Describing the impact of aphasia on close family members using the ICF framework.

PURPOSE: Aphasia is a communication disorder associated with impairments in spoken language, understanding, reading and writing that impacts upon daily activities, participation in society and the quality of life of those with the condition and their family members. Despite existing literature demonstrating the pervasive and significant effects of aphasia on family members, rehabilitation programming, policy and funding are not well developed. The aim of this qualitative study was to describe the impact of aphasia on family members in the context of changes to their functioning and disability using the framework of the International Classification of Functioning, Disability and Health (ICF). Application of ICF concept of disability or "third-party disability" to family members of people with a health condition is discussed. METHOD: Twenty family members participated in individual in-depth semi-structured interviews. Interviews were analyzed using qualitative content analysis. Research codes generated were subsequently mapped to the ICF. RESULTS: The results of this study showed that family members experienced positive, neutral and/or negative changes to their body functions and activities and participation due to their significant other's aphasia. Moreover, some family members attributed the development of a health condition or exacerbation of an existing health condition to the aphasia. CONCLUSION: Interpreted within the framework of the ICF, the results of this qualitative study reveal that family members of people with aphasia experience changes to their functioning and disability, known as "third-party functioning and disability", as a consequence of the health condition of a significant other.

Third-party disability in family members of people with aphasia: a systematic review.

PURPOSE: The WHO's International Classification of Functioning, Disability, and Health (ICF) describes third-party disability as the disability experienced by significant others as a consequence of their family members' health condition (WHO, 2001). A systematic review of the literature was conducted to summarize the current knowledge of third-party disability in aphasia. METHOD: PubMed, CINAHL and three other databases were searched for peer-reviewed studies reporting on how aphasia affects family members with no date restrictions. Findings from relevant studies that met the inclusion criteria were extracted and mapped to the ICF. RESULTS: This paper summarizes what is known about the experience of family members of people with aphasia, describing negative outcomes in the body functions and activities and participation components of the ICF. However, due to the limited consensus between studies, this review reveals an incomplete understanding of the nature of third-party disability. CONCLUSION: While current literature suggests there is a broad range of consequences for family members of people with aphasia, the sequelae of disability for family members of people with aphasia are not well understood. Further research is needed to better describe the nature and degree of third-party disability in aphasia.

Correlates of phonological awareness in preschoolers with speech sound disorders.

PURPOSE: The purpose of this study was to examine the relationships among variables that may contribute to poor phonological awareness (PA) skills in preschool-aged children with speech sound disorders (SSD). METHOD: Ninety-five 4- and 5-year-old children with SSD were assessed during the spring of their prekindergarten year. Linear structural equation modeling was used to compare the fit of 2 models of the possible relationships among PA, speech perception, articulation, receptive vocabulary, and emergent literacy skills. RESULTS: Half the children had significant difficulty with speech perception and PA despite demonstrating receptive language skills within or above the average range. The model that showed the best fit to the data indicated that speech perception is a pivotal variable that has a direct effect on PA and an indirect effect that is mediated by vocabulary skills. Articulation accuracy did not have a direct impact on PA. Emergent literacy skills were predicted by PA abilities. CONCLUSIONS: Children with SSD are at greatest risk of delayed PA skills if they have poor speech perception abilities and/or relatively poor receptive vocabulary skills. Children with SSD should receive assessments of their speech perception, receptive vocabulary, PA, and emergent literacy skills.

Phonological awareness and phonemic perception in 4-year-old children with delayed expressive phonology skills.

The purpose of this study was to compare the phonological awareness abilities of 2 groups of 4-year-old children: one with normally developing speech and language skills and the other with moderately or severely delayed expressive phonological skills but age-appropriate receptive vocabulary skills. Each group received tests of articulation, receptive vocabulary, phonemic perception, early literacy, and phonological awareness skills. The groups were matched for receptive language skills, age, socioeconomic status, and emergent literacy knowledge. The children with expressive phonological delays demonstrated significantly poorer phonemic perception and phonological awareness skills than their normally developing peers. The results suggest that preschool children with delayed expressive phonological abilities should be screened for their phonological awareness skills even when their language skills are otherwise normally developing.