Aphasia Support/Communication Groups

Living with Aphasia
Social Support Group Treatment Suggestions

Social support group settings provide a forum for effective communication, implementation of therapeutic strategies, and psychosocial support. The purpose of this forum (Living with Aphasia) is to prevent social isolation of patients with aphasia, promote social-communication, and increase opportunities for interaction by providing an environment for:

  • Sharing feelings and exchanging ideas
  • Interacting with friends, families, and care-providers
  • Clarifying issues of personal, social, and emotional concern
  • Learning ways to improve communication
  • Increasing participation in daily activities, such as shopping, reading, entertaining, watching television, listening to the news, and meditation
  • Developing friendships based on shared interests

 

Rules of communication: to be established by the clinician

  1. Outlining strategies at the start that are helpful, such as:
    • Taking time to formulate thoughts before speaking
    • Waiting for the turn to speak and signaling when ready for his/her turn
    • Promoting the free use of gestures, facial expressions, and writing to enhance communication
    • Praising patients for all their efforts (successful or not) using adult-appropriate mannerisms, words or utterances of praise, intonations, and expressions
    • Changing the focus of the discussion, if and when needed
    • Permitting time to warm-up for those patients who are initially quiet
    • Encouraging patients to stay on topic with few or no shifts
    • Keeping the group size small, 5-10 patients
    • Keeping meeting times limited to 60-75 minutes

  2. Discussing strategies for successful communication:
    • Patients may have subjective experiences with the effectiveness of communication strategies; they may like to describe the strategies that they find beneficial for themselves.
    • Reflect on the communication strategies that other patients find helpful.

  3. Implementing an assessment tool for measuring baseline performance and monitoring discourse progress over time.
    Calculate the number of:
    • Empty Utterances
      • Fillers that do not express any content
        • Examples: Oh, uh, ah...well
      • Empty utterances in a single discourse
        • Example: Oh Boy! Hard!
      • Pauses
        • Complete silence
    • Sub-clausal Utterance
      • Does not include subject and verb- content words or a semantic units only
        • Example: Food, water, happy
    • Single Clause and Multi-Clause Utterances
      • Single: sentence with subject and verb
        • Example: I go home.
      • Multi: more than one clause in compound (and, or, but) and complex (that, therefore, because) sentences
    • Paragrammatic (semantically anomalous) and agrammatic (with deleted grammatical markers) utterances
      • Paragrammatic example: Chicken George eat.
      • Agrammatic example: Today ..eat.. all- - Sunday.

 

Suggested activities to promote communication in natural settings

  1. Sharing personal experiences:
    • Using memorabilia (pictures, clothes, diaries, gift items, or any other personal item), patients share their life events with other members of the group. This allows for an understanding of patients’ families, emotional memories, life-interests, major life-events, and experiences.
      • The pictures and other items may relate to (a) vacations, (b) weddings, (c) children, (d) neighborhoods, (e) achievements, (f) hobbies, (g) families, and (h) professional and social experiences.
      • Clinicians should be familiar with patient’s background before initiating conversations
      • Encouraging group social events such as short picnics

  2. Educational meetings:
    • Organizing meetings to clarify issues, resolve emotional conflicts, and increase knowledge of treatment advances. The following professionals can be involved:
      • Psychologist for coping with emotions and resolving conflicts—pre- and post-stroke
      • Neurologist for discussing stroke treatment options and medical advances
      • Lawyer for educating about wills and patients’ rights
      • Speech-language pathologist for informing about the strategies for effective communication and discussing options for AAC when appropriate
      • Physical therapist for suggesting skills for postures and locomotion  
      • Occupational therapists for improving participation through skilled movements
      • Dietician for advising on balanced and healthy food intake
      •  Motivational speakers for increasing hope and positivity in the life
      • Social worker for increasing the awareness of social services in the community

  3. Potential topics for Discussion:
    • The following ideas can be discussed in social support group meetings:  
      • Personal updates
      • Current news or social events
      • News related to Bollywood and social stars and/or region specific alternatives
      • Critique of a movie based on the patients’ familiarity
      • Common sports
      • Daily-life issues
        • Water
        • Electricity distribution
        • Traffic and pollution
        • Crime and population  
        • Sanitation
        • Weather
      • Plans for the day, week, and weekend
      • Book reading and storytelling

  4. Activity simulation:
    • Patients simulate (act out) the roles played in their lives, such as profession prior to stroke, role in marriage and marriage parties, role as a student, role as mother/father, and role as an advisor for schooling. This can also include the simulation of daily life activities, such as shopping, bargaining, ordering food, making reservations, paying bills, and banking visits.

  5. Interactive activities:
    • Discussion of books (if possible)
    • Discussion of epic stories (Ramayan, Mahabharat)
    • Discussion of movies
    • Playing games- cards, board games, I spy (patient describes identifying attributes of an object without naming it while other group members try to name the object)

  6. Patients with aphasia as teachers:
    • Invite communicatively improved individuals with aphasia to share their personal experiences so that new individuals with aphasia can learn from their experiences and feel motivated.

  7. Reflection in their own words:
    • This will allow patients to self-reflect on:
      • Stroke experience
      • Conditions prior to their stroke
      • Effects of stroke on daily living & communication
      • Path of improvement over time
      • Emotional experiences and changes
      • Struggles and challenges

  8. Future goals:
    • Each member, along with their spouse/caregiver, can outline his/her goals for the next few years so that they can determine what type of help and supports is needed to meet their goals.

  9. Family involvement:
    • Separate groups should be organized for the families/caretakers. The goal is to counsel them about emotions, fears, concerns, and ways to adjust to changes. Family support groups are very effective since participating people have similar experiences and are sympathetic to common issues.
    • Activities may involve family education regarding:
      • Stroke and aphasia
      • Modes of communication
      • Patient safety in the house
      • Things to do and things not to do
      • Importance of ongoing social involvement
    • Suggestions for interactions at home:
      • Engaging regularly in meaningful conversations
      • Incorporating simple words and easy-to-process sentences
      • Displaying empathy to patients’ language limitations and frustrations
      • Attending to all aspects of conversation (mood, tone, facial expressions, body languages) for a full understanding of the message

 

References:

Adair Ewing, S. E. (1999). Group process, group dynamics, and group techniques with neurogenic communication disorders. In R. J. Elman (Ed.), Group Treatment of Neurogenic Communication Disorders: The Expert Clinician’s Approach (pp. 9-16). Butterworth Heinemann.

Beeson, P. M., & Holland, A. L. (2007). Aphasia Groups in a University Setting.  In R. J. Elman (Ed.), Group Treatment of Neurogenic Communication Disorders: The Expert Clinician’s Approach (pp. 145-158). San Diego, CA: Plural Publishing Inc.

Garrett, K. L. (1999). Measuring outcomes of group therapy. In R. J. Elman (Ed.), Group Treatment of Neurogenic Communication Disorders: The Expert Clinician’s Approach (pp. 17-30). Butterworth Heinemann.

Holland, A. L. & Beeson, P. M. (1999). Aphasia Groups: The Arizona Experience. In R. J. Elman (Ed.), Group Treatment of Neurogenic Communication Disorders: The Expert Clinician’s Approach (pp. 77-96). Butterworth Heinemann.

Kagan, A., Cohen-Schneider, R., Sherman, C., & Podolsky, L. (2007). Groups in the Aphasia Institute’s Introductory Program: Preparing to Live Successfully with Aphasia. In R. J. Elman (Ed.), Group Treatment of Neurogenic Communication Disorders: The Expert Clinician’s Approach (pp. 211-231). San Diego, CA: Plural Publishing Inc.

 

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Disclaimer

This association cannot offer any medical advice or assess any medical-neurological condition.

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