Comparison of clinician and spouse perceptions of the handicap of aphasia: Everybody understands 'understanding'

This study examines whether standard aphasia assessment procedures provide sufficient information for speech pathologists to make socially valid judgements about the extent of disability and handicap experienced by aphasic speakers in their daily lives. Fourteen speech pathologists and six spouses described their impressions of six aphasic speakers' communication problems and completed a 42-item questionnaire rating their perceptions of how language deficits handicapped those individuals in daily living. Clinicians based their judgements on assessment procedures presented on videotape and paper. Spouses based their judgements on their aphasic partner's day-to-day communication. Qualitative analyses comparing speech pathologist and spouse perceptions indicate that both groups of judges used terms relating to disability and handicap to describe the aphasic speakers' communication problems, although clinicians did not tend to describe the same aspects of disability and handicap that were identified by spouses. Clinicians generally agreed with each other and were most reliable in their perceptions of the handicap resulting from deficits of 'understanding', but were less reliable in rating the handicap resulting from 'speaking' and 'conversation' deficits. Clinicians demonstrated some agreement with spouses in rating the handicap of 'understanding' deficits, but less in their ratings of parameters of 'speaking' and 'conversation,' Results suggest that although current aphasia assessment procedures provide essential information about the impairment and disability of aphasia, they may not provide sufficient information for clinicians to accurately predict the handicap of aphasia in terms of the effect on individuals' daily lives. The measurements used are discussed in terms of their potential applications in the management of aphasic clients and in future research.