Group Treatment for People With Aphasia: Getting Your Feet Wet Candace Vickers, M.S., CCC-SLP Founder: Communication Recovery Group Treatment Program for Adults St. Jude Medical Center, Fullerton, California
Providing aphasia group treatment for the first time is a little like diving into cold water. It’s a jolt at first, but soon the water is enjoyable and invigorating! In the same way, it takes courage to step out of one’s comfort zone in individual therapy and try group treatment. Only then can the clinician and group members experience the special magic of camaraderie and realistic communication practice unique to group therapy. In groups for people with aphasia, members try their hardest to communicate with each other, laugh, share stories, encourage each other, and persevere even when the going gets tough. The clinician’s role is to foster an atmosphere of trust and friendship, and to provide support by being ready to use augmentative techniques as needed. The speechlanguage pathologist also has a crucial role to play as group leader by encouraging conversation and providing topics and activities as needed. At the same time, it is important to be flexible and let the group’s natural flow of conversation and interaction develop. Being a Skillful Communication Partner Clinicians today have access to a wealth of information that can aid them in providing group treatment to people with varying levels of aphasia. “Access to conversation” as described by Aura Kagan (1998) is possible for people with even the most severe forms of aphasia when they are given adequate levels of conversational support. Clinicians wishing to provide quality communication opportunities to people with aphasia owe it to their group members to learn to use augmentative techniques in order to become skillful communication partners who adapt to conversing with someone with any severity level of aphasia. Getting Started Clinicians don’t need large numbers of people to begin a group. Adding one or two communication partners to a client’s individual therapy session is a good way to begin. This immediately will facilitate a natural context for conversation and the chance to
practice communication skills with multiple partners, often a functional goal of rehabilitation. Often, graduates of speech therapy desiring more practice and interested spouses or students are highly motivated to participate as communication partners in a group session and can be given different types of roles to fulfill according to the need of the group. Equipment Needs for Groups Some essential items for groups include nametags for members, scratch paper, dark marking pens, maps, and a dry-erase board or chalkboard. Having these items enables the clinician the freedom to draw, create written choices for members, and display names and other information. Group members also often can communicate ideas via writing or drawing as well as indicating locations on maps. Scheduling Groups Scheduling groups in a medical setting can be challenging. Most medical settings offer regularly scheduled exercise or other kinds of physical activity groups. And yet the speech-language pathologist may face an uphill battle in trying to establish a conversation group on the weekly schedule. Clinicians often need to help administration and other staff realize that enhancing psychosocial well-being through providing communication groups is as important as improving physical well-being through exercise. Billing Issues With Group Treatment In the medical setting, clinicians are faced with the constraints of reimbursement and limitations on numbers of visits by Medicare and other third-party payers. Clinicians must decide whether individual therapy, group therapy, or a combination of the two will best meet the needs of a given client. When groups are chosen as a treatment modality during reimbursable treatment, it is vital that the clinician describes specific functional goals and how the group environment will facilitate the rehabilitation process (Busch, 1998). Conversation for Its Own Sake Kagan described aphasia as a disorder that “masks competence” and cuts an individual off from social and community life. Participation in conversation groups can continue to provide a vital a sense of community for people with aphasia long after reimbursable care has ended. Elman (1998) compared the need for continuing
conversation practice during recovery from aphasia to the need for continuing medical treatment in diabetes. In chronic aphasia, just as in other chronic conditions, the need for treatment does not end upon discharge from the hospital. And yet despite this need, many clinicians are facing productivity and time constraints that do not allow large investments of time in developing conversation groups. In these situations, trained volunteers are an invaluable resource. Group Activities In groups for people with more nonfluent forms of aphasia, clinicians will need to provide conversational formats that provide members with a way of expressing themselves. Garrett and Beukelman (1992) as well as Kagan (1998) have described techniques such as written choice communication or supported conversation that allow maximum participation by the person with aphasia in a conversational exchange. Communication behaviors such as giving opinions and preferences or advice can be elicited in such groups (Vickers, 1998) and provide a meaningful basis for conversation. In groups for people who are more fluent speakers, clinicians can select from a variety of treatment approaches ranging from more structured conversation activities that help clients achieve functional goals to a less structured approach where the focus is always on group members establishing and maintaining the conversation more independently. Groups using volunteer co-leaders benefit from using a combination of both approaches. Volunteers can be given structured activities by the clinician but also should be trained to encourage group members to develop their own topics. The changes in health care today have a great impact on people with aphasia and other communication disorders. There has never been a better time for clinicians to hone their group leadership skills, advocate for their clients, and take seriously the role of being a catalyst for change in a person’s communication world by offering ongoing communication opportunities. References Busch, C. (1998).Group treatment reimbursement issues. In R. Elman (Ed.), Group treatment of neurogenic communication disorders: The expert clinician’s approach. Boston: Butterworth Heinemann.
Elman, R. (1998, San Antonio). Treating outside the box. Presented at American SpeechLanguage-Hearing Association, San Antonio, Texas. Garrett, K., and D. Beukelman. (1992). Augmentative communication approaches for persons with severe aphasia. In K. M. Yorkston (Ed.), Augmentative communication in the medical setting. San Antonio, TX: Communication Skill Builders. Kagan, A. (1998). Supported conversation for adults with aphasia: methods and resources for training conversation partners. Aphasiology, 12(9), 816–838. Vickers, C. (1998). Communication recovery: Group conversation activities for adults. San Antonio, TX: Communication Skill Builders.