Everyday reading and writing in aphasia: Role change and the influence of pre-morbid literacy practice

This qualitative study details the findings resulting from semi-structured interviews undertaken with 20 aphasic people and, in some cases, their partners. The aim of the study was to establish factors which might affect the focus of functional reading and writing therapy. This was done by investigating the aphasic respondents' level of pre-morbid and current involvement with a range of roles in a variety of contexts. The literacy practices associated with the roles and the perceived reasons for changes in the roles were delineated. Aspects of pre-morbid literacy practice were described, including the use of social networks, procedures such as drafting and editing in the composition of text, and technical aids. Current use of these practices was also delineated. Pre-morbid and current roles were found to be variable, and gains as well as losses in roles were reported subsequent to the onset of aphasia. Many perceived reasons for change were given, aphasia not always being seen as the predominant factor causing change. Idiosyncratic patterns of pre-morbid and current literacy practice suggest that functional assessment and therapy should not be prescriptive, and that independence may not always be an appropriate goal for rehabilitation. Three levels of functional therapy are suggested: activities, strategies and adjustment. Assessment and therapy of this kind may be more sensitive to the patterns of written language use delineated by contemporary research into literacy.