People with severe and moderate aphasia and their partners as estimators of communicative skills: A client‐centred evaluation

Abstract

Background: According to the philosophy of the social model of disability, clients are the best estimators of their own life situation. Eliciting the experiences of people with severe aphasia is demanding because of their language and possible other cognitive problems. They are therefore usually excluded from the studies. However, there is evidence that modified assessment tools are accessible for them and help them to give self‐reports. Aims: The aim of the present study was to ascertain how people with aphasia evaluate their own communicative skills during rehabilitation by means of modified assessment tools. In addition, their answers were compared with the estimations of their significant others or other partners. Methods & Procedures: The data were collected during regular rehabilitation courses, which were carried out in two parts (8 + 4 days) with 3 months in between. Participants were 35 respondents with aphasia, aged 26 to 65 years, and 35 of their significant others or other partners, aged 29 to 71 years. The study was completed according to an initial, interim, and delayed post‐test questionnaire design. Two measures were used: the Finnish version of the Communicative Effectiveness Index (CETI) (Lomas et al., 1989) and an investigator‐constructed questionnaire, the Use of Different Communication Methods (UDCM). The questionnaires for the people with aphasia were made more accessible by pictures. Outcomes & Results: The self‐assessments of the participants with aphasia indicated that their functional communication skills did not change, but that the use of different communication methods improved slightly during the intervention. The significant others' and other partners' estimations showed that their communication skills improved significantly. Ratings of the two groups in functional communication skills differed significantly from each other before the intervention but thereafter the estimates correlated. There were no significant differences in the ratings of the use of different communication methods at any phase of the follow‐up study. However, the ratings correlated significantly only at the last assessment. Conclusions: The results of the present study indicate that people with severe and moderate aphasia are able to assess their communication skills with modified, aphasia‐friendly self‐assessment tools. The results also indicate that people with aphasia and their partners perceive the communicative skills quite similarly, especially after the intervention has begun. The use of accessible measures enables people with severe aphasia to participate in the evaluation of therapy outcomes, as suggested by the philosophies of the social model of rehabilitation. This study was supported by grants from the Finnish Cultural Foundation. We also thank those with aphasia and their significant others and other partners who participated in this study, and the Finnish Stroke and Dysphasia Association.