A thesis submitted in partial fulfilment of - Queen Margaret University

2.3.3 Impact of aphasia on the family unit
Family members experience difficulties dealing with the various changes that
occur following a stroke (Sarno, 1993) with communication reported as a severe
problem more often in the marriages of people with aphasia than non-aphasic
individuals (Artes and Hoopes, 1976; Kinsella and Duffy, 1979). Effective interpersonal
communication helps to maintain relationships within the family unit
and family members report that they have difficulty understanding their relative’s
message as the aphasia may prevent the individual providing enough
information to be understood. Others find themselves in the role of translatorinterpreter
in social situations (Michallet, Tetreauet and Le Dorze, 2003). It is
also reported that individual members of the family often distance themselves
from the person with aphasia, in particular their children (Michallet et al., 2003).
The practicalities within a family unit also change. Many agreements regarding
roles (e.g. bread winner) and responsibilities (e.g. finances or social organiser)
in the family no longer apply, resulting in major disruption to the family unit as a
whole (Sarno, 1993). Additionally, family members may take on the role of
caregiver. This involves the reorganisation of their day and in many cases their
lives in order to prioritise the needs of their relative (Michallet et al., 2003). The
changed attitude of carers/spouses towards their stroke-affected partner also
has an important influence on intimacy (Keppel and Crowe, 2000) and the lack
of communication may also reduce the ability to deal with any interpersonal
relationship problems. Although the responses of family members to the impact
of stroke and residual disabilities are varied, the most frequently observed
reactions consist of minor mental health disorders (anxiety, guilt, fatigue and
depression) (Michallet et al., 2003). Kotila et al., (1998) investigated the
incidence and severity of depression in people following stroke as well as their
closest relative who was also their main caregiver. They found that depression
was common amongst these carers and there was no difference in frequency or
severity of depression between post-stroke individuals and their caregivers. This
depression has been observed to persist and not decrease at one-year follow-up
14