A Picture Is Worth a Thousand Words: A Unique Voice for People With Aphasia

PURPOSE: The purpose of this qualitative study was to understand the experience of people with aphasia during performance of daily occupations as expressed through photography. There is a scarcity of research on the experience of people with aphasia as they reengage in meaningful occupations. This qualitative study used photo-elicitation to facilitate conversations about occupational performance with aphasia. This study explored two questions: Does digital photography help people with aphasia express and resume daily occupations, and if so, how? What is the experience of people with aphasia as they engage in daily occupations?

METHOD: Seven participants were recruited from an aphasia conversation group. Inclusion criteria were diagnosis of aphasia, age over 18 yr, and ability to grant informed consent. Data collection included three photo assignments and corresponding interviews, followed by a focus group. Transcription was completed within 48 hr. Thematic analysis was completed on transcripts and photos. Memos provided context to concepts uncovered within the text. Member checking was used to verify findings. Researchers used cross-case synthesis to look for patterns and compare themes found in multiple cases (Creswell, 2003; Yin, 2003).

RESULTS: Findings indicate that many aspects of the person and the environment contributed to participation in occupations after a diagnosis of aphasia. Researchers identified three main themes that influenced occupational performance for these participants with aphasia: motivation vs. failure, adaptation, and changes in roles and relationships.

Participants who found occupations to be highly valued were likely to continue to engage in occupations, whereas participants who experienced failure reengaging in occupations stopped participating. Motivation to resume occupations was influenced by social support. Participants’ values and beliefs also influenced their motivation to reengage in occupations.

Adaptations to overcome barriers to occupational performance included technology and changing the physical environment. Barriers to adaptation were physical deficits, the physical environment, and inability to accept a new way of life.

Participants identified a change in roles and relationships. Long-term marital relationships were unchanged or strengthened after aphasia. Participants reported a reliance on their spouse for communication within the community and did not report difficulty communicating with their spouse. Barriers that impacted social relationships and roles with aphasia included a lack of social support from friends and family. The participants also expressed that their feeling of being a burden affected their relationships with their family members.

Participants with aphasia were more willing to reengage in daily occupations if the occupations were meaningful to them. If they experienced failure when reengaging, they were less likely to resume the occupation. People with aphasia who adapted their environment were more successful in resuming occupations. Strong social supports, especially long-term marital supports, were identified as helpful in performing daily occupations.

LIMITATIONS: Limitations included a convenience sample recruited from the same local aphasia conversation group. Participants were at times inconsistent in completing their photo assignments and were challenged to remember the significance of the photo or personal meaning attached to it and the communication barrier due to aphasia.

CONCLUSION: These findings are important to occupational therapists as the use of photography can help impart meaning about occupations when working with individuals who have aphasia. This understanding can improve occupational therapists’ ability to design quality interventions with this population.

References

American Occupational Therapy Association. (2014). Occupational therapy practice framework: Domain and process (3rd ed.). American Journal of Occupational Therapy, 68(Suppl. 1), S1–S48. http://dx.doi.org/10.5014/ajot.2014.682006

Creswell, J. W. (2003). Research design: Qualitative, quantitative, and mixed methods approaches (2nd ed.). Thousand Oaks, CA: Sage.

Yin, R. K. (2003). Case study research design and methods (3rd ed.). Thousand Oaks, CA: Sage.