Using images to support communication in aphasia rehabilitation

Abstract

Background: Images – a widely used tool in aphasia rehabilitation – reduce the degree to which persons living with aphasia (PWA) must rely on symbolic processing and may support their communication. However, variability exists in how speech-language therapists (SLTs) select and use images. Research on how PWA select and use image types is limited. Across three studies, presented in three journal manuscripts, this research project sought to explore SLTs’ image selection and use when working with PWA, PWA’s image preferences, and PWA’s experiences with image self-capture respectively. Method: The first study used a custom-designed electronic survey to describe the perspectives of South African SLTs and SLTs from other international contexts on image use in aphasia rehabilitation. The second study investigated a sample of the image preferences of individuals with mild to moderate aphasia through an adapted verbal survey conducted on a video-conferencing platform. The third study involved a multiple case study design and described the experiences of adults with mild to moderate aphasia in capturing photographs using mobile phones. Results and discussion: Most of the SLTs were found to use images in assessment (n=62 out of 75; 82.7%) and treatment (n=77 out of 92; 72.8%) of PWA. Study 1 showed that SLTs preferred coloured images. South African SLTs more frequently considered culture and religious orientation than did SLTs from other countries. Time constraints and large caseloads, PWA’s variable responses to images, and a lack of resources were the main challenges to image selection and use. Study 2 revealed that PWA in this sample also preferred coloured images, particularly photographs (n=11, 91.7%). Images had to be clear, transparent and meaningful to be considered for selection. The images that were preferred depended on the communication need. Also, participants felt more confident using images (n=10, 83.3%) than selecting them (n=8, 66.7%). Participants in Study 3 reported a positive experience of photograph capture. High-context photographs (n=75 of 116, 64.7%) predominated, and included more objects than people. However, photographs were low in content (85 of 116, 73.3%). Conclusion: The findings of this research project highlight the importance of image considerations in designing and selecting images as communication supports for PWA. Collaboration with the person with aphasia is crucial and warrants a systematic approach to functional image selection and use.