Acquired Dysarthria, Dysphagia, Dysphasia and Dementia, Care of the Elderly 373

Viewing acquired aphasia through the professional journal: 1935-1965

LINDA ARMSTRONG Queen Margaret College, Edinburgh, UK

ABSTRACT The profession has published its own journal continuously since 1935, with four different titles. A historical view of professional and client-group issues can inform current practice by indicating change and development as well as re- minding us that some of the live issues from years past are still pertinent and under discussion today. This paper arises from this interest in history which led to a content analysis of the first 30 years of the professional journal. One branch of the profession (British Society of Speech Therapists) arose from work with clients who had communication disorders acquired through war injury, so adult-acquired apha- sia was an early client group. How was this disorder represented in the journal, especially during the Second World War years and immediately afterwards? Has clinical practice changed or do speech and language therapists today follow the same principles as the early clinicians? All 40 issues of Speech and later Speech Pathology and Therapy underwent content analysis (for a full description of meth- odology see Armstrong and Stansfield (1 996). Two periods were delineated: 1935- 1945 and 1946-1 965. A total of 24 papers were identified in which the main topic was acquired aphasia. Papers which dealt with a range of disorders (but including aphasia) were excluded from this count. While during the early years, the topic of 4.5% of the papers was aphasia, this proportion rose to 12% during the later period. The papers were not evenly distributed throughout the period, nor was there significant interest in the immediate post-war years. The year 1964 featured six papers, but these were reprints from lectures given on a refresher course. The papers were grouped into four categories: descriptions of types of aphasidclassifi- cation; assessment; therapy and the team approach. Papers on acquired aphasia were not as preualent as expected, but were mostly written by people whose names are still familiar today (e.g. MacDonald Critchley, Kingdon Ward, Edna Butfield). The multidisciplinary team approach to rehabilitation is not as recent a concept as was presumed - i t appears in a 1947 paper: Therapists will still recognise the tasks proposed for assessing aphasia in 1952, and the person with aphasia who is anxious to comply with therapeutic suggestions. Although the profession may now use different terminology and haue auailable a wider range of strategies and thera- peutic approaches, the basis for practice was laid down in the early years of the profession.

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INTRODUCTION

It is the opinion of the author that a historical view of professional and client-group issues informs current practice. Change and development can be placed in perspective and we can be reminded that some of the live issues from years past are still pertinent and under discussion today. In fact, some things never seem to change or to resolve. This paper arises from the author’s interest in acquired aphasia. The catalyst, however, was Moira McGovern’s donation of past issues of the professional journal to the de- partment when she retired. The British Society of Speech Therapists arose from work with clients who had communication disorders acquired through injury in the First World War and so acquired aphasia was an early client-group for our profession. How has this disorder been represented in the journal, especially during the Second World War years and immediately afterwards? Has clinical practice changed or do speech and language therapists today follow the same principles and methods as the early clini- cians?

The profession has published its own journal continuously since 1935, with four different titles. For the purposes of this study, all 64 issues of Speech and later Speech Pathology and Therapy underwent content analysis. Two periods were delineated. The first was up to the end of the Second World War, that is from 1935 to 1945, and the second ended when the journal changed its name to become the British Journal of Disorders of Communication, that is from 1946 to 1965. A total of 2 4 authored papers were identified in which the main topic was acquired aphasia. Articles which dealt with a range of disorders were exlcuded from this count.

During the early years, aphasia was the topic of 4.5% of the total papers, whereas dysfluency was the disorder which gained most attention. At this time, about half of the 88 papers were concerned with professional issues, rather than specifically with disor- ders or client-groups. The proportion of papers about aphasia rose to about 12% during the later period, when the journal was more disorder-based. The profession was still interested in dysfluency but was more concerned now with developmental disorders of speech and language. It is perhaps noteworthy that in the most modern period (1966-1995), about an eighth of the papers still have acquired aphasia as their subject, despite the increasing number of journals to which submissions may be made on this topic. The papers were not evenly distributed throughout the period and there was not significant interest in the immediate post-war years, despite Howard and Hatfield (1 987) reporting that ‘the disasters of the Second World War increased the urgency to offer treat- ment for traumatic aphasia’. There was only one such paper published in our journal between 1946 and 1950. The year 1964 featured six papers, but these were reprints from lectures given on a refresher course, rather than papers reporting original research.

WHO WROTE THE PAPERS?

All four strands of modern speech and language therapy undergraduate courses are represented among the authors. By far the majority were produced by speech thera- pists, although the earliest of them tended to be written by doctors. Most of the papers were single-authored, with Edna Butfield being the person who made most contribu- tions: a total of five over a 10-year period. She began her writing career as a speech therapist at Bangour Hospital in West Lothian and, by 1960, was the Principal of the West End Hospital School of Speech Therapy in London. One of the strengths of her papers is the use of her wide clinical experience with large numbers of people with aphasia as the basis for her descriptions and opinions. All but three of the authors were writing in the UK.

Acquired Dysarthria, Dysphagia, Dysphasia and Dementia, Care of the Elderly 375

WHAT WERE THE PAPERS ABOUT?

It actually was not always easy to identify only one theme in some of the papers, especially the early ones which were often overviews. However, four broad topics were identified. The first was descriptions of aphasia, and includes methods of classification and single case studies. This topic accounts for half the total number of aphasia papers from the periods studied. Early articles in this category were very general and anecdo- tal, reflecting the state of knowledge of the time. Aphasia was commonly classified as either sensory or motor and related to the concept of localisation. Gradually, descrip- tions and single case studies became longer and more detailed. One such paper con- sists of extracts from an account of the emotional effects of aphasia written by a person recovering from it. MacDonald Critchley, in 1953, discusses in some depth the still thorny question of articulatory problems and aphasia. The distance between the first and the last paper in the period studied is immeasurable. Johnson, in 1937, describes ‘the theory of the speech function’ in what may now be considered rudimentary terms while Jones, in 1964, describes clinical practice in a neurosurgical department.

Aphasia therapy receives limited detailed attention over the years. In a 1939 article, Kingdon Ward looks beyond clinical techniques to discuss how the therapist should approach aphasia therapy. The next article addressing therapy, in the widest sense, appeared in 1956. Two Californians describe a communication chart consisting of 18 pictures and three words for use with people who have an expressive aphasia. Butfield offers a two-part paper in early editions of Speech Pathology and Therapy, which describes methods of treating different types of aphasia - not an approach advocated today. However, she does describe interviewing and counselling relatives as an integral part of treatment. Fawcus, in 1964, promotes the use of group therapy to ‘dispel the image of the white-coated clinician in the austere hospital clinic’, but warns against replacing this person with the ‘school-teacher in the classroom’. Hatfield concludes that the right approach to therapy depends on the patient.

Only three of the articles specifically concerned assessment. Detailed descriptions of test batteries are given in two while the third is a favourable critique of a battery developed by two psychologists. Butfield’s battery includes tests of memory and rea- soning as well as recognisable tests of comprehension, expression, reading, writing and calculation. The assessment proposed by Rochford and Williams includes both quantitative and qualitative aspects. Performance of an individual is expressed on the basis of age equivalence in an attempt to place all tasks on an equal scale of difficulty. Finally, here, the team approach was the theme of two papers.

CONCLUSION

In conclusion, papers on acquired aphasia were not as prevalent as expected, but were mostly written by people whose names are still familiar today. The number of papers and their subjects cannot, however, be presumed without question to reflect either professional knowledge or practice. Other factors dictate the history which is read into professional publications. These must include the proportion of therapists who worked with this client group, the number of specialists and even the interests of the journal’s editors. Notwithstanding those limitations, this content analysis was a very illuminating experience. For example, the multidisciplinary team approach to rehabilitation is not as recent a concept as presumed - it appears in a 1947 paper. Therapists will still recognise the tasks proposed for assessing aphasia in 1952, and the person with apha- sia, discussed in 1939, who is so anxious to comply with therapeutic suggestions that

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their effectiveness is reduced. Although the profession may now use different terminol- ogy and has available a wider range of strategies and therapeutic approaches, the principles for practice (if not actual clinical techniques) were clearly laid down in the early years of the profession.

Finally, here is a sample of quotations from down the years, which show that some things have changed while others have not!

‘It would be acceptable to m y readers, no doubt, if one were able to say speech is a mechanism which can be readily resolued into its component parts. It would then be simple to understand, and the treatment of certain conditions of speech loss might be euolued on well-defined lines. ’ (Johns ton, 1937)

‘... effective rehabilitation demands the close and constant cooperation of a number of specialist workers.’ (Zangwill, 1947)

‘It is more necessary for the therapist to know the remaining assets of the patient in order to be in a position to suggest circumuentions of deficits. ’ (Butfield, ‘952)

I . . . a well-integrated group is an invaluable social matrix within which the therapist may work, and in which speech therapy can be an influential and enjoyable experience for the patient.’ (Fawcus, 1964)

REFERENCES

Armstrong L, Stansfield J (1996). A content analysis of the professional journal of the British Society of Speech Therapists: the first 10 years. Spotlight on Speech 1935-1945. European Journal of Disorders of Communication 31,91-105. Butfield E (1952). An introduction to the assessment of aphasic patients prior to language re-education. Speech 16,49-55. Critchley M (1953). Articulatory defects in aphasia. Speech 17, 4-16. Fawcus M (1964). Group therapy for the aphasic patient. Speech Pathology and Therapy 7, 30-36. Hatfield F (1964). Rehabilitation of language. Speech Pathology and Therapy 7, 68-77. Howard D, Hatfield FM (1987). Aphasia Therapy: Historical and Contemporary Issues. London: LEA. Johnston W (1937). Aphasia. Speech 2. 8-12. Jones J (1964). The dysphasic patient in a neurosurgical department. Speech Pathology and Therapy 7, 78-83. Kingdon Ward W (1939). Anxiety-reaction in the adult aphasic in relation to speech therapy. Speech 5, 28- 32. Rochford G, Williams M (1964). The measurement of language disorders. Speech Pathology and Therapy

Zangwill OL (1947). Psychology, speech therapy and rehabilitation. Speech 11, 4-8. 7, 3-21.