Impact of aphasia on communication in couples

Abstract

BackgroundCommunication is at the heart of relationships, especially for couples. When language is altered, as it is in aphasia, communication in couples can be affected.AimsTo explore how members of a couple perceive the impact of aphasia on their communication.Methods & ProceduresNine French‐speaking couples participated in the study. One member of each couple had chronic stroke‐related aphasia, which varied in type and severity. The 18 participants took part in individual semi‐structured interviews to understand their perspective on communication within their couple. The interviews were recorded, transcribed and analysed with a qualitative thematic analysis.Outcomes & ResultsThree main themes emerged: (1) experiencing limitations in conversation; (2) assuming changed speaking and listening roles; and (3) experiencing new emotions, feelings and reactions in communication. Couples experienced diminished frequency and duration of conversations as well as restrained topics after the onset of aphasia. Ten participants reported that each member's communication role of listener versus speaker had changed, and that the person with aphasia became a less active participant. Communication was described as ‘positive’ before aphasia and ‘fine’ to ‘difficult’ following aphasia. Persons with aphasia and spouses expressed experiencing difficulties managing emotions related to communication. Frustration and caution towards the other member of the couple had been associated with aphasia. In addition, five spouses reported that they refrained from initiating discussions on specific topics in order to maintain a positive relationship with the person with aphasia.Conclusion & ImplicationsThe results describe some of the consequences of aphasia on communication in couples. Clinicians could use interviews to understand the impact of aphasia on a couple's communication. This may help to design communication partner training (CPT) that better aligns with the particular needs of couples living with aphasia, acknowledging the importance of emotional dimensions of relationships.What this paper addsWhat is already known on the subject The general psychosocial impacts of aphasia on persons with aphasia and spouses are known. Their conversations have been described and used as a focus for CPT. However, CPT may be difficult to implement in clinical settings. What this paper adds to the existing knowledge This paper provides in‐depth descriptions of perceived changes in relational or transactional communication by the PWA and their spouse. The frequency, duration and topics of conversations changed and emotions such as frustration and caution appeared. Participants assumed changed speaking and listening roles. What are the potential or actual clinical implications of this work? The participants’ description of communication could be used by speech–language pathologists when conducting CPT to illustrate how aphasia affects communication in couples. Emotions emerging as a result of changes in communication following aphasia should be assessed before CPT and could be a starting point to work on communication. This could support clients’ commitment in CPT.

Disability as an Interpersonal Experience: A Systematic Review on Dyadic Challenges and Dyadic Coping When One Partner Has a Chronic Physical or Sensory Impairment

“…For instance, in dementia, relationship functioning seems to be strongly related to behavioral problems of the patient (Quinn et al, 2009). However, except for one study that focused on stroke-related aphasia and its impact on couples' communication (Croteau et al, 2020) and two studies suggesting that personality changes in TBI patients might have contributed to emotional distance between the partners (Bodley-Scott and Riley, 2015;O'Keeffe et al, 2020), no studies showed indications that cognitive impairments were responsible for the relationship challenges summarized in this review. Second, the current review focused on dyadic processes and their relation to dyadic outcomes.…”

“…Some studies came to the overall conclusion that couples did not adjust well to physical or sensory disability, as is evidenced, for example, by the theme of "the alienated couple" reported by Wawrziczny et al (2019) in MS couples. Other examples include permanently altered communication in couples coping with stroke (Croteau et al, 2020), or the finding that the majority of spouses of TBI patients felt their love had changed toward a caring relationship lacking romantic aspects (Bodley-Scott and Riley, 2015). Other qualitative studies in this review, however, presented a more balanced account.…”

“…This, in turn, was reported to lead to misunderstandings that were frustrating for both partners and contributed to an increase in emotional disconnection. Croteau et al (2020) focused on a subset of stroke couples where patients presented with chronic stroke-related aphasia, i.e., impairments in language comprehension and/or production. Couples reported that the frequency and duration of their conversations had decreased due to aphasia, conversational topics were narrowed down, conversations became more superficial, and patients participated less in conversation than pre-stroke.…”

“…Holding back from disclosing personal experiences seemed to be a prevalent phenomenon in couples coping with physical and sensory disability of one partner. Studies suggested that avoidance of certain topics, cautious communication and holding back, feeling uncomfortable sharing one's emotions, and protective buffering were common in couples coping with SCI (Chan, 2000;Jeyathevan et al, 2019), stroke (Croteau et al, 2020), MS (Wawrziczny et al, 2019), andTBI (O'Keeffe et al, 2020). Holding back from sharing personal experiences seemed to be relationship-compromising.…”

Aphasia: Definition, clinical contexts, neurobiological profiles and clinical treatments

“…Common age can be considered an important factor in recovery: some studies suggest that recovery from stroke aphasia has failed in patients over seventy years of age compared to younger patients; however, at any age, various degrees of recovery can occur even in remote times from brain injury. [5,6].…”