Language and Cognition
Colombo 2011
Day 7
Working with groups
Benefits of Group Therapy
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Natural communication environment
Socialisation and prevention of isolation
Promotion of psychological well-being
Provides a “safe haven” for communication with
others in similar position
Enhances individual treatment
Generalisation of language recovery to natural
communication
Increased independence for the PWA
Time and cost effective for clinician
Fits with trends in rehab towards life participation
Disadvantages of Group Therapy
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Range of abilities and impairments
Harder for clinician to monitor performance
Attendance rates
Personality clashes!
Considerations
• Open to all or invited to attend
• Ongoing or for a limited period of time for
a specific therapeutic purpose?
• Duration of the group: 1-2hrs, versus half
or whole day; 1x weekly or intensive a
couple of times per year.
• Impairment v’s functional goals
• Size of group and facilitation required for
PWA
Pre-Requisite Skills
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Focused attention for duration of group
Be willing to participate
Turn taking appropriately in conversation
Can follow simple auditory commands
Able to indicate a yes/no response
Case examples
Evaluation of communication, life participation
and psychological well being in chronic aphasia:
the influence of group intervention
Ross, Winslow, Marchant and Brumfitt (2006)
Aims of study
• Evaluate outcomes of group intervention
designed to address communication
disability and enable people with chronic
aphasia
• Specifically to examine communication,
life participation and psychological well
being
Participants
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7 people with chronic aphasia
All >4m post onset (6/7 > 14m)
Pre- post- and 3m follow up treatment design
Communication Measures:
– Conversational analysis profile for people with
aphasia (CAPPA)
• Psychological well-being measures
– Hospital Anxiety and Depression Scale (HADS)
– Visual Analogue Self-Esteem Scale (VASES)
Group Intervention
• Aimed to:
– support total communication and conversation skills
– Engage in social participation
– Enlist understanding of disability and rights
• 2hrs/week for 11 weeks.
• Lead by 2 SLT’s with 4 students and 2 care
workers.
• Held at on-site clinic at University
Group Activities
• Development and use of Total
Communication and strategies to improve
conversation exchange
• Current topic discussion (firemen strike)
• Personal information and experience
sharing and support
• Exploration of social model of aphasia
• Discussion about legal rights, benefits and
disability services
Results
• CAPPA: Conversation abilities:
– mixed results!
• CAPPA: Conversation experiences
– Post intervention, all participants show a beneficial
change
– 3m follow-up, mean beneficial change
• Psychological well being
– HADS – improvements seen in 5/7 patients
– VASES – improvements in 6/7 patient
– Neither statistically significant
Conclusions
• Despite small sample size, group
intervention can contribute to positive
change in communication, life participation
and psychological well-being.
Case example
The Efficacy of Group Communication
Treatment in Adults with Chronic
Aphasia
Elman and Bernstein-Ellis (1999)
Aims of study
• To improve communication abilities in people
with chronic aphasia as measured on:
– Shortened Porch Index of Communicative Abilities
(SPICA)
– Western Aphasia Battery (WAB)
– Communicative Abilities in Daily Living (CADL)
• Ax at intake, 2m, 4m, and 4-6weeks f/up
• Immediate treatment groups and deferred
treatment groups. DT assessed prior to group
start
Participants
• 24 participants, all Left CVA >6m onset
• Randomly assigned to immediate
treatment and deferred treatment (4m
delay)
• Assigned to mild-mod/mod-severe aphasia
groups
• 4 groups of 5-7 individuals each
Treatment
• 2.5hours of group therapy twice weekly for
4 months (32 sessions)
• Focused on:
– Ability to convey a message using total comm.
– Fostering initiation for conversation
– Expanding understanding about aphasia
– Expanding awareness of personal goals and
progress made
– Promoting confidence
Results
• DT group:
– Significant change after but not before group
communication treatment began on SPICA
and WAB. CADL improved but not sig.
• IT group:
– WAB and CADL scores significantly higher
after 4m treatment than those of DT group at
same point in time.
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Results
• After 2m of treatment, SPICA, CADL and
WAB scores differed significantly from pre
treatment in both IT and DT groups
• After 4m, additional significant change on
WAB and CADL.
• Greater changes seen in severe aphasia
group
Conclusions
• Group communication treatment
efficacious for participants with chronic
aphasia
• Many participants reported dramatic life
changes and psychosocial benefits during
and after group involvement e.g. venturing
out of house, beginning to take public
transport
Case Example
An evaluation of short-term group therapy
for people with aphasia
Brumfitt and Sheeran (1997)
Aims
• Demonstrate statistically significant changes in
communicative competence and their attitude to
communication
• Demonstrate those who make communicate
gains, also make improvements in psychological
adjustment
• To examine predictors of improvement and
practice
• To examine the individual’s perception of group
therapy and predictors of satisfaction
Participants
• 6 people with Left CVA and aphasia (2
fluent, 3 mixed, 1 non-fluent)
• All >3yrs post onset
Therapy programme
• 3 parts:
– Communicative activities within the group
– Video-taping of role-play activities for self and
group evaluation
– Practice tasks completed outside the group as
homework
• 1.5hrs, 1xweek, 10 weeks
Evaluation Measures
• Measures of Communication:
– Functional Communication Profile
– Attitude to Communication Scale (S24)
– Stutterers self ratings of reactions to speech
situations scale (modified)
• Measures of Psychological adjustment
– Rosenberg self esteem scale (RSE)
– Hospital Anxiety and Depression scale (HADS)
• Measures of satisfaction
– 7 item scale e.g. “I felt the group has given me increased
confidence” Rated agreement/disagreement on 1-5 scale
Results
• Significant improvement in FCP scores i.e.
Communicative behaviour improved after the
group sessions, especially “speaking” section.
• Reactions to Speech situations scale showed
more positive evaluations after group (stat. Sig.)
• Other measures not stat. Sig. But improvements
in all 7 measures observed for at least 50% of
participants
• Pre-group: self-esteem and communicative
behaviour strongly correlated. After: no longer
sig. Related. Self-esteem measured on other
factors
Conclusions
• Group therapy is capable of demonstrating
changes in communicative ability and
attitudes towards communication (no
control group!)
Summary
• Group treatment efficacy is now
accumulating to support the use of this
approach for PWA
• Group therapy should be considered
essential part of our duty of care rather
than a convenient supplement.
Kearns and Elman in Chapey 2008
Questions?