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Broca's aphasia

Article Review 2

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A Qualitative Study of Feedback in Aphasia Treatment
I. Purpose of Study
The purpose of the study was to determine how feedback influences the effectiveness and efficiency of treatment.
Feedback was defined as behavior that helps to modify communication by providing information regarding the adequacy or accuracy of a response and/or providing general encouragement. Encouragement and reassurance are common features of aphasia treatment. Feedback might include reward, punishment, confirmation or information following a response. By gaining insight on the effectiveness of feedback, clinicians can help identify the precise characteristics of a well managed treatment session and help clinicians and students incorporate the proper feedback in their therapy sessions.
II. Method of Study; Description of Subjects
The method of study used two qualitative research paradigms—ethnography and conversation analysis. Ethnology was used to study the complex social interactions in natural treatment contexts. It allows the researcher to discover social and cultural meanings by getting the perspectives of the persons involved in the study and to describe social events in great detail. Studying aphasia treatment interactions using this method allowed the researchers to uncover patterns of interaction and categorize behavior in a natural setting without needing to control the situation artificially. Conversation analysis was used to identify mechanisms that constitute feedback behaviors and contribute to a detailed understanding of how feedback influences therapy outcomes and interactions. Conversation analysis involves description of interaction by studying utterances to help identify how communicators accomplish social goals.
Participants included 6 SLP’s and 11 clients. The clients were selected based on their agreement to participate, diagnosis of aphasia, and enrollment in therapy with an SLP. The clinicians were all female Caucasian SLP’s who were ASHA certified. They had a range of experience from 5 to 15 years of experience with adult aphasia management. Their age range was from 26 to 45 years.
Treatment contexts were outpatient, inpatient and home health settings in three different cities. Treatment practices included stimulation treatment, compensatory training and functional intervention approaches. Activities included didactic stimulation tasks and facilitators such as written cues and automatic speech tasks. Compensatory strategies included activities of daily living and practice in communicating their ideas using any available modality.
Data collection included video tapes of treatment sessions, participant observation of aphasia treatment, audiotaped interviews with participants and review of case records.
III. Results
The following results give a detailed description of feedback in aphasia treatment:
1. Feedback was multifunctional.
The delivery of feedback by the clinician not only helped to structure the discourse but also helped to fulfill important treatment and interactive goals. Feedback helped to shape targeted behaviors. Encouraging and boosting confidence, modifying or maintaining target communication behavior, soliciting cooperation, establishing tempo, communicating rules and attitudes and consolidating social roles were the feedback techniques used.
2. Individual feedback occurrences were often multi-functional.
More than one function was often fulfilled by a single feedback occurrence.
3. Feedback involved more than one verbal content.
Prosody and body movements were used to enhance the effectiveness of the feedback provided by the clinician.
4. There were very few instances of negative evaluation such as “no, that’s wrong.”
Feedback was usually positive. To correct an error, the clinician might say “wait, watch me” instead of telling the patient that he/she made an error. Providing either positive feedback or facilitating accurate responses rather than focusing on errors had a positive influence on the client and therapy session.
5. Occurrence rates of direct treatment feedback were asymmetrical-extremely high rates of clinician-delivered feedback and minimal instances of client-delivered feedback. This was sometimes at a ratio of 100:1.
6. The success of feedback was dependent on a collaborative effort between the clinician and the client.
Even though the feedback was not always delivered by the client, acknowledgment and agreement  supplied by the clinician was often required before treatment continued.
Some of the phrases/words that worked well for feedback were “good”, “all right”, “that’s good”, and “You worked hard on these,” “ Good try.  “Nice try Let’s try again”, “Good. Let’s try one more time”. Gestures included nodding “yes” for approval, a simple touch on the hand or arm, thumbs up, clapping, smiling.

IV. Discuss Recommendations/Impressions of the Study
The results of this study suggest that feedback has a positive effect on the success of the therapy session. Feedback not only provided motivation and shaped language behavior; it also managed interactions during the treatment exchange. A better understanding of feedback techniques can help clinicians improve the efficiency of therapy sessions and help in training student clinicians. During the study, it was reported that clinicians often use ambiguous feedback responses that project mixed messages to the client. By viewing their videotapes, the clinician was able to review their responses and make adjustments to make their feedback more natural and meaningful.
Feedback should be natural and not rehearsed or artificial. Clinicians should develop their responses portraying their own personalities for the most natural interactions. This may take some practice. Observing taped sessions may help as well as getting feedback from other SLP’s during observation sessions.
In addition to incorporation feedback in to therapy sessions for aphasic clients, it is a useful technique that can be used in therapy session with a wide range of clients. For instance, preschool and school age children would benefit from feedback if it was used in a consistent and natural way. It would help to keep them motivated, raise their self esteem and encourage them continue to work on their speech in other settings.
Children with autism would benefit with the constant reinforcement. Children with cerebral palsy would feel encouraged by their accomplishments. Children with articulation disorders would benefit from the constant reinforcement and try harder.  By practicing and developing a natural method fo incorporating feedback in their therapy sessions, clinicians could improve effectiveness and efficiency of treatment which would benefit their clients.
Simmons-Mackie, N., Damico, J.S., Damico, H.L. (1999) A Qualitative Study of Feedback in Aphasia Treatment. American Journal of Speech-Language 230.

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