The Effect of Combined Individual and Group Treatment on Functional Communication in Aphasia after Acquired Brain Injury
Marshall, Rebecca Shisler, Wallace, Tracey, Journal of Medical Speech - Language Pathology
There is a growing body of evidence supporting the use of group treatment for increasing functional communication skills and pragmatics. However, there is limited research on the use of combined individual and group treatment for individuals with aphasia. Combined individual and group treatment has become increasingly common in health care despite the lack of data describing the effectiveness for individuals with aphasia. For this study, 10 individuals with aphasia were recruited and assigned into either a control group (A), where they received 8 weeks of individual treatment, or an experimental group (B), where they received 2 weeks of individual treatment and 6 weeks of combined individual and group treatment. Each participant completed three evaluation batteries consisting of functional communication, language, cognitive, pragmatic, mood, and quality of life assessments. Performance on the Aphasia Diagnostic Profile (ADP) measure of alternative communication was found to be statistically different for the experimental group, although other measures did not differ significantly. Trends toward statistical significance were found for Group B's performance on the Communicative Abilities in Daily Living (CADL-2) and the ADP. Future research is needed in a larger sample of participants in order to determine the effect of combined group and individual treatment on functional communication measures.
For many years, the traditional model of speech-language pathology services for aphasia has consisted of individual treatment sessions with a focus on linguistic function (Rosenbek, LaPointe & Wertz, 1989; Sarno, 1991). There is growing evidence regarding efficacy of group treatment (El-man & Bernstein-Ellis, 1999a), with many rehabilitation hospitals and clinics implementing group therapy plans (Gillis, 2007; Graham & Avent, 2004). However, Elman and Ellis (1999a) and El-man (2007) state that it is often implemented as an adjunct to individual treatment for aphasia. This is in spite of the lack of data to support this combination treatment.
It has been argued that group settings create a more natural environment and increase functional communication opportunities, with the goal of better generalization to real life environments (Adair Ewing, 1999, 2007; Elman & Bernstein-Ellis, 1999a; Graham & Avent, 2004; Kearns & Elman 2001; Lyon, 1992). In addition, group treatment settings provide a safe, comfortable environment to practice and reinforce communication strategies that have been learned in individual treatments (Adair Ewing, 2007; Bloom, 1962; Elman, 1999; Elman & Bernstein-Ellis, 1999a) and allow for opportunities for patients to benefit from peer modeling and peer feedback (Adair Ewing, 2007; Bernstein-Ellis & Elman, 2007; Garrett, Stalari & Moir, 2007). Furthermore, group intervention is conducive to addressing and fostering pragmatics (Adair Ewing, 1999, 2007; Davis, 1986; Graham, 1999; Wilcox, 1983). Pragmatic language skills such as taking turns, maintaining topics, or using body language are essential to functional communicative competence (Manochiopinig, Sheard, & Reed, 1992; Perkins, 2005), and group settings may provide a less contrived setting than is often experienced in individual therapy treatment sessions, which involve only the clinician and a single patient (Clausen & Beeson, 2003).
Wertz et al. (1981) first demonstrated the efficacy of group treatment for aphasia by comparing group treatment to individual treatment. To date, Wertz et al. (1981) is the only study comparing group treatment to individual treatment. An extensive battery of tests was given at 11-week intervals to 67 patients with aphasia beginning at 4 weeks postonset and continuing over a 44-week treatment period. Patients were divided into two groups, receiving either individual or group therapy. Improvement was observed in both groups, although the individual treatment group scored higher than the group treatment group on the Porch Index of Communicative Ability (PICA). …