Long term adaptation to conversation by people with aphasia and their partners

In this three year (2001-2004) project we investigated the process of adaptation in aphasia by analysing changes over time in the conversation of people with aphasia and their main everyday conversational partner.

Specifically the project had two, linked, aims:

1. To investigate how people with aphasia and their main everyday conversational partner adapt to conversation with aphasia following stroke from the acute, early stages of the disorder up to two and a half years post-onset

2. To investigate the possible relationship between adaptation to conversation over this time and

   1. changes in the aphasic speaker's linguistic resources over this time
   2. changes in the couple's relationship and style of relating together over this time

While the neurological aspects of early recovery from aphasia have been the focus of much research, the social and long term recovery process of adapting to aphasia in everyday life has been less investigated. It is known that post-stroke there is a period of neurophysiological recovery of function. This recovery is usually greatest in the first three months after onset, reaching a plateau at between six and twelve months. When assessed on language tests measuring aspects of language such as lexical semantics and syntax, speakers with aphasia tend not to display spontaneous improvement beyond this 12 month period. Even with speech and language therapy intervention, many speakers will remain aphasic for the rest of their lives. For these speakers and their significant others, therefore, the long term process of recovery and improvement is not primarily one of progress towards 'normality' (however conceived) or of returning to how they were before the stroke but rather one of adaptation i.e. learning to live with aphasia and finding methods of talking and relating together which work well for them despite being perhaps different to those used by non-impaired speakers.

In the project the couple were visited seven times over the two and a half year period. At each stage they videoed themselves in conversation and are interviewed, and the person with aphasia was assessed on a small battery of language tests. We analysed the data, using conversation analysis and other methods, to investigate how the couple change and how the different aspects of the recovery process (i.e. change in conversation, language and relationship 'style') are related. Understanding recovery and change by couples where one partner has aphasia will assist in the development of intervention programmes which can facilitate this process of adaptation.