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DOI: 10.1055/s-0044-1788981
Speaking Up and Being Heard: The Importance of Functional Communication and Discourse Principles in Aphasia Intervention
Abstract
This article acknowledges Audrey Holland's influence on aphasiology as it specifically relates to the emergence of a strengths-based perspective on the everyday communication of people with aphasia. We explore a historical perspective, as well as current ways in which everyday communicative events are approached in both clinical and research practice. The term “functional communication” is synonymous with Audrey's work, with linguistically-based discourse analysis and therapy both viewed as natural companions and extensions of the concept within aphasiology. Audrey's focus on the interactional side of communication and psychosocial impacts of aphasia, as well as her expertise in analysis and measurement, contributed to the coalescing of impairment-based and social communication approaches, encompassing a true sense of humanity and connectedness. Her application of these in international contexts was also noteworthy. In this article, we hope to capture principles of aphasia management that underpin current clinical practice, and also move beyond the traditional clinic context to consider aphasia groups that have had such a key role in promoting successful social communication by and with people with aphasia. We suggest future directions to further promote the principles advocated by Audrey Holland in assisting people with aphasia to move forward with confidence with their conversation partners, friends, and communities.
Publication History
Article published online:
08 August 2024
© 2024. Thieme. All rights reserved.
Thieme Medical Publishers, Inc.
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References
- Archer, B., Azios, J. H., Gulicka, N., & Tetnowski, J. (2021). Facilitating participation in conversation groups for aphasia. Aphasiology, 35(6), 764–782
- Armstrong, E. (2005). Expressing opinions and feelings in aphasia: linguistic options. Aphasiology, 19(3–5), 285–295
- Armstrong, E., & Mortensen, L. (2006). Everyday talk: its role in assessment and treatment for individuals with aphasia. Brain Impairment, 7(3), 175–189
- Armstrong, E., Mortensen, L., Ciccone, N., & Godecke, E. (2012). Expressing opinions and feelings in a conversational setting. Seminars in Speech and Language, 33(1), 16–26
- Armstrong, E. (2018). The challenges of consensus and validity in establishing core outcome sets. Aphasiology, 32(4), 465–468
- Armstrong, E., Colegate, K., Papertalk, L., Crowe, S., McAllister, M., Hersh, D., Ciccone, N., Godecke, E., Katzenellenbogen, J., & Coffin, J. (2024). Intersectionality and its relevance in the context of Aboriginal people with brain injury in Australia. Seminars in Speech and Language, 45(1), 56–70.
- Azios, J. H., Archer, B., Simmons-Mackie, N., Raymer, A., Carragher, M., Shashikanth, S., & Gulick, E. (2022). Conversation as an outcome of aphasia treatment: a systematic scoping review. American Journal of Speech-Language Pathology, 31, 2920–2942.
- Azios, J. H., Lee, J. B., Sigur, A., Archer, B., & Elman, R. J. (2024). Online aphasia groups: navigating issues of voice and identity. American Journal of Speech-Language Pathology, 33(1), 333–348.
- Beeke, S., Maxim, J., & Wilkinson, R. (2007). Using conversation analysis to assess and treat people with aphasia. Seminars in Speech and Language, 28(2), 136–147
- Beeke, S., & Bloch, S. (2023). Better Conversations with Communication Difficulties. J&R Press
- Beeson, P., & Holland, A. L. (2007). Aphasia groups in a university setting. In: R.J. Elman (Ed.) Group Treatment of Neurogenic Communication Disorders: The Expert Clinician's Approach (2nd Ed). Plural Publishing (pp. 145–158)
- Bessarab, D., & Ng'andu, B. (2010). Yarning about yarning as a legitimate method in Indigenous research. International Journal of Critical Indigenous Studies, 3(1), 37–50
- Boyle, M., Akers, C. M., Cavanaugh, R., Hula, W. D., Swiderskic, A. M., & Elman, R. J. (2023). Changes in discourse informativeness and efficiency following communication-based group treatment for chronic aphasia. Aphasiology, 37(3), 563–597
- Bryant, L., Ferguson, A., & Spencer, E. (2016). Linguistic analysis of discourse in aphasia: a review of the literature. Clinical Linguistics & Phonetics, 30(7), 489–518
- Bryant, L., Spencer, E., & Ferguson, A. (2017). Clinical use of linguistic discourse analysis for the assessment of language in aphasia. Aphasiology, 31(10), 1105–1126
- Carragher, M., Karen Sage, K., & Conroy, P. (2015). Preliminary analysis from a novel treatment targeting the exchange of new information within storytelling for people with nonfluent aphasia and their partners. Aphasiology, 29(11), 1383–1408
- Carragher, M., Steel, G., O'Halloran, R., Torabi, T., Johnson, H., Taylor, N. F., & Rose, M. (2021). Aphasia disrupts usual care: the stroke team's perceptions of delivering healthcare to patients with aphasia. Disability and Rehabilitation, 43(21), 3003–3014
- Centeno, J. G., & Laures-Gore, J. S. (2024). Intersectionality in aphasia services for ethnosocially diverse adult populations. Seminars in Speech and Language, 45(1), 1–4. (Advance online publication) doi: 10.1055/s-014-58918
- Cruice, M., Botting, N., Marshall, J., Boyle, M., Hersh, D., Pritchard, M., & Dipper, L. (2020). UK speech and language therapists' views and reported practices of discourse analysis in aphasia rehabilitation. International Journal of Language & Communication, 55(3), 417–442
- Cruice, M., Aujlab, S., Bannister, J., Botting, N., Boyle, M., Charles, N., Dhaliwal, V., Groblere, S., Hersh, D., Marshall, J., Morris, S., Pritchard, M., Scarth, L., Talboth, R., & Dipper, L. (2022). Creating a novel approach to discourse treatment through coproduction with people with aphasia and speech and language therapists. Aphasiology, 36(10), 1159–1181
- Devane, N., Buxton, S., Fox, C., Marshall, J., Staunton, D., Whiddett, J., . . . Hilari, K. (2024). What conversation topics are meaningful to people with aphasia? A qualitative study. Aphasiology, 1–18. Doi: 10.1080/02687038.2024.2319364
- Deng, B.M., Gao, J., Liang, L.S., Zhao, J.X., Lin, F., Yin, M.Y., Zheng, H.Q., & Hu, X. Q. (2024). Discourse task type-specific linguistic characteristics in anomic aphasia and healthy controls: evidence from Mandarin-Chinese AphasiaBank. American Journal of Speech-Language Pathology, 33, 937–951
- Dietz, A., & Boyle, A. (2018). Discourse measurement in aphasia research: Have we reached the tipping point? Aphasiology, 32(4), 459–464
- Dipper, L., Marshall, J., Boyle, M., Botting, N., Hersh, D., Pritchard, M., & Cruice, M. (2021). Treatment for improving discourse in aphasia: a systematic review and synthesis of the evidence base. Aphasiology, 35(9), 1125–1167
- Doedens, W. J., & Meteyard, L. (2022). What is functional communication? A theoretical framework for real-world communication applied to aphasia rehabilitation. Neuropsychology Review, 32(4), 937–973
- Duchan, J., Maxwell, M., & Kovarsky, D. (1999). Evaluating competence in the course of everyday interaction. In: D. Kovarsky, M. Maxwell, & Ju. Duchan (Eds.), Constructing (in)competence: Disabling Evaluations in Clinical and Social Interaction. Routledge
- Dunne, M., Hoover, E., & DeDe, G. (2023). Efficacy of aphasia group conversation treatment via telepractice on language and patient-reported outcome measures. American Journal of Speech-Language Pathology, 32, 2565–2579
- Elman, R. (Ed.). (2007). Group Treatment of Neurogenic Communication Disorders: The Expert Clinician's Approach (2nd ed.). San Diego, CA: Plural Publishing
- Elman, R. J., & Bernstein-Ellis, E. (1999). The efficacy of group communication treatment in adults with chronic aphasia. Journal of Speech, Language, and Hearing Research: JSLHR, 42, 411–419.
- Ferguson, A. (1996). Describing competence in aphasic/normal conversation. Clinical Linguistics & Phonetics, 10(1), 55–63
- Fuller, C. (2016). Echoes of a Closed Door: A Life Lived Following a Stroke. Accessed July 29, 2024 at: www.carolrfuller.com
- Groenewold, R., & Armstrong, E. (2018). The effects of enactment on communicative competence in aphasic casual conversation: a functional linguistic perspective. International Journal of Language & Communication Disorders, 53(4), 836–851
- Hallowell, B. (2017). Aphasia and Other Acquired Neurogenic Language Disorders: A Guide for Clinical Excellence. Plural Publishing
- Handford, M., & Gee, J. P. (2023). The Routledge Handbook of Discourse Analysis (2nd Ed.). Routledge
- Hersh, D. (2007). 'From the Ground Up': The Talkback Group Program in South Australia. In: R.J. Elman (Ed.), Group Treatment of Neurogenic Communication Disorders: The Expert Clinician's Approach (2nd Ed). Plural Publishing. (pp. 255–268)
- Hersh, D., Worrall, L., Howe, T., Sherratt, S., & Davidson, B. (2012). SMARTER goal setting in aphasia rehabilitation. Aphasiology, 26(2), 220–233
- Hersh, D., Wood, P., & Armstrong, E. (2018). Informal aphasia assessment, interaction and the development of the therapeutic relationship in the early period after stroke. Aphasiology, 32(8), 876–901
- Hersh, D., Morrisby, C., & Ryan, B. (2024). The kitchen assessment: an interactional analysis of assessment and feedback between an occupational therapist and a patient with aphasia post stroke. Disability and Rehabilitation, 1–13. (Advance online publication). doi: 10.1080/09638288.2024.2361805
- Holland, A. (1977). Some practical considerations in aphasia rehabilitation. In: M. Sullivan & M. S. Kommers (Eds.), Rationale for adult aphasia therapy (pp. 167–180). University of Nebraska Medical Center Print Shop
- Holland, A. (1980). Communicative Abilities in Daily Living. University Park Press
- Holland, A. (1991). Pragmatic aspects of intervention in aphasia. Journal of Neurolinguistics, 6, 197–211
- Holland, A. L. (1993). Aphasia Treatment: World Perspectives. Chapman & Hall
- Holland, A. L. (1998). Why can't clinicians talk to aphasic adults? Comments on supported conversation for adults with aphasia: methods and resources for training conversational partners. Aphasiology, 12(9), 844–847
- Holland, A. L. (2010). Lessons from a clinical life in aphasia. Topics in Stroke Rehabilitation, 17(1), 13–19
- Holland, A. L. (2006). Living successfully with aphasia: three variations on the theme. Topics in Stroke Rehabilitation, 13, 44–51
- Holland, A. L., & Halpery, A. S. (1996). Talking to individuals with aphasia: a challenge for the rehabilitation team. Topics in Stroke Rehabilitation, 2(4), 27–37
- Hopper, T., Holland, A., & Rewega, M. (2002). Conversational coaching: treatment outcomes and future directions. Aphasiology, 16(7), 745–761
- Holland, A. L., Halper, A. S., & Cherney, L. R. (2010). Tell me your story: analysis of script topics selected by persons with aphasia. American Journal of Speech-Language Pathology, 19(3), 198–203
- Holland, A. L., & Nelson, R. L. (2020). Counseling in Communication Disorders: A Wellness Perspective. Plural Publishing
- Hubbard, H. I., Nelson, L. A., & Richardson, J. D. (2020). Can script training improve narrative and conversation in aphasia across etiology? Seminars in Speech and Language, 41(1), 99–124
- Kagan, A., Simmons-Mackie, N., Villar-Guerrero, E., Chan, M. T., Turczyn, I., Victor, J. C., Shumway, E., Chan, L., Cohen-Schneider, R., & Bayley, M. (2024). Improving communicative access and patient experience in acute stroke care: An implementation journey. Journal of Communication Disorders, 107, 106390
- Lanyon, L. E., Rose, M. L., & Worrall, L. (2013). The efficacy of outpatient and community-based aphasia group interventions: a systematic review. International Journal of Speech-Language Pathology, 15(4), 359–374
- Lanyon, L., Worrall, L., & Rose, M. (2018). What really matters to people with aphasia when it comes to group work? A qualitative investigation of factors impacting participation and integration. International Journal of Language & Communication Disorders, 53(3), 526–541
- Leaman, M. C., & Edmonds, L. A. (2023). Analyzing language in the picnic scene picture and in conversation: the type of discourse sample we choose influences findings in people with aphasia. American Journal of Speech-Language Pathology, 32(4), 1413–1430
- Linnik, A., Bastiaanse, R., & Hohle, B. (2016). Discourse production in aphasia: a current review of theoretical and methodological challenges. Aphasiology, 30(7), 765–800
- Macwhinney, B., Fromm, D., Forbes, M., & Holland, A. (2011). AphasiaBank: methods for studying discourse. Aphasiology, 25(11), 1286–1307
- Maloney, T. C., Dietz, A., Vannest, J., Wilkinson, K., Szaflarski, J. P., Stall, C., & Mamlekar, C. R. (2023). Functional magnetic resonance imaging activation during unscripted discourse in people with poststroke aphasia. Journal of Speech, Language, and Hearing Research: JSLHR, 66, 4838–4848
- Martin, J. R., & Rose, D. (2003). Working with Discourse: Meaning Beyond the Clause. Bloomsbury Publishing
- Martin, J. R., & White, P. R. R. (2005). The Language of Evaluation: Appraisal in English. Palgrave MacMillan
- Olness, G. S., & Ulatowska, H. K. (2011). Personal narratives in aphasia: coherence in the context of use. Aphasiology, 25(11), 1393–1413
- Pettigrove, K., Lanyon, L. E., Attard, M. C., Vuong, G., & Rose, M. L. (2022). Characteristics and impacts of community aphasia group facilitation: a systematic scoping review. Disability and Rehabilitation, 44(22), 6884–6898
- Rose, M. L., Nickels, L., Copland, D., Togher, L., Godecke, E., Meinzer, M., Rai, T., Cadilhac, D. A., Kim, J., Hurley, M., Foster, A., Carragher, M., Wilcox, C., Pierce, J. E., & Steel, G. (2022). Results of the COMPARE trial of constraint-induced or multimodality aphasia therapy compared with usual care in chronic post-stroke aphasia. Journal of Neurology, Neurosurgery, and Psychiatry, 93, 573–581
- Shrubsole, K., Power, E., & Hallé, M.C. (2023). Communication partner training with familiar partners of people with aphasia: a systematic review and synthesis of barriers and facilitators to implementation. International Journal of Language & Communication Disorders, 58, 601–628
- Simmons-Mackie, N., Elman, R. J., Holland, A. L., & Damico, J. S. (2007). Management of discourse in group therapy for aphasia. Topics in Language Disorders, 27(1), 5–23
- Simmons-Mackie, N., & Damico, J. S. (2009). Engagement in group therapy for aphasia. Seminars in Speech and Language, 30, 18–26
- Simmons-Mackie, N., Raymer, A., Armstrong, E., Holland, A., & Cherney, L. R. (2010). Communication partner training in aphasia: a systematic review. Archives of Physical Medicine and Rehabilitation, 91(12), 1814–1837
- Simmons-Mackie, N., Savage, M. C., & Worrall, L. (2014). Conversation therapy for aphasia: a qualitative review of the literature. International Journal of Language & Communication Disorders, 49(5), 511–526
- Simmons-Mackie, N., Raymer, A., & Cherney, L. R. (2016). Communication partner training in aphasia: an updated systematic review. Archives of Physical Medicine and Rehabilitation, 97(12), 2202–2221.e8
- Stark, B. C., Dutta, M., Murray, L. L., Fromm, D., Bryant, L., Harmon, T. G., Ramage, A. E., & Roberts, A. C. (2021). Spoken discourse assessment and analysis in aphasia: an international survey of current practices. Journal of Speech, Language, and Hearing Research: JSLHR, 64(11), 4366–4389
- Tuomenoksa, A., Beeke, S., & Klippi, A. (2023). People with aphasia and their family members proposing joint future activities in everyday conversations: a conversation analytic study. International Journal of Language & Communication Disorders, 58, 310–325
- Ulatowska, H. K., North, A. J., & Macaluso-Haynes, S. (1981). Production of narrative and procedural discourse in aphasia. Brain and Language, 13(2), 345–371
- Whitworth, A., Leitao, S., Cartwright, J., Webster, J., Hankey, G., Zach, J., Howard, D., & Wiltz, V. (2015). NARNIA: a new twist to an old tale. A pilot RCT to evaluate a multilevel approach to improving discourse in aphasia. Aphasiology, 29(11), 1345–1382
- Wilkinson, R. (2015). Conversation and aphasia: advances in analysis and intervention. Aphasiology, 29(3), 257–268