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Aphasia
Treatment

Conversation Partner Training Approaches

(e.g., Supported Conversation for Adults with Aphasia, Conversation Coaching, Communication Partner Training)

 


 

External Scientific Evidence

  

Evidence-Based Practice Guidelines

Royal College of Speech & Language Therapists; Department of Health (UK); National Institute for Clinical Excellence (NICE)
 
Royal College of Speech and Language Therapists Clinical Guidelines: 5.12 Aphasia
Taylor-Goh, S., ed. (2005).
RCSLT Clinical Guidelines. Bicester, Speechmark Publishing Ltd.
Added: May 2012
 
Description

This guideline provides recommendations for the assessment and treatment of individuals with aphasia. These guidelines are specific to speech-language pathologists. Levels of evidence recommendations are graded A, B or C based on the following criteria: 

  • Level A: Recommendations obtained from randomized controlled trials (RCT). 
  • Level B: Recommendations obtained from well-conducted clinical studies.
  • Level C: Recommendations obtained from expert opinion.
Recommendations
  • Treatment should involve communication partners to promote generalization of learned strategies (Level B/C Evidence).
  • Treatment should focus on training the conversation partner on verbal and non-verbal strategies to improve communication interactions and functional communication abilities of individuals with aphasia (Level B Evidence)
 
 
 
Australian Government Department of Health and Ageing
 
Clinical Guidelines for Acute Stroke Management 2010
National Stroke Foundation (2010).
Melbourne (Australia): National Stroke Foundation, 167 pages
Added: May 2012 
 
Description

This guideline provides recommendations for the assessment and management of stroke and transient ischemic attack (TIA) in adults. These guidelines are primarily intended to assist health care workers in improving quality and effectiveness of service. Of particular interest to speech-language pathologists is chapter six which focuses on rehabilitation management for aphasia, dysphagia, dysarthria, apraxia and cognitive-communication deficits. Recommendations are graded A, B, C, D or "Good Practice Point" based on the following criteria:  

  • Grade A: Evidence can be trusted to guide practice.
  • Grade B: Evidence can be used to guide practice in most situations.
  • Grade C: Evidence provides some support, but care should be taken in application.
  • Grade D: Evidence is weak and should be applied cautiously.
  • Good Practice Point: Evidence based on clinical experience and expert opinion
Recommendations
  • Supported conversation techniques are recommended for individuals with aphasia (Grade C Evidence).
  • Conversation partner training should address environmental barriers of individuals with aphasia and promote access and inclusion through aphasia-friendly formats and other environmental adaptions (Good Practice Point).
 
 
 
New Zealand Ministry of Health
 
New Zealand Clinical Guidelines for Stroke Management 2010
Stroke Foundation of New Zealand and New Zealand Guidelines Group (2010).
Wellington (New Zealand): Stroke Foundation of New Zealand, 347 pages
Added: May 2012 
 
Description

This guideline provides recommendations for the management of individuals recovering from stroke and transient ischemic attacks. The target audience of the guideline is all healthcare professionals providing services to persons with stroke and their family in the New Zealand context. Of particular interest to speech-language pathologists are the sections discussing communication (aphasia, apraxia, dysarthria), cognition and swallowing disorders. Levels of evidence recommendations are graded as A, B, C, D or "Good Practice Points" and defined as follows:

  • Level A: Body of evidence can be trusted to guide practice.
  • Level B: Body of evidence can be trusted to guide practice in most situations.
  • Level C: Body of evidence provides some support for recommendation(s) but care should be taken in its application.
  • Level D: Body of evidence is weak and recommendation must be applied with caution.
  • Good Practice Point: Recommended best practice based on clinical experience and expert opinion
Recommendations
  • Supported conversation techniques are recommended for individuals with aphasia (Level C Evidence).
  • Conversation partner training should address environmental barriers of individuals with aphasia and promote access and inclusion through aphasia-friendly formats and other environmental adaptions (Good Practice Point). 
 
 
 
 
Evidence-Based Systematic Reviews
Therapeutic Interventions for Aphasia Initiated More Than Six Months Post Stroke: A Review of the Evidence
Allen, L., Mehta, S., et al. (2012).
Topics in Stroke Rehabilitation, 19(6), 523-535.

This review meets the criteria for a high-quality evidence-based systematic review.
Added: May 2013

Description
This is a review of randomized controlled trials examining the efficacy of aphasia treatments provided to individuals with 6 months post onset of stroke-induced aphasia.

Conclusions

  • Evidence was found in support of a number of treatments for individuals with chronic aphasia. These included:

    • computer-based aphasia treatments


    • constraint-induced language aphasia therapy


    • delivery of intensive aphasia therapy


    • conversation partner training

  • Given the heterogeneity of patients included and wide range of interventions included, further research is warranted.

» See full summary and quality ratings



Evidence-Based Review of Stroke Rehabilitation
Teasell, R. W., Foley, N. C., et al. (2011).
Retrieved from http://www.ebrsr.com.

This review meets the criteria for a high-quality evidence-based systematic review.
Added: October 2012
 
Description

This is an update of the Teasell et al. (2009) evidence-based review investigating the effectiveness of pharmacological and non-pharmacological interventions for stroke rehabilitation. Of particular interest to speech-language pathologists are the modules specific to aphasia, dysphagia, perceptual disorders and cognitive disorders. The levels of evidence used to summarize the review findings are based on the United States Agency for Health Care Policy and Research (AHCPR) criteria:  

  • Level 1a: Strong evidence supported by a meta-analysis or two or more randomized controlled trials (RCTs) with at least “fair” quality.
  • Level 1b: Moderate evidence supported by at least one RCT of “fair” quality.
  • Level 2: Limited evidence supported by at least one controlled trial and with a minimum of 10 participants in each arm of the study.
  • Level 3: Findings supported by expert consensus opinion in the absence of evidence.
  • Level 4: Conflicting evidence based on disagreement between the findings of at least two RCTs. Where there are more than four RCTs, conclusions are based on the results of the majority of studies, unless conflicting results are reported in a higher quality study.   
Conclusions
  • Moderate evidence (Level 1b) suggests that Supported Conversation for Adults with Aphasia (SCA) can enhance conversational skills for individual with aphasia and their conversation partner.
  • There is limited evidence (Level 2) that training conversation partners improves social participation and well-being. However, the authors indicated that further research is required as the majority of studies were small and used single group designs.
 
 
 
Conversational Partner Training Programmes in Aphasia: A Review of Key Themes and Participants' Roles
Turner, S., & Whitworth, A. (2006).
Aphasiology, 20(6), 483-510
.
Added: May 2012 
 
Description
This is a review of scientific controlled research studies investigating the effectiveness of various conversational partner training approaches for individuals with stroke-induced aphasia
 
Conclusions
  • The authors conclude that conversation partner training programs had favorable outcomes for adults with aphasia regardless of the type and severity of aphasia. However, no conclusions could be drawn regarding the effectiveness of one conversation training approach over another.
  • Based on the limited information pertaining to the different conversation partner training approaches and the lack of methodological quality of included studies, further research is needed examining this class of interventions
 
 
 
Communication Partner Training in Aphasia: A Systematic Review
Simmons-Mackie, N., Raymer, A., et al. (2010).
Archives of Physical Medicine and Rehabilitation, 91(12), 1814-37.

This review meets the criteria for a high-quality evidence-based systematic review.
Added: May 2012
 
Description
This is a review of research investigating the use of the conversation partner training approaches to treat individuals with aphasia
 
Conclusions
  • In general, the results of the review suggest that conversation partner training is probably effective for improving communication activities/participation for individuals with chronic aphasia.
  • Findings of the review indicated that training effects were maintained over time. However, there was insufficient evidence to support the use of conversation partner training to improve language outcomes in individuals with acute aphasia.  
 
 
 
 

Clinical Expertise/Expert Opinion

 
Consensus Guidelines  
No consensus guidelines were found. 
 
 
 
 

Client/Patient/Caregiver Perspectives

 
Self-Perceptions of Functional Communication Performance During Total Communication Intervention
Rautakoski, P. (2012).
Aphasiology, 26(6), 826-846.
Added: May 2013

Description
This is a qualitative study of 53 individuals with moderate to severe aphasia. The study examines how individuals with aphasia perceive their functional communication after intervention which focused on communication partner training and total communication and at 6 month follow-up. Communication partner perceptions were also included. 

Conclusions

  • The individual with aphasia did not perceive significant changes in their functional communication after intervention, but did indicate improved communication at six months follow up. No significant differences in perceived communication skills were found between stages.

  • After receiving treatment focused on guided communication training and total communication, caregivers reported improved functional communication of their partners. Communication partners continued to perceive improvements in functional communication at 6 month follow-up. Change in perceived improvement was statistically significant.

» Access the document



The Communication Partner Scheme: A Project to Develop Long-Term, Low-Cost Access to Conversation for People Living with Aphasia

McVicker, S., Parr, S., et al. (2009).
Aphasiology, 23(1), 52-71
.
Added: May 2012
 
Description
This is a qualitative study examining the effects of a communication partner program. This program matches supported conversation volunteer partners trained by speech-language pathologists to work with individuals with chronic aphasia. Patient satisfaction regarding training program was provided.
 
Conclusions
  • The majority of respondents with chronic aphasia were satisfied with the communication partners program with approximately 80% indicating that the program met their expectations and gave them confidence during conversation.
  • Constructive feedback was reported by one respondent suggesting the need for increased training provided to the conversation partner "to facilitate a better balance in conversation" (p. 65).  
 
 
 
Living Successfully with Aphasia: A Qualitative Meta-Analysis of the Perspectives of Individuals with Aphasia, Family Members, and Speech-Language Pathologists
Brown, K., Worrall, L. E., et al. (2012).
International Journal of Speech-Language Pathology, 14(2), 141-55
 
Added: May 2012
 
Description
This is a qualitative meta-analysis of studies investigating the perspectives of three groups (individuals with aphasia, carers and speech-language pathologists) regarding the treatment of aphasia
 
Conclusions

Individuals with aphasia commented on the importance of social engagement, interaction with family and inclusion of family within the treatment process (e.g., intervention focusing on communication with spouse).  

 
 
 
 

 
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