Support for family members

2.6 Speech pathologists can offer education and training to support families, friends and carers of people with aphasia to become skilled conversational partners.


References: Croteau et al., 2020: Qualitative study; Ford et al., 2024: Qualitative study; Howe et al., 2012: Qualitative study; Simmons-Mackie et al., 2010: Systematic review of 31 studies (11 group designs, 8 case studies, 7 SCEDs, 5 qualitative studies); Simmons-Mackie et al., 2016: Systematic review of 25 studies (11 group designs, 11 case studies, 2 qualitative studies, 1 SCED); Shrubsole et al., 2023: Systematic review of 17 studies (5 qualitative, 4 quantitative, 8 mixed methods) 

NHMRC level of Evidence: III-2


Rationale: People with aphasia may rely heavily on close communication partners such as family members in the early stages after stroke (Ford et al., 2024). However, communication partners such as family members report that communication can be challenging with people with aphasia after stroke (Croteau et al., 2020; Howe et al., 2012) and many express a need for communication training (Howe et al., 2012).

Communication partner training can improve the knowledge, skills, and attitudes of communication partners of people with aphasia. While the level of evidence for partner training efficacy is higher for health professionals, there is still developing evidence for training family, friends and carers. Therefore, for any family, friends and carers who are ready (e.g., in terms of availability, motivation, level of carer burden: Shrubsole et al., 2023), CPT can be provided. Research suggests that people with aphasia may be more able to participate in conversation with a skilled, supportive communication partner (Simmons-Mackie et al., 2010; Simmons-Mackie et al., 2016).

 
References:

1. Croteau, C., McMahon‐Morin, P., Le Dorze, G., & Baril, G. (2020). Impact of aphasia on communication in couples. International Journal of Language & Communication Disorders, 55(4), 547–557. https://doi.org/10.1111/1460-6984.12537
2. Ford, A., Douglas, J. M., & O'Halloran, R. (2024). From the Inner Circle to Rebuilding Social Networks: A Grounded Theory Longitudinal Study Exploring the Experience of Close Personal Relationships from the Perspective of People with Post Stroke Aphasia. Aphasiology, 38(2), 261–280. https://doi.org/10.1080/02687038.2023.2185480
3. Howe, T., Davidson, B., Worrall, L., Hersh, D., Ferguson, A., Sherratt, S., & Gilbert, J. (2012). ‘You needed to rehab families as well’: family members’ own goals for aphasia rehabilitation. International Journal of Language & Communication Disorders, 47(5). DOI: 10.1111/j.1460- 6984.2012.00159.x
4. 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.
5. 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(2), 2202-2221. DOI: 10.1016/j.apmr.2016.03.023
6. Shrubsole, K., Power, E., & Hallé, M. (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(2), 601–628. https://doi.org/10.1111/1460-6984.12805

Communication Tips for Caregivers of People with Aphasia:

• Be a conversation partner, not a therapist
• Set up the environment to ensure good communication (e.g. good lighting, minimise distractions, relaxed atmosphere)
• Speak at a normal rate (don’t use “baby talk”) with pauses at phrases and at the end of sentences
• Use strategies.  Writing down key words may assist in comprehension
•  Get things going by providing choices (e.g. Are you talking about dinner tonight? Or about your birthday party at the weekend?)
• Be willing to accept any type of communication.  In addition to speech, respond to gestures, writing, drawing, different intonations or expressions or using of a communication notebook or board.
• Set aside a time at least once per day to have a pleasant conversation.  Perhaps while having morning tea, or after dinner at night.  (Hinckley, 2003)

RESOURCES:

1. Supporting Partners of People with Aphasia in Relationships & Conversation (SPPARC) Lock, S. Wilkinson, R. & Bryan, K. (2008).  SPPARC is a resource specifically designed to provide clinically effective tools to work with people with aphasia and their communication partners.  The SPPARC manual consists of a manual, CD and DVD and provides practical resources to provide support and conversation training programs, conversation assessment and treatment materials and video extracts of everyday conversations which can be used as a resource.  
2. Supported Conversation for Adults with Aphasia (SCA) Kagan, A. Black, S. E., Duchan, F. J., Simmons-Mackie, N. & Square, P. (2001). SCA is an intervention approach specifically design to help people with aphasia express their feelings and opinions in a way that makes them feel appreciated and heard.  SCA is a program which uses a set of techniques which aims to improve conversational interaction through body language and gesture, drawings, pictographs in addition to spoken and written words.
3. Learn more about Supported Conversation for Adults with Aphasia (SCA^TM)).
4. Self-directed learning module.

References:

1. Hinckley, J. (2003) Becoming a Communication Partner, Stroke Connection Magazine, American Stroke association.
2. Kagan, A., Black, S. E., Duchan, F. J., Simmons-Mackie, N. & Square, P. (2001).  Training volunteers as conversation partners using “Supported Conversation for Adults with Aphasia” (SCA): a controlled trial, J Speech Lang Hear Res, 44(3), 624-38.
3. Lock, S. Wilkinson, R. & Bryan, K. (2008).  SPPARC: Supporting Partners of People with Aphasia in Relationships & Conversation, A resource Pack, Bicester: Speechmark.
4. Simmons-Mackie, N. Raymer, A., Armstrong, E., Holland, A. Cherney, L. R. (2010).  Communication partner training in aphasia: a systematic review.  Arch Phys Med Rehabil, 91(12), 1814-37.