages

• Those which serve to instruct others about the
  PWA's communicative needs in the community 
  (e.g., "Do you have a menu that has pictures of
  the items?"  "Would you mind showing her the
  different types of postage stamps you have so
  that she can pick the kind she wants?")

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Implications

• Partner can learn to modify communicative
  environment of PWA to reduce barriers to
  participation
• PWA doesnt have to make ALL of the necessary
  modifications for communicative interaction to
  occur
• PWA/communicative partner can function
  independently in daily living