Abstract
ABSTRACTBackground: Aphasia and other acquired language impairments have the potential to impact greatly on quality of life by disrupting everyday conversation. Different intervention approaches are available to speech and language therapists (SLTs), such as targeting the language impairment itself and/or addressing activity or participation barriers. Conversation therapy is one approach that is gaining in popularity, with a growing evidence base. However, it is not clear how SLTs currently use conversation approaches and what factors may influence delivery.Aims: To investigate how SLTs (i) define conversation therapy, (ii) deliver it in clinical practice, and identify (iii) any challenges faced.Methods & Procedures: An online survey and focus group explored how SLTs working in the south east of England currently deliver conversation therapy to support people with a range of communication disorders, in particular aphasia. Data were analysed using descriptive statistics and thematic content analysis.Outcomes & Results: A total of 50 SLTs completed the survey and 6 participants attended the focus group. Conversation therapy was found to be widely employed by participants, however there was considerable variation in the approaches used, and a number of major challenges were raised. SLTs reported delivering conversation therapy with a range of client groups and preferably working with the client and partner together. Conversation goals predominantly reflected an approach based on: (i) strategy use and/or total communication (TC), and (ii) Conversation Analysis. Three overarching themes around conversation therapy emerged from the focus group: (1) What is conversation therapy? (2) showing it works, and (3) complexities of delivering it. SLTs acknowledged the benefit of conversation therapy but felt they lacked the tools and skills needed to deliver it.Conclusions: SLTs wanted to use conversation therapy and desired clear outcome measures to demonstrate its effectiveness, but were not accessing the available evidence base, highlighting the ongoing difficulty of translating research into clinical practice. Whilst these data are limited by the small number of participants, the study provides a first view of how conversation therapy is articulated in practice. Further investigation of conversation therapy delivery is warranted with a larger sample of SLTs based across the United Kingdom, as is comparison with practice in other countries.
Highlights
According to Wilkinson and Wielaert (2012), aphasia rehabilitation should facilitate an individual’s ability to communicate within their everyday environment through holding conversations
The survey link was distributed by email to: (1) people who had expressed interest in the Better Conversations with Aphasia (BCA) project after attending workshops on conversation therapy University College London (UCL) for two London-based Clinical Excellence Networks (CENs) (Aphasia Therapy CEN, Domiciliary/Community CEN); (2) the general membership of those CENs; (3) the first author’s National Health Service colleagues; and (4) British Aphasiology Society members
This study found that less than half the SLTs worked with conversation partner (CP) individually and even fewer in groups, despite the availability of the SCATM (Kagan, 1998) and SPPARC (Lock et al, 2001)
Summary
According to Wilkinson and Wielaert (2012), aphasia rehabilitation should facilitate an individual’s ability to communicate within their everyday environment through holding conversations. CP training in particular has a robust evidence base (Simmons-Mackie et al, 2010; Simmons-Mackie, Raymer, & Cherney, 2016; Turner & Whitworth, 2006), and the Royal College of Physicians Intercollegiate Stroke Working Party (2016) recommends it as an approach to enhance participation in social interaction for people with aphasia. Conclusions: SLTs wanted to use conversation therapy and desired clear outcome measures to demonstrate its effectiveness, but were not accessing the available evidence base, highlighting the ongoing difficulty of translating research into clinical practice. Whilst these data are limited by the small number of participants, the study provides a first view of how conversation therapy is articulated in practice. Further investigation of conversation therapy delivery is warranted with a larger sample of SLTs based across the United Kingdom, as is comparison with practice in other countries
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