An analysis of the “goal” in aphasia rehabilitation

Abstract

Background: Despite the central importance of goal setting in aphasia rehabilitation, the notion of the goal itself has not been fully explored. Aims: This paper considers how speech pathologists conceptualise the nature of the “goal” in aphasia rehabilitation. Methods & Procedures: The researchers conducted a qualitative study involving 34 speech pathologists (32 female and 2 male; mean age 41 years, range 24–60 years) from Adelaide, Brisbane and Newcastle, Australia, who worked across acute and rehabilitation inpatient, outpatient, community, and domiciliary services. The speech pathologists participated in semi-structured in-depth interviews about their experiences of providing therapy to people with aphasia post stroke and their family members. Transcriptions of the recorded interviews were subjected to an interpretive thematic analysis involving careful reading and re-reading for recurring themes around notions of goals. Outcomes & Results: The analysis of the transcripts revealed six main categories of goal concepts: goals as desires; SMART goals; impairment and functional goals; goals as steps; goals as contracts; and implicit goals. The first two of these conceptual categories competed with each other reflecting broader tensions within speech pathology practice, and the relative prominence of these goal categories differed according to the rehabilitation context. Conclusions: The findings suggest that the notion of the goal is multifaceted, dynamic, context dependent, and involves inherent tension. A more detailed understanding of the different facets of a goal might assist speech pathologists in their efforts towards collaborative goal setting. A conceptual shift to include the goal as a vehicle of empowerment may be helpful as a precursor to effective, collaborative, and person-centred goal setting with people with aphasia.