Informal aphasia assessment, interaction and the development of the therapeutic relationship in the early period after stroke

Background: Speech pathologists tend to favour informal assessment over formal, standardised batteries in the acute/sub-acute hospital setting, often using their own local screening tools, subtests or non-standardised assessments. Despite the tendency to use informal assessment measures, little research has been done on what might characterise informality in assessment.Aims: Using a systemic functional linguistics framework and thematic analysis of interview data, the aims of this study were to explore interactions during informal assessment, the balance of clinician-centred and client-centred interactions during sessions and their impact on the development of the therapeutic relationship.Methods and Procedures: This small study sought to capture authentic initial and review informal assessment sessions and involved three men with aphasia (74years/3weeks post; 48years/6weeks post; 80years/4days post), who happened to be on the caseload of a single therapist at the time of the study. Inclusion criteria were the ability to provide consent (with communication support if necessary), to be inpatients within the first 12weeks post-stroke, with no psychiatric history or dementia. Videos of three aphasia assessment sessions were collected, with recorded reflective interviews with the therapist, and two of the patients, following each one. Assessment sessions were transcribed and then analysed in full for their speech function moves. Both synoptic analysis (quantifying choices per speaker) and dynamic analysis (looking at choices through the exchange) were carried out. The exchanges were also considered in the light of the issues raised in the reflective interviews.Outcomes and Results: While all the assessment sessions were typically controlled by the therapist and had sections which followed the classic request, response, evaluation type pattern, there were examples of dynamic assessment and of casual conversation including a range of moves to introduce new material and humour. The clinician's reflections highlighted the need to individualise sessions, integrate assessment and therapy, and reveal competence and areas of retained ability.Conclusions: This work highlights the importance of distinguishing between informal assessment measures/tools and informal assessment interaction. It shows the efforts both therapists and patients make to normalise or casualise their interactions within the potentially awkward context of testing, and has implications for how to make the best therapeutic use of the time spent in early aphasia assessment. The tendency to use informal assessments along with informality in exchanges reflects relationship building required for therapy.