Talk about goals for aphasia therapy
A systemic functional analysis
DOI:
https://doi.org/10.1558/jircd.v1i1.95Keywords:
aphasia, critical discourse analysis, systemic functional linguistics, therapy goalsAbstract
Employing Systemic Functional Linguistics, this paper presents a critical discourse analysis of talk about goals for aphasia therapy by five people with aphasia, their five family members, and their eight treating speech-language pathologists. While speech-language pathologists talked explicitly about goals, people with aphasia and their family members talked about these implicitly. The further analysis of one set of participants found that the wife was observed to use very concrete, activity focused language, in contrast to the more abstract and technical language used by the speech-language pathologist. The language used by these participants indicated different ways of conceptualising goals for people with aphasia. The counterpoint available through this critical discourse analysis is suggested to offer useful reflection on talk in everyday clinical contexts, and to provide directions for further research.
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Beach, M. C. and Inui, T. (2006). Relationship-centered care: A constructive reframing. Journal of General Internal Medicine 21: S3–S8. doi:10.1111/j.1525-1497.2006.00302.x
Beecham, R. (2005). ‘Clients’ as teachers: Power-sharing in the speech-language therapy curriculum. Advances in Speech-Language Pathology 7: 130–137. doi:10.1080/14417040500181197
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Bourdieu, P. (1991). Language and Symbolic Power. Oxford: Polity Press.
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Cunningham, R. (1998). Counselling someone with severe aphasia: An explorative case study. Disability and Rehabilitation 20: 346–354. doi:10.3109/09638289809166092
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Derrida, J. (2004). Positions (Originally published in France in 1972 as Positions by Les Editions de Minuit), London: Continuum.
Duchan, J. F. (1999). Reports written by speech-language pathologists: The role of agenda in constructing client competence (ch. 10). In D. Kovarsky, J. F. Duchan and M. Maxwell (eds) Constructing (In)competence: Disabling Evaluations in Clinical and Social Interaction. Mahwah, NJ: Lawrence Erlbaum.
Evans, C. C., Sherer, M., Nakase-Richardson, R., Mani, T. and Irby, J. W. (2008). Evaluation of an interdisciplinary team intervention to improve therapeutic alliance in post-acute brain injury rehabilitation. Journal of Head Trauma Rehabilitation 23: 329–338. doi: 10.1097/01.HTR.0000336845.06704.bc
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Ferguson, A. (2008b). Expert Practice: A Critical Discourse. San Diego, CA: Plural Publishing.
Ferguson, A. (2009). The discourse of speech-language pathology. International Journal of Speech-Language Pathology 11: 104–112. doi:10.1080/17549500802412651
Ferguson, A. (2010). Critical tensions in talk about brain injury. Brain Impairment 11 (1): 17–30.
Ferguson, A. and Armstrong, E. (2004). Reflections on speech-language therapists’ talk: Implications for clinical practice and education. International Journal of Language & Communication Disorders 39: 469–477. doi:10.1080/1368282042000226879
Ferguson, A., Worrall, L., Davidson, B., Hersh, D., Howe, T. and Sherratt, S. (2008a). (Abstract) Goals, metaphorically speaking. (Paper presented at 13th Aphasiology Symposium of Australia, Brisbane, 2–3 October). Brain Impairment 9: 307–308.
Ferguson, A., Worrall, L., Davidson, B., Hersh, D., Howe, T. and Sherratt, S. (2008b). Talking about goals in aphasia therapy. International Aphasia Rehabilitation Conference. Ljubljana, Slovenia, 30 June–3 July.
Ferguson, A., Worrall, L., Davidson, B., Hersh, D., Howe, T. and Sherratt, S. (2009). Describing the experience of aphasia through metaphor. Clinical Aphasiology Conference. Keystone, CO, 26–30 May.
Foucault, M. (1994). The order of things. In J. D. Faubion (ed.) Essential Works of Foucault 1954–1984: Vol. 2 – Aesthetics, Method, and Epistemology. London: Penguin.
Geldard, K. and Geldard, D. (2005). Practical Counselling Skills: An Integrative Approach. Basingstoke: Palgrave Macmillan.
Halliday, M. A. K. and Matthiessen, C. (2004). An Introduction to Functional Grammar. New York: Arnold.
Hamilton, H. E. (2003). Patient’s voices in the medical world: An exploration of accounts of noncompliance. In D. Tannen and J. E. Alatis (eds) Georgetown University Round Table on Languages and Linguistics 2001: Linguistics, Language, and the Real World – Discourse and Beyond. Washington, DC: Georgetown University Press.
Hand, L. (2003). Discourses in the Professional Practices of Speech Pathology Interviews. Department of Linguistics. Sydney: Unpublished PhD thesis, Macquarie University.
Hand, L. (2006). Clinicians as ‘information givers’: What communication access are clients given to speech-language pathology services? Topics in Language Disorders 26: 240–265. doi:10.1097/00011363-200607000-00007
Hersh, D., Howe, T., Sherratt, S., Worrall, L., Davidson, B. and Ferguson, A. (2008a). (Abstract) Goals in aphasia therapy: What are they, how do we set them and how do we score? (Paper presented at the Aphasiology Symposium of Australia, Brisbane, 2–3 October). Brain Impairment 9: 307.
Hersh, D., Howe, T., Sherratt, S., Worrall, L., Davidson, B. and Ferguson, A. (2008b). Reflections on connections between clinicians and clients during goal-setting in aphasia rehabilitation: How close are they? Reflecting connections: A joint conference between New Zealand Speech-Language Therapists Association and Speech Pathology Australia. Auckland, NZ, 25–29 May.
Higgs, J. and Titchen, A. (2001). Practice Knowledge and Expertise in the Health Professions. Oxford: Butterworth Heinemann.
Ireland, C. and Wotton, C. (1996). Time to talk: Counselling for people with dysphasia. Disability and Rehabilitation 18: 585–591. doi:10.3109/09638289609166319
Kagan, A., Black, S. E., Duchan, J. F., Simmons-Mackie, N. and Square, P. (2001). Training volunteers as conversation partners using ‘Supported Conversation for Adults with Aphasia’ (SCA): A controlled trial. Journal of Speech, Language, and Hearing Research 44: 624–638. doi:10.1044/1092-4388(2001/051)
Kertesz, A. (2006). Western Aphasia Battery – Revised, San Antonio, TX: Harcourt Assessment.
Levack, W., Taylor, K., Siegert, R. and Dean, S. (2006). Is goal planning in rehabilitation effective? A systematic review. Clinical Rehabilitation 20: 739–755.
Locke, T. (2004). Critical Discourse Analysis, London: Continuum.
Marquardt, T. P. and Gillam, R. B. (1999). Assessment in communication disorders: Some observations on current issues. Language Testing 16: 249–769.
McHoul, A. and Grace, W. (1993). A Foucault Primer: Discourse, Power and the Subject. Melbourne: Melbourne University Press.
Miller, J. F. (2003). Systematic Analysis of Language Transcripts – SALT. V8.0 ed. Madison, WI: Language Analysis Laboratory, University of Wisconsin-Madison.
Monaghan, J., Channell, K., McDowell, D. and Sharma, A. K. (2005). Improving patient and carer communication, multidisciplinary team working and goal-setting in stroke rehabilitation. Clinical Rehabilitation 19: 194–199. doi:10.1191/0269215505cr837oa
Nair, K. (2003). Life goals: The concept and its relevance to rehabilitation. Clinical Rehabilitation 17: 192–202. doi:10.1191/0269215503cr599oa
Parr, S., Byng, S., Gilpin, S. and Ireland, C. (1997). Talking about Aphasia, Buckingham: Open University Press.
Parr, S., Pound, C. and Duchan, J. (2003). Aphasia Inside Out: Reflections on Communication Disability. Milton Keynes: Open University Press.
Pennycook, A. (2001). Critical Applied Linguistics: A Critical Introduction, Mahwah, NJ: Lawrence Erlbaum.
Pillay, M. (2001). ‘Do you speak practice-ese?’ A discourse of practice for sharing communication. International Journal of Language & Communication Disorders 36: 351–356. doi:10.3109/13682820109177910
Playford, E. D., Siegert, R., Levack, W. and Freeman, J. (2009). Areas of consensus and controversy about goal setting in rehabilitation: A conference report. Clinical Rehabilitation 23: 334–344. doi:10.1177/0269215509103506
Redmond, B. (2004). Reflection in Action: Developing Reflective Practice in Health and Social Services. Burlington, VT: Ashgate.
Rogers, R. (2004). An Introduction to Critical Discourse Analysis in Education. Mahwah, NJ: Lawrence Erlbaum.
Sarangi, S. (1998). Interprofessional case construction in social work: The evidential status of information and its reportability. Text 18: 241–270.
Siegert, R. and Taylor, W. (2004). Theoretical aspects of goal-setting and motivation in rehabilitation. Disability & Rehabilitation 26: 1–8. doi:10.1080/09638280410001644932
van den Broek, M. D. (2005). Why does neurorehabilitation fail? Journal of Head TraumaRehabilitation 20: 464–473. doi:10.1097/00001199-200509000-00007
Visser-Meily, J. M. A., Post, M., Gorter, J. W., Berlekom, S. B., Van den Bos, T. and Lindeman, E. (2006). Rehabilitation of stroke patients needs a family-centred approach. Disability & Rehabilitation 28: 1557–1561. doi:10.1080/09638280600648215
Wagner, B. T. and Hess, C. W. (1999). Supervisors’ use of social power with graduate supervisees in speech-language pathology. Journal of Communication Disorders 32: 351–368. doi:10.1016/S0021-9924(99)00016-7
Wodak, R. and Meyer, M. (2009). Methods of Critical Discourse Analysis, 2nd edn. London: Sage.
Worrall, L. (1999). Functional Communication Therapy Planner. Oxon, UK: Winslow Press.
Worrall, L. (2000). The influence of professional values on the functional communication approach in aphasia. In L. Worrall and C. Frattali (eds) Neurogenic Communication Disorders: A Functional Approach ch. 11, pp. 191–205. New York: Thieme.
Worrall, L., Davidson, B., Ferguson, A., Hersh, D., Howe, T. and Sherratt, S. (2007a). What people with aphasia want: Towards person-centered goal-setting in aphasia rehabilitation.
ASHA (American Speech-Language-Hearing Association) Annual Convention. Boston, MA, 15–17 November.
Worrall, L., Davidson, B., Hersh, D., Ferguson, A., Howe, T. and Sherratt, S. (2009). Setting goals from the perspectives of people with aphasia, family members and their treating speech-language pathologists. Clinical Aphasiology Conference. Keystone, CO, 26–30 May.
Worrall, L., Davison, B., Ferguson, A., Hersh, D., Howe, T. and Sherratt, S. (2007b). What people with aphasia want: Towards person-centered goal-setting in aphasia rehabilitation. ASHA (American Speech-Language-Hearing Association) Annual Convention. Boston, MA, 15–17 November.
Worrall, L., Hersh, D., Howe, T., Davidson, B., Ferguson, A. and Sherratt, S. (2007c). What people with aphasia want: Toward person-centered goal-setting in aphasia rehabilitation. Living Successfully with Aphasia: Intervention, Evaluation and Evidence Conference. Toronto, Canada, 19–20 September.
Young, L. and Harrison, C. (2004). Systemic Functional Linguistics and Critical Discourse Analysis. London: Continuum.
Armstrong, E. (1993). Aphasia rehabilitation: A sociolinguistic perspective. In A. J. Holland and M. M. Forbes (eds) Aphasia Treatment: World Perspectives. San Diego, CA: Singular.
Armstrong, E., Ferguson, A., Mortensen, L. and Togher, L. (2005/2007). Acquired language disorders perspective. In J. Webster, R. Hasan and C. Matthiessen (eds) Continuing Discourse on Language: A Functional Perspective. London: Equinox.
Bayne, R. and Thompson, K. L. (2000). Counsellor response to clients’ metaphors: An evaluation and refinement of Strong’s model. Counselling Psychology Quarterly, 13: 37–49. doi:10.1080/09515070050011051
Beach, M. C. and Inui, T. (2006). Relationship-centered care: A constructive reframing. Journal of General Internal Medicine 21: S3–S8. doi:10.1111/j.1525-1497.2006.00302.x
Beecham, R. (2005). ‘Clients’ as teachers: Power-sharing in the speech-language therapy curriculum. Advances in Speech-Language Pathology 7: 130–137. doi:10.1080/14417040500181197
Bourdieu, P. (1977). Outline of a Theory of Practice. Cambridge, New York: Cambridge University Press.
Bourdieu, P. (1991). Language and Symbolic Power. Oxford: Polity Press.
Bradley, E. H., Bogardus, S. T., Tinetti, M. E. and Inouye, S. K. (1999). Goal-setting in clinical medicine. Social Science and Medicine 49: 267–278. doi:10.1016/S0277-9536(99)00107-0
Cott, C. A. (2004). Client-centred rehabilitation: Client perspectives. Disability & Rehabilitation 26: 1411–1422. doi:10.1080/09638280400000237
Cunningham, R. (1998). Counselling someone with severe aphasia: An explorative case study. Disability and Rehabilitation 20: 346–354. doi:10.3109/09638289809166092
Davidson, B., Worrall, L., Hersh, D., Ferguson, A., Howe, T., Sherratt, S. and Gilbert, J. (2007). Family members’ goals for aphasia rehabilitation. Biennial International Conference – British Aphasiology Society. Edinburgh, 9–12 September.
Derrida, J. (2004). Positions (Originally published in France in 1972 as Positions by Les Editions de Minuit), London: Continuum.
Duchan, J. F. (1999). Reports written by speech-language pathologists: The role of agenda in constructing client competence (ch. 10). In D. Kovarsky, J. F. Duchan and M. Maxwell (eds) Constructing (In)competence: Disabling Evaluations in Clinical and Social Interaction. Mahwah, NJ: Lawrence Erlbaum.
Evans, C. C., Sherer, M., Nakase-Richardson, R., Mani, T. and Irby, J. W. (2008). Evaluation of an interdisciplinary team intervention to improve therapeutic alliance in post-acute brain injury rehabilitation. Journal of Head Trauma Rehabilitation 23: 329–338. doi: 10.1097/01.HTR.0000336845.06704.bc
Fairclough, N. (1995). Critical Discourse Analysis: The Critical Study of Language. London: Longman.
Ferguson, A. (2008a). A critical discourse perspective on speech-language pathology assessment. Critical Approaches to Discourse Analysis Across Disciplines (CADAAD conference). University of Hertfordshire, UK, 10–11 July.
Ferguson, A. (2008b). Expert Practice: A Critical Discourse. San Diego, CA: Plural Publishing.
Ferguson, A. (2009). The discourse of speech-language pathology. International Journal of Speech-Language Pathology 11: 104–112. doi:10.1080/17549500802412651
Ferguson, A. (2010). Critical tensions in talk about brain injury. Brain Impairment 11 (1): 17–30.
Ferguson, A. and Armstrong, E. (2004). Reflections on speech-language therapists’ talk: Implications for clinical practice and education. International Journal of Language & Communication Disorders 39: 469–477. doi:10.1080/1368282042000226879
Ferguson, A., Worrall, L., Davidson, B., Hersh, D., Howe, T. and Sherratt, S. (2008a). (Abstract) Goals, metaphorically speaking. (Paper presented at 13th Aphasiology Symposium of Australia, Brisbane, 2–3 October). Brain Impairment 9: 307–308.
Ferguson, A., Worrall, L., Davidson, B., Hersh, D., Howe, T. and Sherratt, S. (2008b). Talking about goals in aphasia therapy. International Aphasia Rehabilitation Conference. Ljubljana, Slovenia, 30 June–3 July.
Ferguson, A., Worrall, L., Davidson, B., Hersh, D., Howe, T. and Sherratt, S. (2009). Describing the experience of aphasia through metaphor. Clinical Aphasiology Conference. Keystone, CO, 26–30 May.
Foucault, M. (1994). The order of things. In J. D. Faubion (ed.) Essential Works of Foucault 1954–1984: Vol. 2 – Aesthetics, Method, and Epistemology. London: Penguin.
Geldard, K. and Geldard, D. (2005). Practical Counselling Skills: An Integrative Approach. Basingstoke: Palgrave Macmillan.
Halliday, M. A. K. and Matthiessen, C. (2004). An Introduction to Functional Grammar. New York: Arnold.
Hamilton, H. E. (2003). Patient’s voices in the medical world: An exploration of accounts of noncompliance. In D. Tannen and J. E. Alatis (eds) Georgetown University Round Table on Languages and Linguistics 2001: Linguistics, Language, and the Real World – Discourse and Beyond. Washington, DC: Georgetown University Press.
Hand, L. (2003). Discourses in the Professional Practices of Speech Pathology Interviews. Department of Linguistics. Sydney: Unpublished PhD thesis, Macquarie University.
Hand, L. (2006). Clinicians as ‘information givers’: What communication access are clients given to speech-language pathology services? Topics in Language Disorders 26: 240–265. doi:10.1097/00011363-200607000-00007
Hersh, D., Howe, T., Sherratt, S., Worrall, L., Davidson, B. and Ferguson, A. (2008a). (Abstract) Goals in aphasia therapy: What are they, how do we set them and how do we score? (Paper presented at the Aphasiology Symposium of Australia, Brisbane, 2–3 October). Brain Impairment 9: 307.
Hersh, D., Howe, T., Sherratt, S., Worrall, L., Davidson, B. and Ferguson, A. (2008b). Reflections on connections between clinicians and clients during goal-setting in aphasia rehabilitation: How close are they? Reflecting connections: A joint conference between New Zealand Speech-Language Therapists Association and Speech Pathology Australia. Auckland, NZ, 25–29 May.
Higgs, J. and Titchen, A. (2001). Practice Knowledge and Expertise in the Health Professions. Oxford: Butterworth Heinemann.
Ireland, C. and Wotton, C. (1996). Time to talk: Counselling for people with dysphasia. Disability and Rehabilitation 18: 585–591. doi:10.3109/09638289609166319
Kagan, A., Black, S. E., Duchan, J. F., Simmons-Mackie, N. and Square, P. (2001). Training volunteers as conversation partners using ‘Supported Conversation for Adults with Aphasia’ (SCA): A controlled trial. Journal of Speech, Language, and Hearing Research 44: 624–638. doi:10.1044/1092-4388(2001/051)
Kertesz, A. (2006). Western Aphasia Battery – Revised, San Antonio, TX: Harcourt Assessment.
Levack, W., Taylor, K., Siegert, R. and Dean, S. (2006). Is goal planning in rehabilitation effective? A systematic review. Clinical Rehabilitation 20: 739–755.
Locke, T. (2004). Critical Discourse Analysis, London: Continuum.
Marquardt, T. P. and Gillam, R. B. (1999). Assessment in communication disorders: Some observations on current issues. Language Testing 16: 249–769.
McHoul, A. and Grace, W. (1993). A Foucault Primer: Discourse, Power and the Subject. Melbourne: Melbourne University Press.
Miller, J. F. (2003). Systematic Analysis of Language Transcripts – SALT. V8.0 ed. Madison, WI: Language Analysis Laboratory, University of Wisconsin-Madison.
Monaghan, J., Channell, K., McDowell, D. and Sharma, A. K. (2005). Improving patient and carer communication, multidisciplinary team working and goal-setting in stroke rehabilitation. Clinical Rehabilitation 19: 194–199. doi:10.1191/0269215505cr837oa
Nair, K. (2003). Life goals: The concept and its relevance to rehabilitation. Clinical Rehabilitation 17: 192–202. doi:10.1191/0269215503cr599oa
Parr, S., Byng, S., Gilpin, S. and Ireland, C. (1997). Talking about Aphasia, Buckingham: Open University Press.
Parr, S., Pound, C. and Duchan, J. (2003). Aphasia Inside Out: Reflections on Communication Disability. Milton Keynes: Open University Press.
Pennycook, A. (2001). Critical Applied Linguistics: A Critical Introduction, Mahwah, NJ: Lawrence Erlbaum.
Pillay, M. (2001). ‘Do you speak practice-ese?’ A discourse of practice for sharing communication. International Journal of Language & Communication Disorders 36: 351–356. doi:10.3109/13682820109177910
Playford, E. D., Siegert, R., Levack, W. and Freeman, J. (2009). Areas of consensus and controversy about goal setting in rehabilitation: A conference report. Clinical Rehabilitation 23: 334–344. doi:10.1177/0269215509103506
Redmond, B. (2004). Reflection in Action: Developing Reflective Practice in Health and Social Services. Burlington, VT: Ashgate.
Rogers, R. (2004). An Introduction to Critical Discourse Analysis in Education. Mahwah, NJ: Lawrence Erlbaum.
Sarangi, S. (1998). Interprofessional case construction in social work: The evidential status of information and its reportability. Text 18: 241–270.
Siegert, R. and Taylor, W. (2004). Theoretical aspects of goal-setting and motivation in rehabilitation. Disability & Rehabilitation 26: 1–8. doi:10.1080/09638280410001644932
van den Broek, M. D. (2005). Why does neurorehabilitation fail? Journal of Head TraumaRehabilitation 20: 464–473. doi:10.1097/00001199-200509000-00007
Visser-Meily, J. M. A., Post, M., Gorter, J. W., Berlekom, S. B., Van den Bos, T. and Lindeman, E. (2006). Rehabilitation of stroke patients needs a family-centred approach. Disability & Rehabilitation 28: 1557–1561. doi:10.1080/09638280600648215
Wagner, B. T. and Hess, C. W. (1999). Supervisors’ use of social power with graduate supervisees in speech-language pathology. Journal of Communication Disorders 32: 351–368. doi:10.1016/S0021-9924(99)00016-7
Wodak, R. and Meyer, M. (2009). Methods of Critical Discourse Analysis, 2nd edn. London: Sage.
Worrall, L. (1999). Functional Communication Therapy Planner. Oxon, UK: Winslow Press.
Worrall, L. (2000). The influence of professional values on the functional communication approach in aphasia. In L. Worrall and C. Frattali (eds) Neurogenic Communication Disorders: A Functional Approach ch. 11, pp. 191–205. New York: Thieme.
Worrall, L., Davidson, B., Ferguson, A., Hersh, D., Howe, T. and Sherratt, S. (2007a). What people with aphasia want: Towards person-centered goal-setting in aphasia rehabilitation.
ASHA (American Speech-Language-Hearing Association) Annual Convention. Boston, MA, 15–17 November.
Worrall, L., Davidson, B., Hersh, D., Ferguson, A., Howe, T. and Sherratt, S. (2009). Setting goals from the perspectives of people with aphasia, family members and their treating speech-language pathologists. Clinical Aphasiology Conference. Keystone, CO, 26–30 May.
Worrall, L., Davison, B., Ferguson, A., Hersh, D., Howe, T. and Sherratt, S. (2007b). What people with aphasia want: Towards person-centered goal-setting in aphasia rehabilitation. ASHA (American Speech-Language-Hearing Association) Annual Convention. Boston, MA, 15–17 November.
Worrall, L., Hersh, D., Howe, T., Davidson, B., Ferguson, A. and Sherratt, S. (2007c). What people with aphasia want: Toward person-centered goal-setting in aphasia rehabilitation. Living Successfully with Aphasia: Intervention, Evaluation and Evidence Conference. Toronto, Canada, 19–20 September.
Young, L. and Harrison, C. (2004). Systemic Functional Linguistics and Critical Discourse Analysis. London: Continuum.
Published
2010-09-28
Issue
Section
Articles
How to Cite
Ferguson, A., Worrall, L., Davidson, B., Hersh, D., Howe, T., & Sherratt, S. (2010). Talk about goals for aphasia therapy: A systemic functional analysis. Journal of Interactional Research in Communication Disorders, 1(1), 95-118. https://doi.org/10.1558/jircd.v1i1.95
