Marriage and Post-stroke Aphasia: The Long-Time Effects of Group Therapy of Fluent and Non-fluent Aphasic Patients and Their Spouses

Abstract

Background Studies of therapy influence on after-aphasia marital relations are lacking. Much needs to be learned about the range of factors associated with couples benefiting from therapy. Understanding these issues is key to facilitating optimal post-aphasia outcomes from the perspective of the patient and his caretaking spouse. This paper reports an evaluation of a group therapy intervention conducted with aphasic people and their life partners. Methods The intervention comprised of 10 sessions of approximately 90 min duration and included two groups of couples, with fluent and non-fluent aphasic partner. The therapy program consisted of basic communication activities within the group which encouraged sharing of personal experience but mostly relied on psychoeducation, gaining knowledge about after-stroke aphasia. The respondents were interviewed and completed neuropsychological assessment. Quality of marriage was determined using Dyadic Adjustment Scale. Marital adjustment was measured twice, before intervention and after 6 months. Long-time effects of therapy included a significant mean difference in quality of marriage between therapy attendants and controls. Marital relationship decline seems to be worse amongst control subjects, who were not involved in any kind of psychological support. In spite of initial non-distressed relationship they report deterioration of their bond in half a year’s time. We also showed changes in dynamics of quality of marriage during this time in all investigated groups. The implications of these findings for counseling services are discussed.

Systematic Review of the Evidence for Stroke Family Caregiver and Dyad Interventions

“…40 Aside from the largest study with 349 caregivers, 24 there were 5 studies with over 100 caregivers or dyads 19,26,28,33,34 ; however, 2 of the studies reported findings using the same sample. 33,34…”

“…Of the 18 studies reviewed, only 3 caregiver 19,20,28 and 3 dyad 32–34 intervention studies reported testing for significance in survivor outcomes. One caregiver intervention study reported improvements in survivor cognition, depression, and anxiety.…”

“…33 One dyad study found that, although the overall relationship quality and relationship consensus improved between the survivor and the caregiver, there were no significant differences with respect to relationship cohesion, relationship satisfaction, and affectional expression. 34 Two caregiver intervention studies reported no significant findings for any of their measured caregiver outcomes. 21,24 Another 5 studies reported data trends, but were not powered to detect significance in caregiver outcomes.…”

“…40 Aside from the largest study with 349 caregivers, 24 there were 5 studies with over 100 caregivers or dyads 19,26,28,33,34 ; however, 2 of the studies reported findings using the same sample. 33,34 Interventions Detailed descriptions of content and procedures for the intervention and control conditions were provided in each of the 18 articles. Only 1 study reported blinding of participants to the type of intervention they received.…”

“…20 Other studies measured survivor quality of life using the European Quality of Life EuroQol, 25 Older People's Quality of Life Questionnaire, 35 and the Satisfaction with Life Scale. 32 Several studies addressed the stroke survivor's social functioning, dyadic interactions, and the quality of relationship with the caregiver and used the Social Relationships Index, 35 Active Engagement Communication Scale, 31 Protective Buffering Communication Scale, 31 McMaster Family Assessment Device General Functioning Subscale, 31 Patient Expectations Scale, 31 Perceived Criticism Scale, 31 Communication in Marriage Questionnaire, 33 Intimate Bond Measure, 29 Dyadic Adjustment Scale, 34 Mutuality Scale, 31 and the Relationship Assessment Scale. 31 Several studies measured survivor satisfaction with the Client Satisfaction Questionnaire 29 or investigator designed or adapted acceptability measures.…”