Language and Cognition Colombo 2011

1. Language and CognitionColombo 2011 Day 7 Working with groups

2. Benefits of Group Therapy • 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

3. Disadvantages of Group Therapy • Range of abilities and impairments • Harder for clinician to monitor performance • Attendance rates • Personality clashes!

4. 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

5. Pre-Requisite Skills • 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

6. 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)

7. 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

8. Participants • 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)

9. 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

10. 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

11. 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

12. Conclusions • Despite small sample size, group intervention can contribute to positive change in communication, life participation and psychological well-being.

13. Case example The Efficacy of Group Communication Treatment in Adults with Chronic Aphasia Elman and Bernstein-Ellis (1999)

14. 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

15. 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

16. 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

17. 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. • .

18. 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

19. 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

20. Case Example An evaluation of short-term group therapy for people with aphasia Brumfitt and Sheeran (1997)

21. 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

22. Participants • 6 people with Left CVA and aphasia (2 fluent, 3 mixed, 1 non-fluent) • All >3yrs post onset

23. 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

24. 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

25. 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

26. Conclusions • Group therapy is capable of demonstrating changes in communicative ability and attitudes towards communication (no control group!)

27. 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

28. Questions?