A thesis submitted in partial fulfilment of - Queen Margaret University

where therapy should target, a model of rehabilitation would similarity prove
invaluable in determining the exact nature of therapy to use for a given
impairment. To date however there is not yet a model or theoretical account that
explains the dynamic therapist-patient interaction (Horton and Byng, 2000), what
therapy actually is or the process involved in rehabilitating the damaged
language component(s). In order to develop this theoretical account/ model of
rehabilitation additional questions need to be addressed to determine how
therapy works and to clarify what therapy is aiming to achieve (Byng, 1993)
which in turn may help define exactly what therapy is (Basso, 1989).
Ferguson (1999) discusses models of aphasia therapy that were identified by
Horner, Loverso and Rothi (1994) and asserts that their specification does not
inform us as to HOW the therapy process targets the impaired language function
and achieves its outcomes. Speech and language therapists in the United
Kingdom have begun to address what therapy is aiming to achieve through
making the decision-making process of rehabilitation more explicit, overtly
stating the aims (e.g. rehabilitative, curative, enabling) and goals of therapy,
specifying tasks chosen to assess and treat people and the provision of
evidence of therapy outcome (Malcomess, 2001; McCarthy, Lacey and
Malcomess, 2001). However that process which guides the judgement of the
speech and language therapist in choosing the actual form of the therapy is still
not explicitly addressed (Byng and Black, 1995) and in contrast to theories about
impairments, theories about the therapy process still remain largely under
developed (Byng and Black, 1995). Currently therapists rely on their own and
other therapists’ experience, skill and clinical judgement in choosing tasks and
procedures to target identified language impairments (Wilson and Patterson,
1990). While these have been proven to be effective on the whole it is not
possible to discern which approaches or tasks will be successful in rehabilitating
which particular aspects of aphasia (Best and Nickels, 2000). Additionally, as
previously discussed (see section 2.4.1), it is not currently understood why some
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