Collaborative Goals for Communicative Life Participation in Aphasia: The FOURC Model

Abstract

Purpose Collaborative goal setting is at the heart of person-centered rehabilitation but can be challenging, particularly in the area of aphasia. The purpose of this clinical focus article is to present a step-by-step model for forming a collaborative partnership with clients to develop an intervention plan that follows the client's lead, addresses communicative participation, and integrates multiple treatment strategies. Method We introduce the rationale and core features of a 4-step and 4-pronged process (the FOURC model) and illustrate its application through 3 cases of people with aphasia who were treated in outpatient rehabilitation. Conclusions The model invites client initiative in a clinically feasible manner while supporting the clinician's role in guiding the intervention based on professional expertise and growing familiarity with the case. Outcomes observed in case studies include strengthened motivation and improved real-life communication.

Achieving Participation-Focused Intervention Through Shared Decision Making: Proposal of an Age- and Disorder-Generic Framework

“…In the participation-focused approach to treatment planning that we are proposing in Figure 2, the "communicative participation" circle in the center represents a single, specific situation that will be the target for intervention (this process may be replicated sequentially or in parallel for multiple situations). Be sure the situation chosen for the participation goal is not too complex, grandiose, or distant into the future, all of which may be counterproductive to seeing meaningful change in a realistic timeline (Haley, et al, 2019 intervention techniques and strategies may remain vague and nonspecific, leaving it to the client to try to tailor and adapt strategies for specific situations. Some clients may be good at that, but others will strugglehence perpetuating the risk of a disconnect between intervention and real life.…”

“…Even if the client is significantly impaired and needs simplified stimuli, these can still be taken directly from the targeted participation situation and modified as needed. Therapy that is engaging for the client because of a direct and obvious relevance to their chosen life situation may be more likely to motivate clients to follow through with recommendations (Haley, et al, 2019). As one of our SLP students said, we need to make therapy, "Come to life.…”

“…For example, the Life Participation Approach to Aphasia (LPAA) provides a foundational call to action emphasizing that a participation-focused approach to therapy must meet several critical criteria including: (a) The primary purpose of intervention is to improve life participation; (b) Services should be provided not only to the person with the communication disorder, but to everyone in their circle of family and close companions who are impacted by the condition; (c) Environmental and personal issues are appropriate and necessary targets for intervention; (d) People should receive services when they need assistance regardless of the stage of their condition; and (e) Outcomes measures should include documentation of the impact on life participation (Chapey et al, 2000;Kagan, et al, 2008;Worrall, 2006). A more recent guide begins to translate the LPAA into concrete examples for choosing communication goals and creating collaborative, client-centered plans to address those goals, (Haley, Cunningham, Barry, & de Riesthal, 2019). Even with these initial guides, however, resources are limited, and are concentrated in the area of aphasia treatment for adults.…”

Written Language Usage With Pen and Technology in Adults Across Generations

“…Speech-language pathology studies have addressed treatment approaches using assistive technology, such as word prediction and spelling aids to facilitate written tasks (Armstrong & Macdonald, 2000;Beeson et al, 2010;Dinnes et al, 2018;Murray & Karcher, 2000). A few case studies have implemented texting along with a hand-written or spoken rehabilitation technique (Beeson et al, 2013;Fein et al, 2020;Haley et al, 2019) or texting modified with symbols and speech synthesis, meaning artificial speech generation along with texting (Buchholz et al, 2013). In occupational therapy, assessment of graphemic production and speed also includes analysis of handwriting versus keyboard at paragraph levels (Weintraub et al, 2010), but not at the functional task level.…”

Can Script Training Improve Narrative and Conversation in Aphasia across Etiology?

“…We highlight two recent resources that provide excellent information about developing and implementing treatment plans involving script training. Haley et al 85 presented their FOURC model for goal writing, with the following steps: (1) choose communication goal, (2) create client solutions, (3) collaborate on a plan, and (4) complete and continue. In this article, they provide an excellent case presentation in which they developed a relevant script training plan and cooperatively formulated person-centered goals for a PWSA.…”