Interactional Challenges to the Consistent Enactment of Therapy for Language Impairments in Aphasia

INTRODUCTION ‘Task’ or ‘information-processing demands’ (e.g. Wallach and Miller 1988) are the challenges that essentially set in motion the language and cognitive processing work through which the goals of aphasia language therapy are achieved (Robson and Horton, in press). Therapists operationalise goals by introducing stimuli, getting the client to respond, responding contingently themselves, and then moving on to the next stimulus (McTear and King 1991). Byng and Black (1995: 311) argue that therapists’ contingent responses – “modulating the therapy task” – could be one of the critical aspects in the process of therapy. As SimmonsMackie et al (1999) point out, clients receive feedback from therapists, but therapists also modify their treatment in response to the feedback they receive from clients. It has also been suggested (Horton and Byng 2002) that therapists’ increased awareness of consistency in implementing interventions could lead to more efficient and possibly more effective therapy. A study aimed at developing a systematic and explicit descriptive framework for aphasia language therapy examined therapy between experienced clinicians and people with aphasia in day-to-day practice. One question addressed in this study concerned the type of evidence which might provide explicit definitions of techniques such as those described in the literature as ‘cueing’, ‘facilitation’ and ‘feedback’ – in other words those techniques implicated in the modulation and consistent enactment of therapy tasks.