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The aims of this thesis were to describe the experiences of persons with aphasia and their significant others of their conversations and use of communication strategies, examine current practice of family-oriented speech-language pathology (SLP) services, and test a family-oriented intervention in the early phase of rehabilitation. The persons with aphasia valued having conversations despite perceiving their aphasia as a serious social disability. They acknowledged the importance of the communication partners’ knowledge and understanding of aphasia and their use of supporting conversation strategies. Their own use of communication strategies varied considerably. The persons with aphasia longed to regain language ability and to be active participants in society. A majority of the significant others perceived their conversations with the person with aphasia as being less stimulating and enjoyable than conversations before stroke onset. Aphasia was considered a serious problem. The significant others took on increased communicative responsibility, where two thirds had changed their communicative behaviour to facilitate conversations. Type and severity of aphasia were especially related to the communicative experiences of the significant others and their motivation to be involved in SLP services. Thirty percent of the speech-language pathologists worked with people with aphasia and typically met with their families. They considered the involvement of significant others in SLP services as very important, especially in providing information about aphasia and communication partner training (CPT). However, involvement of significant others was restricted because of a time shortage and perceived limited skills and knowledge. In addition, there were national differences regarding aphasia rehabilitation services. The intervention consisted of three sessions directed to significant others (primarily emotional support and information) and three directed to the dyads (a person with aphasia and a significant other) (primarily CPT). All six participants (three dyads) felt that their knowledge and understanding of aphasia had increased and that their conversations had improved. These improvements were also evident to some extent with formal assessments. These results suggest the following: CPT should be an integral part of SLP services, national clinical guidelines are needed, and further education of speech-language pathologists and implementation of new knowledge into clinical practice requires consideration.

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General lack of awareness regarding neurogenic communication disorders generally, and cognitive-communicative disorders following a traumatic brain injury (TBI) specifically has resulted in pervasive environmental and attitudinal barriers for these individuals. Paradigm shifts within the rehabilitation context have been highlighted which aim to remove barriers, provide social supports, and thereby enhance their participation in all aspects of life. While collaborative communication partner training programs have been advocated as a means to achieve this, a dearth of published programs is evident within the field of TBI, leading to the need for such programs to enhance the awareness and skill of the communication partner, and reduce barriers for the individual. Transformations are likewise apparent in the corporate context, where in spite of legislative changes encouraging diversity awareness programs for employees, few training programs exist worldwide, and in South Africa particularly, which remove barriers between employees and customers with a communication disability, and a TBI specifically. The current research targeted the retail supermarket environment as a context in which a significant number of everyday communicative exchanges take place. The study investigated the ability of a group of sales assistants to identify barriers to, and facilitators of interaction involving customers with a cognitive-communication disorder, using a control group design. This was achieved by the development and administration of 2 questionnaires on 2 different occasions to determine the confidence and skill with which they identified barriers and facilitators during videotaped sales interactions. A once-off training session was developed and conducted with the experimental group participants, in order to increase their confidence and skill in identifying barriers and facilitators of such interactions. The training session employed a number of customized components considered to be powerful contributors to the positive outcome of the study. These included: extensive use of customized video material professionally produced and comprising real interactions involving individuals with a TBI as “customers” in various stores of the participating national supermarket chain during operating hours. Collaboration with an individual with a TBI in the training, together with use of adult learning and diversity awareness principles were considered effective in shifting previous attitudes and fostering new learning. Inter-and-intra-group results on the confidence and skill constructs of the pre-and-post questionnaires were examined. All pointed consistently to the impact of the training session on the improvement demonstrated in the experimental group as compared to the control group on the post-questionnaires as compared with the pre-questionnaires. In addition all subjective training session evaluations by the experimental group participants were consistently highly rated, reflecting the active participation observed during training. The need for companies to expand their concept of customer service to include an acknowledgement of the customer with a disability is emphasized. Training programs empowering their employees to interact with greater awareness and confidence with customers with a TBI specifically will potentially facilitate deeper participation for both. The current research lays the groundwork for more in-depth research that can be generalized beyond this specific population of individuals with a communication disorder. / Thesis (DPhil (Communication Pathology))--University of Pretoria, 2007. / Centre for Augmentative and Alternative Communication / unrestricted

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La communication avec les proches, tout comme celle avec des interlocuteur·trice·s non famili·ère·s comme le personnel à l’épicerie ou à la pharmacie, est au centre de nombreuses activités qui permettent d’exercer une participation sociale satisfaisante. Or, pour réaliser une société inclusive, des adaptations humaines sont essentielles pour les personnes vivant avec un trouble de la communication. En effet, les interactions difficiles avec les individus rencontrés dans leur(s) communauté(s) pourraient restreindre leur participation sociale. Notamment, leur accès au transport collectif semble freiné par les attitudes et habiletés de communication du personnel. Considérant le rôle clé des transports collectifs dans la participation sociale, cette thèse présente un projet de recherche qui a pour ambition d’améliorer les échanges entre les chauffeur·e·s de transport adapté et les passager·ère·s du service vivant avec un trouble de la communication. Une formation des partenaires de communication, une intervention orthophonique visant à outiller des interlocuteur·trice·s à mieux interagir avec des personnes vivant avec un trouble de la communication, a été développée spécialement pour les chauffeur·e·s de transport adapté d’une société de transport public d’une grande ville québécoise. Son développement a été encadré par un modèle provenant du domaine de l’éducation aux adultes, le modèle andragogique de processus d’apprentissage. La formation intitulée Pour une communication inclusive dans les transports publics a été offerte à treize chauffeur·e·s de transport adapté. Ses effets sur les chauffeur·e·s ont été explorés avec un devis exploratoire à groupe unique. La première étude de la thèse consiste en une revue de la portée. Elle décrit les écrits scientifiques sur la formation des partenaires de communication destinée à des travailleur·euse·s ou des interlocuteur·trice·s non familier·ère·s visant à améliorer la communication avec des personnes vivant avec un ou plusieurs troubles neurologiques acquis de la communication. Les constats de cet article sont que la majorité des formations des partenaires de communication abordent un seul trouble de la communication et qu’elles sont principalement offertes à du personnel ou des étudiant·e·s du domaine de la santé. Malgré une variabilité dans les mesures utilisées pour évaluer les effets de ces formations, les résultats rapportés étaient prometteurs pour améliorer les interactions entre les personnes formées et les individus vivant avec un trouble de la communication. La deuxième étude de la thèse explore l’utilité du modèle andragogique de processus d’apprentissage. L’étude souligne que le modèle s’est avéré utile pour développer, déployer et évaluer une formation en milieu de travail qui a semblé être appréciée des participant·e·s, et ce bien que la majorité des éléments du modèle ait été adapté pour répondre aux contraintes organisationnelles. L’étude souligne que l’appréciation des besoins d’apprentissage, l’établissement d’une ambiance de bienveillance, d'acceptation, de confiance et de respect propice à l’apprentissage ainsi que le choix des méthodes de formation semblent constituer des éléments clés du modèle. La troisième étude explore les effets de la formation sur treize chauffeur·e·s de transport adapté. Après avoir été formé·e·s, les chauffeur·e·s semblent avoir plus de connaissances sur la communication avec une personne vivant avec un trouble de la communication. De plus, l’analyse des vidéos des déplacements de passager·ère·s vivant avec un trouble de la communication par les chauffeur·e·s-participant·e·s révèle que ces dernier·ère·s ont amélioré leur communication relationnelle et ont augmenté le nombre de gestes utilisés avec ces passager·ère·s. La présente thèse soutient qu’une formation des partenaires de communication basée sur des théories de l’éducation aux adultes a le potentiel d’améliorer les échanges entre les chauffeur·e·s de transport adapté et les personnes vivant avec un trouble de la communication. Elle pose les bases pour d’autres études qui devront, elles, tâcher d’évaluer l’efficacité et de comprendre davantage les effets de formations similaires. Cette thèse réaffirme l’importance des recherches sur les formations des partenaires de communication, car celles-ci représentent une intervention prometteuse pour réaliser une société plus inclusive à l’égard des individus vivant avec un trouble de la communication. / Communicating with family and friends, as well as with unfamiliar partners such as grocery store or pharmacy staff, is at the heart of many activities that enable satisfactory social participation. However, to achieve an inclusive society, human adaptations are essential for people living with a communication disability. Indeed, difficult interactions with individuals encountered in their community(ies) could restrict their social participation. In particular, their access to public transportation seems to be hindered by staff attitude and communication skills. Considering the key role of public transport in social participation, this thesis presents a research project that aims to improve interactions between adapted transport drivers and their passengers living with a communication disability. A communication partner training program, a speech-language pathology intervention aiming to train communication partner to better interact with people living with a communication disability, has been developed specifically for drivers of an adapted transport service in a large Quebec city. Its development was guided by a model from the field of adult education, the andragogical process model for learning. The training entitled Accessible Communication in Public Transportation was offered to thirteen adapted transport drivers. Its effects on the drivers were explored using an exploratory single-group design. The first study of the thesis is a scoping review. It describes the scientific literature on paid worker and unfamiliar partner communication training aiming to improve communication with people living with one or more acquired neurogenic communication disorders. The findings of this study are that the majority of communication partner training programs are disorder-specific and that they are mainly offered to health care staff or students. Despite variability in the measures used in the studies, the reported effects were promising for improving interactions between the people trained and individuals living with a communication disability. The second study of the thesis explores the usefulness of the andragogical process model for learning. The study points out that the model is useful for developing, delivering, and evaluating a workplace training that seemed to be appreciated by participants, even though the majority of the model's elements were adapted to meet organizational constraints. The study also points out that the assessment of learning needs, the establishment of an atmosphere of caring, acceptance, trust and respect conducive to learning, and the choice of training methods appear to be key elements of the model. The third study explores the effects of the communication partner training on thirteen adapted transport drivers. After being trained, the drivers appeared to have more knowledge about communicating with a person living with a communication disability. In addition, analysis of videos of the travel of passengers living with a communication disability by the driver-participants reveals that the drivers improved their relational communication and increased the number of gestures used with these passengers. This thesis suggests that a communication partner training based on adult education theories has the potential to improve interactions between adapted transport drivers and people living with communication disabilities. It lays the groundwork for further studies to evaluate the effectiveness and understand further the effects of similar trainings. This thesis reaffirms the importance of research on communication partner training as a promising intervention to realize a more inclusive society for people living with communication disabilities.